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UNDIAGNOSED ILLNESS, FATAL - UGANDA: (KASESE), TYPHOID SUSPECTED
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<http://www.isid.org>

Date: Thu 14 Aug 2008
Source: People's Daily Online, Xinhua News Agency report [edited]
<http://english.peopledaily.com.cn/90001 ... 74968.html>


So far 9 people out of 27 cases have died of an unidentified epidemic
that has hit the western Ugandan district of Kasese in recent weeks,
a district official has said.

Peter Mukobi, the district health officer, told Xinhua by telephone on
Wednesday [13 Aug 2008] that preliminary investigations show that the
outbreak may be typhoid but he is awaiting confirmatory results from
the country's central public [health] laboratory. He said that the
victims showed signs and symptoms of fever, abdominal pain, diarrhea,
and later constipation.

A medical team from the health ministry is already in the district
carrying out various tests and promoting proper hygiene and
sanitation as one of the measures to contain the spread of the
disease, he said.

"We are advising people to drink boiled water, wash hands after going
to the toilet, dispose off fecal matter properly, and generally
maintain proper hygiene," said Mukobi.

--
Communicated by:
Kate Kelley
Brigham and Women's Hospital
Boston, MA
USA
<kkelley@rics.bwh.harvard.edu>

[ProMED-mail thanks Kate Kelley for this report.

Not enough information regarding the illness is given here but typhoid
fever should certainly be considered. A high case fatality rate (CFR)
-- 33 percent -- is not at all incompatible with typhoid infection
occurring in the absence of specific antimicrobial therapy in the
developing world. With appropriate treatment, the CFR should be less
than one percent.

The Kasese district of Uganda is located in the southwestern part of
this African nation, bordering to the west the Democratic Republic of
the Congo. Its location can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. - Mod.LL

Photo of Kasese town, in the shadow of the Ruwenzori Mountains range:
<http://www.shunya.net/Pictures/Uganda/Q ... Kasese.jpg>
- Mod.JW]

Uganda - Tollwut
15.08.2008

Aus Mukono wird ein Tollwutausbruch unter Haustieren gemeldet. Wildtiertollwut ist im ganzen Land verbreitet und gefährdet über Haustiere und streunende Hunde den Menschen. Das Risiko reicht bis in die Städte. Nach verdächtigen Tierkontakten ist sofort ein Arzt aufzusuchen. Bei vorhersehbarem Risiko, speziell bei längeren Aufenthalten ist eine vorbeugende Impfung empfohlen. / Quelle: crm

DENGUE/DHF UPDATE 2008 (35): JAPAN ex ELFENBEINKÜSTE
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Date: Mon 18 Aug 2008
From: Tomohiko Takasaki <takasaki@nih.go.jp>


We are responding to ProMED archive no. 20080808.2446 posted on 8 Aug
2008. An imported dengue case from Cote d'Ivoire was diagnosed on 26
Jun 2008 in Japan. Chikungunya virus was negative by PCR.

The patient was a 65-year-old man who stayed in Abidjan from 19 May
2008 to 17 Jun 2008. He arrived in Japan on 19 Jun 2008 and was
hospitalized for 8 days because of high fever, myalgia,
thrombocytopenia (38000/L) and hemorrhagic tendency.

Dengue virus type 3 was detected by real-time PCR and isolated by
cell culture. The E gene of the isolated virus was sequenced, and the
virus was shown with 99.4 percent homology to the isolate (GenBank
AM746229) of Saudi Arabian (Jeddah) in 2004.

The sequence was registered with GenBank on 18 Jul 2008. The GenBank
accession number is AB447989. IgM and IgG antibodies were positive
for dengue in the convalescent serum sample. We believe the patient
was the 1st exported case infected with DENV-3 in Cote d'Ivoire.
There is a possibility of both a yellow fever and a dengue fever
epidemic in Cote d'Ivoire.

--
Communicated by:
Tomohiko Takasaki <takasaki@nih.go.jp>
Ichiro Kurane <kurane@nih.go.jp>
Researcher (Virologist)
National Institute of Infectious Diseases, Japan
Hajime Iwagoe <iwagie2008@yahoo.co.jp>
Clinical medical doctor
Kumamoto City Hospital, Japan

[This is another example of long-distance movement of a
dengue-virus-infected person, probably viremic, from Cote d'Ivoire,
in this instance, to Japan. In addition to illustrating how disease
agents can be moved, it also indicates that dengue virus is being
actively transmitted in Cote d'Ivoire, although no reports of a
dengue outbreak have been received from that country or elsewhere in
West Africa.

Recent reports of yellow fever (YF) cases indicate that _Aedes_
mosquitoes are sufficiently abundant in Cote d'Ivoire to transmit YF
virus (see ProMED archive no. 20080814.2532).

As Mod.JW pointed out in ProMED archive no. 20080809.2449, Abidjan,
the capital of the country, has a population of 3.5 million,
certainly large enough to sustain a major dengue outbreak, assuming
that Abidjan was the location where these dengue virus infections
were acquired.

