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YELLOW FEVER - AFRICA (02): SENEGAL, REQUEST FOR INFORMATION
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Date: Fri 10 Feb 2012
Source: Agence de Presse Senegalaise [Trans. by Mod.MPP, edited]
http://www.aps.sn/aps.php?page=articles ... icle=90508


41 teams mobilized to fight against yellow fever
-------------------------------------
The Chief Medical officer announced in a press briefing that the Medical Region of Kedougou has mobilized 41 vaccination teams for a vaccination campaign against yellow fever.

According to Dr. Habib Ndiaye, who reported 3 cases of yellow fever, "the entire population of 3 health districts - Kedougou, Saraya and Salemata - are being covered with the exception of pregnant women, children under 9 months [of age] and people who were already vaccinated during previous campaigns during the last 10 years"

"A strategic plan has been established for the 82 trained health workers, the 82 aides, and 8 supervisors who will go anywhere", he said praising the contribution of the red cross who "has invested both materially and with personnel to the success of this campaign."

In an interview with the APS, the regional chief medical officer emphasized that the vaccination sites "are health posts, schools and public places of the villages and neighborhoods."

Habib Ndiaye provided 160 000 doses [of yellow fever vaccine] "to vaccinate the entire population", taking into account the influx of people into the gold [mining] zones at Gamou de Salemata and those crossing the border." [Kedougou is located in the South east of Senegal bordering with Guinea. - Mod.MPP]

Yellow fever is a viral disease caused by a virus transmitted by mosquito bites and is manifested by fever and jaundice.

In closing, Habib Ndiaye said: "Because the region is fertile ground, there must be a mobilization of the entire population to stop yellow fever".

Communicated by:
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[A campaign response is welcome. The government did well to take the bull by the horns, because the lethality associated with the disease is very high. At present there is no specific treatment for yellow fever. The use of bednets by people (as in the case of malaria) could prevent human-vector contact and reduce the transmission of the disease. Neighboring countries, because [of the fact that] the borders are porous and that people can easily obtain a vaccination record in [apparent] "good standing" without actually being vaccinated, must (neighboring countries) reinforce their vigilance and strengthen their[disease] surveillance efforts for yellow fever.

The interactive map HealthMap/ProMED map for Senegal is accessible at: http://healthmap.org/r/00-e. - Mod.BM]

[There were YF cases in the Kedougou Medical Region in October 2011. The above cases may be the same ones reported last year (2011). The health districts of Kedougou and Saraya had a preventive mass vaccination campaign in December 2007, where the vaccination coverage was 94.9 per cent and 94.8 per cent respectively. The Ministry of Health of Senegal planned to organize a vaccination campaign in mid-December 2011, targeting the non-vaccinated individuals aged 9 months and above, excluding pregnant women in Kedougou, Saraya, and Salemata health districts. Perhaps the above campaign is the one planned earlier, but had been delayed. Clarification from knowledgeable sources would be greatly appreciated. - Mod. TY/JW]

PLAGUE, FATAL - UGANDA: (ARUA) REQUEST FOR INFORMATION
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Date: Wed 8 Feb 2012
Source: AllAfrica, The New Monitor (Uganda) report [edited]
http://allafrica.com/stories/201202080058.html


A fresh outbreak of plague is suspected after 2 people died of similar symptoms in Vurra County, Arua district, where health officials here have put the community on alert.

Over the years, plague outbreaks have been emerging from the neighboring DR Congo. When contacted, the district health officer, Dr Patrick Anguzu, said he was still consulting for details of the disease. "I have not yet received a report on the outbreak, but I will try to consult," he said.

But the Vurra MP, Dr Sam Okuonzi, told Daily Monitor in a telephone interview that the 2 died in Opia parish. As a drive to fight the annual disease, in 2009, the Ministry of Health launched a sensitization program for the 2 bordering districts of Nebbi and Arua, where previous outbreaks have occurred.

[byline: Felix Warom Okello, Clement Aluma]

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[No specific details of the cases are included in the posting. Most cases are due to bubonic plague following the bite of an infected rodent flea, causing a swollen and very tender lymph gland. The swollen gland is called a "bubo". Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being bitten.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. At this stage, person-to-person spread can occur, causing other cases of "primary" plague pneumonia.

The districts of Uganda can be seen on the map at http://www.coetzee-uganda.com/index_fil ... Uganda.htm. The HealthMap/ProMED-mail interactive map of Uganda is available at http://healthmap.org/r/00XI. - Mod.LL]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (05): AFRICA
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[1] Cholera - Malawi (Southern Region)

Date: Fri 10 Feb 2012
Source: Inter Press Service [edited]
http://www.news-medical.net/news/201202 ... tions.aspx


Inter Press Service reports on a cholera outbreak in Malawi's Nsanje and Chikhwawa districts, located on the southern border with Mozambique, noting that government officials have attributed the outbreak to declining sanitation conditions as a result of flooding in late January 2012.

According to IPS: "Up to 550 pit latrines were washed away in Nsanje alone, a district hardest hit by the floods, ... and sewage from the latrines has contaminated water sources in the district, including boreholes and dug-out wells, thereby escalating the cholera incidents, according to the assistant disaster management officer for Nsanje, Humphrey Magalasi."

In addition, the news service notes that camps for those displaced by the flooding "are now congested, and the survivors are living in unhygienic conditions." According to IPS: "There were a few incidents of flooding in Nsanje and Chikhwawa during the rainy season last year [2011], and the entire country recorded 76 cholera cases only."

The news service added: "District commissioner for Nsanje Rodney Simwaka told IPS that government has been building the capacity of villagers in flood preparedness for the past 3 years since the area is flood prone."

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[2] Cholera - Congo DR (Bas-Congo Province)
Date: Wed 8 Feb 2012
Source" XinHuaNet [edited]
http://english.peopledaily.com.cn/90782 ... 23478.html


A cholera epidemic which was reported early in February 2012 in the village of Muanda, which is situated in Bas-Congo province, south west of Kinshasa, has left at least 4 people dead, a source from DR Congo's National Institute for Biomedical Research (INRB) said on Mon 6 Feb 2012.

Epidemiology experts from INRB said that the cholera epidemic had equally affected the Kitona military base, which is not far away from Muanda.

