Wüstenschiff

YELLOW FEVER - AFRICA (13): SIERRA LEONE (SOUTHERN PROVINCE)
************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 19 Dec 2008
Source: Awareness Times [edited]
<http://www.news.sl/drwebsite/publish/ar ... 0729.shtml>


Sierra Leone's Chief Medical Officer, Dr. Kisito S. Daoh, has been
alerted of a reported case of yellow fever [YF] in the Bo district
[Southern Province] and laboratory tests conducted have confirmed
evidence on 2 patients following results from the Institut Pasteur
Laboratories in Abidjan and Dakar.

Yellow fever is a viral disease found in tropical regions of Africa.
It principally affects human and monkeys, and is transmitted via the
bite of the _Aedes aegypti_ mosquitos. It can produce devastating
outbreaks, which can be prevented and controlled by mass vaccination
campaigns.

Meanwhile, all District Medical Officers and their team have been
requested to sensitize their various communities and educate them on
the prevailing situation.

The Ministry of Health and Sanitation has intensified surveillance in
the country and there are plans to immunize all residents of Bo
district excluding pregnant women and children under 9 months.

The public is advised to stay calm as there is no cause for alarm.
The Government of Sierra Leone with support from the world Health
Organisation and other partners are in full control of the situation.

The public should note that yellow fever is spread by mosquitos. You
can protect yourself and your family if you:
* Always sleep under an insecticide treated bed net
* Report all cases of fever and yellowing of the eyes to the nearest
health facility immediately

--
Communicated by:
ProMED Rapporteur A-Lan Banks

[Since _Ae. aegypti_ bites during daylight hours, including dawn and
dusk, when most people are not asleep under bed nets, other measures
need to be taken to avoid infection as well. Elimination of water
catchments in and around houses and other buildings is important for
YF virus vector control.

It is hoped that the district medical teams are urging citizens to do
this, as well as implement the critically important YF virus
vaccination campaign. The Bo district had a population of 472 919
inhabitants in 2004. Bo is the 2nd largest city in Sierra Leone,
after Freeport, the capital. If Bo has large populations of _Ae.
aegypti_, as seems likely, occurrence of YF virus transmission in the
area is worrisome. _Aedes_ spp. other than _Ae. aegypti, are involved
in YF virus transmission in rural agricultural and in forested areas
in Africa. YF has occurred in other countries in West Africa in 2008,
but this is the 1st report from Sierra Leone for the year.

A map showing the location of Bo in the Southern Province in Sierra
Leone can be accessed at:
<http://en.wikipedia.org/wiki/Bo,_Sierra_Leone>
A HealthMap/ProMED-mail interactive map of Sierra Leone can be accessed at:
<http://healthmap.org/promed/en?v=8.6,-11.8,5>.
- Mod.TY]

******
[2]
Date: Mon 22 Dec 2008
Source: All Africa.com [edited]
<http://allafrica.com/stories/200812221407.html>


In August 2003, the health ministry reported one confirmed case and
45 suspected cases of yellow fever in the Tonkolili district,
Northern Province.

Between 7-10 Aug 2003, there was a joint investigation mission from
the ministry, WHO and UNICEF that collected samples on site and took
them to the laboratory for testing while surveillance was
strengthened.

In September [2003], one month later, the ministry reported a total
of 90 cases from 8 districts: Tonkolili, Bombali, Kenema, Koinadugu,
Porto Loko and Kambia in the north and Kono in the eastern province
[Only 7 districts are listed - Mod.LM].

Of the 90 cases, there were 4 laboratory confirmed cases, all from
Tonkolili district, and 10 deaths.

Over the last 20 years, the number of yellow fever epidemics has
risen, and more countries are reporting cases.

Mosquito numbers and habitats are increasing. In both Africa and the
Americas, there is a large susceptible, unvaccinated population.
Changes in the world's environment, such as deforestation and
urbanization, have increased contact with the mosquito/virus.

Widespread international travel could play a role in spreading the
disease. The priorities are vaccination of exposed populations,
improved surveillance and epidemic preparedness.

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[A map showing the 4 provinces of Sierra Leone can be accessed at:
<http://www.lib.utexas.edu/maps/africa/s ... l_2005.jpg>.
- Mod.TY]

MALARIA - EUROPE ex GAMBIA: (03)
********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: 18 Dec 2008
Source: Eurosurveillance Vol. 13, Issue 51 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19077>


"European cluster of imported falciparum malaria from Gambia."
T Jelinek1, C Schade Larsen2, H Siikamaki3, B Myrvang4, P Chiodini5,
J Gascon6, L Visser7, A Kapaun4,8, G Just-Nubling9

1. Berlin Centre for Travel and Tropical Medicine, Berlin, Germany
2. Department of Infectious Diseases, Aarhus University Hospital,
Skejby, Denmark
3. Helsinki University Central Hospital, Division of Infectious
Diseases, Department of Medicine, Helsinki, Finland
4. Department of Infectious Diseases, Ullevaal University Hospital,
Oslo, Norway
5. Hospital for Tropical Diseases and Health Protection Agency
Malaria Reference Laboratory, London School of Hygiene and Tropical
Medicine, United Kingdom
6. International Health Centre, Hospital Clinic, Barcelona Centre for
International Health Research (CRESIB), Barcelona, Spain
7. Department of Infectious Disease, Section Travel Medicine, Leiden
University Medical Centre, Leiden, the Netherlands
8. Section Clinical Tropical Medicine, Heidelberg University
Hospital, Heidelberg, Germany
9. Klinik II, Centre for infectious and tropical diseases , J.W.
Goethe University, Frankfurt/Main, Germany

Abstract
A cluster of 56 patients returning from Gambia with falciparum
malaria has been noted in several countries of the European Union
since September this year [2008]. TropNetEurop, the European Network
on Imported Infectious Disease Surveillance, collected and reported
the cases. Lack of awareness and, consequently, of prophylactic
measures against malaria were apparent in the majority of patients.

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

******
[2]
Date: 22 Dec 2008
From: David Conway <dconway@mrc.gm>

The vast majority of all tourists stay in the coastal resort area, so
it is fully expected that most of the European tourists who recently
were reported to have returned with malaria in the Eurosurveillance
articles would have stayed there. We know that malaria transmission
persists in this area, and there have been cases this year [2008]
among local people and expatriate residents. Of course, the important
thing to emphasize is that there is no part of The Gambia that is
malaria free, and the recommendation for chemoprophylaxis for
visitors should be reinforced.

The MRC, NMCP, and NGO partners (CIAM) are analyzing 2008 data from a
number of health centres, including those previously analysed and
reported for the period until the end of 2007 in the recent Lancet
article. Malaria in most health facilities appears to be continuing
to decline, particularly upcountry in places where the decline had
previously been less marked than at the coast.

Community based surveys have also recently shown lower prevalences
than ever seen previously; these are being written up with a
manuscript hopefully available in January 2009, which we would be
glad to get your comment on. We have noticed in at least one facility
in the coastal region that numbers of cases are higher in 2008 than
in the previous 2 years, so it seems that the distribution is now
more patchy spatially, and we need to be alert to the possibility of
very local resurgences.

If you and the other European investigators could get details on the
hotel names and dates of stay for each case, we could help
investigate whether there was a micro-focus of "high" transmission or
not. We would not need further details of itineraries, such as day
trips, as nearly all transmission of malaria here occurs at night.

--
Dr David J Conway
Head of Malaria Research Programme
Medical Research Council Laboratories
Fajara, P.O. Box 273
Banjul, The Gambia
<dconway@mrc.gm>

******
[3]
Date: 22 Dec 2008
From: Anders Bjorkman


We now have 3 patients from Sweden at Karolinska Hospital/Solna and
Huddinge. We are investigating the details of the hotel and locality
involved.

Age / Gender / Hospital of malaria diagnosis / Date of return to
Sweden / Date trip started / Malaria prophylaxis

59 / M / Karolinska-Solna / 18 Nov 2008 / 11 Nov 2008 / No
35 / M / Karolinska-Huddinge / 27 Nov 2008 / 15 Nov 2008 / No
48 / M / Karolinska-Solna / 10 Dec 2008 / 8 Dec 2008 / No

--
Anders Bjorkman
Prof
Division of Infectious Diseases
Karolinska University Hospital
SE-171 76 Stockholm
Sweden

******
[4]
Date: 22 Dec 2008
From: Heli Siikamaki


We have had 2 more Finnish tourists with falciparum malaria from
Gambia in December 2008 after writing the Eurosurveillance articles;
the same story: no appropriate prophylaxis.

