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UNDIAGNOSED CEREBRAL DISEASE - UGANDA (03): NODDING DISEASE
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Date: Wed 7 Mar 2012
Source: Daily Monitor (Uganda) [edited]
http://www.monitor.co.ug/News/National/ ... axes6qz/-/


Experts link nodding to black flies
-----------------------------------
President Museveni [Uganda] pledged helicopters for aerial spraying of black flies believed to be a cause of the disease.

Experts have said they are getting clues that the black fly associated with river blindness could be the cause of nodding disease. Prof James Tumwine, a pediatrics and child health expert at Mulago Hospital, said 80 per cent of children studied in southern Sudan had onchocerciasis parasites in their bodies, which cause an abnormal electric flow in the brain.

He said CT scans also revealed structural damage to the brain of the victims, which in turn increases brain activity in form of epileptic seizures.

"As a child nods, you can see that the child electric brain activity is very high, consequently causing seizures and convulsions in the rest of the body parts, and we have absolutely no doubt that river blindness is connected to this condition," Prof Tumwine said during president Museveni's visit to the 24 nodding victims at Mulago Hospital yesterday [6 Mar 2012].

However, the ministry of health officials accompanying the president said the new revelation is not conclusive and that there could be other factors, or combination of factors which they will continue investigating until they get to the root of the problem.

The president, who commended Kitgum Woman MP Beatrice Anywar's support to the affected children, directed the health ministry to carry out mass treatment for onchocerca parasites in the victims and spraying of black flies in affected districts.

The disease is said to have taken toll in the villages along River Pader, through Agago, crossing over to Kitgum, South Sudan, and areas around River Aswa.

The president also suggested killing the fly that is specifically found along very fast flowing rivers, but health minister Christine Ondoa said the exercise could be difficult, due to the nature of the fly and its movement.

Mr Museveni said helicopters could be availed for aerial spraying of the flies. The children are currently being treated using sodium valproate -- an anticonvulsant used in the treatment of epilepsy, anorexia nervosa, panic attack, posttraumatic stress disorder, as well as other psychiatric conditions.

Meanwhile, the attendants of the children at Mulago are said to have refused posho [east African dish of maize flour] and beans saying since the government considered their plea, they should have a diet change. When asked whether the children were improving, in unison, the attendants said that the condition of the children was still the same.

At least 3000 children are affected by nodding and 200 have since died of it.

[byline: Agatha Ayebazibwe]

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[ProMED-mail reviewed the literature on nodding disease (ND) in our posting from 15 Dec 2011 (archive no 20111215.3605). It was first described in 1962 and the link to onchocerciasis (transmitted by black flies) suggested in 1994. The electrical brain activity referred to here is probably an EEG (electroencephalography), which is pathological in most diseases of the central nervous system. Nodding disease is perceived as a variant of epilepsy and it is not surprising that the EEG is abnormal, but it provides little clue to the cause of the disease. MRI scans are usually better to pick up changes in the brain than CT scans and a study that performed MRI on 7 patients with ND found that 4 had normal scans (Winkler AS, et al. The head nodding syndrome -- clinical classification and possible causes. Epilepsia. 2008; 49(12): 2008-15; available at http://onlinelibrary.wiley.com/doi/10.1 ... 671.x/full). Thus the cause of ND remains elusive. - Mod.EP

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

TYPHOID FEVER UPDATE 2012 (06)
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[1] Zimbabwe (Harare)
Date: Mon 5 Mar 2012
Source: Sowetan Live [edited]
http://www.sowetanlive.co.za/news/2012/ ... oar-in-zim


About 3000 cases of typhoid have been reported in Zimbabwe's capital Harare since the 1st case was detected in a working-class suburb in January 2012, state media have reported. "At the moment we have over 3000 cases, both suspected and confirmed," The Sunday Mail newspaper quoted Prosper Chonzi, the city's health services director, as saying.

More than 90 people from one of the capital's suburbs, Kuwadzana, were admitted to hospital in January 2012. Health authorities banned open-air food vending to try to curb the spread of the disease. "Our worry is that typhoid is now spreading to other areas adjacent to Kuwadzana," Chonzi said.

"We are now moving into the unaffected areas so that we can educate people about the spread of typhoid. The city has found it better to concentrate on preventive measures rather than corrective measures."

Health minister Henry Madzorera has said the government had no money to deal with the typhoid outbreak, which has since spread to other provinces. Some suburbs go for weeks without running water as Zimbabwean municipalities struggle to keep up services. Last October 2011, more than 6000 cases of diarrhea were reported in the southern towns of Masvingo and Kadoma and children were the worst affected. 4 years ago over 4000 people died of cholera in an outbreak which affected nearly 100 000 people.

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[2] Zimbabwe
Date: Tue 6 Mar 2012
Source: WHO [edited}
http://www.who.int/hac/crises/zwe/sitre ... ry2012.pdf


Zimbabwe Weekly Epidemiological Bulletin
No. 151 epidemiological week 7 (week ending 19 Feb 2012)
--------------------------------------------------------
Since 10 Oct 2011 Harare City has been experiencing an outbreak of typhoid fever. As of 19 February 2012, a total of 3088 cases have been reported, 60 of which have been confirmed by laboratory diagnosis. From 1 Jan 2012 to 19 Feb 2012, a total of 2001 cases were reported. During week 7, 204 cases were reported: 181 from Harare and 23 from Bindura. The most affected suburbs were Kuwadzana and Dzivarasekwa.