"We appeal to the people not to panic but to maintain proper hygiene conditions, especially by avoiding contact with people who have been contaminated, to boil drinking water, and to properly cook food," the Muanda zone chief medical officer Dr Jean Miambi said. He added that it was important for the people to properly wash their hands after going to the toilet.

Between October and December last year [2011], 42 people died during a cholera outbreak in Equator province and Kinshasa, the capital of the Democratic Republic of Congo (DR Congo).

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[

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1KlW, http://healthmap.org/r/1Ahy.]

ANTHRAX, HUMAN, BOVINE - TOGO: (KARA)
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Date: Tue 21 Feb 2012
Source: Republic of Togo [in French, trans., edited]
http://www.republicoftogo.com/Toutes-le ... arbonneuse


Anthrax alert
-------------
Health services have identified cases of anthrax in the village of Koku-Tamberma (Prefecture of Keran, Kara Region). According to information gathered on site, they already deplore the death of two people and 15 cattle.

The ministers of agriculture, Messan Ewovor, and health, Charles Agba Condi, were keen to reassure the public by publishing a statement Monday [20 Feb 2012] indicating that "appropriate provisions such as vaccination of cattle around homes and immediate management of human patients have already been implemented to control the epidemic and save human lives."

The authorities are asking the people of this region of Togo to refrain from consuming meat from dead animals.

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[Describing these events as an epidemic is a bit early based on the fact that there have only been 2 human deaths and 15 cattle lost. Either this is ministerial exaggeration or there is more going on than we are aware of.

Anthrax is regularly seen in cattle and sometimes reported in sheep and goats in Togo, along with human cases. This is because there are 'champs maudit' (accursed fields) in the regions of Savanes and Kara, and control is inconstant. In spite of the high risk of this disease in Togo, this is only our 2nd report. Anthrax is a significant livestock threat in West Africa.

A map of Togo can be seen at http://www.maplibrary.org/stacks/Africa/Togo/index.php. For an interactive map of Togo with links to other ProMED-mail postings in neighboring countries, see http://healthmap.org/r/1J_m. - Mod.MHJ]

TRYPANOSOMIASIS - BELGIUM ex KENYA: (MASAI MARA)
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Date: Wed 22 Feb 2012
From: Emmanuel Bottieau [edited]


Early stage _Trypanosoma rhodesiense_ HAT in a Belgian traveler visiting Masai Mara, Kenya
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A Belgian adult male traveler had stayed in Kenya from 30 Jan to 13 Feb 2012 to Kenya, and visited Masai Mara from 7 Feb until 9 Feb 2012. Details about the places visited in that game park will follow soon.

He had fever from 16 Feb 2012 onwards and a diagnosis of human African trypanosomiasis (HAT) was made on a thick film in another Belgian hospital on 19 Feb 2012. The patient was transferred the next day to the inpatient ward for tropical diseases of the Institute of Tropical Medicine, University Hospital Antwerp, Belgium, for treatment.

He had a painless chancre on his left upper arm and had fever, malaise, and headache on admission.

The prepatent period lasted thus 7 to 9 days, and the hematogenic phase of the acute disease before diagnosis (and treatment) was 4 days. This short period precludes brain invasion, which may occur from the 3rd week after the blood stage becomes apparent.

The patient was promptly treated with suramin soon after transfer on 20 Feb 2012. Pretreatment blood analysis showed a high parasitemia, marked thrombocytopenia (47.000/=B5L), ALAT/ASAT 3x UNL, and moderately increased CRP. An ECG showed diffuse S-T elevation. So far no other complications occurred, and patient's condition is not life-threatening.

Acute rhodesiense trypanosomiasis has to be regarded as a medical emergency, requiring immediate treatment with suramin or, when suramin cannot be obtained within a day, with pentamidine. Treatment delay results often in a rapidly progressive multi-organ dysfunction with high mortality.

--
Jan Clerinx, MD
Emmanuel Bottieau, MD, PhD

Institute of Tropical Medicine of Antwerp
Belgium

[This is the 2nd case of HAT in a tourist visiting Masai Mara within a month (see ProMED-mail posting Trypanosomiasis, human - Germany ex Kenya: Masai Mara 20120202.1031130).

A review of cases imported into trypanosomiasis non-endemic countries identified 95 cases from 19 countries (Simarro PP et al: Human African Trypanosomiasis in Non-Endemic Countries (2000-2010). J Trav Med 2012; 19(1): 44-53; available at http://onlinelibrary.wiley.com/doi/10.1 ... 576.x/full).
Cited from the paper: "Cases of Rhodesiense HAT were mainly diagnosed in tourists after short visits to DECs [disease endemic countries], usually within a few days of return. The majority of them were in 1st stage. Initial misdiagnosis with malaria or tick-borne diseases was frequent. Cases of Gambiense HAT were usually diagnosed several months after initial examination and subsequent to a variety of misdiagnoses. The majority were in 2nd stage. Patients affected were expatriates living in DECs for extended periods and refugees or economic migrants from DECs."

The paper concludes that "the risk of HAT in travelers and migrants, albeit low, cannot be overlooked."

A map of the geographic range of tsetse flies can be found in ProMED-mail posting 20120202.1031130.

A HealthMap/ProMED-mail interactive map of Kenya can be seen at http://healthmap.org/r/1J6F. - Mod.EP]

MENINGITIS, MENINGOCOCCAL - GHANA: (UPPER EAST REGION), SUSPECTED
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Date: Fri 24 2012
Source: Myjoyonline.com [edited]
http://edition.myjoyonline.com/pages/ne ... /81989.php


An outbreak of cerebro-spinal meningitis (CSM) in the Upper East Region has claimed 16 lives in two months.

Health authorities in the region are stepping up efforts to halt the spread of the disease, which has assumed an epidemic proportion. The Upper East Director of Health Service Dr. Awoonor Williams confirmed to Joy News that about 102 persons have been affected by the disease so far.

He said his outfit has received logistics from Accra to treat the disease but added more vaccines would be needed to adequately cover all the endemic areas. Dr Williams said the outbreak is being managed well in the region and assured residents “there is no cause for alarm; we are on top of the issue here”.

