Wüstenschiff

CHIKUNGUNYA (10) - FRANCE ex AFRICA (DEMOCRATIC REPUBLIC OF THE CONGO), CORRECTED
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Date: Wed 3 Aug 2012
From: Violaine Gauthier [edited]


[Due to a technical problem, the full report was not received and posted in archive no. 20120802.1225107. The complete report is posted below, with apologies for any inconvenience that may have resulted. - Mod.TY]

Since the beginning of July 2012, 2 chikungunya cases imported from the Democratic Republic of Congo (DRC) have been diagnosed by the French Reference Laboratory, IRBA Marseille.

The 1st case is resident in Kinshasa, DRC [Democratic Republic of the Congo]. She presented onset of symptoms (fever, headache, joint pains) on 1 Jun [2012], travelled to France on 3 Jul [2012] and attended an outpatient department on 10 Jul [2012] in Laveran military teaching hospital in Marseille (South of France) with persisting arthralgia. ELISA tests were unambiguously positive for both IgM and IgG anti-chikungunya

The 2nd case spent 3 months in DRC (Kinshasa). Before heading to Kinshasa, she spent one day in the city of Brazzaville (Republic of Congo). She presented onset of symptoms on 25 Jun 2012 and returned to France on the same day. She attended the outpatient department of Villeneuve St George's hospital (Paris suburbs) on 5 Jul [2012] with severe headache, polyarthritis with liver damage. Her serology (ELISA) was strongly positive for [CHIK] IgM. For both cases additional tests (dengue, West Nile and Rift Valley fever were negative)

In DRC, the last large chikungunya outbreak was described in 1999-2000 with more than 50 000 cases. In 2011, an outbreak with more than 11 000 cases was reported in the neighboring Republic of Congo (Brazzaville).

Chikungunya virus is known to be present in many countries in Africa but its magnitude and circulation remain poorly documented. As for most arboviruses, very few countries have implemented specific surveillance. The occurrence of cases of chikungunya in the DRC is not unexpected but demonstrates a persistence of virus circulation in the region. In a context of high malaria incidence and of limited arbovirus diagnostic capacities the circulation of chikungunya virus in Africa is likely to be underestimated. In this regards, cases diagnosed among travelers provide indirect indications of the viral circulation.

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Communicated by:
Isabelle Leparc-Goffart, Sebastien Plumet
National Reference Centre for Arboviruses;
Institut de recherche biomedicale des Armees (IRBA),
Marseille, France

Fabrice Simon
Laveran Military Teaching Hospital,
Marseille, France (site for the GeoSentinel network).

Pauline Caraux Paz, Olivier Patey
Service des Maladies Infectieuses et Tropicales,
Villeneuve Saint Georges Hospital, France

Violaine Gauthier, Philippe Barboza
Institut de Veille Sanitaire (French Institute for Public Health Surveillance) InVS,
Saint Maurice, France

[ProMED thanks the above contributors for this 1st-hand report. The 1st reported infection above was acquired before 1 Jun 2012 and the patient traveled to France on 3 Jul 2012, well after the viremic period. However, the 2nd case returned to France on the day of onset of symptoms, so likely was viremic on arrival but with no potential risk of ongoing transmission since _Aedes albopictus_, a vector mosquito competent for chikungunya virus transmission, is present in southern France but not in the Paris area.

In addition to the information about both cases, this report provides a significant amount of new information about the large chikungunya virus outbreaks in the DRC in 1999-2000. However, ProMED has received previous reports of smaller outbreaks in the Republic of the Congo in 2011, (see archives listed below), as mentioned in the above report. The above contributors are very likely correct about the under-reporting of chikungunya cases in Africa. One hopes that this report will lead to inclusion of chikungunya virus and its antibody in routine diagnostic tests of febrile disease, particularly those with significant arthralgia that is typical of chikungunya virus infections.
- Mod.DK]

RABIES - MALAWI: ex MOZAMBIQUE
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Date: Fri 10 Aug 2012
Source: Nyasa Times, Malawi News Agency [edited]
http://www.nyasatimes.com/malawi/2012/0 ... es-malawi/


Influx of Mozambique rabies cases worries Malawi
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The District Health Officer (DHO) for Mwanza, Raphael Piringu has expressed worry over sudden rising numbers of rabies cases being referred to Mwanza hospital from Mozambique and the neighbouring districts of Chikhwawa and Neno, since last month (July 2012). Piringu said the hospital is recoding an average of 30 people each day suspected to having been bitten by rabies dogs. "I believe there's an outbreak out there because we are receiving an average of 30 rabies [dog bite?] cases each day from Zobue in Mozambique since the end of last month. We have also received 3 cases from Neno and 2 from Chikhwawa, but so far we haven't registered any case from Mwanza," he said.

Piringu said the rabies cases were on the higher side compared to the available rabies vaccines at the hospital. The DHO said that the development had put pressure on the already limited resources allocated to Mwanza district. "We have already limited stocks of viral [vaccine?] for rabies to cater for our population in the district and the funds we receive are not adequate to procure more viral [vaccine?] to meet the rising demand. This has placed us in an awkward situation since rabies vaccines are expensive," he said. A single vaccine at central medical government stores is sold at K 12 000 [USD 44.83] while in private pharmacies it costs over K 50 000 [USD 186.81] according to the DHO.