(As of this week, typhoid is being reported in towns outside of Harare, also.) This week 23 cases were reported from Bindura in Mashonaland Central province.

communicated by:
Christopher B Nelson, PhD MPH
Director, Coalition against Typhoid (CaT)
Sabin Vaccine Institute
Washington, DC


[ProMED-mail thanks Dr Nelson for this contribution. - Mod.LL]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (08): AFRICA
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In this update:
[1] Cholera - Congo DR (Kivu province)
[2] Cholera - Uganda
[3] Cholera - Sierra Leone

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[1] Cholera - Congo DR (Kivu province)

Date: Thu 8 Mar 2012
Source: Radio Netherlands Worldwide (edited)
http://allafrica.com/stories/201203081121.html


A month-long water shortage in Goma has led to an outbreak of cholera. Poorer neighborhoods are suffering in this city in the eastern Democratic Republic of Congo. Cholera outbreaks regularly occur in Goma, capital of the DRC's Northern Kivu province. Yet, in the past few weeks the disease has spread rapidly, claiming over 50 lives. "Because of the shortage of clean water, we have to use the water from the lake for our daily drinking, cooking and washing. In our neighborhood, 3 children and 4 women have already succumbed to the disease," says Virginie Kahambu.

"Since the Rwandan refugee camps in 1994, where cholera was widespread, Lake Kivu has been a breeding ground for the cholera bacteria," says Dr Dominique Baabo, the provincial health inspector for North Kivu. "When there is a water shortage and people are forced to use the water from the lake, there is always a new cholera outbreak."

The current water shortage is said to be the result of the failure of the national water company [Regideso; Regie de distribution d'eau] to pay its electricity bill, which compelled national electricity company SNEL to cut its power supply. According to provincial Regideso director Deogratias Kizibisha Kabiona, the water shortage is caused by a failing pump.

Today, more than 300 million Africans lack access to clean water.

[byline: Melanie Gouby]

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[2] Cholera - Uganda
Date: Thu 8 Mar 2012
Source: Uganda Pulse [edited]
http://www.ugpulse.com/uganda-news/heal ... 24364.aspx


The Ministry of Health has announced an outbreak of cholera in some parts of the country. On behalf of the director general of the health service Dr Denise Lwamafa says that 280 cholera cases have been reported in the districts of Kasese, Mbale, Sironko, Bududa, and Buliisa.

Dr Lwamafa promises that the Ministry of Health is undertaking a number of measures to control the spread of cholera and the other water-related diseases ahead of the rainy seasons. He says that surveillance and epidemiological programs will continue in the affected and neighbouring districts to detect cases for early treatment. The National Medical Stores (NMS) has disbursed the necessary drugs to the affected districts in case more cases are reported.

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[3] Cholera - Sierra Leone
Date: Thu 8 Mar 2012
Source: Bloomberg News [edited]
http://www.bloomberg.com/news/2012-03-0 ... e-ill.html


At least 34 people have been killed by a cholera outbreak in Sierra Leone, deputy health and sanitation minister Borbor Sawyer said. The West African nation has recorded 2137 cases of the bacterial infection since Feb 2012 in 3 districts in the north and south, he told reporters in Freetown, the capital.

[byline: Silas Gbandia]

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ANTHRAX - LESOTHO: (BEREA) HUMAN, LIVESTOCK
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Date: Sun 11 Mar 2012
Source: Sunday Express [edited]
http://sundayexpress.co.ls/?p=6288


A total of 7 people from 2 villages in Berea district died last week after eating contaminated meat. It is suspected that the 7 who are from Masaleng and Ha Popa villages died after eating meat from a cow that had succumbed to anthrax. A number of people from the 2 villages have been hospitalised and are being treated for anthrax.

The director general of Veterinary Services, Malefane Moleko, said they had received reports that the 7 died after eating contaminated meat. "We received a message on Tuesday [6 Mar 2012] that a number of people and livestock died of a disease suspected to be anthrax in Berea," Moleko said. "One of our doctors went to the district to investigate after receiving a message from the Ministry of Health that some people had died," he said. The disease had also killed 18 cattle and 6 donkeys in recent weeks.

Moleko added that the Veterinary Services department was working hard to bring the disease under control. The department took samples on Wednesday [5 Mar 2012] and the results came out on Friday [8 Mar 2012] confirming that it was anthrax.

The disease has so far been restricted to Berea district but there is a real danger that if it is not controlled it might spread to other areas. The consequences of such an outbreak could be catastrophic. The department of livestock in the area is now making preparations to launch a vaccination campaign to control the disease.

Moleko said they had sent a message to World Organisation for Animal Health [OIE] in France to report the outbreak so that they will notify other countries. "As we export wool and mohair to other countries we need to notify them that there has been an outbreak that has affected a certain area and we have made sure that it's under control."