Although enough measures have been put in place to stop the perennial recurrence of the disease, the Director of Health Service conceded they have not been successful. He was however delighted that their strong surveillance system is able to identify the CSM. He said a team of personnel is on the ground educating residents about the disease.

[Byline: Isaac Essel]

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[Although the above news release does not specify the microbial cause of the meningitis outbreak in Ghana, the sub-Saharan region of Africa is plagued yearly by large epidemics of meningococcal meningitis. This region, known as the "Meningitis Belt," stretches from the east to the west coast of Africa, and includes Ghana, as well as Nigeria, Burkina Faso, Benin, Chad, Democratic Republic of the Congo,Ethiopia, Ivory Coast, Kenya, Mali, Niger, Sudan, Togo, and Uganda (http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm). The meningitis outbreaks occur in the dry season (December to June), and every 8-12 years large outbreaks occur (http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx). Attack rates during these cyclic epidemics of meningitis range from 100 to 800 per 100 000 population, but individual communities have reported rates as high as 1000 per 100 000 (World Health Organization: Meningococcal meningitis fact sheet: http://www.emro.who.int/sudan/pdf/FactS ... ngitis.pdf).

The following is extracted from the moderator’s comments in ProMED-mail post Meningitis, meningococcal - Nigeria: (YO), susp. 20110524.1581:

“Epidemic thresholds are used to confirm the emergence of an epidemic in order to step up control measures, that is, mass vaccination and appropriate case management. For definitions of epidemic thresholds, see http://www.who.int/disasters/repo/6618.doc.

“To control an outbreak, WHO recommends mass vaccination with the appropriate meningococcal vaccine in every involved district in an attempt to induce herd immunity, whereby transmission is blocked when a critical percentage of the population has been vaccinated (see http://www.who.int/mediacentre/factsheets/fs141/en/). In 2009, meningococcal serogroups A and W135 were involved in outbreaks in Nigeria (see ProMED mail post Meningitis, meningococcal - Nigeria (03)
20090509.1731). These serogroups cause meningitis that is potentially vaccine-preventable. However, in 2010, a new strain (serogroup X) of meningococcal meningitis emerged in Burkina Faso that led to huge outbreaks in that country, with 46 percent (6/13) of the regions in the country being at epidemic level. Serogroup X is one of those for which no vaccine exists. Niger, which borders the Yobe State of Nigeria, also experienced cases due to serogroup X in 2010 and experienced an epidemic of meningitis due to this strain in 2006 (see ProMED-mail post Meningitis, meningococcal - Africa (02): WHO meningitis region. 20100426.1343).”

The Upper East Region of Ghana is primarily rural and is the smallest of 10 administrative regions in Ghana, with only 2.7 per cent of the total land area of Ghana and with a population in 2000 of 920,089, which accounts for 4.9 per cent of Ghana’s total population (http://en.wikipedia.org/wiki/Upper_East_Region). It is bordered by Burkina Faso to the north and Togo to the east.

A map of Ghana, on which the Upper East Region is indicated, can be accessed at (http://en.wikipedia.org/wiki/File:Ghana_UpperEast.png). The HealthMap/ProMED-mail interactive map of Ghana is available at http://healthmap.org/r/1smp. - Mod.ML
]

FOODBORNE ILLNESS, FATAL - NAMIBIA: (OMUSATI) CASSAVA SUSPECTED
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Date: Wed 22 Feb 2012
Source: New Era [edited]
http://www.newera.com.na/articles/43026 ... rns-deadly


One child has died while 3 others are recovering after eating what is suspected to be poisonous cassava roots. 3 adults were discharged from the Outapi State Hospital after also eating the roots.

Cassava is often used to make a tropical delicacy in the form of a flour. However, if it is not properly washed or cooked, its roots contain a toxin called cyanide [see comment below] that is fatal to humans, even in small doses.

The incident took place at Ombonde-Yomutzegwondjamba in the Ruacana Constituency [Omusati Region] over the weekend [18-19 Feb 2012].

It is reported that the family ate the cassava, which was prepared by a 63-year-old grandmother, for lunch on Saturday afternoon [18 Feb 2012]. After lunch, the pensioner allegedly left the home and went to local cuca shops [unlicensed houses selling alcoholic liquor]. The younger members of the family went to get some more cassava, and cooked and ate it before their grandmother returned.

During the evening, [the woman] allegedly returned home complaining of stomach cramps and she was vomiting, only to realise that all her 6 grandchildren were complaining of similar symptoms.

By midnight, the condition of a 7-year-old girl worsened. She died around 00h30 at home. Police were called to remove the body and the rest of the family was taken to the Outapi State Hospital where they were kept overnight under doctor's observation.

Three adults, including the grandmother, a young man and woman, both 27, were discharged from the hospital on Sunday [19 Feb 2012]. By yesterday morning, 3 children (2 6-year-olds and a 4-year-old boy) were still at the Outapi State Hospital.

According to Omusati Regional Health director Loide Haipinge, the children were likely to have been discharged by yesterday afternoon [21 Feb 2012] as they were recovering well. According to Haipinge, it is difficult for her office to point to the exact source of poisoning, as investigations are still under way.

"We have sent officials to the village to investigate. The children are claiming that they ate roots of a certain plant while the parents were at the cuca shops. But they (the children) are too young to give reliable information," she said.

Haipinge said the autopsy on the deceased child and an investigation of the roots that the family claims to have eaten will determine the exact cause of death. According to Haipinge, there is a poisonous type of cassava, but at the moment it is premature to conclude that the family ate the roots of the poisonous plant

[Byline: Helvy Shaanika]

--
Communicated by:
Dr Julie Cliff
Faculdade de Medicina
Universidade Eduardo Mondlane
CP 479
Maputo, Mozambique


[Omusati Region in northern Namibia may be found on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/1SSB.

Cassava (_Manihot esculenta_, Crantz) is a root crop widely consumed in Africa and South America. Although it originated in Brazil (where it is called manioc), it was brought to Africa by Portuguese colonists, and is now an important crop there and in Indonesia and Southeast Asia. It is the principal source of nutrition for about 500 million people. Its leaves are edible, but the prize is its starchy root, rich in protein, minerals, and vitamins A, B, and C.