ProMED hopes that these reports of dengue virus infection acquired in
Cote d'Ivoire will stimulate issuance of further information about
the current status of dengue and mosquito vectors in Cote d'Ivoire as
well as in other West African countries. - Mod.TY]

Djibouti - Myiasis
19.08.2008

Aus Djibouti wird ein Myiasis Ausbruch gemeldet. Es handelt sich um die bis dato in Djibouti unbekannte Tumbu-Fliege. Die Tumbu-Fliege legt ihre Eier bevorzugt in Textilien ab, die nach der Wäsche im Freien getrocknet werden. Bei Hautkontakt schlüpfen die Maden und durchdringen anschließend die Haut. Steht ein Trockner nicht zur Verfügung, ist die Wäsche in fliegendichten Räumen zu trocknen. Ist auch das nicht möglich, muss im Freien getrocknete Wäsche gebügelt werden. / Quelle: crm

DENGUE/DHF UPDATE 2008 (36): FRANKREICH ex WEST AFRICA
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Date: Tue 19 Aug 2008
From: Martine Ledrans <m.ledrans@invs.sante.fr>


Reported dengue cases imported from West Africa in France have been
increasing since 2006.

In France, dengue fever was included in mandatory notifiable diseases
in 2006. From 1 Jan 2006 to 8 Aug 2008, 19 dengue cases imported from
West Africa to France have been reported to Institut de Veille
Sanitaire (French Institute for Public Health Surveillance). This
information originates from mandatory notification reports but also
from data provided by a network of laboratories performing biological
diagnosis of dengue and other vector-borne viral infections.
Confirmation of the cases was done either by PCR [polymerase chain
reaction] or serology (IgM).

In 2006, 4 cases were reported (2 from Benin, 1 from Burkina Faso, 1
from Cote d'Ivoire), 7 cases in 2007 (3 from Burkina Faso, 3 from
Cote d'Ivoire, 1 from Senegal), and 8 cases in 2008 up to 8 Aug (7
from Cote d'Ivoire including the recent case diagnosed in Marseille
[ProMED archive no.] 20080808.2446, and 1 from Mali).

To date, 3 other suspected dengue cases from Togo (2 cases) and Ghana
(1 case) are under investigation.

For the 4 [dengue virus serotypes] strains (out of the 19 imported
cases reported) for which serotyping was performed, DENV-1 (2 cases
from Burkina Faso in 2007) and DENV-2 or DENV-3 (2 cases from Cote
d'Ivoire in 2007 and 2008) were isolated. (See
<http://www.invs.sante.fr/international/ ... 120808.pdf> for more
information in French.)

Although the country of acquisition is insufficiently documented,
this surveillance system allows monitoring trends of imported cases
in continental France. Since the beginning of 2008, dengue cases
imported from Cote d'Ivoire are increasing, which could be related to
an intensification of dengue viruses' circulation in this area.

The dengue virus is circulating in West Africa, but the magnitude of
this circulation in this area remains poorly known. In a context of
high malaria incidence, and in the absence of dengue-specific
preventive or curative measures, most countries in the region have
not implemented specific dengue surveillance system. Therefore, the
circulation of dengue virus in the area is likely to be underestimated.

--
Guy La Ruche <g.laruche@invs.sante.fr>
Dominique Dejour-Salamanca <DITAlerte@invs.sante.fr>
Martine Ledrans <m.ledrans@invs.sante.fr>
Institut de Veille Sanitaire (French Institute for Public Health Surveillance)
Department of International and Tropical Diseases
France

[ProMED-mail is especially appreciative of Drs La Ruche,
Dejour-Salamanca, and Ledrans for this first-hand report of their
dengue information from West Africa. As they suggest, the lack of a
formal surveillance and reporting system in West Africa no doubt
results in significant under-reporting (or, in many cases no
reporting) of dengue cases. Their information above hints that the
cases in these West African countries is an indication of a much
larger public health problem due to dengue.

ProMED will welcome additional reports on dengue cases originating in
West Africa, as they become available. These imported dengue cases
may provide the only information available about the presence of
dengue virus serotypes circulating currently in West Africa.

The HealthMap/ProMED-mail interactive map of Cote d'Ivoire and the
other West African countries mentioned above can be accessed at
<http://healthmap.org/promed?v=7.6,-5,5>. - Mod.TY]

MEASLES - SUDAN: (UPPER NILE)
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Date: Fri 22 Aug 2008
Source: Bloomberg.com [edited]
<http://www.bloomberg.com/apps/news?pid= ... fer=africa>


Southern Sudan Measles Outbreak Kills 22 People; 80 Infected
------------------------------------------------------------
At least 22 people died in Southern Sudan after an outbreak of
measles, said Rueben Madit, a Health Ministry official. The
worst-affected area is in Maiwut County in the northeastern Upper
Nile state, Madit said in a telephone interview today [22 Aug 2008]
from Malakal, the state capital. The deaths occurred in the last 4
days and those infected have been admitted to hospital. "We are doing
all we can to eradicate the disease but we are poorly equipped," Madit said.