The outbreak of anthrax in Berea district has raised fears it might have a bad effect on the country's wool and mohair exports. Lesotho exports about 3500 tonnes of raw wool annually, mainly to China, while mohair is destined for the South African market. The sales of wool and live animals are also a major source of income for the rural communities. Moleko said the outbreak could affect the market as some customers might be reluctant to buy wool and mohair from Lesotho. "We started shearing goats in May so we need to assure our buyers that the disease has been controlled and that the mohair from Lesotho is free from diseases," he said. There was need to assure buyers that the disease was confined to one place and it was being treated to ensure that it does not spread to other districts.

Moleko urged people not to eat meat from dead animals as that could be dangerous to their health. He also advised the public to report the death of their livestock if they suspect diseases such as anthrax so that they can be controlled before they spread. Other animal diseases common in Lesotho include rabies and tuberculosis.

[byline: Mantoetse Maama]

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[The last reported outbreak in Berea was in January 2009, and involved cattle -- the OIE report just lists one animal affected, which is typical when reports are derived from submissions to the diagnostic laboratory. That is usually all that is listed on a sample submission form, whatever the reality.

Anthrax in the country is sporadic but the losses are excessive through inadequate control and surveillance. As can be seen from this report the veterinary response appears to have been initiated only after human deaths had occurred and not in respect of the earlier cattle and donkey deaths. A quick response then might have limited if not prevented the human deaths reported here.

Berea district can be located on the map of Lesotho at http://www.lib.utexas.edu/maps/africa/lesotho.gif. The HealthMap/ProMED-mail interactive map of the country can be seen at http://healthmap.org/r/1ZIX. - Mod.MHJ]

Sierra Leone - Darminfektionen
12.03.2012

Risiko für Durchfallerkrankungen landesweit. Seit Februar gibt es in den drei nördlichen Regionen Port Loko, Kambia und Pujenhun einen Cholera-Ausbruch. 2.137 Erkrankungen wurden registriert, mindestens 34 sind an der Infektion verstorben. In 2009 wurden erstmals wieder 6 Polio-Fälle gemeldet, für 2010 nur eine Erkrankung. 2011 traten keine Polio-Fälle auf. Hygiene und Impfschutz (Polio) weiterhin beachten. / Quelle: crm
___________

Simbabwe - Typhus
12.03.2012

Bereits seit Oktober 2011 ist in Simbabwe ein Typhus-Ausbruch im Gange. Mehrere Tausend Menschen sind seitdem erkrankt. Täglich werden nach Angabe des Gesundheitsministeriums zur Zeit 30 bis 50 Neuerkrankungen gemeldet. Besonders betroffen ist die Hauptstadt Harare. Dort wurden seit Januar 3.000 Erkrankungen registriert. Eine weitere Ausbreitung ist zu befürchten, zumal adäquate Mittel zur Behandlung aufgrund finanzieller Mängel nicht ausreichend zur Verfügung stehen. Als Ursache werden mangelhafte Trinkwasserversorgung und Abwasserentsorgung angegeben. Hygiene und Impfschutz beachten. / Quelle: crm

Gruß
Birgitt

Lesotho - Milzbrand
15.03.2012

In zwei Dörfern des Distriktes Berea (NW) sind 7 Menschen an Milzbrand gestorben, nachdem sie Fleisch einer infizierten Kuh gegessen hatten. In den letzten Wochen gab es wiederholt Ausbrüche bei Rindern sowie Affen. Für Reisende ist das Risiko einer Infektion gering. Menschliche Erkrankungen treten auf nach direktem Kontakt mit dem Erreger Bacillus anthracis entweder über die Haut, über das Einatmen der Sporen oder über die Aufnahme von infektiösen Tierprodukten über die Nahrung. Eine Übertragung von Mensch zu Mensch kommt praktisch nicht vor. Für Reisende gilt: Kontakt zu toten oder erkrankten Tieren sollte unbedingt vermieden werden, auf gute Nahrungsmittelhygiene ist zu achten. / Quelle: crm

Gruß
Birgitt

TRYPANOSOMIASIS – KENYA: (MASAI MARA): CDC ALERT
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[1]

Date: Fri, Mar 16, 2012
Source: Examiner
http://www.examiner.com/infectious-dise ... g-sickness


CDC issues travel alert concerning African Trypansomiasis
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The US Centers for Disease Control and Prevention (CDC) issued a travel notice Monday [12 Mar 2012] concerning the prevention of African trypanosomiasis -- see [2] below.

This notice comes after 2 European tourists contracted the deadly parasitic disease after a holiday in Kenya, which included a two day excursion to the Masai Mara National Reserve -- see ProMED archives below.

A study published in the Journal of Travel Medicine last year [2011-- see ref. at end] shows that during the last decade, cases of human African trypoanosomiasis were
reported in travelers who [had visited] national parks, wildlife reserves and
game parks in Tanzania, Malawi, Zambia, and Zimbabwe.

The CDC reports that, on average, the infection is reported in one US
traveler per year; it is usually acquired in East African game parks.