--
Heli Siikamaki
Helsinki
Finland

******
[5] Spain
Date: 22 Dec 2008
Source: TropMEDnet [edited]
<http://www.bctropen.de>


We know of a cluster of 3 imported malaria cases (one fatal case) in
a group of returning travelers from the Gambia seen at a secondary
hospital in Madrid. None was on prophylaxis.

[Rogelio Lopez-Velez, Madrid, Spain]

--
Communicated by:
Tomas Jelinek
<jelinek@bctropen.de>
TropNetEurop coordinator
Berlin Center for Travel and Tropical Medicine
Jagerstr. 67-69, 10117 Berlin, Germany
<http://www.bctropen.de>

[ProMED thanks Tomas Jelinek from TropNetEurop for permission to
publish the additional cases from Sweden, Finland and Spain, bringing
the total number of reported cases to 64 with 3 fatalities. None of
the new cases took malaria prophylaxis.

The comment from Dr David Conway that the distribution of malaria in
The Gambia is patchy makes detailed investigation of the movements in
The Gambia of the patients and mapping of the hotels where they
stayed important. However, The Gambia is known as a malaria endemic
destination, and the fact that very few had been recommended malaria
chemoprophylaxis by the travel agent who sold the travel highlight
that this situation can only be prevented in the future by travel
agents taking responsibility for information on health issues at the
destination.

Maps of The Gambia are available at
<http://www.lib.utexas.edu/maps/africa/gambia.gif>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?v=13.5,-15.5,6>.
- Mod.EP]

PLAGUE - FATAL - UGANDA (02): (ARUA, NEBBI)
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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: Sat 20 Dec 2008
Source: The East African [edited]
<http://www.theeastafrican.co.ke/news/-/ ... rm3wy3z/-/>


The death toll from bubonic plague in Uganda continues to rise as the
government struggles to come up with a clear response even though
early signs of the disease were detected at the beginning of 2008. At
least 68 people have died since February 2008 when the plague was 1st
reported, and now health experts warn that it could spread rapidly in
the absence of an adequate response from health workers and local
communities. About 32 000 people are at risk of acquiring the disease
if they do not take precautions.

The outbreak was initially restricted to one district but has now
spread to 2 others, where 73 cases have been reported. Arua District
Health Officer Dr Patrick Anguzu said the area has been registering a
few cases every year, but this year the numbers started rising,
reaching alarming levels in August 2008.

Dr William Mbabazi of the World Health Organization said the rising
rates are due to poor hygiene and sanitation because people do not
clean their houses, allowing bacteria-infected wild rats to find a
conducive environment in dirty homes, spreading the infected fleas.
Domestic rats then picking the fleas and due to their contact with
humans, the fleas pass on the disease.

The plague, which mainly affects women and children, has spread into
the districts of Arua and Nebbi, where residents still live in mud
huts. The WHO says the casualties in these districts are victims of a
cultural belief that women and children must sleep on the floor while
the men sleep on beds.

[Byline: Eve Mashoo]

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

[Arua and Nebbi are endemic for plague and are located in
northwestern Uganda as can be seen on a map at:
<http://www.un.org/Depts/Cartographic/ma ... uganda.pdf>. The
HealthMap/ProMED-mail interactive map of Uganda is available at:
<http://healthmap.org/promed?g=443328&g= ... 2,31.167,5>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (55)
**********************************************
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 - Africa: WHO
[2] Cholera - Zimbabwe
[3] Cholera - Zimbabwe (IFRC Map)
[4] Cholera - South Africa (Limpopo)
[5] Cholera - South Africa (Gauteng)
[6] Cholera - Burundi (Cibitoke)

*****
[1] Cholera - Africa: WHO
Date: 22 Dec 2008
Source: World Health Organization (WHO) [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Africa weekly emergency situation update No. 41
-----------------------------------------------
- Angola: The cholera outbreak is still of high concern. On week 50,
a total of 131 new cases and 1 death were reported. From January 2008
to 14 Dec 2008, nationwide, 10 186 cases and 232 deaths were
reported. The WHO is supporting national authorities to strengthen
coordination and response activities.

- Congo DR: According to the UN mission (MONUC), the security
situation remains precarious in the zones of North Kivu controlled by
the Congres National pour la Defense du Peuple (CNDP). The cholera
outbreak is ongoing; during week 50 a total of 125 new cases without
death were reported versus 232 cases with 1 death on week 49.

- Ethiopia: No new cases of acute watery diarrhea have been reported
in the past 4 weeks. From 1 Jan 2008 to 30 Nov 2008, total cumulative
cases and deaths nationally were 3804 and 23 respectively in 54
districts. The WHO continues technical support to strengthen
surveillance, early warning system, assessment and response.

- Kenya: There is an on-going cholera outbreak in the 3 districts of
Mandera. More than 1400 cases with 13 deaths reported since 17 Nov
2008.

- Mozambique: The cholera outbreak is ongoing. 6 provinces are
affected. On week 50, a total a 131 new cases with 2 deaths were
reported. Cumulative total since week 34 is 1585 cases with 31
deaths. The WHO and partners are supporting the control of the
outbreak.

- Zimbabwe: The cholera outbreak is not yet under control. As of 18
Dec 2008, a total of 20 896 with 1123 deaths (CFR, 5.4 percent) have
been reported in 2/3s of the country's 62 districts. The WHO and
other partners are supporting the response activities.

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

[A map of the continent showing the mentioned countries can be found at:
<http://www.un.org/Depts/Cartographic/ma ... africa.pdf>. - Mod.LL]

*****
[2] Cholera - Zimbabwe
Date: Tue 23 Dec 2008
Source: Agence France Presse (AFP [edited]
<http://www.google.com/hostednews/afp/ar ... WRytJ8o-Og>


The toll from Zimbabwe's cholera epidemic rose again Tuesday [23 Dec
2008] with 1174 people now known to have died from the disease since
August 2008, the United Nations Children's Fund UNICEF said. "The
disease is still popping up in the country which means it is still
not under control," UNICEF representative in Zimbabwe Roeland Monasch
told a press conference in Geneva by telephone.

Almost 3000 new cases have been diagnosed since the last UN figures
were published 5 days ago, Monasch said, taking the total number of
confirmed infections to 23 712.

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

[The number of cases of cholera in this catastrophic situation in
Zimbabwe continues to rise dramatically, underscoring the need for
rapid intervention. Since the last posting on 18 Dec 2008, there were
3131 more cases reported, with 63 more deaths.

[A map of Zimbabwe with provinces can be found at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at:
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

*****
[3] Cholera - Zimbabwe (IFRC Map)
Date: Tue 23 Dec 2008
Source: International Federation of Red Cross And Red Crescent
Societies (IFRC) [edited]
<http://www.reliefweb.int/rw/fullMaps_Af ... penElement>


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

[A Cholera Situation Map can be found at this URL. - Mod.LL]

*****
[4] Cholera - South Africa (Limpopo)
Date: Mon 22 Dec 2008
Source: The Right Perspective [edited]
<http://www.therightperspective.org/?p=666>


The Afrikaans newspaper Beeld has reported over the weekend that
cholera has spread to another 3 rural areas within the Limpopo
province of South Africa. A spokesperson from the Limpopo health
department said that more than 100 people have already been infected
in these areas. Mr Seloba reminded the public that cholera isn't just
a Zimbabwean disease and that it can spread to any area with poor
sanitation facilities. The disease is spread through dirty water.

The Musina hospital in the province has treated close to 900 patients
for the disease, most of them Zimbabweans, since mid-November 2008. A
total of 8 deaths has been reported in South Africa.

The premier of Limpopo, Sello Moloto, declared the Vhembe district in
Limpopo a disaster area. Additional doctors and nursing staff have
already been dispatched to the area to assist with the treatment of
cholera patients. The department of health is distributing water
purification tablets in an attempt to contain the disease.