The DHO has since appealed to authorities to assist their hospital to enable them provide necessary remedy to patients on whom they had diagnosed [suspected?] to have rabies after being bitten by dogs. He also appealed to veterinary department officials to find ways and means of preventing the rabies cases from increasing in the area. The district veterinary officer, Salifu Kawaghe assured the people that his office would conduct massive rabies vaccination campaign for pets including dogs in the district before the end of August [2012]. Meanwhile, he is appealing to key stakeholders to support the campaign to ensure its success. Kawaghe warned that dogs found loitering [loose?] during the campaign would be killed.

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[It is difficult to assess the urgency of the situation in Malawi without information about the relative incidence of rabies in the dog populations of Mozambique and Malawi, and the actual number of dog bite cases from Mozambique treated in the Malawi hospital. From the information provided it must be presumed that all cases of dog bite are treated as potential rabies cases and administered post-exposure protective vaccination, a costly and unsustainable practice anywhere [1 MWK = 0.00373622 USD]. As the medical authorities in Malawi are aware the problem can only be tackled by a control of rabies in the dog population of the 2 countries.

A map showing the geographical relationship of Malawi and Mozambique can be accessed at: http://kodu.ut.ee/~olli/eutr/html/htmlBook_151.html. The HealthMap/ProMED-mail interactive map of Malawi can be accessed at
http://healthmap.org/promed?g=925788&v=-16,35.583,5. - Mod.CP]

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2012 (37): AFRICA
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In this update:
Africa
[1] Cholera - Guinea
[2] Cholera - Congo DR
[3] Cholera - Cote d'Ivoire (Lagunes region)
[4] Cholera - Sierra Leone (Western area)


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[1] Cholera - Guinea

Date: Thu 9 Aug 2012
Source: Agence France-Presse (AFP) [edited]
http://www.google.com/hostednews/afp/ar ... cb2bd9.2c1


[Guinea's] health ministry said on Thu 9 Aug 2012 that 60 people have died of cholera and [the outbreak] is showing no signs of letting up. Officials have registered 2054 cases, with the capital Conakry and the south western city of Forecariah worst affected. 13 people have died in Conakry and 23 in Forecariah.

The NGO Medecins sans Frontieres [Doctors Without Borders] stated that it had increased the number of hospital beds to "soon reach 600 to prepare for the height of the outbreak." 2 other organisations, UNICEF and Action Against Hunger, have donated hygiene kits containing soap and chlorine to purify water. Guinean health authorities are also running local awareness campaigns in a bid to stem the outbreak.

Sierra Leone, Mali, and Niger have also been hard hit, with high levels of malnourishment as a result of a drought exacerbating the problem.

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[2] Cholera - Congo DR
Date: Wed 8 Aug 2012
Source: Vaccine News Daily [edited]
http://vaccinenewsdaily.com/africa/3195 ... -of-congo/


According to local authorities 10 people have died in the Democratic Republic of Congo due to a cholera epidemic. Cramped and unsanitary conditions in a displaced people's camp in the east [near Goma] have led to confirmed cases of the deadly waterborne disease. Thousands of people have fled to the camp to escape conflict in their homes, IB Times reports. A cholera outbreak spread through DRC in 2011, as well, killing hundreds in communities along the Congo River.

A makeshift clinic has been set up by doctors in the camp to care for the sick, while experts try to curb the spread of the disease, IB Times reports. Eastern Congo saw 18 552 cholera cases in 2011 resulting in 232 deaths.

[byline: Tina Redlup]

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[3] Cholera - Cote d'Ivoire (Lagunes region)
Date: Wed 8 Aug 2012
Source: Pasteur Institute in Abidjan, Agence Ivoirienne de Presse (AIP) report [in French, machine trans., edited]
http://news.abidjan.net/h/438576.html


On Wed 8 Aug 2012, the director of the health district of Tiassale, Koffi Kouakou Eugene, told AIP [Cote d'Ivoire Press Agency] that an epidemiological alert was declared on Fri 3 Aug 2012, after the Pasteur Institute in Abidjan confirmed the presence of cholera in the area of Assinze village, Tiassale department, Lagunes Region.

The "emergency measures to stop the spread of the disease" have been taken by the departmental authorities and medical officials, he indicated, stating that "a special observation room has been appointed within the general hospital of Tiassale, free kits have been distributed, and the people have been made aware of the risks of contagion of cholera."

Koffi Kouakou Eugene, who urged the people to follow the rules of hygiene, also called the political and administrative authorities of Tiassale to mobilize to eradicate the epidemic from this village of about 1500 individuals.

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[4] Cholera - Sierra Leone (Western area)
Date: Fri 3 Aug 2012
Source: Awoko [edited]
http://www.awoko.org/2012/08/03/cholera ... tern-area/


Since 23 Jun 2012, cholera has so far claimed the lives of 105 people, with 35 deaths recorded in the Western Area alone, according to the manager of the National Disease Surveillance and Response.