[Byline: Robert Herriman
Infectious Disease Examiner]

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[2]
Date: Sat, 17 Mar 2012
Source: CDC: http://wwwnc.cdc.gov/travel/notices/in- ... -kenya.htm


African Trypanosomiasis in Kenya
--------------------------------
What Is the Current Situation?

The form of trypanosomiasis seen in eastern and southeasthern Africa (rhodesiense) was recently reported in two European tourists who visited the Masai Mara National Reserve in Kenya. From 2000 to 2010, cases of human African trypoanosomiasis were reported in travelers who traveled to national parks, wildlife reserves, and game parks in Tanzania, Malawi, Zambia, and Zimbabwe.i Trypanosomiasis is a disease that has been historically found in this region of East Africa.

What Is African Trypanosomiasis (African sleeping sickness)?

African trypanosomiasis, also called African sleeping sickness, is caused by a parasite that is transmitted by an infected tsetse fly. The tsetse fly is found only in sub-Saharan Africa. Symptoms include fatigue, high fever, headaches, and muscle aches. If the disease is not treated, it is fatal. On average, the infection is reported in one US traveler per year; it is usually acquired in East African game parks.

How Can Travelers Protect Themselves?

***No vaccine or drug can prevent African trypanosomiasis. You can prevent the disease by avoiding tsetse flies.

Tsetse flies are found in woodland and savannah areas, and they bite during daylight hours. If you are touring or hunting in a game park, you are most likely to be exposed to tsetse flies. Travelers to cities are not at risk.

Take the following steps to avoid tsetse fly bites:
•Wear protective clothing, including long-sleeved shirts and pants. The tsetse fly can bite through thin fabrics, so clothing should be made of medium-weight material.
•Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.
•Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles.
•Avoid bushes. The tsetse fly is less active during the hottest period of the day. It rests in bushes but will bite if disturbed.
•Use insect repellent. Although insect repellents have not proven effective in preventing tsetse fly bites, they are effective in preventing other insects from biting and causing illness.

If you are bitten by a tsetse fly during your trip (the bite is often painful), watch for symptoms and see your doctor immediately if you get sick. Be sure to mention that you have been traveling in Africa and that you were bitten by a tsetse fly.

Clinician Information

There are two types of African trypanosomiasis. East African trypanosomiasis is caused by the _Trypanosoma b. rhodesiense_ parasite, which is spread by tsetse flies in eastern and southeastern Africa. West African trypanosomiasis caused by the _T.b. gambiense_ parasite, which is spread by tsetse flies in in western Africa.

With East African trypanosomiasis, illness progresses more rapidly and symptoms generally appear within 1-3 weeks of the bite. Symptoms may include high fever, a sore at the site of the infective bite, skin rash, headache, muscle aches, and less commonly, enlargement of the spleen, kidney failure, or heart problems. Central nervous system involvement can occur within the first month of infection. If untreated it is fatal.

People infected with West African trypanosomiasis may remain without symptoms for many months after the bite. Symptoms and signs may include fever, headache, discomfort, muscle aches, facial swelling, itching, and weight loss. Central nervous system involvement occurs after months of infection and is characterized by drowsiness, severe headache, and a wide range of other symptoms, including mood disorders, behavior change, and endocrine disorders. If untreated, it is eventually fatal.

Diagnosis is made by microscopic identification of parasites in specimens of blood, chancre fluid or tissue, lymph node aspirate, or cerebrospinal fluid. Buffy-coat preparations concentrate the parasite. Parasitemias are higher in T. b. rhodesiense than in T. b. gambiense infection. Serologic tests are not helpful for diagnosis of T. b. rhodesiense. CDC can help arrange serologic testing for T. b. gambiense, which is not available in the United States. Diagnostic assistance is available through CDC’s Division of Parasitic Diseases and Malaria (www.dpd.cdc.gov/dpdx).

Medical treatment of East African trypanosomiasis should begin as soon as possible, based on the infected person’s laboratory results. Medication for the treatment of East African trypanosomiasis is available through CDC. Hospitalization for treatment is usually necessary. Periodic follow-up exams that include a spinal tap are required for 2 years.

Additional Information
•African Trypanosomiasis (from Yellow Book)
•African trypanosomiasis (from Division of Parasitic Diseases and Malaria)
•WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases—African trypanosomiasis (Background of Surveillance with Map)

[The article in the Journal of Travel Medicine referred to in the text is:

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. – Mod. EP

HealthMap location: http://healthmap.org/r/1J6F]

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (04): NODDING DISEASE
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Date: Sat, Mar 17, 2012
Source: Observer, Uganda
http://www.observer.ug/index.php?option ... cle&id=3D=
17720:-govt-turns-to-choppers-to-fight-nodding-disease&catid=3D34:news&It=
emid=3D114 [Edited]


Nodding disease update: Uganda Government considering spraying
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Government [Uganda] is considering using helicopters to spray areas affected bythe nodding disease, the minister of Health, Dr Catherine Ondoa, has said.