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

[It appears that more of the South African cases are locally
acquired. Limpopo province (called Northern province on the map)
which can be seen on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
The HealthMap/ProMED-mail interactive map of South Africa can be seen at:
<http://healthmap.org/promed/en?g=1085597&v=-26,29.5,5>. - Mod.LL]

*****
[5] Cholera - South Africa (Gauteng)
Date: Mon 22 Dec 2008
Source: Deutsche Presse-Agentur [edited]
<http://www.monstersandcritics.com/news/ ... hannesburg_>


South African authorities reported new cholera deaths in the province
surrounding Johannesburg, indicating that the spread of the disease
from Zimbabwe is becoming more pronounced.

Another person had died of cholera over the weekend, bringing the
province's death count to 3, Chika Asomugha, spokesman for the health
department of Gauteng Province, told the South African Press
Association (SAPA) on Monday [22 Dec 2008].

Gauteng, home to both the city's economic center of Johannesburg and
the national capital of Pretoria, now has 21 positively identified
cases of cholera, with the heaviest concentration in the Johannesburg
district.

Health officials are worried that there could be further outbreaks of
the disease in both Zimbabwe and South Africa over the Christmas
holidays, when Zimbabweans who live in South Africa return home to
visit relatives, perhaps risking infection and the further spread of
the disease.

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

[Gauteng, formerly known as Pretoria-Witwatersrand-Vereeniging (PWV),
is the smallest province in South Africa, with only 1.4 percent of
the land area, but it is highly urbanized. It lies below Limpopo
(formerly Northern Province).

Gauteng can be seen on the map at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
The HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/promed/en?g=108559 ... 83,28.25,5>. - Mod.LL]

*****
[6] Cholera - Burundi (Cibitoke)
Date: Mon 22 Dec 2008
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


The 1st cholera case was reported in Rugombo commune / Cibitoke
province on 14 Nov 2008 and confirmed by the laboratory of National
Institute for Public Health (INSP) 3 days later. Until 19 Dec 2008, a
total of 96 cases including 1 home death were treated in Cibitoke
hospital and other health centres.

The most affected area is Rugombo commune with a total of 60 cases.

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

[A map of Burundi showing Cibitoke province in the northwest can be found at:
<http://www.un.org/Depts/Cartographic/ma ... urundi.pdf>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (56 )
**********************************************
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 - Zimbabwe (latest statistics)
[2] Cholera - Zimbabwe (WHO)
[3] Cholera - Zimbabwe (WHO Outbreak Report)
[4] Cholera, prisons - Zimbabwe


*****
[1] Cholera - Zimbabwe (latest statistics)
Date: Mon 29 Dec 2008
Source: International Herald Tribune [edited]
<http://www.iht.com/articles/ap/2008/12/ ... holera.php>


The number of people who have died in Zimbabwe's cholera outbreak has
risen to 1564, an increase of almost 50 deaths from the 1518 reported
over the weekend, the United Nations said Monday [29 Dec 2008].

The latest figures, dated 28 Dec 2008, also show that the number of
cholera cases since the start of the outbreak has reached 29 131,
World Health Organization spokesman Gregory Hartl said.

The WHO said Saturday that by 25 Dec 2008, 1518 people had died since
the start of the outbreak in August 2008. More than 2/3 of the
deaths occurred in December 2008 alone.

Hartl cautioned that the figures may not reflect the full extent of
the outbreak. "Not all districts are reporting," he told The
Associated Press. "We don't know how many cases are out there."

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

[The number of cases of cholera in this catastrophic situation in
Zimbabwe continues to rise dramatically, underscoring the need for
rapid intervention. Since ProMED's last posting on 23 Dec 2008, there
were 5419 more cases reported, with 344 more deaths. The following
item [2] provides the data from which this report is derived.

[A map of Zimbabwe with provinces can be found at:
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at:
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

*****
[2] Cholera - Zimbabwe (WHO)
Date: Sun 28 Dec 2008
Source: World Health Organization [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... report.pdf>


Highlights of the day:
- 227 cases and 3 deaths added today (0.8 percent in comparison to
cases added previous day). The 3 deaths were reported in Masvingo.
- Reports received from 8 out of 52 affected districts (29.4 percent)
- 84 percent of districts reported to be affected (53/62 districts)
- Follow up established that there were 1851 cumulative cases and
139 deaths in Chegutu on 27 Dec 2008, making the overall total 28 904
up to 27 Dec 2008. No report for Chegutu for 28 Dec 2008
- Cumulative case-fatality rate (CFR) of 5.3 percent (far above the
1 percent which is normal in large outbreaks), with range 0 percent
to 71.4 percent.

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

[The high CFR reflects the conditions in Zimbabwe and the lack of any
medical care in most cases. - Mod.LL]

*****
[3] Cholera - Zimbabwe (WHO Outbreak Report)
Date: Fri 26 Dec 2008
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2008_12_26/en/index.html>


As of 25 Dec 2008, a total of 26 497 cases, including 1518 deaths,
have been reported by the Ministry of Health in Zimbabwe. Cases are
now being reported from all 10 of the country's provinces. Harare,
particularly Budiriro suburb in the southwest, accounts for the
majority of cases, followed by Beitbridge in Matabeleland South and
Mudzi in Mashonaland East. The current outbreak is the largest ever
recorded in Zimbabwe and is not yet under control. In fact, the
epidemiological week ending 20 Dec 2008 saw more than 5000 new cases,
an increase in the number of weekly cases relative to previous weeks,
and an increase in deaths outside treatment/health centres.

The overall Case Fatality Rate (CFR) has risen to 5.7 percent, far
above the 1 percent which is normal in large outbreaks, and in some
rural areas it has reached as high as 50 percent. Mortality outside
of health care facilities remains very high. This is a clear
indication that better case management and access to health care is
needed, in particular an increased use of oral rehydration therapy
with Oral Rehydration Salts in communities very early after onset of
the disease.

The current situation is closely linked to the lack of safe drinking
water, poor sanitation, declining health infrastructure, and reduced
numbers of health care staff reporting to work. Other current risk
factors include the commencement of the rainy season and the movement
of people within the country, and possibly across borders, during the
Christmas season.

The WHO, together with the Ministry of Health and partners from the
health and Water and Sanitation clusters, has established a cholera
outbreak response coordination unit in order to strengthen the
reporting and early detection of cases, improve the response
mechanism and access to health care and ensure proper case
management. The WHO has also deployed experts in public health, water
and sanitation, logistics and social mobilization. In light of the
extent and pace of expansion of the outbreak, reinforcing all control
activities across the country is critical.

Given the current dynamic of the outbreak and the context of the
collapsed health system, a cholera vaccination is not recommended.
Moreover, the use of the internationally available WHO prequalified
oral cholera vaccine is not recommended once an outbreak has started
due to its 2-dose regimen and the time required to reach protective
efficacy, high cost and the heavy logistics associated to its use.
The use of the parenteral cholera vaccine has never been recommended
by the WHO due to its low protective efficacy and the occurrence of
severe adverse events.

In controlling the spread of cholera, the WHO does not recommend any
special restrictions to travel or trade to or from affected areas.
However, neighboring countries are encouraged to reinforce their
active surveillance and preparedness systems. Mass chemoprophylaxis
is strongly discouraged, as it has no effect on the spread of
cholera, can have adverse effects by increasing antimicrobial
resistance and provides a false sense of security.

--
Communicated by:
ProMED Rapporteur Marianne Hopp
<promed@promedmail.org>

*****
[4] Cholera, prisons - Zimbabwe
Date: Sat 27 Dec 2008
Source: Zimbabwe Times [edited]
<http://www.thezimbabwetimes.com/?p=9237>


Cholera has hit Zimbabwe's prisons with more than 200 inmates said to
have died in the country's prisons over the past week alone. There
are reports that the government now contemplates the closure of some
of the country's prisons because of the epidemic.

Poor sanitary conditions and the generally deplorable state of the
country's prisons are hampering efforts by health officials to
control the disease. More than 20 inmates have died in Masvingo
Remand Prison over the past 5 days. A cholera treatment camp has
since been established at the prison. At Mutimurefu Prison also in
Masvingo Province 9 inmates succumbed to the epidemic while at Hwahwa
prison in the Midlands Province 16 are reported to have died.