Dr Foday Dafae disclosed in an interview with Awoko on 2 Aug 2012, disclosed that between 23 Jun 2012 and 31 Jul 2012, 1964 cases were reported across the country with 35 deaths recorded in the Western Area alone. The manager said the cholera outbreak started in the Kambia, Port Loko, and Pujehun districts in January 2012.

He stressed that the Western Area has recorded more cases than all the affected areas, disclosing further that in the Western Area alone, a total of 219 affected under 5 cases [cases under 5 years of age? - Mod.SH] were recorded with 4 deaths.

Dr Dafae however maintained that the National Disease Surveillance and Response unit of the Ministry of Health and Sanitation has now established Cholera Treatment Units in a number of locations in the Western Area, including Connaught Hospital, Marbella, Macauley Street, and at the Wellington Community Center with a bed capacity of 60.

[byline: Abibatu Kamara]

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RABIES - NAMIBIA: (OMUSATI) ANIMAL, HUMAN
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Date: Fri 17 Aug 2012
Source: New Era [abbreviated &edited]
http://www.newera.com.na/articles/47007 ... ati-Region


Rabies rampant in Omusati Region
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OSHAKATI: Rabies in the Omusati Region is said to be on the increase with reports of one loss of life already and a huge number of livestock affected that were bitten by dogs suffering from this life-threatening disease. While other northern regions enjoy free vaccinations against rabies, the Omusati Region is the only odd one out, with a rapid increase in cases of rabies among pets and livestock. The escalating cases are attributed to a lack of commitment among residents, especially among pet owners in that region. Animal health technician for the Omusati Region Abisai Taapopi said the region has a population of over 20 000 dogs. However, less than 50 per cent of that canine population was vaccinated since last year. Between August last year and July this year, 4 out of 6 postmortems carried out on dogs and cats suspected to have died of rabies, tested positive in the region. However, a disconcerting number of rabies cases went unreported, according to the animal health official. In the Oshana, Oshikoto, and Ohangwena regions the disease is said to have reduced significantly and this is all credited to the commitment of farmers and pet owners. "We are not saying farmers in our region are not aware of rabies -- they are simply not serious. We always use the radio to announce vaccination schedules prior to our visits to cattle posts, but only a few farmers turn up with their cats and dogs. The elderly claim that they are unable to manhandle their animals, since their children -- who are the only ones who can help them, are often at schools during vaccination campaigns," said Taapopi.

Villagers in the Anamulenge Constituency claim that a pregnant woman from Okakekete village died last week after she was bitten by a dog suffering from rabies. Two more people including a 9 year old boy were also bitten by dogs, according to the villagers. Health officials could, however, not confirm the villagers' claims. Apart from dogs and one reported human fatality, villagers also claim that some of their livestock, especially donkeys, display rabies symptoms and it is believed that a number of stray dogs in the region are responsible for the spread of the disease.

A veterinarian responsible for the the Oshana and Oshikoto regions Dr Phillep Shilongo said unlike the Omusati Region, cases of rabies in his regions have reduced significantly. "We carried out awareness campaigns and people are serious about vaccinations. We have people bringing their pets to our clinics and we also have teams of our officials out in the field who are vaccinating livestock as well as pets. As for Omusati, we need to increase education campaigns and
create awareness among the communities," said Shilongo.

Dr Gordon Ssengoye, a government veterinarian in the Ohangwena Region said campaigns against rabies carried out mainly in the Ohangwena, Engela, Oshikango, Eenhana, and Okongo constituencies have reduced the disease drastically. Between the end of 2011 and March this year, an average of 6 to 10 cases of rabies were reported on a monthly basis in the Ohangwena Region, this number has however reduced to an average of one to 2 cases at present. Ssengoye attributed the drastic reduction to aggressive campaigns carried out by the regional council, traditional authorities, the Ministry of Health, and the Ministry of Agriculture Water and Forestry officials in the Ohangwena Region. "We also threatened to shoot stray dogs if people were not taking their pets for vaccinations, instead of tying them up in their yards. Luckily we did not shoot any dog since members of the community cooperated and brought their animals for vaccination," said Ssengoye. He however maintains that even if the disease has significantly reduced in the region, officials will not sit back and relax, but will continue with the campaigns against rabies.

(byline: Helvy Shaanika)

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[The occurrence of only one unconfirmed human case of rabies in the Omusati Region of Namibia suggests that the veterinary vaccination programmes are having some impact on the prevalence of rabies virus infection despite the poor level of compliance.

Nonetheless of the extent of rabies virus infection in domestic animals and livestock remains alarming. Travellers to Namibia shold be made aware of the extent or rabies virus infection in some parts of the country.

A map of the Districts of Namibia can be accessed at http://www.mapsofworld.com/namibia/nami ... l-map.html. The HealthMap/ProMED-mail interactive map of Namibia can be accessed at http://healthmap.org/r/00tY. - Mod.CP]

An outbreak of cholera in Sierra Leone has infected more than 10,000 people and killed at least 176 since January, authorities have said. They have appealed for international assistance to help them contain the spread of the disease. President Ernest Bai Koroma has declared the outbreak a national emergency. There have been 100 deaths in the capital, Freetown, in the last month alone.