Ondoa also told journalists during a press briefing yesterday that her ministry has dispatched a team of doctors and researchers to northern Uganda to tackle the syndrome that is killing children in droves in Kitgum, Pader and Lamwo districts. Families in these districts have been forced to watch their children present with nodding, seizures, malnutrition and disability. Often, these symptoms have culminated in death.

World health bodies like the World Health Organisation and Centres for Disease Control and Prevention have researched but failed to find the exact cause and cure of Nodding Disease Syndrome. Dr Ondoa told journalists that government trained and dispatched some 99 health workers to Pader, Kitgum and Lamwo to manage the estimated 3000 or so cases.

"This syndrome involves a multitude of problems and we are managing it in a multi-sector way. We are giving patients anti-epileptic drugs as well as vitamins because most of the children suffer from vitamin deficiency," Dr Ondoa said.

She added that 3 specialised screening centres have been opened up in Katanga Health Centre III at Kitgum general hospital and Para Bekan specifically to handle Nodding Disease. Patients who go to these health facilities undergo physical checkups, blood tests, and brain and heart scans. They receive medical treatment as well as psychological and occupational therapy.

"Nodding Disease right now is being handled as a medical, nutritional, psychiatric, behavioural and cognitive disorder," Dr Anthony Mbonye, the Commissioner Health Services, told journalists at the media briefing. Mbonye added that government is also planning outreach programmes for patients who are unable to [get] to the health centres.

Researchers who have been deployed will carry out environmental and ecological
studies in Pader, the worst hit district. Dr Ondoa noted that since the disease is associated with river blindness (onchocerciasis), government has decided to give preventative medicine to the people in the areas affected by that ailment.

Every 6 months, government will give people medication to kill off the microfilariae in their bodies and cut the cycle of spreading the disease from one infected person to another, she said. Government also plans to spray the affected areas using helicopters to kill off the blackflies [_Simulium_ sp.]that pass on the disease from person to person.

"We urge communities to swallow the medicine and cooperate with us during the spraying so that we prevent the cycle," Dr Ondoa said.

Nodding Disease facts
. More than 3000 children diagnosed with Nodding Disease.
. 200 reported to have died from the disease.
. In 4 days alone, government has registered 437 cases at one health centre of Katanga. Of these, 38 have been admitted.
. Pader is worst hit with 1700 cases.
. In one day, 40 patients were diagnosed and 5 admitted at Kitgum general hospital.
. 9 patients admitted at Para Bekan in Lamwo.
. All 25 patients admitted at Mulago hospital [Kampala] are stable. One, though, was diagnosed with a brain tumour and underwent surgery.
. 2 of the patients at Mulago have epilepsy, 12 are ready to be discharged.
. Of the Shs 3.6bn [USD 1.4m] needed for research and management, Shs 1.1bn
[USD 438 000] has been released.
. Ministry of Finance has promised another Shs 2.7bn [USD 1.1m].


[Byline: Shifa Mwesigye
smwesigye@observer.ug]

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[ProMED reviewed the literature on Nodding Disease, ND, in our post of 15 Dec 2011 (see below). The decision to start aerial spraying and 6-monthly drug administration [with ivermectin we suppose] imply that the Government of Uganda has decided that onchocerciasis is a likely cause of the disease. ProMED will be happy to post further information as it becomes available.

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

[Photos of afflicted children, some tethered to prevent straying:
http://cdn.radionetherlands.nl/data/fil ... teaser.jpg
http://www.ghfn.org/Topics/NoddingDisea ... dding7.jpg
http://www.goddiscussion.com/wp-content ... isease.jpg
- Mod.JW]

Meningococcal Disease: situation in the African Meningitis Belt
23.03.2012 - WHO

From 1 January to 11 March (epidemiologic week 10), outbreaks of meningococcal disease has been reported in 15 districts in Benin, Burkina Faso, Chad, Côte d'Ivoire and Ghana (see table below1).

These outbreaks have been detected as part of the enhanced surveillance in the African Meningitis Belt conducted in 14 countries2 where a total of 6 685 suspected meningitis cases including 639 deaths have been reported.

The outbreaks are mainly caused by the W135 serogroup of Neisseria meningitidis (Nm) bacteria. In Chad, the predominant pathogen is Nm A, although NmW135 contributed to an outbreak in one district. Whereas NmA has always been the leading cause of epidemics in sub-Saharan Africa, outbreaks of NmW135 have already occurred in the region, since 2002.

The countries are responding to these outbreaks by enhancing surveillance, reinforcing treatment of patients and implementing mass vaccination campaigns. The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has approved the release of 117'500 doses of polysaccharide ACW vaccine to Côte d'Ivoire, 195'540 doses of polysaccharide ACYW vaccine to Ghana and 359'000 doses of conjugate Men A vaccine to Chad, along with injection materials and ceftriaxone (antibiotic) when necessary. The ICG constitutes of United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF), International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO.

WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministry of Health in the affected countries.

The supply of the appropriate vaccine to respond to W135 outbreaks is presently limited, and WHO and UNICEF are working closely with the vaccine manufacturers to ensure that this stock is maintained and adapted to the evolving outbreak situation.