Although figures of inmates who died in other prisons could not be
obtained, Justice Legal and Parliamentary Affairs minister Patrick
Chinamasa yesterday [26 Dec 2008] confirmed the outbreak of the
disease, adding that cholera treatment camps had since been
established at the affected institutions.

[Byline: Owen Chikari]

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

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (01)
**********************************************
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 - Zimbabwe
[2] Cholera - South Africa (Western Cape Province) NOT ex Zimbabwe
[3] Cholera - Zambia (Southern Province)
[4] Diarrhea - Swaziland (Shiselweni Province)

*****
[1] Cholera - Zimbabwe
Date: Thu 1 Jan 2009
Source: Agence France-Presse (AFP) [edited]
<http://www.google.com/hostednews/afp/ar ... NlXSdSO5ow>


More than 30 000 people in Zimbabwe have been diagnosed with cholera,
the World Health Organization (WHO) said Thursday [1 Jan 2009], as the
number of those contracting the deadly disease continues to mount. As
many as 31 656 suspected cases were diagnosed to date with 1/3rd of
them in the capital, Harare, the WHO said. The organisation last
reported some 29 131 suspected cases on Monday [29 Dec 2008] and 1564
deaths from the water-borne disease.

The Red Cross announced on Wednesday [31 Dec 2008] that it would send
7 international emergency response teams to the impoverished southern
African country to help fight the spread [of the disease.]

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

[The WHO daily cholera update (31 Dec 2008)
(<http://reliefweb.int/rw/rwb.nsf/db900SI ... c=1&cc=zwe>)
from which this posting is derived noted that 741 cases and 38 deaths
were added from the cumulative data reported on 30 Dec 2008. Clearly,
the epidemic continues.

A new map of the country showing the affected areas with data through
28 Dec 2008 can be found at
<http://www.reliefweb.int/rw/fullMaps_Af ... penElement>
- Mod.LL]

******
[2] Cholera - South Africa (Western Cape Province) NOT ex Zimbabwe
Date: Fri 2 Jan 2009
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?click_id ... 579C190910>


The City of Cape Town's health department says only one case of
cholera, in Khayelitsha, has been confirmed and 2 adults are being
monitored for suspected cholera, allaying fears that Zimbabwe's
cholera outbreak may have spread to the city. Virginia Azevedo of the
city's health department said laboratory tests had confirmed that the
strain of cholera identified in the Khayelitsha patient was different
from the strain responsible for the cholera outbreak in Zimbabwe.

Azevedo said the cholera case in Khayelitsha, a woman in her mid-20s,
was an isolated instance that should not be seen as a "flare-up." The
patient had been admitted to the GF Jooste Hospital with cholera.
Another 2 adults, neighbors of the cholera patient, were being
monitored. None of the 3 had traveled to Zimbabwe, she said.

Executive director of city health Ivan Bromfield said health
officials had visited the home to assess hygiene and contain the
spread of the disease.

Azevedo said a 10-year-old child had gone to Karl Bremer with
suspected cholera, but cholera was not confirmed.

[Byline: Anel Powell]

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

[This report does not mention a 6-month-old child with suspected
cholera reported in ProMED's Cholera, diarrhea & dysentery update 2008
(54)
20081218.3988.

A map of South Africa showing Cape Town's location in the
southwestern part of the Western Cape Province can be seen at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
The HealthMap/ProMED-mail interactive map of South Africa can be seen at
<http://healthmap.org/promed/en?g=336595 ... 5,22.667,5>. - Mod.LL]

******
[3] Cholera - Zambia (Southern Province)
Date: Thu 1 Jan 2009
Source: Lusaka Times, ZANIS [Zambia National Information Service]
report [edited]
<http://www.lusakatimes.com/?p=6922>


A total of 13 cholera patients have since been discharged from Ndeke
Cholera Centre in Mazabuka District of Southern Province. Health
staff at the centre told ZANIS in Mazabuka today [1 Jan 2009] that
only 2 patients are still admitted at the centre while no new cholera
cases have been recorded in the last 24 hours.

Mazabuka district commissioner, Tyson Hamaamba, told ZANIS that he is
happy to note that no patient died of cholera since the disease broke
out in the district. Cholera broke out in Mazabuka a week ago and a
total of 64 cases have since been attended to by health experts.

Meanwhile, some residents of Ndeke Township in Mazabuka are
reportedly drinking illicit beer called "Kachasu" to protect
themselves from cholera. Mazabuka town clerk, Ekan Chingangu, who
disclosed this to ZANIS in Mazabuka today [1 Jan 2009] urged
residents to desist from imbibing Kachasu as the illicit beer is not
a protection against cholera.

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

[For those readers who are interested, the 2004 WHO publication
Global Status Report on Alcohol 2004 has a discussion on traditional
alcoholic beverages in Zimbabwe
(<http://www.who.int/substance_abuse/publ ... mbabwe.pdf>).

Although the posting above refers to kachasu as a beer, the report
states, "Some traditional fermented beverages produced at household
level in Zimbabwe include alcoholic beverages made from sorghum or
millet malt (doroluthwala and chikokivana) and distilled spirits such
as kachasu... there is a strong enough market for kachasu, a name
given to home-distilled products with 10 percent to 70 percent
alcohol, to make it a major problem.

A map of the Southern Province and Mazabuka and the geographical
relationship to Zimbabwe can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
The HealthMap/ProMED-mail interactive map of Zambia can be accessed at
<http://healthmap.org/promed/en?g=907108&v=-16,28,5>. - Mod.LL]

******
[4] Diarrhea - Swaziland (Shiselweni Province)
Date: Fri 2 Jan 2009
Source: Swazi Observer [edited]
<http://www.observer.org.sz/index.php?news=532>


The Ministry of Health has allayed fears of an outbreak of cholera in
Matsanjeni area following reports that residents were recently
attacked by bouts of diarrhea. Masitsela Mhlanga, who is in charge of
the ministry's Emergency Preparedness and Response Unit, said they
were on the alert for cholera.

"It's true that there were cases of diarrhea amongst the population
of Matsanjeni and Lavumisa areas but it had nothing to do with
cholera. Our investigations established that these may have been a
result of food poisoning," Mhlanga said.

[Byline: Njabulo Dlamini]

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

[Swaziland is a small country in southern Africa surrounded on 3
sides by South Africa and to the east by Mozambique, 2 countries where
cholera has been occurring. The areas mentioned are in the southern
province of Shiselweni. The country can be seen on a map at
<http://designbymartha.com/sixth_grade/swaziland-map.jpg>
and on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=934867&v=-25,31.667,6>. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (02)
**********************************************
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 - Zimbabwe
[2] Cholera - South Africa (Gauteng, Limpopo)
[3] Cholera - South Africa (Western Cape)
[4] Cholera - Zambia (Lusaka)
[5] Cholera - Ghana (Greater Accra)

*****
[1] Cholera - Zimbabwe
Date: Sun 4 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, World Health Organization (WHO) report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... c=1&cc=zwe>


Zimbabwe: daily cholera update - 3 Jan 2009
-------------------------------------------
Highlights of the day:
- 693 cases and 9 deaths added today (in comparison 635 cases and 49
deaths yesterday)
- 46.3 percent of the districts affected have reported today (25 out
of 54 affected districts)
- 87 percent of districts reported to be affected (54 districts/62)
- Rumors of cases in Nyanga district in Manicaland (not previously
affected). District shares borders with affected districts Makoni and Mudzi
- All 10 of the country's provinces are affected

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

[The total reported cases of cholera as of 3 Jan 2009 is now 33 212
and the number of cholera-related fatalities is 1640. This represents
increases of 1556 cases and 76 deaths since the last ProMED-mail
posting of 1 Jan 2009 data. The overall case-fatality rate is 4.93
percent, substantially higher than most outbreaks of cholera. This
likely reflects the difficulty in accessing adequate medical care in Zimbabwe.

A map of Zimbabwe with provinces can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>.

The full report can be accessed at
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>.
- Mod.LL]

******
[2] Cholera - South Africa (Gauteng, Limpopo)
Date: Mon 5 Jan 2009
Source: News24, South African Press Association (SAPA) report [edited]
<http://www.news24.com/News24/South_Afri ... 29,00.html>


The number of confirmed cholera cases in Gauteng stands at 21, a
health official said on Monday [5 Jan 2009]. "The confirmed cases in
Gauteng are 21 since the outbreak in mid-November [2008]. The death
toll is still 3," said Dr Chika Esomugha, a medical advisor for
public health in Gauteng.