Sierra Leone cholera death toll rises
20.08.2012 - BBC

Gruß
Birgitt

Guinea - Darminfektionen
21.08.2012

Risiko für Durchfallerkrankungen landesweit. Aktuell gibt es einen Cholera-Ausbruch mit über 3.350 Erkrankten. Am stärksten betroffen sind die Hauptstadt Conakry und die Stadt Forecariah. 2009 wurde zum ersten Mal seit 2004 wieder Polio durch Reimporte nachgewiesen, nachdem das Land zuvor bereits poliofrei war. Für 2010 wurde keine Polio-Erkrankung gemeldet, 2011 gab es 3 Fälle. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm
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Kongo, Demokratische Republik - Ebola hämorrhagisches Fieber (EHF)
21.08.2012

In Isiro und in Dungu in der Provinz Orientale (NO) sind im August Ebola-Fälle aufgetreten. Es gibt bisher 10 Verdachts- und 6 Todesfälle. Die Provinz Orientale grenzt an Uganda, wo es seit Anfang Juli eine Ebola-Epidemie gibt, diese scheint aber beendet zu sein. Der Virustyp bei den beiden Ausbrüchen ist nicht derselbe, es handelt sich also um zwei unabhängig voneinander aufgetreten Ereignisse. Die WHO in Zusammenarbeit mit Gesundheitsbehörden und internationalen Hilfsorganisationen ist dabei, Eindämmungsmaßnahmen einzuleiten. / Quelle: crm
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Sierra Leone - Darminfektionen
21.08.2012

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Land endemisch, Ausbrüche kommen immer wieder vor. Seit Mitte Juni gibt es einen Ausbruch in einigen westlichen Regionen des Landes inkl. der Hauptstadt Freetown. 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
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Uganda - Ebola hämorrhagisches Fieber (EHF)
21.08.2012

Seit Anfang Juli gibt es einen Ausbruch des hämorrhagischen Fiebers im Distrikt Kibaale im Westen des Landes, es sind mindestens 16 Menschen verstorben, etwa 24 waren erkrankt. Bei 70% der etwa 400 Kontaktpersonen ist mittlerweile klar, dass sie sich nicht angesteckt haben. Die Infektion verläuft in 50-80% der Fälle letal. Die ugandischen Gesundheitsbehörden zusammen mit Experten der WHO sowie weiteren Hilfsorganisationen haben zahlreiche Maßnahmen eingeleitet, um eine weitere Ausbreitung zu verhindern. Diese Maßnahmen zeigen sehr gute Erfolge, momentan scheint es als sei der Ausbruch erfolgreich eingedämmt worden. Die Übertragung erfolgt durch engen Kontakt (Blut, Körperflüssigkeiten) von Mensch zu Mensch. Die Infektion ist hochansteckend, eine spezifische Therapie existiert nicht. Zuletzt waren bei Epidemien in den Jahren 2000 und 2007 über 200 Menschen verstorben. Im vergangenen Jahr starb ein 12-jähriges Mädchen. / Quelle: crm

Gruß
Birgitt

Cholera in Sierra Leone
22.08.2012 - WHO

Since the beginning of the year, Sierra Leone has recorded 11,653 cases of cholera, with 216 deaths (Case Fatality Rate of 1.9%). The rate of new cases has accelerated rapidly since the beginning of August: since then, 5706 cases have been recorded, and two new districts, Bonthe and Kono, have been affected by the epidemic . Ten of the country’s 13 districts are now registering cases and this spread emphasizes the need to rapidly scale up the response.

The two most heavily affected districts are Western Area and Tonkolili.

The President of Sierra Leone has declared the escalating cholera epidemic a “humanitarian crisis”. Consequently, a multi-sectoral approach to the response has been adopted involving the Ministry of Health and Sanitation (MOHS), as well as other line ministries such as Finance, Information and Communication, and Local government, together with partners and stakeholders. A National Emergency Task force has been established with sub-committees dealing with surveillance, case management, water and sanitation, logistics and social mobilization. The WHO Country Office (WCO) in Sierra Leone is chairing a weekly meeting of partners and stakeholders to better coordinate harmonize and strategize support.

The MOHS, in partnership with Médecins sans Frontières (MSF), UNICEF, WHO, and other partners, is implementing the following prevention and control activities: epidemiological investigation, surveillance, case management at established cholera treatment centres, water and sanitation control measures, social mobilization and community education.

WHO is supporting Sierra Leone in the areas of epidemiology, social mobilization and surveillance. WHO has deployed two (2) epidemiologists, and three (3) cholera experts from Zimbabwe to support coordination, public information, social mobilization, case management and infection control.

WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone.