Health authorities are sending a medical team to the area to carry
out vaccinations in an effort to stop the disease from spreading,
Peter Oganjok, director of Health and Immunization in Upper Nile,
said in a phone interview. An immunization campaign that was supposed
to have been carried out last year [2007] didn't take place because
of heavy rains, he said.

[Byline: Godfrey Maganda]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[By 2007 measles deaths in Africa had plunged by 91 percent, and
according to the World Health Organisation (WHO) Africa led the
decline in global measles deaths.

Measles deaths in Africa fell by 91 percent between 2000 and 2006,
from an estimated 396 000 to 36 000, reaching the regional target 3
years early. The spectacular gains achieved in Africa helped generate
a strong decline in global measles deaths which fell 68 percent
during the same time period (see:
<http://www.who.int/immunization_monitor ... verage.jpg>).


The WHO map of immunization coverage with measles containing vaccines
in infants shows that in 2006 immunization coverage in Sudan lagged
behind that in some other regions (see:
<http://www.who.int/immunization_monitoring/diseases/
big_measles_map_coverage.jpg>). The Bloomberg report above suggests
that the measles vaccination momentum in Sudan is becoming difficult
to maintain.

A map of Sudan showing the location of the Upper Nile state and the
town of Malakal can be accessed at:
<http://www.mapsofworld.com/sudan/sudan- ... l-map.html>. - Mod.CP]

HEMORRHAGIC FEVER, FATAL - CONGO DEMOCRATIC REPUBLIC: (KATANGA),
REQUEST FOR INFORMATION
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Date: Fri 22 Aug 2008
Source: Radio Okapi [in French, trans. Mod.MPP, edited]
<http://www.radiookapi.net/index.php?i=53&a=20047>


Five cases of suspected hemorrhagic fever with 4 fatal outcomes in Butumba
--------------------------------------------------------------------------
The situation for the past month: according to the district chief
medical officer of Upper Lomami, a report issued by the Butumba
health zone, approximately 500 kilometres (311 mi) from Lumbumbashi
in Katanga, reported 5 cases of hemorrhagic fever in this
jurisdiction, all from a single health area, Bulongo, reported [Radio Okapi.]

Samples were collected by a provincial team and sent to Kinshasa.
According to Dr Patrick Banza, chief medical officer for the health
district of Upper Lomami, the disease presents with a fever and
bleeding from the nose, anus, and mouth. "We had a case in the 24th
week [9-15 Jun 2008], then in the 25th week [16-22 Jun 2008], another
case [words missing].... In total there have been 5 [cases] and 4 of
whom have died." According to the source, a team from Lumbumbashi and
supported by WHO, has already obtained clinical samples. "Until then,
we are awaiting the results to confirm [the cause of death and await
the outcome of the surviving case. In the field, we have taken
precautions so that the entire nursing staff who had contact with
these patients and their families are closely monitored," said the
chief medical officer of the health district of Upper Lomami.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[During the course of 2008, outbreaks of monkeypox, yellow fever,
pneumonic plague, meningococcal meningitis, and Ebola hemorrhagic
fever have been reported from the Democratic Republic of the Congo.
Of these the current outbreak in Katanga most resembles Ebola
hemorrhagic fever. However, the suspected outbreak of hemorrhagic
fever earlier in 2008 and the mixed outbreak of Ebola hemorrhagic
fever and other infections in 2007 occurred at locations remote from
the current outbreak of hemorrhagic fever in Katanga. Further
information is awaited.

A map of the Democratic Republic of the Congo showing the location of
Lumbumbashi in the extreme south of Katanga can be accessed at
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (33)
**********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Guinea-Bissau
[2] Cholera - Benin


******
[1] Cholera - Guinea-Bissau
Date: Sat 16 Aug 2008
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5hA6 ... xFvlBKd6zA>


The United Nations (UN) gave 400 000 euros (USD 600 000) in aid to
the tiny west African nation of Guinea Bissau to fight a cholera
epidemic that has claimed 40 lives to date, the UN said Saturday [16
Aug 2008].

"The funds complement contributions by all the local UN agencies," in
response to an urgent June [2008] appeal by the government, the UN
said in a statement. The money will partly be used to help train
health agents and for a public awareness campaign via the media.

Some 1900 cases of cholera have been registered over the last 2
months, a medical official said, with the capital city [Bissau] hardest hit by
the epidemic. Strong rains have "facilitated the rapid spread of the
disease," said Agostinho Pedro Semedo, director of Bissau's central
hospital.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The country can be located on the map at
<http://www.un.org/Depts/Cartographic/ma ... ineabi.pdf>. - Mod.LL]

******
[2] Cholera - Benin
Date: Mon 11 Aug 2008
Source: China View, Xinhua News Agency report [edited]
<http://news.xinhuanet.com/english/2008- ... 204788.htm>


A cholera outbreak in Benin since July 2008 has killed at least one
person, with 90 others infected by the disease, said reports reaching
Lome [Togo] Monday [11 Aug 2008].