In Limpopo, the overall number of confirmed cases is 1441, said its
provincial health spokesperson Phuti Seloba. He said 33 suspected
cases were reported at the weekend [3-4 Jan 2009] but these had not
been confirmed as cholera yet. Limpopo's cholera death toll since 15
Nov 2008 is 9.

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

[It is not clear how many of the cases were locally acquired.

A map of South Africa showing the location of Gauteng and Limpopo
provinces can be seen at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.

******
[3] Cholera - South Africa (Western Cape)
Date: Sat 3 Jan 2009
Source: Bush Radio News [edited]
<http://bushradionews.blogspot.com/2009/ ... -town.html>


The Western Province Health Department and Cape Town City Health say
7 close contacts of 2 confirmed cholera patients in the city are
being closely monitored. A 29-year-old woman and a 42-year-old woman,
both from Khayelitsha, are improving after being diagnosed with the disease.

Western Cape director communications Faizah Steyn says as soon as
there was a cholera outbreak in Zimbabwe, the provincial health
department warned its workers to be vigilant.

[Byline: Mandisi Tyulu]

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

[This report does not mention a 6-month-old child with suspected
cholera reported in ProMED-mail's Cholera, diarrhea & dysentery
update 2008 (54) 20081218.3988.

A map of South Africa showing Cape Town's location in the
southwestern part of the Western Cape Province can be seen at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.

The HealthMap/ProMED-mail interactive map of South Africa can be seen at
<http://healthmap.org/promed/en?g=336595 ... 5,22.667,5>.
- Mod.LL]

******
[4] Cholera - Zambia (Lusaka)
Date: Sun 4 Jan 2009
Source: Afrique en Ligne, Panafrican News Agency (PANA) report [edited]
<http://www.afriquejet.com/news/africa-n ... 18757.html>


The number of cholera patients in Zambia's capital city, Lusaka, has
risen to 30 since the disease broke out in Zambia, district
commissioner of Lusaka, Christah Kalulu, has confirmed. According to
local media reports, Kalulu said since the outbreak of cholera, 334
people had been treated.

Kalulu said cholera cases had been recorded in the high-density areas
of Kanyama, Chaisa, and Matero.

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

[A map of Zambia showing Lusaka can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
The HealthMap/ProMED-mail interactive map of Zambia can be accessed at
<http://healthmap.org/promed/en?g=909137&v=-16,28,5>. - Mod.LL]

******
[5] Cholera - Ghana (Greater Accra)
Date: Fri 2 Jan 2009
Source: Peace FM Online, Daily Graphic/Rispah Agyekum(Citifmonline)
report [edited]
<http://www.peacefmonline.com/index.php? ... &Itemid=59>


A cholera scare has gripped residents of some parts of Accra,
especially those of the Okaikoi, Ablekuma, and Ayawaso constituencies.

Over the past 3 weeks, 32 cases of cholera have been recorded at
various hospitals and clinics. No deaths have been recorded. Poor
environmental sanitation and lack of potable water in the affected
areas have been identified as major contributors to the outbreak.

Giving statistics, an official of the Metro Public Health Department
of the Accra Metropolitan Assembly (AMA) said 11 cases were reported
at Ablekuma, 20 at Okaikoi, and one at Ayawaso.

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

[Accra in the Greater Accra region can be seen in southern Ghana on a map at
<http://www.un.org/Depts/Cartographic/ma ... /ghana.pdf>.
The HealthMap/ProMED-mail interactive map of Ghana can be accessed at
<http://healthmap.org/promed/en?g=230610 ... 5,-0.217,6>. - Mod.LL]

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

Yellow feverin Sierra Leone
WHO - 06.01.2009

On 12 December 2008, The Ministry of Health (MoH), Sierra Leone reported two laboratory confirmed cases of Yellow fever in the communities of Gerihun and Jembe, Bo district. Both cases were reported by the Yellow fever surveillance system and presented with symptoms of fever and jaundice. Additionally, a further 7 suspected cases have been reported. There have been no deaths, to date.

On the basis of the outbreak investigation, a reactive mass vaccination campaign targeting 527,978 people will be carried out in the district of Bo. The campaign is planned for the 10 January 2009. The MoH has made a request for Yellow fever vaccines for the mass vaccination campaign from the GAVI funded Global Emergency Stockpile for Yellow fever Vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG).

The initial case was a 28 year old man from the village of Jembe. The onset of his symptoms was the 7th October 2008. The second case was a 11 year old child that presented with signs of a haemorrhagic fever. The onset of his symptoms was 13 November 2008. Both cases were confirmed at the WHO regional laboratory for Yellow fever at the Institute Pasteur, Dakar where differential diagnosis for other haemorrhagic fevers was done.

RABIES, HUMAN - UNITED KINGDOM (04): (NORTHERN IRELAND) ex SOUTH AFRICA
***********************************************
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: Wed 7 Jan 209
Source: Daily Telegraph online [edited]
<http://www.telegraph.co.uk/health/healt ... tuary.html>


A woman who contracted rabies while working in an African animal
sanctuary has become the 1st Briton to die from this virus infection
for 4 years. The woman, from Northern Ireland, had been in a critical
condition in the intensive care unit of Belfast's Royal Victoria
Hospital since the condition was diagnosed in December [2008]. It is
thought she was infected with the virus -- which is invariably fatal
if not treated immediately -- after being scratched or bitten by a
rabid dog she had been helping to look after.

The woman had traveled to Africa a number of times over the last
couple of years but began to feel unwell after being home for several
months after her last trip in March 2008.

A statement from her brothers said: "We are devastated by the loss of
our sister. We are extremely proud not only of all she achieved in
life but also of the bravery with which she fought her illness. Her
courage was inspiring and typical of the passionate and determined
way in which she led her life. Her loss will leave a huge hole in all
our lives, and her family and friends will miss her terribly."

Since 1946, there have been 23 deaths among Britons infected with
rabies abroad. The most recent human case was in 2005 when a woman
became infected after being bitten by a dog in Goa, India and later
died in hospital in Liverpool. It is believed the Belfast patient may
have been infected as far back as December 2006 while working in an
animal sanctuary in South Africa. She sent home emails at the time
detailing how she had been scratched while separating 2 dogs. One of
the animals later had to be put down after it started foaming at the mouth.

The woman, who was in her 30s, worked as an adoption manager at the
Cats Protection centre at Dundonald [in Northern Ireland]. She is
believed to be the 1st person in Northern Ireland to have contracted
rabies for 70 years. The Eastern Health and Social Services Board in
Belfast led a multi-agency investigation into her case and insisted
the risk to the community was negligible; there is no documented case
of human-to-human transmission of rabies anywhere in the world. In
the UK, the last human death from [canine] rabies contracted
domestically was in 1902. The World Health Organization has estimated
the annual number of human rabies deaths to be between 40 000 and as
high as 70 000. Most of these deaths take place in developing
countries, particularly in South and Southeast Asia.

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

[The length of the presumed incubation period is surprising but not
exceptional and probably contributed to the late diagnosis of the
unfortunate woman's condition. The vaccination status of the victim
is not revealed, but it must be presumed that she had not sought or
been offered post-exposure vaccination after sustaining a bite from a
aggressive canine while working in South Africa. The deceased woman
should have been offered protective anti-rabies vaccination prior to
her employment in an animal sanctuary, a high risk environment in a
rabies-endemic country.

Northern Ireland and the city of Belfast can be located on the
HealthMap/ProMED-mail interactive map of the United Kingdom at:
<http://healthmap.org/promed/en?g=2641364&v=54.5,-6.5,5>.
- Mod.CP]

ANTHRAX, HUMAN, BOVINE - KENYA: (EASTERN)
*******************************************
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: 9 Jan 2009
Source: Saturday Nation [edited]
<http://www.nation.co.ke/News/regional/- ... /70q7pp/-/>


The government [of Kenya] has banned the movement of livestock in
Embu District [Eastern Province] following the death of a man from
anthrax. According to district commissioner Mohammed Maalim, the ban
will remain in force indefinitely as the government monitors the
spread of the disease. "We have imposed quarantine because of a
reported case of anthrax," he said. He warned that anyone found
moving their animals from one area to another would be arrested and prosecuted.