Gruß
Birgitt

Kongo, Demokratische Republik - Ebola hämorrhagisches Fieber (EHF)
24.08.2012

In Isiro, Pawa und in Dungu in der Provinz Orientale (NO) sind im August Ebola-Erkrankungen aufgetreten. Es wurden bisher 15 Verdachts- und 10 Todesfälle registriert. Die Provinz Orientale grenzt an Uganda, wo es seit Anfang Juli eine Ebola-Epidemie gibt, die aber jetzt beendet zu sein scheint. Der Virustyp bei den beiden Ausbrüchen ist nicht derselbe, es handelt sich also um zwei unabhängig voneinander aufgetretene Ereignisse. Die WHO in Zusammenarbeit mit Gesundheitsbehörden und internationalen Hilfsorganisationen ist dabei, Eindämmungsmaßnahmen einzuleiten. Die letzte große Ebola-Epidemie im Kongo war 1995, damals waren 245 Menschen gestorben. / Quelle: crm
_____

Sierra Leone - Darminfektionen
24.08.2012

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Land endemisch, Ausbrüche kommen immer wieder vor. Seit Mitte Juni gibt es einen Ausbruch, die meisten Fälle werden aus den westlichen Teilen des Landes gemeldet, auch die Hauptstadt Freetown ist betroffen. 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
_____

Uganda - Ebola hämorrhagisches Fieber (EHF)
24.08.2012

Seit Anfang Juli gibt es einen Ausbruch des hämorrhagischen Fiebers im Distrikt Kibaale im Westen des Landes, es sind mindestens 16 Menschen verstorben, etwa 23 waren erkrankt. Bei 70% der etwa 400 Kontaktpersonen ist mittlerweile klar, dass sie sich nicht angesteckt haben. Die Infektion verläuft in 50-80% der Fälle letal. Die ugandischen Gesundheitsbehörden zusammen mit Experten der WHO sowie weiteren Hilfsorganisationen haben zahlreiche Maßnahmen eingeleitet, um eine weitere Ausbreitung zu verhindern. Diese Maßnahmen zeigen sehr gute Erfolge, momentan scheint es als sei der Ausbruch erfolgreich eingedämmt worden. Die Übertragung erfolgt durch engen Kontakt (Blut, Körperflüssigkeiten) von Mensch zu Mensch. Die Infektion ist hochansteckend, eine spezifische Therapie existiert nicht. Zuletzt waren bei Epidemien in den Jahren 2000 und 2007 über 200 Menschen verstorben. Im vergangenen Jahr starb ein 12-jähriges Mädchen. / Quelle: crm

Gruß
Birgitt

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (42): AFRICA
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In this update:
Africa
[1] Cholera - West & Central Africa
[2] Cholera - Guinea
[3] Cholera - Zambia (Northern Province)


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[1] Cholera - West & Central Africa

Date: Thu 23 Aug 2012
Source: Pittsburgh Post-Gazette, Associated Press (AP) report [edited]
http://www.post-gazette.com/stories/new ... ms-650122/


A fierce cholera epidemic is spreading through the coastal slums of West Africa, killing hundreds and sickening many more in one of the worst regional outbreaks in years, health experts said. Cholera, transmitted through contact with contaminated feces, was made worse in 2012 by an exceptionally rainy season that flooded the sprawling shantytowns in Freetown and Conakry, the capitals of Sierra Leone and neighboring Guinea.

In both countries, some 2/3 of the population lack toilets and defecate in the open, a potentially lethal threat in the rainy season because of contamination of the water supply. Doctors Without Borders said there had been nearly twice as many cholera cases so far in 2012 as there were in the same period in 2007 in Sierra Leone and Guinea.

Already, about 13 000 people suffering from the disease's often-fatal symptoms -- diarrhea, vomiting and severe dehydration -- have been treated in those 2 countries, and 250 to 300 have died, Doctors Without Borders said.

In Sierra Leone, the government last week [week of 13 Aug 2012] declared the cholera outbreak a national emergency, while aid workers in Guinea said the peak of the outbreak was not likely to have been reached. Both countries have been wracked by years of civil and political unrest -- with Sierra Leone still recovering from a decade of bloody civil war that drove thousands from rural areas into the city's slums, and Guinea emerging from a half-century of often-brutal dictatorship.

Rains have already contributed to cholera deaths in the landlocked nations of Mali and Niger as well, health officials said.

There have been more than 11 600 cholera cases in Sierra Leone since January 2012, at least 216 of them fatal, according to the country's health minister, Zainab Bangura. In Guinea, there have been 80 deaths out of 2700 cases so far. More than 1000 new cases a week are being recorded in Freetown, health officials said.

In the 14 countries of West and Central Africa, there have been 40 799 cholera cases in 2012, and 846 deaths, with more than half the reported cases originating in the Democratic Republic of Congo. UNICEF said those figures were comparable to the regional totals for 2011, when there were more than 105 000 cases and nearly 3000 deaths. Whereas the 2011 epidemic was focused on the Lake Chad area of Cameroon, Nigeria, Chad, and Niger, in 2012 it is concentrated on the coast.

[Byline: Adam Nossiter]

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[2] Cholera - Guinea
Date: Thu 23 Aug 2012
Source: Agence France-Presse (AFP) [edited]
http://www.google.com/hostednews/afp/ar ... cb2bd9.2c1


An outbreak of cholera in Guinea has killed 60 people since February 2012 and is showing no signs of letting up, the country's health ministry said Thu 23 Aug 2012.