Cholera outbreaks are a regular occurrence in the Beninese economic
capital Cotonou and its surrounding areas due to flooding during the
rainy reason, say experts.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Benin is located in West Africa and can be found on a map at:
<http://www.un.org/special-rep/ohrlls/ld ... /benin.gif>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (34)
**********************************************
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ProMED-mail is a program of the
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<http://www.isid.org>

In this update:
Africa
[1] Cholera - Somalia
[2] Cholera - Kenya (Rift Valley)
[3] Cholera - Zimbabwe (Mashonaland East)

******
[1] Cholera - Somalia (Hiran)
Date: Thu 4 Sep 2008
Source: AllAfrica, Shabelle Media Network (Mogadishu) report [edited]
<http://allafrica.com/stories/200809040651.html>


An outbreak of acute watery diarrhea (AWD) in and around Hiran
region, central Somalia, has killed at least 7 children in the past 3
days, residents said on Thursday [4 Sep 2008]. The children have died
in Jalalaqsi, Buuqaqable, and Ceel cali areas in Hiran region.

The death toll in the villages due to the outbreak of diarrhea may
rise from this [number]. The children who died were among children
below 8 [years old].

Many villagers have been left helpless due to the outbreak of
diarrhea. The number of patients in critical condition is not ascertained.

[Byline: Abdinasir Guled]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Acute watery diarrhea is often used as a term for cholera. Hiran (or
Hiraan) is in south central Somalia and can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... omalia.pdf>. - Mod.LL]

******
[2] Cholera - Kenya (Rift Valley)
Date: Thu 4 Sep 2008
Source: Kenya Broadcasting Corporation (KBC), Kenya News Agency (KNA)
report [edited]
<http://www.kbc.co.ke/story.asp?ID=52280>


Following an outbreak of cholera in the area, 2 people have been
reported dead and another admitted at the Nandi hills district
hospital. Area medical officer of health (MOH), Dr Aouko Anyango,
speaking to KNA Thursday [4 Sep 2008] said that more than 70 eating
places plus 5 food markets have been closed indefinitely until all
hygienic standards are adhered to. The district public health officer
Ropishe Pulimo said that Chemase and Tainet divisions were the most affected.

Pulimo has advised the public to maintain high standards of hygiene
by boiling drinking water, washing hands after visiting toilets to
keep at bay the water borne disease.

[Byline: Brian Opundo]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The Nandi hills area is located in the Rift Valley province in
western Kenya. The province can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

******
[3] Cholera - Zimbabwe (Mashonaland East)
Date: Thu 4 Sep 2008
Source: The Earth Times, Deutsche Presse Agentur (DPA) report [edited]
<http://www.earthtimes.org/articles/show ... break.html>


Health officials said Thursday [4 Sep 2008], 2 people have died and
23 are in hospital following an outbreak of cholera in one of
Harare's crowded townships, The outbreak occurred on Monday [1 Sep
2008] in Chitungwiza, a dormitory township of about a million people
on Harare's southern outskirts where sewerage routinely flows through
the streets and people's yards.

Chitungwiza hospital chief executive Obadiah Moyo said the
institution had dealt with a total of 34 people with the disease, but
said "we have enough medication for all the cholera victims."

"Residents of this area have been getting their water from
unprotected wells because there is no proper water supply system,"
said Chitungwiza town clerk Godfrey Tanyanyiwa. "We suspect these
wells could have been contaminated by burst sewer pipes."

Residential areas nearly all over the Zimbabwean capital often suffer
broken sewerage pipes and open streams of raw sewerage are visible in
all poor townships. Zimbabwe has suffered several cholera outbreaks
in recent years following the collapse of infrastructure due to the
country's political and economic crisis.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Harare and Chitungwiza are in Mashonaland East province and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

[The outbreaks discussed in this update can also be found on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

HEPATITIS E VIRUS - UGANDA ( 09 ): (KITGUM)
*****************************************
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Date: Fri 05 Sep 2008
Source: Relief Web [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Hepatitis E continues to bite; 7727 cases registered
----------------------------------------------------
A total of 175 new cases of hepatitis E were registered in Epi week
35 (25 - 31 Aug 2008) reflecting a decline of 21 percent in the
number of new cases compared to Epi week 34.

In Epi week 34 220 new cases were registered. There are cases of
relapse because some patients are failing to complete treatment. In
the same week (Epi week 35), 4 people succumbed to the disease. A
cumulative total of 7727 cases and 121 deaths have been registered in
17 sub counties in Kitgum district since the onset of the epidemic on
25 Oct 2007. It should, however, be noted that there are deaths and
hepatitis E cases that are not reported to health centres.