Speaking to the press in Embu Town, Mr Maalim said there could be an
outbreak of the deadly disease and urged residents to take the
necessary precautions.

The decision to restrict the movement of animals was reached after a
crisis meeting between the DC and veterinary officials. "We don't
want to take chances with the lives of the people, and that is why we
have taken this bold measure," he said. The administrator said all
the livestock in the area would be vaccinated against the disease to
ensure that it did not spread further. He called on the residents to
take their animals for vaccination when the exercise kicks off next week.

On Tuesday [6 Jan 2009], a man died a few days after slaughtering an
infected cow at Njukiiri village in Manyata Division. The man, 28,
fell sick a fortnight later and died on the way to Embu Provincial
Hospital. He had joined another 9 villagers who were assisting a
local farmer in slaughtering the sick cow. A meat inspector confirmed
that the cow was suffering from the deadly disease and ordered it to
be disposed of. Following the death, other residents who came into
contact with the animal flocked to the hospital for checkups.

[Byline: George Munene]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Anthrax, though widespread, is under reported in Kenya, especially
in sheep and goats, and the recent increases may be real but are more
likely just a change in enthusiasm and proximity to diagnostic
facilities. OIE has the following numbers of livestock outbreaks:
2001, 4 cattle; 2002, 6 cattle; 2003, 2 cattle; 2004, 6 cattle; 2005,
19 cattle; 2006, 41 cattle, 2 sheep and goats, 2 involving pigs;
2007, 28 cattle, 4 sheep and goats, 6 pigs; 2008 (6 months) 6, all
cattle. Outbreaks have been reported in the following provinces:
Central, Coast, Eastern, Nairobi, and the Rift Valley. There were 15
human cases in 2001, 106 with 2 deaths in 2005-6, and 10 in 2007.

To find Embu, go to:
<http://www.un.org/Depts/Cartographic/ma ... /kenya.pdf>.
It abuts the eastern border of Central Kenya and is south of Mount
Kenya. To find Manyata, which is due north of Embu in the foothills
of Mt. Kenya, go to:
<http://www.fallingrain.com/world/KE/3/Manyata.html>.
- Mod MHJ]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (04)
***********************************************
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 - Zimbabwe: WHO
[2] Cholera - Mozambique (Maputo)
[3] Cholera - South Africa (Limpopo)
[4] Cholera - South Africa (KwaZulu-Natal)
[5] Cholera - South Africa (Western Cape)


******
[1] Cholera - Zimbabwe: WHO
Date: 8 Jan 2009
Source: Government of Zimbabwe; World Health Organization (WHO) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Highlights of the day:
- 632 cases and 28 deaths added today [8 Jan 2009] (in comparison to
709 cases and 26 deaths yesterday).
- 52.7 percent of the districts affected have reported today (29 out
of 55 affected districts).
- 88.7 percent of districts reported to be affected (55 districts/62).
- All 10 of the country's provinces are affected.
- Matate area in Gokwe South (4 households affected), Rumour in
Munyati Area of Kwekwe, Makuwerere and Rambire in Mberengwa.

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

[The total number of cases reported in the full report
<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>
is 36 671, and the total fatality count is 1822. A map of Zimbabwe
with provinces can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>.
- Mod.LL]

******
[2] Cholera - Mozambique (Maputo)
Date: Fri 9 Jan 2009
Source: AllAfrica [edited]
<http://allafrica.com/stories/200901090866.html>


So far this rainy season, 317 cases of cholera have been diagnosed in
Maputo city, but nobody in the Mozambican capital has yet died of the
disease. According to the Maputo City chief doctor, Maria Benigna,
cited in Friday's [9 Jan 2008] issue of the independent daily "O
Pais," the 1st case in the current outbreak was diagnosed on 12 Oct
2008. She said that the cholera situation is under control and that
there is no reason for alarm.

A cholera treatment centre (CTC) was reopened in the Mavalane General
Hospital on 17 Dec 2008. Benigna said that currently 55 people are
hospitalized there. Recently, the CTC has been receiving 15-20
patients a day, and the trend is for the number of new cases to decline.

Most of the cases have been reported from densely populated, poor
neighborhoods such as Chmaculo, Mavalane and Polana-Canico. Ministry
of Health data indicate that over the past 10 months, there were
about 3000 cholera cases in 8 of Mozambique's 11 provinces, resulting
in 50 deaths.

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

[The city and province of Maputo are located in southern Mozambique
and can be found on a map at:
<http://www.un.org/Depts/Cartographic/ma ... zambiq.pdf>.
- Mod.LL]

******
[3] Cholera - South Africa (Limpopo)
Date: Fri 9 Jan 2009
Source: Mail & Guardian [edited]
<http://www.mg.co.za/article/2009-01-09- ... in-limpopo>


68 new cholera cases have been reported in Limpopo, the Department of
Health said on Friday [9 Jan 2009]. 11 new cases were recorded in
Musina and Madimbo, 46 in Dilokong and 11 in Botlokwa since 8 Jan
2009, department spokesperson Phuti Seloba said.

"Our hot spots at the moment are Botlokwa and Dilokong. At present,
there were 1634 cases of cholera in Limpopo that have been recorded
since the outbreak," said Seloba. He said the department expected to
treat more cholera patients as Zimbabweans were moving back into
South Africa in large numbers.

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

[The areas mentioned in the postings regarding South Africa can be
found on a map of the country at:
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>.
Limpopo is called the Northern Province on this map.
- Mod.LL]

*****
[4] Cholera - South Africa (KwaZulu-Natal)
Date: Thu 8 Jan 2008
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 919C609485>


A 41-year-old Zululand woman has been diagnosed with cholera, the
KwaZulu-Natal health department said on Thursday [8 Jan 2009].
Spokesperson Chris Maxon said this case brought the number of
confirmed cases in the province to 3. Tests on several others with
suspected cholera were negative.

Two others who were diagnosed with the water-borne disease in
December 2008 included a Zimbabwean trucker who died and an Ethiopian
man who traveled through Zimbabwe to South Africa. He was treated at
the Nkonjeni Hospital in Zululand and survived.

The South African victim had told health workers she had never been
to Zimbabwe and had never traveled "anywhere far in her life."

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

******
[5] Cholera - South Africa (Western Cape)
Date: Tue 6 Jan 2009
From: Steve Oliver <Stephen.Oliver@uct.ac.za>


May I just correct some of the details and update you on the current
situation. _V. cholerae_ has been isolated from the stools of 2 more
patients following on that initial young woman. Both are contacts of
that initial case, and person-to-person transmission is the most
likely mechanism of spread.

The strain is _V. cholerae_ O1 biotype Ogawa and phenotype El Tor.
This is the same as the predominant strain being isolated in Zimbabwe
but does not mean that there is necessarily any connection between
the 2 outbreaks. As Dr de Azevedo said, there was no history of
travel in these cases and no contact with any refugees from Zimbabwe.
The strains will undergo molecular analysis to further elucidate this issue.

--
Steve Oliver
Pathologist-in-charge Medical Microbiology Laboratory
National Health Laboratory Service (Groote Schuur Hospital)
University of Cape Town, South Africa
<Stephen.Oliver@uct.ac.za>

[There are 3 distinct O1 biotypes, named Ogawa, Inaba, and Hikojima,
each of which may display the "classical" or El Tor phenotype. The
biotypes are distinguished by their expression of surface antigens A,
B, and C. Ogawa contains antigens A and B; Inaba antigens A and C;
and Hikojima antigens A, B, and C. The latter serotype is relatively rare.

ProMED thanks Dr. Oliver for this firsthand information. - Mod.LL]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (05)
**********************************************
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 - Zimbabwe: WHO
[2] Cholera - South Africa
[3] Cholera - Nigeria (Niger State)
[4] Cholera - Tanzania (Mara)

******
[1] Cholera - Zimbabwe: WHO
Date: Sun 11 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe: daily cholera update and alerts, 11 Jan 2009
------------------------------------------------------
- 541 cases and 25 deaths added today [11 Jan 2009] (compared with 300
cases and 12 deaths yesterday [10 Jan 2009])
- 27 per cent of the districts affected have reported today (15 out of 55
affected districts)
- 89 per cent of districts reported to be affected (55 districts/62)
- newly affected areas: Shambwe RHC (Beitbridge)

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[The total number of cases reported in the full report
(<http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf>)
is 38 334, and the total fatality count is 1937. This is an increase of
1663 cases and 115 deaths since the last posting 2 days ago. The overall
case fatality rate remains quite high at 5.1 per cent.