Cassava is used in a vast variety of cakes, snacks, and desserts and grows wild in many places, being tough and drought-resistant. In countries where hunger is an overt reality for many poor households, cassava is among those food crops that can make the crucial difference between starvation and survival. The cassava plant is the world's 3rd most important crop. Cassava enters the North American diet also, as it is made into tapioca.

Surprising for an important edible plant, cassava is quite poisonous without proper preparation. The toxin in cassava is called linamarin. When eaten raw or inadequately prepared, the human digestive system will convert this to cyanide. Even 2 cassava roots contain a fatal dose of poison. While the bitter variety (white cassava) of the plant has larger concentrations of cyanide than the sweet variety (yellow cassava), the sweet cassava is not without risk.

To prepare cassava, it should be peeled, grated, and soaked in warm water for several days. This allows the cassava's own natural enzyme (linamarase) to convert the cyanogen linamarin to sugar and cyanide gas, and the volatile gas disperses usually harmlessly. However, women -- who are usually charged with processing the plant -- can be sickened by inhaling cyanide gas. What remains after processing can be boiled and eaten, or more usually, dried and ground.

The shelf life of a cassava root is quite short once it is removed from the stem, so there is an urgency to get the food to market. Roots can turn to mush in less than a week. The rush to get cassava to the market may keep some batches of cassava from being processed properly.

Cyanide is normally converted in humans to the less toxic thiocyanate by the enzyme rhodanese, a mitochondrial enzyme which is widely present throughout the human body, with the highest concentrations in the liver and kidneys. Thiocyanate is the chief metabolite of cyanide. Thiocyanate itself has a goitrogenic effect if there is a shortage of iodine in the diet. The body uses sulphur-containing amino acids to render cyanide harmless. If the diet is deficient in protein, cyanide will be converted to cyanate, which induces neurodegenerative disease in both animals and humans. The cells which are most affected are Betz cells in the motor cortex. Tropical ataxic neuropathy can also be produced.

Konzo, a neurological disease characterized by an acute isolated and symmetrical hypertonic paraparesis, which is permanent but non-progressive, causing the inability to walk or at best, present with ataxia. To date, 2 large epidemics have been reported, each of more than 1000 cases. The 1st was in the Bandundu region in Congo (1936-37) and the 2nd in the Nampulla province of Mozambique (1981). Small outbreaks have been reported from Congo, Mozambique, Tanzania, and the Central African Republic. Sporadic cases of konzo also occur. The majority of cases of konzo occur in the dry season, chiefly during a long drought. Familial clustering is common.

Konzo begins abruptly, without prodromal signs. In 90 percent of cases the onset of symptoms takes less than a day. The initial symptoms are described as tremor, cramps, a heavy feeling, and/or weakness in the legs, a tendency to fall down, and difficulty remaining upright. There is a visible hypertonic gait when walking or running. Occasionally there will be lower back pain, blurred vision, speech difficulties, and/or paresthesia of the legs, but they disappear within a month. During the 1st 2 days the majority of patients have general muscular weakness and are confined to bed.

Hypertonicity is present from day one. Flaccid paralysis of the limbs does not occur. Later there is a slight partial improvement. Finally the affected person develops a stable hypertonic paraparesis, which persists for the remainder of life, or might improve a little. After onset the neurological signs remain constant or improve minimally if no further cyanide is ingested.

Prevention of konzo therefore involves avoiding a farming system dominated by bitter cassava (which contains higher cyanide levels), insufficient cassava processing, and a protein deficient diet.

In an effort to avoid this toxicity, it has been reported by Siritunga and Sayre (1) that transgenic cassava free of cyanogens can be produced. The investigators generated transgenic plants in which cytochrome oxidase enzymes that catalyze the 1st step in linamarin synthesis are inhibited. The plants showed a 94 percent reduction in leaf linamarin content and a 99-percent decrease in root linamarin levels. Additionally, the same group (2) has reported that transgenic cassava plants can be produced that overexpress the gene for hydroxynitrile lyase, facilitating cyanogenesis during processing and producing a final product with less risk. The tubers of cassava do not have this enzyme, and processing relies on spontaneous conversion. Combining these methods could further decrease the risk of cyanide poisoning from cassava.

References
----------
1. Siritunga D, Sayre RT: Generation of cyanogen-free transgenic cassava. Planta 2003; 217(3): 367-73; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14520563.
2. Siritunga D, Arias-Garzon D, White W, Sayre RT: Over-expression of hydroxynitrile lyase in transgenic cassava roots accelerates cyanogenesis and food detoxification. Plant Biotechnol 2004; 2(1): 37-43; abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17166141.

Portions of this comment were extracted from http://www.itg.be/itg/DistanceLearning/ ... ntsp13.htm. - Mod.TG]

YELLOW FEVER - AFRICA (03): CAMEROON (NORD)
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Date: Tue 14 Feb 2012
Source: Cameroon Radio Television (CRTV) [edited]
http://www.crtv.cm/cont/nouvelles/nouve ... ield=10818


The Secretary of State in the Ministry of Public Health in charge of epidemics and pandemics, Alim Hayatou, recently launched a vaccination campaign against yellow fever at Lagdo in the Northern Region.

Speaking during the launching ceremony, the Secretary of State indicated that the vaccination campaign targets the population of the regions especially inhabitants of the banks of the Lagdo River because of their vulnerability to attacks.

The Minister reiterated government's determination to protect the population against the ravaging effects of yellow fever.

The campaign is being launched at a time when the 2011 health report indicates that 62 cases were registered in the area.

The campaign targets some 2 million inhabitants.

[Byline: Sam Bokuba]

--
Communicated by:
ProMED-mail from HealthMap alerts
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[The 3 Feb 2012 ProMED-mail post (see archive no 20120203.1032090), cited the Ministry of Health as reporting a total of 23 yellow fever cases, including 7 deaths, having occurred since October 2011 in Guider, Bibemi, Gaschiga, Lagdo, Mayo Oulo, and Golombe districts (all in the Northern Region). At least 13 of these cases from 6 health districts were laboratory confirmed at the Institute Pasteur of Cameroon.