According to the Branch Field Coordinator, Kitgum, Mr. Peter Opika
Opoka, health assistants in all sub counties have been asked to
follow up and clarify the case definition. The increase in the number
of deaths is attributed to late reporting to health facilities and
consumption of the local Herbs which add toxic materials to the
already infected liver. Mr. Opika says residents usually consume the
local herbs in KWETE (Local Brew) and this causes re-infection.

Of the 19 sub counties in Kitgum District, 17 have been affected. The
2 sub counties of Palabek Kal and Palabek Ogili that have not been
affected have in the past suffered cholera outbreaks but sanitation
in the areas has reportedly improved, a reason they could have
survived the Hepatitis E outbreak.

A team from Ministry of Health is holding several meetings with
stakeholders in Kitgum District to review strategies of fighting the
disease and coordinating resources. The team includes; one officer in
charge of Environmental Health, another in charge of social
mobilization and the in-charge clinical medicine.

Uganda Red Cross Society (URCS) is continuing with interventions in
Agoro Sub County, one of the worst affected sub counties in Kitgum
District, through provision of safe water. URCS is chlorinating water
at 24 boreholes and as of 31 Aug 2008, 3 260 000 litres of water had
been chlorinated.

URCS is also conducting hygiene promotion through the village health
teams and the Local council one chairman. This is being done through
sensitization and clean-up campaigns; ensuring latrine cleaning and
safe water and food at household level.

The National Society is verifying village registers with the view of
distributing Jerry cans and soap to enhance hygiene and safe water
storage. IEC materials (Posters, Brochures and T-shirts) to create
awareness on the prevention and control of Hepatitis E are also being
distributed throughout the district. The interventions have helped to
scale down the rate of infections in Agoro.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[One hopes that the 21 percent decline in cases signals that the peak
of the epidemic has passed. The Ministry of Health/WHO/ Uganda Red
Cross Society efforts to provide safe water and improve hygiene in
the affected areas may be slowing the spread of this fecal-orally
transmitted virus disease. - Mod.TY]

Mods CP and JW wrote the following in ProMED archive no. 20080813.2511:

A comprehensive account of all aspects of hepatitis E disease and its
control can be accessed at:
<http://www.who.int/mediacentre/factsheets/fs280/en/>.

A map of Uganda showing the location of Kitgum district in the north
of the country can be accessed at:
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>.

Madi Opei, where the outbreak was reported 1st (and which is about 10
miles (16 km) from the Agoro crossing point with Sudan) can be located at:
<http://www.fallingrain.com/world/UG/84/Madi_Opei.html>. - Mod.CP

Aerial views of Kitgum:
<http://www.svliberty.org/images-2002/ki ... p_1160.jpg>
and displaced persons' camp there:
<http://upload.wikimedia.org/wikipedia/c ... Uganda.jpg>
- Mod.JW]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (35)
**********************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Guinea-Bissau
[2] Cholera - Zambia (Southern province)
[3] Cholera - Niger (Maradi)
[4] Cholera - Kenya (Rift Valley)
[5] Cholera - Sudan (South)
[6] Cholera - Zimbabwe (Mashonaland East)


******
[1] Cholera - Guinea-Bissau
Date: Sun 7 Sep 2008
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5h4u ... SyObNCrKrQ>


A cholera epidemic, which has claimed 90 lives to-date in
Guinea-Bissau, with more than 3900 people suffering from the disease,
is spreading but no new cases have been reported from neighboring
Guinea, the WHO said Sunday [7 Sep 2008].

"The cholera outbreak continues with 3915 cases and 90 deaths
reported as of 31 August [2008]" in Guinea-Bissau, said a World
Health Organization (WHO) report seen by AFP.

"New cases have been detected in Bijagos archipelago bringing the
number of regions affected to 10 out of 11." Aid groups MSF [Medecins
Sans Frontieres]-Spain and OXFAM-US have mobilized teams to support a
response, the report added.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[A map of Guinea-Bissau can be found at
<http://www.un.org/Depts/Cartographic/ma ... ineabi.pdf>. The
archipelago may be seen off the coast of the country. - Mod.LL]

******
[2] Cholera - Zambia (Southern province)
Date: Sat 6 Sep 2008
Source: China View, Xinhua News Agency report [edited]
<http://news.xinhuanet.com/english/2008- ... 810791.htm>


Cholera has broken out in the Mazabuka district, southern Zambia,
state media reported on Saturday [6 Sep 2008]. According to Zambian
News and Information Services (ZANIS), no deaths have been recorded
since the disease broke out late in August 2008. All the patients
admitted at the cholera center are responding to the treatment, ZANIS
said.