Officials have registered 2054 cases, with the capital Conakry and the southwestern city of Forecariah worst affected. 13 people have died in Conakry and 23 in Forecariah.

Sierra Leone, Mali, and Niger have also been hard hit, with high levels of malnourishment as a result of a drought exacerbating the problem.

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[3] Cholera - Zambia (Northern Province)
Date: Thu 23 Aug 2012
Source: Zambia Daily Mail [edited]
http://www.daily-mail.co.zm/?p=12024


The number of cholera cases in Mpulungu has risen to 74 from 68 but no more deaths have been recorded. 1 person had previously died from the deadly water-borne disease.

The Ministry of Health has managed to deliver medical supplies to Mpulungu, while all cholera patients have been isolated to prevent the spread of the disease.

Ministry of Health spokesperson Kamoto Mbewe confirmed the development in an interview yesterday, 22 Aug 2012.

He said Medical Stores has delivered enough medical supplies for cholera treatment and chlorine for disinfecting drinking water. Dr Mbewe said Ministry of Health staff have also been dispatched to Mpulungu to boost health service delivery in the district and help in disinfecting houses and toilets.

[Byline: Monica Kayombo]

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Sierra Leone - Darminfektionen
28.08.2012

Risiko für Durchfallerkrankungen landesweit. Cholera ist im Land endemisch, Ausbrüche kommen immer wieder vor. Seit Mitte Juni gibt es einen Ausbruch mit bisher etwa 12.000 Erkrankten, die meisten Fälle werden aus den westlichen Teilen des Landes gemeldet, auch die Hauptstadt Freetown ist betroffen. 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

Gruß
Birgitt

Cholera in Sierra Leone - update
30.08.2012 - WHO

Since the beginning of the year, Sierra Leone has recorded 13,934 cases of cholera, with 232 deaths (Case Fatality Rate of 1.7%). The rate of new cases has accelerated rapidly since the beginning of August. Eleven of the country’s 13 districts are now registering cases with Western Area and Port Loko being the most affected. The most recently affected district is Kenema district.

The President of Sierra Leone has declared the escalating cholera epidemic a “humanitarian crisis”. Consequently, a high-level Presidential Cholera Task Force has been established to oversee coordination, mobilize resources and guide response. A multi-sectoral approach to the response has been adopted involving the Ministry of Health and Sanitation (MOHS), as well as other line ministries such as finance information and communication, and local government, together with partners and stakeholders.

A Cholera Control and Command Centre (C4) has been established at the WHO Country Office in Freetown to better coordinate all the response activities to the cholera outbreak. This approach was previously used and proved effective in the response to the Cholera outbreak in Zimbabwe in 2008-2009.

The first C4 meeting took place on 28 August 2012 and will subsequently be held daily. The C4 comprises all the technical sub-committees dealing with surveillance, case management, water and sanitation, logistics and social mobilization.

The MOHS, in partnership with Médecins sans Frontières (MSF), UNICEF, WHO, and other partners, is implementing the following prevention and control activities: epidemiological investigation, surveillance, case management at established cholera treatment centres, water and sanitation control measures, social mobilization and community education.

WHO continues to support Sierra Leone in the areas of epidemiology, social mobilization, surveillance and has mobilized experts from the AFRO Regional Office (including Inter-country Support team) and WHO headquarters.

The Global Outbreak Alert and Response Network (GOARN) has provided experienced case management and laboratory expertise from the International Center for Diahorrheal Disease Research, Bangladesh (ICDDR,B) who have long-standing experience in responding to cholera internationally.

WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone.

Gruß
Birgitt

Cholera in Sierra Leone - update
08.09.2012 - WHO

The Ministry of Health and Sanitation (MOHS) is closely working with partners at the national and international levels to step up response to the cholera outbreak that has affected Sierra Leone since the beginning of the year.

As of 5 September 2012, a total of 16,360 cases including 255 deaths with a case fatality rate (CFR) of 1.6% have been reported from 12 out of 13 districts. The Western area of the country where the capital city of Freetown is located, reported more than 60% of all new cases.

The President of Sierra Leone has declared the cholera epidemic a ‘’humanitarian crisis’’. A high level Presidential Cholera Task Force was established to oversee coordination, mobilization of resources and guide the response. A multi-sectoral approach to the response has been adopted involving the MOHS and other line ministries such as Finance, Information and Communication, and local governments together with partners and stakeholders.

With support from national and international partners and donors, including UNICEF, Oxfam, British Red Cross, Save the Children, Care, Concern MSF, DFID, OCHA, IRC, and WHO, the MOHS is scaling up the response particularly in the areas of coordination of the overall response, surveillance and case management.

A Cholera Control and Command Center (C4) has been established at the WHO Country Office in Freetown to strengthen the coordination, and support the MOHS and other health providers to implement activities related to Cholera Preparedness and Response Operation Plan (CPROP), in order to bring the epidemic under control as soon as possible. The C4 will also provide information to guide the decision-making of the national task force.