The report above indicates that there were 62 cases, but does not state how many of these were laboratory confirmed. Both the report above and the 3 Feb 2012 report indicate that the vaccination campaign had begun at the end of January or the beginning of February 2012, 3-4 months after the October 2011 cases occurred. Fortunately, there is no indication that additional, recent cases are occurring.

A HealthMap/ProMED-mail interactive map of Cameroon can be seen at http://healthmap.org/r/1Vax and a map showing the regions of the country can be accessed at http://www.lib.utexas.edu/maps/africa/c ... _pol98.jpg. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (06): AFRICA
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In this update:

[1] Cholera - Rwanda (Western province) ex Congo DR
[2] Cholera - Nigeria (Kaduna, Gombe states)
[3] Cholera - Republic of the Congo (Likouala province)
[4] Cholera - Congo DR
[5] Cholera - Mozambique (Maputo province)
[6] Cholera - Uganda (Mbale district)

******

[1] Cholera - Rwanda (Western province) ex Congo DR

Date: Wed 29 Feb 2012
Source: AllAfrica, The New Times report [edited]
http://allafrica.com/stories/201202290171.html


The Ministry of Health says that although cholera is now declared an epidemic in DRC [Democratic Republic of the Congo], Rwanda was not under threat and that imported cases were being contained. "As a result of this outbreak in DRC, the 1st case of cholera was diagnosed in Rwanda on 13 Feb 2012 from an individual returning from North Kivu," a statement from the ministry reads.

"Since then, 12 other cases were diagnosed and successfully treated and discharged from our health facilities a week ago. All registered cases were infected in the DRC but returned for treatment and have since been discharged with no deaths recorded," said the statement. The ministry also reported that no new cases have been reported since 22 Feb 2012.

Health minister, Dr Agnes Binagwaho, emphasised the need for hygiene, continuous sensitisation, as well as quick and accurate rapid treatment for the sick. "For now we have managed to contain this outbreak, but what I need to remind everyone is that this outbreak is a ticking bomb, especially within our neighbors and, therefore, if we are not prepared, it could spread to our population," she cautioned health officials during a meeting.

[Byline: Ivan R Mugisha]

--
Communicated by:
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[A HealthMap/ProMED-mail interactive map of Rwanda can be seen at http://healthmap.org/r/1VV2. - Sr.Tech.Ed.MJ]

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[2] Cholera - Nigeria (Kaduna, Gombe states)
Date: Tue 28 Feb 2012
Source: AllAfrica, Daily Trust report [edited]
http://allafrica.com/stories/201202280475.html


The annual rampage of the cholera disease is now so predictable that millions of Nigerians rarely pay attention to it. Yet, its re-occurrence in areas most prone, have had devastating effects with death numbers steadily climbing. In the midst of this harvest of deaths, we also have oasis of hope, that is the near cholera free states. Why are some states cholera prone and some cholera free? Daily Trust Health Insight investigates.

The casualties started trickling in before the rains began in 2011. 5 deaths in Adamawa, 30 in hospital; 11 deaths in Nasarawa; another 11 deaths in Oyo. They spanned 203 local government areas across 26 states. With a fatality ratio estimated at 3.2 percent, the disease claimed 742 lives by the end of 2011. Epidemiologists in weekly updates overseen by the federal health ministry recorded a total 23, 377 cases.

The 1st 2 months in 2012, just 2 states have recorded cholera cases, the federal health ministry said in its weekly epidemiological update. The 1st 5 weeks saw 14 cases with no deaths in Kaduna and Gombe. A week later, the suspected cases jumped to 40; 1 death was reported.

Kaduna lay right at the heart of an official map showing the extent of outbreak last year [2011]. In 2012, Kaduna is still on the map, with 3 council areas, Kuban, Ikara, and Zaria, affected. Funakaye and Gombe in Gombe state are 2 other areas where cases have been recorded in 2012 also.

[Byline: Judd-Leonard Okafor]

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******
[3] Cholera - Republic of the Congo (Likouala province)
Date: Tue 21 Feb 2012
Source: UN Integrated Regional Information Networks (IRIN) News [edited]
http://www.irinnews.org/report.aspx?reportid=94915


Health authorities in the Republic of the Congo have recorded 340 cases of cholera, 9 of them fatal, since June 2011, in the northern district of Likouala, and have warned that the disease continues to spread and that some health centers lack sufficient treatment.

"Some deaths have not been taken into account because the families have not reported them," said Jean Martin Mabiala, the doctor in charge of health services in the district, adding that there were other suspected cases that had not been confirmed because of the remoteness of their locations.

He said the crew of a river boat from the Central African Republic had buried 2 people suspected to have died of cholera in early February [2012]. The epidemic has struck a 500 km [300 mi]-radius area stretching from Betou to Liranga, which includes the department's main town, Impofondo.

"We have received some medical supplies from Brazzaville but the cholera patients use so much we have almost run out," said Mabiala. "There is a lot to be done to raise awareness and disinfect houses," he added.

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******
[4] Cholera - Congo DR
Date: Tue 21 Feb 2012
Source: News24.com, South African Press Association (SAPA) report [edited]
http://www.news24.com/Africa/News/Chole ... C-20120221


A cholera epidemic has spread to 9 out of 11 provinces in the Democratic Republic of the Congo, the UN said on Tuesday [21 Feb 2012]. The UN said the spread was "worrisome" as the epidemic had so far killed 644 people and infected 26 000 since January 2011.

"Lack of access to potable water remains the single most important cause of the recurrent cholera outbreaks," according to a research note from the Office for the Coordination of Humanitarian Affairs (UN OCHA). OCHA cited the example of the north eastern city of Bunia, where over a third of the residents, more than 100 000 people, have been cut off from drinking water since the start of 2012. Conflict in the northern parts of the country continues to displace thousands of people.

[Byline: Shabtai Gold]

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******
[5] Cholera - Mozambique (Maputo province)
Date: Mon 20 Feb 2012
Source: CRIENGLISH.COM, Xinhua News Agency report [edited]
http://english.cri.cn/6966/2012/02/20/3124s682221.htm


Inhaca Island located at 32 kilometres [20 mi] from the capital Maputo has been reporting increasing cases of cholera due to lack of safe water and the practice of non hygienic methods, the Maputo daily paper Noticias reports on Monday [20 Feb 2012].