The source of the disease is due to contamination of water villagers
fetch from shallow wells, which they also use to wash their clothes
and cooking, according to ZANIS. Health staff also issued a circular
to discourage people from converging in groups following the cholera
outbreak.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The Mazabuka district is in the Southern province of Zambia and can
be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. - Mod.LL]

******
[3] Cholera - Niger (Maradi)
Date: Fri 5 Sep 2008
Source: African Press Agency (APA) [edited]
<http://www.apanews.net/apa.php?page=sho ... icle=74491>


A cholera outbreak in the Maradi region of Niger's economic capital
(about 700 km (435 mi) east of Niamey) has killed 3 people, according
to initial reports by the regional health authorities who set up a
camp to quarantine patients at the district health center, a reliable
source told APA on Thursday [4 Sep 2008].

The 1st cases were recorded late in August 2008 when the health
centers were stormed by patients suffering from diarrhea and vomiting
in Bagalam, a district known to be dirty and with a high human
density. An official with the Maradi integrated health center told
APA that the situation seems to have calmed down even though there
were still grounds for concern as this epidemic coincides with
Ramadan during which the consumption of raw vegetables increases.

As the administrative district of the region named after it, Maradi
city is one of Niger's most populated cities and also a commercial
center of attraction for the local population and others in
neighboring states like northern Nigeria.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Maradi is located in southern Niger bordering on Nigeria and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /niger.pdf>. - Mod.LL]

******
[4] Cholera - Kenya (Rift Valley)
Date: Fri 5 Sep 2008
Source: The Daily Nation [edited]
<http://www.nation.co.ke/News/regional/- ... /6jtmb0/-/>


Five people have died of cholera in the Nandi East District in the
last 2 weeks. 4 of them died in Tindiret while another died on
arrival at the Nandi Hills District Hospital on Friday [5 Sep 2008].

Of the 5 patients that had been admitted at Nandi Hills Hospital, 3
had been discharged.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Nandi is in the Rift Valley province in western Kenya. The province
can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>. - Mod.LL]

******
[5] Cholera - Sudan (South)
Date: Thu 4 Sep 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Miraya FM report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


The Ministry of Health in the Government of Southern Sudan said that
over 9000 cases of acute watery diarrhea have been reported in
Southern Sudan in 2008.

The Ministry's director general for preventive medicine, Dr John
Rumunu, told Miraya FM that from January to August 2008 several
outbreaks of diarrhea have been registered in Juba [Central
Equatoria], Magwi [Eastern Equatoria], Torit [Eastern Equatoria], and
Aweil [North Bahr al Ghazal].

The minister of health in Central Equatoria State, Dr Pius Subek, has
urged citizens to avoid drinking untreated water.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[South Sudan and the states affected can be found on a map at
<http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf>. - Mod.LL]

******
[6] Cholera - Zimbabwe (Mashonaland East)
Date: Thu 4 Sep 2008
Source: Voice of America [edited]
<http://voanews.com/english/Africa/Zimba ... -voa40.cfm>


An outbreak of cholera has claimed at least 9 lives in Chitungwiza,
Zimbabwe, and another 30 people have been admitted to the central
hospital in the Harare satellite town. Unconfirmed reports said as
many as 19 people had died at the hospital since Tuesday [2 Sep 2008].

The worst affected areas of Chitungwiza were said to Units O and Unit
K where burst sewer pipes have long been a common sight. Local
sources added that residents are drawing water from unprotected wells
because the local water supply system has broken down. A Chitungwiza
municipal official said authorities have sent bowsers, or water
tanker trucks, to the affected areas to provide residents with clean
drinking water.

[Byline: Jonga Kandemiiri]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Harare and Chitungwiza are in Mashonaland East province and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. - Mod.LL]

[The outbreaks discussed in this update can also be found on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

POLIOMYELITIS (06): DJIBOUTI ex ETHIOPIA
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 6 Sep 2008
From: Ammar Abdo Ahmed <ammarmed@yahoo.com> [in French, trans. Mod.MPP]


Dear Colleagues,

I have the honor to inform you that our epidemiologic surveillance
system has detected a case of laboratory confirmed polio; serotyping
is underway. The details of the viral strain will be sent later by a
laboratory in Johannesburg. Otherwise, the measures mentioned are
those implemented in the context of rapid response.

To get an idea about the case and the measures put in place [below
is] a detailed investigation and response.

However, it is requested that all clinicians raise their level of
vigilance to take into account the clinical forms of atypical polio.

The surveillance has certainly proved its effectiveness. It is now
necessary to review the immunization strategy completely. I am
currently working on revising the plan of action to fight against
polio and also the installation of border post sentries in the form
of quarantine offices. I subsequently communicate these documents to
serve as a guide in countries with limited resources.

Report on the investigation and response to an imported case of polio
in Djibouti:
-----------------------------------------------
The child, [a 24-month-old], from Harrouah Ethiopia, came with his
mother to Djibouti on 19 Jun 2008 and stayed with relatives in the
town of Warableh in the Commune of Balbala in Djibouti city. On [24
Jun 2008], she consulted the Hayableh [health] center due to [the
child's] inability to walk.