Emphasis is being placed on early detection of cases and timely provision of treatment at the district levels, in order to reduce deaths. Cholera cases are managed in Cholera treatment units (CTUs) and where there are no established CTUs, emphasis is placed on designating specific areas within the health facilities for isolation purposes.

WHO through the Global Outbreak Alert and Response Network (GOARN) has provided experienced case management and laboratory experts from the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) to build capacity among health care workers and laboratory technicians in case management and laboratory diagnosis.

Laboratories at the national level are being supplied with appropriate materials and reagents to collect, transport and analyze laboratory specimens. Laboratory confirmation is important, particularly in new areas experiencing the cholera outbreak.

There are ongoing community interventions on cholera prevention and control activities. More than 200 traditional healers have been oriented on cholera. Community meetings are organized in Freetown to raise awareness to avoid drinking water from unprotected water sources. Text messages are also being used to channel information to the public by telephone companies. UNICEF and other partners are supporting water, sanitation and hygiene activities.

With respect to this event, WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone.

Gruß
Birgitt

LASSA FEVER- NIGERIA (09): (LAGOS) ALERT
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Date: Mon 10 Sep 2012
Source: Leadership [edited]
http://leadership.ng/nga/articles/34543 ... fever.html


Following an outbreak of Lassa fever in some parts of the country, Lagos State government, on the weekend [8-9 Sep 2012], alerted residents on the need to maintain adequate personal and environmental hygiene at all times as part of the precautionary measures to prevent the [spread] of Lassa fever in the State. The Commissioner for Health, Dr Jide Idris, who disclosed this in Lagos, explained that the message to the residents became necessary to stem a possible outbreak of the disease in the state in the wake of reported cases in [other] parts of the country.

Dr Idris, who urged members of the public to avoid contact with rats, [instructed] them to cover their food and water properly, while ensuring that they cook all their food thoroughly, as well as block all rat hideouts and holes through which rats could enter the house. The commissioner also counseled the residents to store their grains and other dried food items in containers with covers, as well as keeping pets like cats in the house.

He explained that Lassa fever is an acute viral infection caused by Lassa virus associated with persistent high fever, and added that as the disease progresses into a severe form, the patient begins to develop facial swelling, fluid in the chest, bleeding from the mouth, nose, vagina, and gut, low blood pressure, shock, disorientation, coma, and kidney and liver failure. According to him, other usual symptoms include general weakness, malaise, headache, sore throat, nausea, diarrhea, and vomiting. "Lassa fever is an acute viral infection caused by the Lassa virus and associated with persistent high fever. It is spread by exposure to and eating of foods contaminated with rat droppings or urine. It is also spread by direct contact with the blood, urine, faeces, or other bodily secretions of person with Lassa fever," Idris noted. He urged members of the public to report the case of anybody with the symptoms above, or persistent high fever that is not responding to standard treatment for malaria and typhoid fever, to the nearest health facility in the state.

The Commissioner noted that though Lagos state is not in the Lassa fever belt region, members of the public should practice adequate personal and environmental hygiene at all times to avert an outbreak of the disease in the state.

[Byline: George Okojie]

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Communicated by:
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[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. A photograph of a multimammate rat can be viewed at http://en.wikipedia.org/wiki/File:Mastomys.jpg.

Lassa fever is known to be endemic in Guinea (Conakry), Liberia, Sierra Leone, and parts of Nigeria, but probably exists in other West African countries as well. 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. The incubation period of Lassa fever ranges from 6-21 days. 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.

Humans usually become infected with Lassa virus from direct contact with rat droppings or urine and through touching objects or eating food contaminated with rat droppings or urine of infected _Mastomys_. 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.

Prevention of Lassa fever in the community centers on promoting good "community hygiene" to discourage rodents from entering homes. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats. Because _Mastomys_ are so abundant in endemic areas, it is not possible to completely eliminate them from the environment. Further information can be accessed at http://www.who.int/mediacentre/factshee ... index.html.

Lagos State is an administrative division of Nigeria, located in the southwestern part of the country. The smallest in area of Nigeria's states, Lagos State is the most economically important state of the country, containing Lagos, the nation's largest urban area. The HealthMap/ProMED-mail interactive map of Nigeria is available at http://healthmap.org/r/2iLp. - Mod.CP]

HEPATITIS E - SOUTH SUDAN: REFUGEE CAMPS
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Date: 14 Sep 2012
Source: Reuters [Edited]
http://in.reuters.com/article/2012/09/1 ... GF20120913


Hepatitis outbreak kills 16 in South Sudan refugee camps
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An outbreak of the Hepatitis E virus has killed 16 people in 3 South Sudanese refugee camps near the volatile border with Sudan, authorities and the United Nations said on Thursday. South Sudan's border region has been flooded with hundreds of thousands of refugees fleeing fighting in Sudan's South Kordofan and Blue Nile states.