Travelers are reminded of the importance of keeping their vaccination status up to date and to follow WHO travel advice. WHO emphasizes that individuals planning to travel to countries in the African Meningitis Belt obtain vaccine to protect against the four serogroups responsible for the epidemic disease (tetravalent vaccine ACYW135).

Quelle mit weitergehenden Tabellen: WHO

Gruß
Birgitt

MENINGITIS, MENINGOCOCCAL - AFRICA
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[1] Cote d'Ivoire
Date: Thu 22 Mar 2012
Source: AllAfrica.com [edited]
http://allafrica.com/stories/201203230695.html

An outbreak of meningitis has claimed the lives of a dozen people in the western town of Toulepleu according to a report by Le Nouveau Reveil. The epidemic, the paper said, is spreading quickly throughout the war-torn city despite the timely reaction of the Ivorian government which has delivered drugs to the area and is undertaking measures to curb the disease.

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[2] Uganda
Date: Fri 23 Mar 2012
Source: IRIN News [edited]
http://www.irinnews.org/Report/95139/UG ... 6-in-north

At least 16 people have died in a meningitis epidemic in two districts in northern Uganda over the past 3 weeks, say health officials. Amuru District, where the epidemic is spreading fast, has recorded 33 cases with 14 deaths since 24 Feb 2012, while Oyam District has reported 25 cases with 2 deaths. The districts are just recovering from 2 decades of Lord's Resistance Army insurgency which displaced over 1.8 million people and left thousands dead.

"The deadly disease is spreading. The number could be higher as not all come to health facilities," Charles Okwera, deputy district health officer in Amuru, told IRIN.

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[There are at least 13 serogroups of _Neisseria meningitidis_ based on the antigenic specificity of their capsular polysaccharides; disease is most commonly due to serogroups A, B, C, Y, and W135. All these serogroup polysaccharides except B are immunogenic in humans. Rarely outbreaks of meningococcal meningitis have been related to other serogroups such as type X which has occurred in Niger in 2006 and Burkina Faso in 2010. - Mod. LL

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

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (05): NODDING DISEASE
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Date: 26 Mar 2012
Source: The John Benneth Journal [edited]
http://johnbenneth.wordpress.com/2012/0 ... g-disease/


Nodding disease mostly afflicts children. It's called nodding disease because those who have it have a strange pendulous nodding of the head, especially when they are trying to eat certain foods or when they get cold. They also have an inability to eat and are affected by malnutrition. Nodding disease could be a systemic necrotizing vasculitis due to a mycosis infection.

The pathogen here specifically could be to be _Claviceps africana_, also called sorghum rot or sorghum ergot. Sorghum is a type of grain that is grown widely in the regions of Africa affected by the nodding disease.

Nodding disease in children develops from eating infected sorghum cereal and simply breathing the spores downwind from sorghum fields. Sorghum ergot fungi cause symptoms in animals that are similar to symptoms in children who have the nodding disease [see for instance: Blaney BJ et al. Sorghum ergot (_Claviceps africana_) associated with agalactia and feed refusal in pigs and dairy cattle. Aust Vet J. 2000;78:102-7].

Many children who have the nodding disease have stunted growth and mental retardation and other symptoms. These symptoms are very similar to ergot mold poisoning in rye.

Cattle and pigs that have eaten ergot-infected sorghum suffer from the same refusal to eat and from the same severe hypothermia experienced by children with the nodding disease.

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[Food toxins have been mentioned before, but not sorghum rot as the specific course. So far, data from analysis of mycotoxins have not been released to the public. Recent reviews of mycotoxins include: Richard JL. Some major mycotoxins and their mycotoxicoses--an overview. Int J Food Microbiol. 2007;119:3-10; and Bennett JW, Klich M. Mycotoxins. Clin Microbiol Rev. 2003;16:497-516.

The suggestion that nodding disease could be a systemic vasculitis is contradicted by the normal finding in the cerebral fluid and inconsistent changes seen on MRI. - Mod.EP]

[For information on sorghum ergot, see ProMED-mail post "Ergot, sorghum - Australia 20080125.0307," which contains pictures, information, and see also's for _C. africana_. - Mod.DH]

[For the HealthMap/ProMED map of Uganda, see http://healthmap.org/r/1wa6. - Mod.MPP]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (09): AFRICA
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In this update:

Africa
[1] Cholera - Uganda (Nebbi district)
[2] Cholera - Ghana (Accra)
[3] Diarrhea - Somalia (Gedo region)

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[1] Cholera - Uganda (Nebbi district)

Date: Sun 1 Apr 2012
Source: New Vision [edited]
http://www.newvision.co.ug/news/630017- ... Nebbi.html


At least 8 people have been confirmed dead and over 150 others admitted in various health units following the outbreak of cholera in Nebbi district. According to the survey carried by New Vision online on Thu, 29 Mar 2012 most of the victims affected by the disease are women and children.

Philbert Otto Acaye, the in-charge Akworo health center III said 6 people have been killed and 74 others have been admitted at the health center in the past week. It was at Akworo health center that the 1st case of cholera was reported Sat, 24 Mar 2012 before spreading to the neighboring sub-counties of Panyimur, Parombo and Pakwach sub-county.