According to local health units at least 20 cases of cholera are treated every month but they fear that the number of cases could be more than the figures indicated because many patients do not seek for medical assistance when they are sick due to the long distances they have to walk to find one.

The municipal district health director, Isac Piassone, said that the residents of the island do not have the habit of building conventional latrines and do everything outdoors. This is combined with the consumption of unsafe water and they have very little options because the piped water coverage is very poor though the island only takes 5000 inhabitants, Noticias says.

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[6] Cholera - Uganda (Mbale district)
Date: Sun 19 Feb 2012
Source: AllAfrica, The Monitor report [edited]
http://allafrica.com/stories/201202210103.html


Authorities in Mbale District have ordered the closure of all eating places that do not meet minimum health standards following a cholera outbreak that has left 2 people dead and left 14 others admitted to hospital. This outbreak comes at a time when the district is facing water shortage for close to a week now.

The district health officer, Dr John Baptist Waniaye told Sunday Monitor that about 14 people who had been admitted at Mbale Regional Hospital have been transferred to Busiu health centre IV cholera treatment centre and that the district health technical team has already issued warnings to people to stop buying prepared food and drinks sold along the streets in Mbale suburbs, in order to curb further spread of the disease.

Mr Patrick Namweru said it was clear from the beginning of 2011 that there would be an outbreak of cholera in town after Mbale Municipal Council authorities failed to collect garbage in town and NWSC [National Water and Sewerage Corporation] failed to repair the broken pipes in Mbale municipality. "We where just sitting on a time bomb. The municipal council failed on their responsibility of collecting garbage and the town was littered with human waste. It is sad and we must do something to save our people," said Mr Namweru.

[Byline: David Mafabi]

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LEISHMANIASIS – EGYPT: (ISMAILIA GOVERNORATE)
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Date: Fri, 2 Mar 2012
Communicated by: "Dr. Abdallah" [edited]



The first leishmaniasis call to public in Egypt
-----------------------------------------------
Today, all Egyptian mass media announced the emergence of a new cutaneous leishmaniasis case in Serobion district, Faiad, Ismailia governorate. However, this is not the first time to identify _Leishmania_ infection in Egypt, and approximately 25 cases occurs monthly in the Sinai peninsula, but today is the first time that Egyptian mass media consider leishmaniasis to the public.

Leishmaniasis disease burden was low across much of the country in the twentieth century; in the past decade, however, changing land use and natural disasters have placed several parts of the region at risk. As a consequence, this important disease has become a particularly difficult health problem. Today, Egypt raises the condition of emergence against leishmanasis spread.

The case identified suffers from the characteristic cutaneous leishmaniasis in different parts of the face region (nose, under the left eye, and between the eyes). The wet lesion is the predominant characteristic of the lesions; so, the culprit parasite may be _L. major_.

Abdallah M. Samy, M.Sc
Assistant lecturer of Entomology
Division of vector biology and control
Faculty of Science
Ain Shams University
Abbassia, Cairo, Egypt

Website: http://shams.academia.edu/t/yBp/AbdallahSamy


[Leishmaniasis is endemic in Mediterranean countries including Egypt. In a study of 150 patients with cutaneous lesions, 15.9% were diagnosed with leishmaniasis (El-Khalawany M et al. Clinicopathological features and the practice of diagnosing infectious cutaneous granulomas in Egypt. Int J Infect Dis. 2011;15:e620-6.). The Sinai peninsula is a well know focus in Egypt, and both _Leishmania major_ and _L. tropica_ have been found (Shehata MG et al. First report of _Leishmania tropica_ from a classical focus of _L. major_ in North-Sinai, Egypt. Am J Trop Med Hyg. 2009;81:213-8).

HealthMap location: http://healthmap.org/r/1zkM. - Mod. EP
]

CHICKENPOX - LIBERIA: (LOFA)
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Date: Fri 2 Mar 2012
Source: Daily Observer [edited]
http://www.liberianobserver.com/index.p ... aches-lofa

Outbreak of Chickenpox in Guinea Reaches Lofa
----------------------------------------
Health workers assigned to the border town of Yealla Town, Zorzor District, Lofa County have expressed fear for the lives of the residents of the area following the outbreak of chickenpox in towns on the Guinean side of the border.

The second clinical screener at the Yealla Health Post, Tommy G. Flomo, informed our reporter who visited the area that if nothing is done to contain the spread of the disease, residents along the border towns would come in contact with it. The recent outbreak of chickenpox in the neighboring Guinean towns of Kpawu, Walemai, Balogisia, Koyanma, etc. is posing: "a serious health hazard for the communities in Liberia," the health worker said. To confirm Mr. Flomo's assertion, our reporter, who toured some part of Yealla Town was informed by some of the residents that they fear for the lives of their children attending school there. According to them, some of the students have complained that their counterparts from Guinea have also contracted the disease. "People affected by this disease in recent times come in their numbers on a daily basis to the Yealla Clinic alone. We are therefore worried for the health needs and concerns of our residents," a medical practitioner stated. Meanwhile, the clinic has appealed to the government to supply the requisite drugs or vaccines to contain the spread of the disease.

(By C.Y. Kwanue)

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[Chickenpox is a contagious disease caused by varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or never received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. VZV also causes shingles in adults and chickenpox can be contracted from adults with shingles.

A person with chickenpox can spread the disease from 1 to 2 days before they get the rash until all their chickenpox blisters have formed scabs. It takes from 10 to 21 days after exposure to a person with chickenpox or shingles for someone to develop chickenpox.

For most people, getting chickenpox once provides immunity for life. However, for a few people, they can get chickenpox more than once. Chickenpox vaccine is very safe and effective at preventing the disease. Chickenpox vaccine prevents almost all cases of severe disease.

Lofa is a county in the northernmost portion of the West African nation of Liberia. One of 15 counties that comprise the first-level of administrative division in the nation, it has six districts. Voinjama serves as the capital. As of the 2008 Census, it had a population of 270,114, making it the fourth most populous county in Liberia.

The location of Lofa county can be seen in the map of Liberia at: http://en.wikipedia.org/wiki/Lofa_County. - Mod.CP


A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1KlR.]