Physical examination revealed an acute flaccid paralysis [AFP]. On
interview, it was found that the child was not well in the period
preceding her arrival in Djibouti. Four days prior to the onset of
paralysis, the child had presented with fever, diarrhea and vomiting.

The case was declared [reported] on the same day to the surveillance
and epidemiological investigations unit, and investigations were made
within 24 hours following the declaration [report].

The girl returned to Ethiopia 2 weeks later.

Samples were sent to the Polio [reference] Laboratory in Nairobi on 3
Aug 2008. On [25 Aug 2008], the Department of Polio Eradication, WHO
Regional Office for the Eastern Mediterranean, informed us by mail of
the presence of a polio virus in stool samples from this child, and
the sample was sent to the Reference Laboratory in South Africa.

Given this situation, the Ministry of Health has set up a committee
to respond to imported cases of polio. The plan established by the
Committee is as follows:

- Conduct a vaccination campaign around the house where the girl
stayed on 30 and 31 Aug 2008.
- Take at least 5 samples in the vicinity of the house of the
parents of the girl.
- Strengthen active surveillance and the search for AFP cases.
- In the same context, a vaccination campaign was conducted at the
camp with displaced families from Ethiopia near the localities of
Sankal and Bondara.
- Carry out AFP detection [activities] and administration of an
extra dose of OPV [oral polio vaccine] to all children entering
Djibouti at border posts beginning on 1 Sep 2008.

1) The response campaign:
- Was organized within a radius of 300 meters from the house where
the girl stayed.
- Eight teams took part in this campaign for 2 days.
- The number of families visited was 354; the number of children
under 5 years [identified] and vaccinated were 656, including 550
that were fully immunized (83.8 percent).
- During the campaign, 4 stool samples were obtained.

2) The strengthening of active surveillance:
- A memo was sent to districts to double surveillance [routine?] and
strengthen active surveillance.

3) The response in the villages of Sankal and Bondorra:
- The mobile team of Dikhil led this campaign. On the other hand,
the national focal point PFA visited localities in search of AFP
cases and to check whether the campaign was conducted properly.

The following table summarizes the number of children vaccinated:

Locality / Origin / Sites visited / Infants vaccinated / Infants
completely vaccinated
Sankal / Villager / 10 / 16 / 17
Sankal / Refugee / 77 / 181 / 3
Bondora / Villager / 22 / 37 / 7
Bondora / Refugee / 17 / 43 / 0

Total / / 126 / 307 / 27

4) Control and vaccination of children in border centers:
- A note was sent to doctors and heads of districts to implement
vaccine supply, training of agents and data collection.

--
Dr Ammar Abdo Ahmed MD, MPH
Director of Epidemiology & Health Information
Focal point of International Health Regulation, Avian Flu and
Surveillance/Research
Ministry of Health
BP: 4244 Recette Principale
Djibouti
<ammarmed@yahoo.com>

[ProMED-mail would like to thank Dr. Ammar Abdo Ahmed for sharing
this excellent report on the investigation and control measures
implemented in Djibouti, responding to a recently identified imported
case of polio in Djibouti from Ethiopia. From the date of onset of
illness and the date of travel of the case from Ethiopia to Djibouti,
it is fairly clear that the case was infected with the poliovirus
while in Ethiopia.

According to the most recent information available on the polio
eradication website, as of 3 Sep 2008, there have been a total of 2
confirmed cases of polio attributable to wild poliovirus (WPV)
infection in Ethiopia since the beginning of 2008, with the date of
onset of the most recent case 27 Apr 2008 (see
<http://www.polioeradication.org/casecount.asp>).

The summary report on polio activity in the Horn of Africa mentions
the following:
* No new cases were reported in the past week. The total number of
cases in the region remains 5 (4 in the southern Sudan/western
Ethiopia cross-border area, and one in West Darfur, Sudan). The most
recent case had onset of paralysis on [6 Jul 2008] (WPV3 from West
Darfur, Sudan).
* Immunization activities took place last week in northern Sudan
(including the Darfurs), using tOPV (trivalent OPV). Further
activities in Sudan are tentatively planned for [27 Oct 2008 and 24
Nov 2008].

This report does not contain information on the above mentioned case
imported from Ethiopia to Djibouti.

As the date of onset of paralysis of this case was in early August
2008, while no cases have been reported from Ethiopia since the case
with date of onset of disease in late April 2008, one can assume
there is still WPV circulation in Ethiopia as of August 2008. The
absence of reports of cases in this interval can represent
deficiencies in surveillance or low level circulation with resulting
non-paralytic infections (remembering that on average, for every 200
individuals that are infected with poliovirus, only one will have
paralytic disease, but the range of paralytic to non-paralytic can
vary from a high of one in 50 infections to a low of one in 1000
infections.