A map of Zimbabwe with provinces can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. The
HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

******
[2] Cholera - South Africa
Date: Mon 12 Jan 2009
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?set_id=1 ... 747C531765>


On Monday [12 Jan 2009], 77 new suspected and confirmed cholera cases were
reported in South Africa. There were 64 new suspected cholera cases
reported in Limpopo and Gauteng. A total of 13 confirmed cholera cases were
reported in the Western Cape, KwaZulu-Natal, and North West.

Limpopo Water Affairs chief director Alson Matukane said ongoing tests of
water resources in the province indicated that parts of the Tubatse River
in the Steelpoort area were contaminated with cholera. However, he said
other parts of the river tested negative. "It seems areas that tested
positive are where people use plastic containers to carry water," he said.
Matukane said they were still investigating if the water was contaminated
by human beings or the environment.

Limpopo health spokesperson Phuti Seloba said about 48 new suspected cases
were reported, taking the total number of those affected by the disease in
the province to 1802. He said 11 of the 48 new cases were reported in the
areas where the Tubatse River tested positive. The province's cholera death
toll remained at 9.

Meanwhile, the number of new cases had increased in other South African
provinces. Gauteng health spokesperson Phumelele Kaunda reported the 2nd
highest increased number of suspected cases at 16, bringing the total of
people affected in the province to 160 from Friday's [9 Jan 2009] 144. Of
the 160 suspected cases, only 30 were confirmed as cholera. The Gauteng
cholera death toll still stood at 3.

Western Cape health spokesperson Faiza Steyn said they had 7 confirmed
cases by Monday [12 Jan 2009]. The province had not had any cholera-related
deaths.

KwaZulu-Natal reported 4 new suspected cases in the Zululand district.
Spokesperson for the province's health department Chris Maxon said the
cases increased KwaZulu-Natal's confirmed number of cholera cases to 6.

The North West, which had reported 2 cases in December 2008, recorded 2 new
cases in the 1st week of January 2009. However, the province's health
spokesperson Nthabiseng Makhongoana said all cases had since been cleared.
Of the most recent patients, one was admitted to a private hospital and
another to a public hospital in Rustenburg. Makhongoana said one of the
patients, a Mozambican man, was discharged last week [5-11 Jan 2009] and
the other, a Zimbabwean woman, was released from hospital on Monday [12 Jan
2009].

Eastern Cape health spokesperson Sizwe Kupelo said they had not had any new
cholera cases since the December 2008 single confirmed case.

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[Most of the new cases are likely to be locally acquired and not directly
from Zimbabwe.

The areas mentioned in the postings regarding South Africa can be found on
a map of the country at
<http://www.un.org/Depts/Cartographic/ma ... uthafr.pdf>. Limpopo is
called the Northern Province on this map. The HeatlhMap/ProMED-mail map of
South Africa is available at <http://healthmap.org/promed/en?v=-29,25.1,5>.
- Mod.LL]

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[3] Cholera - Nigeria (Niger State)
Date: Sun 11 Jan 2009
Source: China View, Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009- ... 639921.htm>


At least 3 people were killed and 35 others hospitalized following the
suspected outbreak of cholera at Dokogi village in Nigeria's Niger state,
the News Agency of Nigeria reported on Sunday [11 Jan 2009]. The villagers
had alerted the authorities after a resident died from diarrhea and
vomiting. An eyewitness claimed that more people reported their cases as
the situation worsened, leading to the death of 2 more people. He said the
council later mobilized its medical personnel, including those of the
Federal Medical Center, Bida, to control the spread of the disease.

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[The Niger state of Nigeria is in the west central part of the country and
can be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>. The
HealthMap/ProMED-mail interactive map ot Nigeria is available at
<http://healthmap.org/promed/en?v=9.6,8.1,5>. - Mod.LL]

******
[4] Cholera - Tanzania (Mara)
Date: Sat 10 Jan 2009
Source: Daily News (Tanzania) [edited]
<http://dailynews.habarileo.co.tz/magazi ... hp?id=9447>


Government medical experts have confirmed a cholera outbreak in 2 remote
villages of Kisoria and Bwanza in Bunda District, Mara Region. "Until today
(9 Jan 2009) there were 3 cholera patients admitted at an emergency health
camp that we have put in place in the affected villages and one them is due
to be discharged later today," Bunda district medical officer (DMO) Dr
Rainer Kapinga told the 'Sunday News'.

So far there have been no deaths caused by the disease that was first
reported on 24 Dec 2008 in the area, according to Dr Kapinga. "It is feared
that 2 people have died after undergoing severe diarrhea but we can't say
that it is cholera because they died before we confirmed the outbreak in
the area," Dr Kapinga explained.

Mara regional medical officer (RMO) Dr Stephen Kebwe also confirmed the
reports yesterday morning [9 Jan 2009], saying that the disease has only
been reported in the 2 villages of Bunda across the lake zone region.

[byline: Jacob Mugini]

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[Mara Province is in northern Tanzania bordering southern Kenya and can be
found on a map at
<http://www.un.org/Depts/Cartographic/ma ... nzania.pdf>. The
HealthMap/ProMED-mail map of Tanzania is available at
<http://healthmap.org/promed/en?v=-6,35,5>. - Mod.LL

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

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (06)
**********************************************
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 - Zimbabwe: WHO
[2] Cholera - Africa: WHO
[3] Cholera - Togo (Maritime)
[4] Cholera - Malawi (Chikwawa)
[5] Cholera - Zambia

******
[1] Cholera - Zimbabwe: WHO
Date: Mon 12 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Zimbabwe: daily cholera update and alerts, 12 Jan 2009
------------------------------------------------------
Highlights of the day:
- 1472 cases and 117 deaths added today (in comparison 541 cases and 25
deaths yesterday [11 Jan 2009])
- 68 per cent of the districts affected have reported today (38 out of 55
affected districts)
- 89 per cent of districts reported to be affected (55 districts/62)
- newly affected areas: Chamunangana (Beitbridge), Ngungumbane (Mberengwa)

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[The total number of cases reported in the full report
(http://reliefweb.int/rw/rwb.nsf/db900si ... report.pdf)
is now just short of 40 000 at 39 806, and the total fatality count has
broken the 2000 barrier at 2024. The outbreak continues to spread to new
areas and the overall case fatality rate, reflecting the overall poor
conditions in the country, remains quite high at 5.1 per cent.

A map of Zimbabwe with provinces can be found at
<http://www.un.org/Depts/Cartographic/ma ... mbabwe.pdf>. The
HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

******
[2] Cholera - Africa: WHO
Date: Mon 12 Jan 2009
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... c=1&cc=zwe>


Africa: weekly emergency situation update vol 2, no 2
-----------------------------------------------------
Acute crises
------------
Angola: the cholera outbreak is still spreading. In week 2 of 2009, a total
of 54 new cases without death were reported. Since the beginning of 2009, a
cumulative number of 90 cases without death have been reported.

Congo DR: the cholera outbreak is still ongoing in the North Kivu, on week
one of 2009, a total of 119 cases with one death were reported in 6 health
districts.

Ethiopia: acute watery diarrhea (AWD) [usually a more politically correct
term for cholera - Mod.LL] has reappeared in Humbo district of Welayita
zone in SNNPR [Southern Nations, Nationalities, and People's Region]
according to the Federal Ministry of Health. In epidemiological week 51
[15-21 Dec] of 2008; 58 cases have been reported compared to 8 cases in
epidemiological week 52.

Mozambique: the cholera outbreak is ongoing. 8 provinces are affected from
a total of 11 provinces. According to the Ministry of Health, as of 4 Jan
2009, a total of 10 066 cases of cholera, including 113 deaths (CFR [case
fatality rate] 1.12 per cent), have been reported.

Zimbabwe: the cholera outbreak is not under control. As of 9 Jan 2009, a
total of 37 556 cases with 1915 deaths (CFR 5.1 per cent) have been
reported in 55 of the 62 districts (89 per cent) countrywide.