LASSA FEVER- NIGERIA (03): (TARABA), FATALITIES
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Date: 10 Feb 2012
Source: Nigerian Tribune [edited]
http://tribune.com.ng/index.php/news/35 ... -in-taraba


Lassa fever kills 7 in Taraba
-----------------------
Seven people have reportedly died in Taraba State, following an outbreak of Lassa fever a couple of days ago. The state Commissioner for Health, Prince Mustapha Hamman Gabdo, confirmed this while briefing journalists in the state. The commissioner said 4 of the victims of the disease died at the Federal Medical Centre, Jalingo, one died at the Government House Clinic, Jalingo, and the 2 others, who contracted the disease in Taraba State died in Gombe State after travelling there for treatment. He said the ministry had already taken measures to stop the spread of the epidemic and would embark on sensitisation campaigns as well as vaccinate the entire people of the state against the disease. [Vaccine not yet available. - Mod.CP]

Shedding more light on the source of the dreaded fever and its dangers to human beings, the head of Epidemiology unit in the state Ministry of Health, Innocent Vakai, said the disease was transmitted by a specific rat which had no hair on its tail [The multimamate rat -- _Mastonomys_]. The Epidemiologist said the symptoms of Lassa Fever included severe headache, high fever, vomiting that passed through all the openings in the human body, just as he advised persons having such symptoms to rush to the nearest hospital for medical attention.

Similary, the Taraba State House of Assembly, on Thursday [9 Feb 2012], summoned an urgent public importance sitting, following reported cases of outbreak of Lassa fever in Jalingo, the state capital.

The Member representing Gembu Constituency, Honorable Abubakar Jugidda, who disclosed this before the assembly, stressed the need for the state government to look into the issue immediately to control the epidemic to save lives. The law maker urged the house to impress on the state government to direct the Ministry of Health to provide the necessary drugs to the victims of the disease. He also advised the house to embark on an enlightenment campaign to educate the people of the danger of the diseases and ways of preventing same. Other members who commented on the issue, seconded the motion describing the disease as a dangerious thing to mankind that needed urgent attention.

Members, Mark Useni, Josiah Sabo Kente and Abubakar Lawal regretted the alarming rate the disease was claiming lives within and outside the state and urged the state government to take proactive step to address the issue.

[Byline: Celestine Ihejirika]

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[Lassa virus is a single-stranded RNA virus belonging to the virus family _Arenaviridae_. Lassa fever is known to be endemic in Guinea, Liberia, Sierra Leone and parts of Nigeria, but probably exists in other West African countries as well. This is the 1st recent report of Lassa fever in Taraba state. So far 2 other outbreaks of Lassa fever been reported in Rivers state and Ebonyi state, also in southern of Nigeria.

About 80 percent of human infections are asymptomatic; the remaining cases have severe multi-system disease, where the virus affects several organs in the body, such as the liver, spleen and kidneys. Lassa fever is a zoonotic disease. The animal reservoir of Lassa virus is a rodent of the genus _Mastomys_, commonly known as the "multimammate rat". _Mastomys_ infected with Lassa virus do not become ill, but they can shed the virus in their excreta.

Lassa fever occurs in all age groups and in both men and women. Persons at greatest risk are those living in rural areas where Mastomys are usually found, especially in areas of poor sanitation or crowded living conditions. Health care workers are at risk if proper barrier nursing and infection control practices are not maintained. Because the symptoms of Lassa fever are so varied and non-specific, clinical diagnosis is often difficult, especially early in the course of the disease. Lassa fever is difficult to distinguish from many other diseases which cause fever, including malaria, shigellosis, typhoid fever, yellow fever and other viral haemorrhagic fevers. Contrary to the statement in the above press report, no vaccine is available present.

A map of Nigeria showing the locations of the 3 states (Ebonyi, Rivers and Taraba) reporting outbreaks of Lassa fever so far in 2012 can be accessed at: http://www.waado.org/nigerdelta/Maps/Ni ... tates.html.

Images of a multimammate rats scan be viewed at: http://www.google.co.uk/search?q=multim ... 39&bih=386. - Mod.CP]

LASSA FEVER - NIGERIA (04)
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Date: Wed 22 Feb 2012
Source: AllAfrica, Leadership Newspaper (Abuja) report [edited]
http://allafrica.com/stories/201202220127.html


In the last 6 weeks 40 people have died across the country from the outbreak of Lassa fever. So far, 397 cases have been reported and all patients are to be treated free. This was disclosed in a statement by the minister of health, Prof Onyebuchi Chukwu, yesterday [21 Feb 2012]. The minister said that 6 of the dead were health workers (2 doctors and 4 nurses) and that cases have been reported in 12 states Edo, Nasarawa, Plateau, Ebonyi, Taraba, Yobe, Ondo, Rivers, Gombe, Anambra, Delta, and Lagos.

Out of the 397 cases reported, only 87 cases have been positively confirmed by medical officials. Chukwu narrated the case of a 28-year-old female corps member who completed her 3 weeks orientation in Rivers State but travelled home to visit her families in Afikpo and Abakiliki, capital of Ebonyi State, where she contracted the fever on 1 Jan 2012 and died 2 days later.

On what the Ministry is doing to contain the situation, Chukwu said adequate quantities of ribavirin injections and tablets, the specific antiviral drug for Lassa fever, have been released to the affected states. He also said that the ministry has deployed rapid response teams to all affected states and there is great emphasis on routine barrier nursing precautions. Chukwu added that no travel restriction will be imposed on the affected areas but hotlines have been provided for health workers for expert advice. The numbers are: 08037154575, 08023214998, 08037879701, and 08023047101.

However, the minister of state for health, Dr Muhammad Ali Pate, in a media conference yesterday [21 Feb 2012], said the ministry has also distributed over 750 000 ribavirin doses of injection and tablets as well as safety gloves and protective vests for health workers. He said that there are 9 specialist centres across Nigeria where tests on Lassa fever can be done. Pate advised Nigerians not to panic as the government is responding promptly and effectively to the outbreak.