At Dei health center III in Panyimur sub-county, Kimo Henry, the In-charge said 2 people have so died of the disease, and he expressed concern that the death toll is likely to rise due to shortage of drugs at the centre.

Nebbi district had reported the last case of cholera in 2007 and it was attributed to poor sanitation and hygiene but the recent outbreak has left both the politicians and the technocrats in the district baffled about the origin of the disease. Shaban Ofoy, the Panyimur sub-county LC3 chairperson argued that the disease could have originated from neighbouring Democratic Republic of Congo (DRC).

[By Benedict Okethwengu]

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[For the HealthMap/ProMED map of Nebbi District, Uganda, see http://healthmap.org/r/26No. - Mod.MPP]

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[2] Cholera - Ghana (Accra)
Date: Fri 30 Mar 2012
Source: Ghana Web [edited]
http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=234450


The Adabraka Polyclinic in Accra has recorded 33 cholera cases in 2 weeks but no deaths has since been recorded. Victims were said to have contracted the disease from the Adabraka, Odorna, Mamobi and Kasoa-Ofankor areas. Most of affected persons have since said to have been discharged after treatment.

The Osu-Klottey Sub-metro Medical Director of Health, Dr. Bright Davies- Teye, told Joy News TV the outbreak is due to unclean environment and unhygienic practices by the public, with most of the patients contracting the sickness from food they bought from food vendors in town. Dr. Davies-Teye cautioned the public to be particular about where they buy their food from and also encouraged them to practice good personal hygiene and avoid dumping fecal matter in gutters.

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[For the HealthMap/ProMED map of Accra, Ghana, see http://healthmap.org/r/1oA-. - Mod.MPP]

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[3] Diarrhea - Somalia (Gedo region )
Date: Wed 28 Mar 2012
Source: Suna Times [edited]
http://sunatimes.com/view.php?id=1768


Health workers in the rebel-held southwest Somali town of Bardera, Gedo region, are calling for urgent medical aid to respond to an outbreak of suspected diarrhea in the district. Reports say at least 23 people have been hospitalized following the outbreak of suspected diarrhea in the district. The victims, mainly children and elderly people, are said to be in bad condition.

A doctor in Bardera town who requested not to be named due to security reasons told Suna Times that the situation is getting out of hand, and locals need immediate medical supplies to respond to the emerging human tragedy in the area. He said the few privately owned health facilities in the area do not have enough drugs and trained staff to deal with this diarrhea outbreak. Diarrhoea is common in the area during the rainy seasons.

More than 17 under-5-year-old children have reportedly died of diarrhea-related complications in 2011 in this district. Medics in the area now say the situation at hand is tragic and needs immediate response to avert further human catastrophe in the district.

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[For the HealthMap/ProMED map of Gedo, Somalia see http://healthmap.org/r/26Np. - Mod.MPP]

Lassa fever in Nigeria
04.04.2012 - WHO

At the beginning of 2012, WHO was notified by the Federal Ministry of Health in Nigeria of an outbreak of Lassa fever. As of March 22, 2012, 623 suspected cases, including 70 deaths have been recorded from 19 of the 36 States since the beginning of the year. Laboratory analysis undertaken at the Irrua Specialist Teaching Hospital, Irrua Edo State has confirmed the presence of Lassa virus infection in 108 patients. Three doctors and four nurses were reported to be among the fatalities. This information is provisional and subject to change when laboratory results for Lassa fever in suspected cases become available.

The Federal and State governments are responding to the outbreak by enhancing the disease surveillance for early detection, reinforcing treatment of patients, and conducting awareness campaigns among the affected population.

Major challenges are the ongoing security risks in the country limiting access to some areas as well as the limited availability of resources to respond to the escalating outbreak.

WHO does not advise or recommend any restrictions on travel or trade with Nigeria. Travellers returning from affected areas who develop symptoms of fever, malaise, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, and abdominal pain should seek medical advice.

People usually become infected with Lassa virus from exposure to infected rodents belonging to Mastomys species. Person-to-person transmission occurs through direct contact with sick patients in both community and health care settings. Those at greatest risk are persons living in rural areas where Mastomys are found. Health care workers are at risk if adequate infection control practices are not maintained.

Quelle: WHO

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (11): AFRICA
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In this update:

Africa
[1] Cholera - Malawi (Blantyre district)
[2] Cholera - Ghana (Accra)
[3] Cholera - Congo DR
[4] Cholera - Republic of Congo (Brazzaville)
[5] Cholera - Uganda (Nebbi district)

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[1] Cholera - Malawi (Blantyre district)

Date: Thu 5 Apr 2012
Source: Reuters Africa [edited]
http://af.reuters.com/article/commoditi ... 6720120405


A cholera outbreak in Malawi's commercial capital, Blantyre, has killed 11 people in the last few months as an acute economic crisis has hit clean water supplies and hospitals have been unable to buy medicines, a health official said on Thu 5 Apr 2012.

Blantyre city health officer Chrissie Banda told Reuters a lack of water and proper sanitation were to blame for 80 percent of more than 200 cholera cases reported since December 2011. "Eleven people have died from cholera in the last 17 weeks, mainly because of persistent water shortages in the city, which has forced many people to drink water from streams and shallow wells," he said.