South Sudan's Ministry of Health has reported almost 400 cases of the virus since the outbreak was identified in July [2012]. "Cases are rising day by day, thus placing immense pressure on the available heath services and resources. This is of grave humanitarian concern," the ministry said in a joint statement with U.N. agencies. In Maban county, the area affected, 108 000 Sudanese refugees live in camps in dire conditions, aid officials say. Hepatitis E causes liver infections and is spread by drinking water contaminated with faeces. John Lagu, director of preparedness and response at the Ministry of Health, said the virus thrived in camps that are overcrowded and flooded.

"The good thing is that the virus is not very aggressive ... and that cases of mortality are low. Few people die from it," Lagu told Reuters by telephone.

However, he warned that there was a risk the virus could spread to local people, who have less access to healthcare than those in the camps. "It's just another indication of the very bad conditions that are there," said Stefano Zannini at medical aid group Medecins Sans Frontieres. "There is a lack of food, clean drinking water and the number of latrines is very low ... so you have all the right conditions for this type of outbreak to take place," he said. South Sudan became independent in July 2011 from Sudan under a 2005 peace agreement that ended decades of civil war but the two nations are at loggerheads over demarcation of the border and other issues.

[Byline: Hereward Holland; Editing by Ulf Laessing]
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Communicated by:
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[Hepatitis E is a form of viral hepatitis (HEV) that is spread by the fecal-oral route and may cause waterborne outbreaks in settings of poor sanitation. Human infection normally causes a self-limited hepatitis but rarely may cause fulminant disease (in less than 1 per cent), which is a particular problem in pregnant women with mortality of 20% reported during the 3rd trimester of pregnancy. The 16 deaths reported here suggests a very large number of infected individuals. An incubation period following exposure to HEV has been described from 3-8 weeks, with a mean of 40 days. The period of communicability is unknown. There are no chronic infections reported.

A recombinant vaccine has recently been developed in China, though it has not been widely tested in pregnant women (see for example: Labrique AB, Sikder SS, Krain LJ, et al. (2012) Hepatitis E, a Vaccine-Preventable Cause of Maternal Deaths. Emerg Infect Dis 18(9):1401-1401. Available at http://dx.doi.org/10.3201/eid1809.120241. HEV is likely also a cause of zoonotic disease, found in several animal species. In developed countries infection has been described, particularly following ingestion of pork liver. - Mod.LM

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3q1_.]

LEISHMANIASIS, VISCERAL - SOUTH SUDAN (UNITY STATE)
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Date: Thu, 6 Sep 2012
Source: http://www.sudantribune.com/spip.php?article43808 [edited]


Outbreak of visceral Leishmaniasis in Unity State, South Sudan
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Unity State health officials and the World Health Organization are struggling to contain an outbreak of Kala azar, a disease spread by sand-fly bites, in Koch County, 90 kilometres south of the state capital Bentiu.

Dr. Santino John Tabang, Director general of the Health Ministry in Unity State, informed on 5 Sep 2012 that since 1 Sep [2012], nearly 200 people are believed to have contracted Kala azar, with 84 being treated in Koch County Hospital for the potentially fatal disease that has already killed one person.

There was a previous Kala azar outbreak in Unity State in late 1980 during the civil war between Khartoum and former rebels who now govern the independent Republic of South Sudan.

South Sudan's largest state, Jonglei, normally has the most Kala azar cases. After the current outbreak, Unity State is now ranked second. Authorities are concerned about the spread of the disease, transmitted by sand-flies which live in bushy acacia trees which are common in South Sudan. The World Health Organization has transported drugs to Koch County to help treat victims but there are a lack nurses and ward space to cope with the number of patients.

Unity State health officials say they are working to put up more tents. "We can't say if the cases are still on the rise, so the capacity will be limited, so we have a plan to put up tents in future so to accommodate if people are still going and the cases are still going [on] and in terms of human resources, we have human resources but we are thinking of sending more teams, more staff to help".

Dr. Tabang urged people to move away from bush areas in order to limit the transmission of the disease and encouraged people to use mosquito nets at night and in the evening to decrease the risk of being bitten. The symptoms of Kala azar include fever, weight loss, and loss of appetite. Without proper treatment the mortality rate for kala-azar almost 100 [percent].

[Byline: Bonifacio Taban Kuich]

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Communicated to ProHED-mail from Health Map alerts

[South Sudan and Sudan are highly endemic for Leishmaniasis. The statement that 200 people are infected in just 5 days is difficult to substantiate as the disease has an incubation period of weeks to months, but there is no doubt that Leishmania is highly prevalent, has a high mortality and is out of control.

A recent review of the distribution of Leishmaniasis (Alvar J et al & the WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671. Supplementary material S81) which provides detailed data from South Sudan, reports that more than 90 per cent of global visceral leishmaniasis (VL) cases occur in 6 countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. The annual number of reported cases in Sudan is estimated between 15 700 and 30 300, and in South Sudan 7400 to 14 200 with an estimated underreporting of up to 8-fold in both countries. However, asymptomatic cases occur and the proportion of the population infected without symptoms is not known. 10 per cent of VL cases in South Sudan are estimated to be co-infected with HIV, and malnutrition is further adding to the risk of developing clinical leishmaniasis. - Mod. EP]

[For Unity state, South Sudan, see Healthmap at:
http://healthmap.org/r/3qgC - Mod.JW]