Lassa fever is a viral disease that attacks the liver, nervous system, spleen, and kidney, causing them to bleed, hence the haemorrhagic fever designation. According to the online encyclopaedia Wikipedia, Lassa fever was first described in 1969 in the town of Lassa, in Borno State, Nigeria, in the Yedseram river valley at the south end of Lake Chad. It is an infection that is endemic in the West African countries of Liberia, Sierra Leone, Guinea, and even Central African Republic and Congo DR. About 300 000 to 500 000 cases occur annually, with approximately 5000 deaths. Symptoms of Lassa fever include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhoea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding, bleeding from the mouth, nose, vagina, or gastrointestinal tract and low blood pressure.

The virus lives in rats and infects humans when they come in contact with these rats' urine and faeces. Pate explained that increasing awareness is being created for Nigerians to avoid rats and keep them away from stored food and drinking water. People living in rural areas or in crowded and unsanitary environments, where rats breed, are at the greatest risk. However, health experts warn that Lassa fever can be contracted through body fluids like blood and excrements of infected persons.

[Byline: Ezra Ijioma]

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Communicated by:
Richard A "Ran" Nisbett, PhD, MSPH
Assistant Professor
Global Health Practices Track
Department of Global Health
College of Public Health
University of South Florida
13201 Bruce B Downs Blvd, MDC56
Tampa, FL 33612-3805
USA
Research Associate
PIRE-University of Liberia


[About 80 percent of human infections are asymptomatic; the remaining cases have severe multi-system disease, where the virus affects several organs in the body, such as the liver, spleen, and kidneys. Lassa fever is a zoonotic disease. The animal reservoir of Lassa virus is a rodent of the genus _Mastomys_, commonly known as the "multimammate rat". _Mastomys_ infected with Lassa virus do not become ill, but they can shed the virus in their excreta.

Humans usually become infected with Lassa virus from exposure to excreta of infected _Mastomys_ rats. Lassa virus may also be spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person with Lassa fever. There is no epidemiological evidence supporting airborne spread between humans. Person-to-person transmission occurs in both community and health care settings, where the virus may be spread by contaminated medical equipment, such as re-used needles. Sexual transmission of Lassa virus has been reported.

Lassa fever occurs in all age groups and in both men and women. Persons at greatest risk are those living in rural areas where _Mastomys_ rats are usually found, especially in areas of poor sanitation or crowded living conditions. Health care workers are at risk if proper barrier nursing and infection control practices are not maintained. Because the symptoms of Lassa fever are so varied and non-specific, clinical diagnosis is often difficult, especially early in the course of the disease. Lassa fever is difficult to distinguish from many other diseases that cause fever, including malaria, shigellosis, typhoid fever, yellow fever, and other viral haemorrhagic fevers. (For further information, see http://www.who.int/mediacentre/factshee ... index.html.)

This outbreak of Lassa haemorrhagic fever is remarkable in its extent, initially being reported from Ebonyi state only on 18 Jan 2012 and now apparently affecting 12 of the 36 states of Nigeria. A map of the states of Nigeria can be accessed at http://www.waado.org/nigerdelta/Maps/Ni ... tates.html and the HealthMap/ProMED-mail interactive map of the country at http://healthmap.org/r/1qGF. - Mod.CP]

Kongo, Demokratische Republik - Infektionskrankheiten
05.03.2012

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Die seit Februar 2011 herrschende Cholera-Epidemie hat nach UNO-Angaben bislang zu mindestens 26.000 Erkrankten und 644 Todesopfern geführt. 9 von 11 Regionen des Landes sind betroffen, incl. der Hauptstadt Kinshasa. Alle Formen der Virushepatitis kommen im Land vor. Angesichts des desolaten Gesundheitswesens ist davon auszugehen, dass der Polio-Erreger in der DRC weiterhin zirkuliert. Im Jahr 2011 wurden insgesamt 93 Fälle gemeldet, 2010 waren es 101. Der Erreger wurde wahrscheinlich aus Angola importiert. Schlafkrankheit und Tollwut sind weit verbreitet, Risiko auch für örtliche Auftritte von Pest, vor allem im NO des Landes, für Affenpocken sowie viralen hämorrhagischen Fiebern. / Quelle: crm

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (07): AFRICA
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In this update:
[1] Cholera - Guinea (Kindia, Boke regions)
[2] Cholera - Sierra Leone (Northern province)

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[1] Cholera - Guinea (Kindia, Boke regions)

Date: Sat 3 Mar 2012
Source: Le Figaro (France), Agence France-Presse (AFP) report [in French, machine trans. edited]
http://www.lefigaro.fr/flash-actu/2012/ ... -morts.php


A cholera outbreak in western Guinea has caused at least 14 deaths and 83 cases recorded in a month.

"The cholera epidemic which resurfaced just a month ago affects the coastal prefectures of Forecariah [Kindia region] and Boffa [Boke region], where a medical team recorded 14 deaths," said a source close to the Ministry of Health and Public Health. "The 1st cases were recorded in the islands of Kaback (off Conakry), bordering Sierra Leone."

Another medical source in Guinea argued that "if nothing is done", Guinea "could find 8000 cases of cholera with 800 deaths" in 2012. During a crisis meeting, the Guinean minister of health, Naman Keita, invited international partners of Guinea to "get involved to stop the epidemic and fight together against the diarrheal diseases."

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[2] Cholera - Sierra Leone (Northern province)
Date: Mon 5 Mar 2012
Source: The Monitor [edited]
http://www.monitor.co.ug/News/World/-/6 ... 123ek36/-/


At least 20 people have died as a result of a cholera outbreak, the Health Ministry in Sierra Leone has said. More than 1000 cases have been recorded in 3 districts in the Northern region of the country, Port Loko, Kambia, and Pujenhun.

Health ministry officials confirmed that those reported to have contracted the disease did so from drinking contaminated water. "The reported cases suggest an outbreak and the most affected people contracted the cholera bacteria from drinking infected water," said Dr Foday Dafae, manager National Disease Surveillance and Response at the Ministry of Health and Sanitation, at the weekend [3-4 Mar 2012].

Sierra Leone faces, among other major problems, an unavailability and inaccessibility of clean drinking water in most areas, especially in its rural districts.

[byline: Kemo Cham]

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[With outbreaks of cholera occurring in West African countries prior to the rainy season that should start next month [April 2012], the prospect of a substantial amount of diarrheal disease, including cholera, is large. - Mod.LL]