Nearly 1000 people died from a cholera outbreak in Malawi in 2001/02, the worst recorded outbreak of the disease.

[Byline: Mabvuto Banda]

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[2] Cholera - Ghana (Accra)
Date: Thu 5 Apr 2012
Source: Ghana News Agency [edited]
http://www.dailyguideghana.com/?p=44266


The Accra Metropolitan Assembly (AMA) has confirmed 11 deaths from cholera in 2 weeks and called for strict adherence to basic hygiene practices to curb spread of the disease in the metropolis. At a press conference in Accra, the AMA Health Director, Dr. Simpson Anim Boateng, said 5 of the deaths were recorded at Maamobi Polyclinic, 2 at the Korle-Bu Teaching Hospital, and one each at 37 Military Hospital, at La Hospital, at Ridge Hospital, and at a private facility.

There have been over 200 reported cases of cholera within the last 3 months in Accra. The press conference comes in the wake of a cholera alert issued by health officials a few weeks ago. The AMA has admitted that poor sanitation in the metropolis was likely to trigger an outbreak of cholera and other water borne diseases.

[Byline: Alban Sumana Kingsford Bagbin]

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[3] Cholera - Congo DR
Date: Tue 4 Apr 2012
Source: Voice of America [edited]
http://www.voanews.com/english/news/afr ... 082915.htm


The number of cholera cases this year [2012] in the Democratic Republic of Congo could far surpass the total for 2011. UN officials are calling for an increase in prevention programs in a country where the disease has become endemic.

UN humanitarian spokesman Yvon Edoumou described the cholera situation in the DRC as bleak. "In 2011, we had about 22 000 cases of cholera throughout the country. So far, for the 1st 3 months of 2012, we have just about 8000 cases. So we're looking at already 40 percent of the total caseload that was reported in 2011. At the current rate that we're going, by the end of 2012, we'll be well above the caseload for last year [2011]," he said.

The cholera problem is especially bad in the Eastern DRC. South Kivu is the most affected province with more than 2200 cases. "So far, the numbers are quite high. Just an example: for the whole of last year [2011] in Eastern DRC, we had 150 deaths. So far for this year, we have 77 deaths. I'm talking about Eastern DRC. So we're already at 50 percent of the total number of deaths last year," he said.

For all of DRC, 120 cholera deaths have been reported from January to March 2012.

[Byline: Joe DeCapua]

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[4] Cholera - Republic of Congo (Brazzaville)
Date: Mon 2 Apr 2012
Source: IRIN [edited
http://allafrica.com/stories/201204021312.html


A cholera outbreak is adding to the woes of thousands of people displaced by a huge munitions blast in the Congolese capital Brazzaville about a month ago, say officials. "We have 10 confirmed cases of cholera," Youssouf Gamatie, the UN World Health Organization's representative in Congo, told IRIN.

Poor hygiene and sanitation conditions in the sites for the displaced as well as ongoing rains have helped spread the disease, which is affecting all age groups, added Gamatie.

The covered market in Nkombo, north Brazzaville and the downtown Sacred Heart Cathedral sites are the worst affected. Together, these places are providing refuge for 11 000 of the 14 000 people who were displaced by the explosions, according to official estimates.

Alexis Elira Dokekias, director-general of health, told IRIN there were 13 suspected cases of cholera with one confirmed case; one person had died.

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[5] Cholera - Uganda (Nebbi district)
Date: Tue 3 Apr 2012
Source: Daily Monitor [edited]
http://www.monitor.co.ug/News/National/ ... awn6yxz/-/


Two weeks ago, 2 children died of cholera in Panyimur Sub-county, Nebbi District. Now the death toll has risen to 10, while 255 are fighting for their lives.

At Dei Health Centre III, treatment centres have been erected, but the shortage of medical personnel and equipment has made the situation dire.

Due to inadequate room at the facility, pale-looking children and their attendants have been huddled under trees, where bottles of intravenous fluids, fixed on tree branches, are being administered.

Dr Godfred Bwire, an official from Control Diarrhea Disease Department, said the cholera had spread from DR Congo to Nebbi. He said poor waste disposal and lack of pit-latrines are the main reasons behind the outbreak.

"The latrine coverage is very poor. Only 5 out of every 20 households have pit-latrines. The rest of the population defecates in the lake, and others use polythene bags to dispose of waste near water sources," he said.

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Kongo, Demokratische Republik - Infektionskrankheiten
10.04.2012

Hohes Risiko für Darminfektionen, speziell Durchfallerkrankungen einschließlich Ruhr und Cholera landesweit. Die seit Februar 2011 herrschende Cholera-Epidemie hat nach UNO-Angaben im Jahr 2011 zu etwa 22.000 Erkrankten und 644 Todesopfern geführt, in diesem Jahr traten bis Ende März schon etwa 8.000 Erkrankungen und 120 Todesfälle auf, so dass UN-Experten befürchten, dass die Fallzahlen 2012 die vom vergangenen Jahr deutlich überschreiten könnten. 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