For a general map of Djibouti, see
<http://www.lib.utexas.edu/maps/africa/djibouti.gif>.
This moderator was not able to find definitive maps of the above
mentioned areas of Sankal and Bondora.

For the interactive HealthMap/ProMED map of Djibouti with links to
other recent ProMED-mail postings on events in Djibouti and
neighboring countries, see
<http://healthmap.org/promed?v=11.7,42.6,5>.
- Mod.MPP]

Guinea-Bissau - Darminfektionen
08.09.2008

Risiko für Durchfallerkrankungen landesweit. Nach einer Pause von zweieinhalb Jahren gab es im Land wieder Cholera: Bei dem seit Anfang August anhaltenden Ausbruch sind bisher mehr als 3.200 Personen erkrankt, wovon 70 verstarben. Die Tendenz ist weiterhin deutlich ansteigend. Die Hauptstadt Bissau ist am stärksten betroffen. Guinea-Bissau erlitt mit mehr als 25.000 Erkrankungen und 400 Todesfällen in der zweiten Jahreshälfte 2005 eine der schwersten Cholera-Epidemien in seiner Geschichte. Hygiene beachten. / Quelle: crm

Simbabwe - Darminfektionen
15.09.2008

Risiko für Durchfallerkrankungen landesweit. Cholera gab es zuletzt immer wieder in den hygienisch schlecht versorgten Bezirken und Vororten der Hauptstadt Harare sowie im Mashonaland im Norden. Bei einem aktuellen Ausbruch sind bisher 11 Personen verstorben, 35 weitere mussten hospitalisiert werden. / Quelle: crm
____________________

Tansania - Darminfektionen
15.09.2008

Risiko für Durchfallerkrankungen landesweit. Ein Cholera-Ausbruch wird aus dem Tarime-Distrikt (NW) mit mindestens 180 Erkrankten gemeldet. Auch in anderen Landesteilen kommt es regelmäßig zu örtlich begrenzten Ausbrüchen. Hygiene beachten. / Quelle: crm

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (36 )
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Africa
[1] Cholera - Nigeria (Kano)
[2] Cholera - Tanzania (Mara)
[3] Cholera - Guinea-Bissau

******
[1] Cholera - Nigeria (Kano)
Date: Mon 15 Sep 2008
Source: This Day [edited]
<http://www.thisdayonline.com/nview.php?id=122522>


No fewer than 5 people were feared dead as a result of an outbreak of
cholera in some local government areas of Kano state. Although the
disease is yet to assume epidemic status, the State Commissioner for
Health, Hajiya Aishatu Isyaku Kiru, said her ministry had swung into
action to tackle the situation. She attributed the development to the
consumption of unhygienic foods or drinks, describing such foods to
include vegetable salads and fruits and contaminated food and water,
which, if not properly prepared, could become vehicles for the
infection and spread of cholera.

[Byline: Ibrahim Shuaibu]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[A map of Nigeria showing the north-central state of Kano can be found at:
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>.
- Mod.LL]

******
[2] Cholera - Tanzania (Mara)
Date: Wed 10 Sep 2008
Source: UN - Integrated Regional Information Networks (IRIN) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Four people have died of cholera, and dozens were admitted to health
centers in the northern Tanzanian region of Mara, according to health
officials. Mara Regional Medical Officer Stephen Kebwe said 4
patients died in the 1st week of September 2008 in Tarime district,
which borders Kenya.

Kebwe said cholera cases were 1st reported in Tarime on 16 Aug 2008.
The officer said so far 180 cases have been reported in Tarime and
Rorya districts. Kebwe said 164 cases were treated at various health
centers and discharged. Kebwe said 16 patients were still admitted at
health centers in the 2 districts as of 10 Sep 2008 morning.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Mara is located in extreme northern Tanzania and can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>.
- Mod.LL]

******
[3] Cholera - Guinea-Bissau
Date: Thu 11 Sep 2008
Source: Missionary International Service News Agency (MISNA) [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


The toll continues to rise in a cholera outbreak since the end of May
2008 in Guinea-Bissau. Based on the latest estimates of the United
Nations Office for the Coordination of Humanitarian Affairs (OCHA),
as of 1 Sep 2008, the outbreak claimed 110 lives with over 5000
people suffering from the disease. The capital of Guinea-Bissau
[Bissau] remains the worst-affected with 3500 cases, although the
outbreak is spreading in the provinces of Quinara (south), Biombo
(west), and new cases were reported also in Sao Domingo (north-west)
and the Bijagos Islands.

The government recently defined the situation as "difficult" and
called for urgent international help in containing the epidemic,
specifying that, due to the "alarming proportions" of the outbreak,
the national authorities were no longer able to contain it. UN
agencies and top international health organizations are already on
the scene in an attempt to contain the spread.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The areas mentioned can be found on the map of Guinea-Bissau at:
<http://www.un.org/Depts/Cartographic/ma ... ineabi.pdf>.

The outbreaks discussed in this update can also be found on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>.
- Mod.LL]