Countries under surveillance
----------------------------
Cholera in southern Africa: cholera outbreaks are still on going in
Botswana (5 confirmed cases without death on 8 Jan 2009), Malawi (370 cases
with 13 deaths (CFR 3.5 per cent) as of 6 Jan 2009), South Africa (as of 5
Jan 2009, a total of 1608 cumulative cases and 14 deaths (CFR 0.87 per
cent) were reported).

Guinea-Bissau: the cholera outbreak is under control. On the 1st week of
2009, 2 cases without death were reported. A cumulative total of 14 228
cases and 225 deaths have been reported since the beginning of the outbreak.

Kenya: there is an ongoing cholera outbreak in the 3 districts of Mandera.
Over 1400 cases, 13 deaths reported since 17 Nov 2008.

Mali: security forces continue to be active against rebel groups operating
in northern and north eastern Mali. On 11 Jan 2009, the army attacked
several positions of Touareg rebel group in the north.

Zambia: cholera outbreak: 6 provinces are affected; as of 6 Jan 2009, a
total of 1759 cases with 21 deaths (figures have been reviewed) have been
reported in Lusaka District.

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******
[3] Cholera - Togo (Maritime)
Date: Tue 13 Jan 2008
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Int Fed of Red Cross and Red Crescent Societies report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


The Togolese Red Cross (TRC) is assisting the government in controlling the
outbreak of cholera epidemic in Lome [Golfe prefecture, Maritime Region]
and its environs since December 2008. With 429 cases and 3 deaths reported
since the outbreak, the Togolese Red Cross through its team of volunteers
has been active in sensitizing the affected communities and carrying out
health and hygiene activities. The national society is also involved in
detecting and referring cases to health facilities. Though number of
reported cases is decreasing in Lome, the Togolese Red Cross plans to
intensify its activities in the affected communities as well as in
neighbouring districts identified as prone to the widely contagious epidemic.

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[A map of Togo showing the affected area in the south of the country can be
found at
<http://reliefweb.int/rw/fullMaps_Af.nsf ... penElement>.
The HealthMap/ProMED-mail interactive map of Togo is available at
<http://healthmap.org/promed/en?g=629648 ... 66,1.255,7>. - Mod.LL]

******
[4] Cholera - Malawi (Chikwawa)
Date: Tue 13 Jan 2009
Source: The Daily Times (Malawi) [edited]
<http://www.dailytimes.bppmw.com/article ... leID=11819>


A suspected cholera patient was on Sunday [11 Jan 2009] admitted to
Chikwawa District Hospital with medial authorities suspecting the disease
has also affected some rural parts of the district. In an interview on 11
Jan 2009, Chikwawa District [Southern Region] health officer Malangizo
Mbewe confirmed the admission of the patient. However, Mbewe said the case
in admission was subject to confirmation because specimen was sent to Queen
Elizabeth Central Hospital in Blantyre.

"We have so far got only one cholera suspect who was admitted on Sunday. At
the moment, we have taken specimen for tests and confirmation in Blantyre,"
Mbewe said. According to Mbewe, the cholera suspect hails from Sipuni
Village in Traditional Authority Katunga in the district. He said this was
the 1st reported case of cholera in the district.

Likuni in Lilongwe was the first area in the country to report cases of
cholera since onset of this rainy season.

[byline: Lucas Bottoman]

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[The area mentioned is in southern Malawi bordering on Mozambique and can
be seen on a map at
<http://www.un.org/Depts/Cartographic/ma ... malawi.pdf>. The
HealthMap/ProMED-mail interactive map of Malawi is available at
<http://healthmap.org/promed/en?g=931067 ... 67,34.75,6>. - Mod.LL]

******
[5] Cholera - Zambia
Date: Tue 13 Jan 2009
Source: The Times (Zambia), SAPA-DPA report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=917455>


Cholera deaths in Zambia have reached 28 as the southern African nation
battles to contain about 2000 reported cases of cholera, according to radio
reports today [13 Jan 2008]. Ministry of Health spokesman, Cannisius Banda,
told a private radio program that traffic from neighboring Zimbabwe and
poor water and sanitation systems, mainly in Zambia's peripheral urban
areas have contributed to the spread of the waterborne disease.

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[A map of Zambia showing Lusaka where previous postings have reported
cholera can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. The
HealthMap/ProMED-mail interactive map of Zambia can be accessed at
<http://healthmap.org/promed/en?v=-14,27.8,6>. - Mod.LL

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

MEASLES - CAMEROON: (EXTREME-NORD)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 9 Jan 2009
Source: Africa News [edited]
<http://www.africanews.com/site/list_messages/22574>


Cameroon: measles outbreak strikes
----------------------------------
A measles outbreak has hit the town of Maroua in northern Cameroon
[Extreme-Nord province], leaving 2 dead and over 160 infected. Medical
officials in the town are on high alert to abate the progress of what they
now refer to as an epidemic.

It should be recalled that the 1st cases of measles were diagnosed in
March, April, and May of 2008. The virus later appeared to have been
contained since October 2008. The disease now appears to have witnessed an
upsurge.

The majority of cases reported cases live in specific neighbourhoods such
as Dogouil, Baligo-kodec, Domayo, and Lopere. This has raised fears that
checking the spread can be increasingly difficult to deal with.

However, health officials in the region have assured the population that
measures are being put in place to curb the spread of the disease. They
have urged vulnerable persons and all suspected cases to report to health
facilities as soon as possible for as they argue, early detection is
imperative as it guarantees speedy treatment.

[byline: Solomon Tembang Mforgham]

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******
[2]
Date: Mon 12 Jan 2009
Source: All Africa, Le Messager (Douala) report [in French, trans. & summ.,
edited]
<http://fr.allafrica.com/stories/200901121086.html>


Cameroon: measles outbreak in Extreme-Nord province
---------------------------------------------------
The current balance is 3 deaths. The regional health authorities of the
Maroua urban area issued a measles epidemic alert at the beginning of last
week [week of 5 Jan]. About 160 cases and 2 deaths have been reported to
date in the different health districts of Maroua.

If the reluctance of the rural population to seek medial assistance, except
in the most extreme circumstances, is taken into account, it is likely the
actual number of measles cases is much greater. The number of cases already
apparent is indicative of an impending epidemic. Previous experience
indicates that the months of March and April have been the most favourable
period for the spread of this childhood illness.

The most significantly affected places are the health districts of Dougoy,
Djarengol-Kodek, Domayo I and II, Lopere, and Ouro Tchede. Other individual
cases are distributed across the far north region of the country
[Extreme-Nord province]. The extent of the outbreak is still being assessed
as all the available data have yet to collated.

[byline: Jacques Kaldaoussa]

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[Maps of Cameroon are available at
<http://www.lonelyplanet.com/maps/africa ... meroon.jpg> and
the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/en?g=2228373&v=6.7,12.7,6>. The precise
location of Maroua in the Far North Province can be found at
<http://www.fallingrain.com/world/CM/12/Maroua.html>. - Mod.CP]

Yellow fever in Guinea
WHO - 14.01.2009

On 31 December 2008, The Ministry of Health (MoH), Guinea reported two laboratory confirmed cases of Yellow fever in the health district of Faranah. Both cases were reported by the Yellow fever surveillance system and presented with symptoms of fever and jaundice. The initial case was a 40-year old man from Faranah Koura and the second case was another 40-year old man from the sector of Nianfourando, both localities belong to Faranah centre area. The onset of symptoms for both cases was the beginning of November 2008.

The cases were confirmed at the WHO Collaborating Centre for Yellow Fever, the Pasteur Institute, Dakar, Senegal where differential diagnosis for other haemorrhagic fevers was carried out. Additionally, another 21 clinical Yellow fever suspected cases were reported, of which three died.

On the basis of the outbreak investigation, a reactive mass vaccination campaign, planned for 26 January 2009 and targeting 60,485 people, will be carried out in some strategic areas in the health district of Faranah. The MoH has made a request for Yellow fever vaccines for the mass vaccination campaign from the GAVI funded Global Emergency Stockpile for Yellow fever Vaccine, managed by the International Coordinating Group on Vaccine Provision for Yellow Fever Control (YF-ICG).