Wüstenschiff

HEPATITIS E - SOUTH SUDAN (02): CHRONIC
****************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: 15 Sep 2012
From: Yannick Debing [Edited]


To further improve the information you are providing, I would like to correct a minor mistake in the general information on hepatitis E virus (I am currently doing a PhD on the virus). Contrary to what is stated [in the post], chronic infections have been reported since 2008, mainly in immunocompromised individuals like transplant or HIV patients.

This is a link to the 2008 publication that first reported chronic HEV infection: http://www.ncbi.nlm.nih.gov/pubmed/18287603 (Kamar N et al., Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008 Feb 21;358(8):811-7.)

A good review on the subject can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21458513 (Aggarwal R. Clinical presentation of hepatitis E. Virus Res. 2011 Oct;161(1):15-22. Epub 2011 Mar 31.)

Reduction of immune suppression and both interferon and ribavirin have been found effective in treating chronic hepatitis E.

I hope this will help to improve the background information on HEV.

--
Yannick Debing, PharmD
PhD student
Rega Institute for Medical Research
University of Leuven (KU Leuven)
Minderbroedersstraat 10
B-3000 Leuven
BELGIUM


[We appreciate Yannick Debing's correction updating us on the occurrence of chronic hepatitis E in immunosuppressed individuals. - Mod.LM]

Cholera in Sierra Leone - update
18.09.2012 - WHO

As of 16 September 2012, a cumulative total of 18,508 cases including 271 deaths (with a case fatality ratio of 1.5%) has been reported in the ongoing cholera outbreak in Sierra Leone since the beginning of the year.

The highest numbers of cases are reported from the Western area of the country where the capital city of Freetown is located.

The Ministry of Health and Sanitation (MOHS) is closely working with partners at national and international levels to step up response to the cholera outbreak. The ongoing activities at the field level include case management; communication and social mobilization; water, sanitation and hygiene promotion; surveillance and data management.

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.

At the national level, the Cholera command and Control Centre (C4) continues to provide technical advice, coordinate and monitor the outbreak. The C4 was established to implement activities related to the 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.

WHO and partners are supporting the government in the response to the outbreak. Through the Global Outbreak Alert and Response Network (GOARN), experienced case management and laboratory experts from the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B) are deployed to build capacity among health-care workers and laboratory technicians in case management and laboratory diagnosis.

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

Gruß
Birgitt

WEST NILE VIRUS - TUNISIA
***************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: 19 Sep 2012
Source: Epi South eWeb 235 [edited]
http://www.episouthnetwork.org/sites/de ... _09_12.pdf


Tunisia
-----
On 18 Sep 2012, the Tunisian ministry of health reported to EpiSouth 3 additional confirmed West Nile virus cases in humans:
- 2 women aged 29 and 33 years old from north of Kebili city (Rabra and Tombar, cf. map 3) were hospitalized at the end of August 2012 for fever, severe headache, and vomiting.
- An 80-year-old male farmer from Zeramine, Monastir governorate, was hospitalized on 1 Sep 2012 with meningocencephalitis.

The Pasteur Institute in Tunis confirmed that these 3 cases were infected with WNV. Samples of sporadic suspect cases in the Gabes area have been tested: 2 cases were negative, while 6 other cases are still under investigation.

The last WNV human case in Tunisia was reported on August 2012 in Ksar Helal, Monastir governorate. To date in Tunisia, a total of 4 WNV human cases were reported.

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

[This is the 1st ProMED-mail report of human WNV infections in Tunisia.

Maps of the affected areas are shown in the above URL. - Mod.TY]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (44): AFRICA
**************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update:


Africa
[1] Cholera - Sierra Leone
[2] Cholera - Sierra Leone, Guinea
[3] Cholera - Ghana (Greater Accra, Upper East regions)
[4] Cholera - Ghana (Volta region)
[5] Cholera - Somalia (Lower Juba region)


******

[1] Cholera - Sierra Leone

Date: Wed 19 Sep 2012
Source: China Central Television (CCTV), Xinhua News Agency report [edited]
http://english.cntv.cn/20120919/101308.shtml


A total of 18 508 cases have been reported in the ongoing cholera outbreak in Sierra Leone as of 16 Sep 2012 since the beginning of 2012, and of these 271 people died, the WHO said Tue 18 Sep 2012. The highest numbers of cases are reported from the western area of the west African country where the capital city of Freetown is located, according to WHO.

The Ministry of Health and Sanitation of Sierra Leone has been stepping up response to the outbreak. Emphasis is being placed on early detection of cases and timely provision of treatment at the district levels in order to reduce deaths, the WHO said. WHO has deployed case management and laboratory experts through the Global Outbreak Alert and Response Network [GOARN] to build capacity among health-care workers and laboratory technicians in case management and laboratory diagnosis.

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

[A HealthMap/ProMED-mail map of Sierra Leone can be accessed at http://healthmap.org/r/1KlT. - Mod.LL]

******
[2] Cholera - Sierra Leone, Guinea
Date: Mon 24 Sep 2012
Source: gantdaily.com, UN Integrated Regional Information Networks (IRIN) News [edited]
http://gantdaily.com/2012/09/24/cholera ... rra-leone/


The cholera outbreak in Guinea and Sierra Leone that has killed 392 people and infected more than 25 000 others since February 2012 is slowing down, say aid groups who also call for sustained measures to wipe out the disease. Between late August 2012 and 16 Sep 2012, new cholera cases per week have dropped from 2110 to 1418 in Sierra Leone and from 1152 to 346 in neighboring Guinea, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in a report.

"The situation is improving faster in Guinea in terms of new cases and in Sierra Leone in terms of lethality. The number of affected districts remains unchanged: 12 out of 13 in Sierra Leone and 11 out of 33 in Guinea," OCHA said. In Sierra Leone, updates from 84 health centres in the hardest hit Western Area indicated that there were 112 cases and one death in 32 health centers, and no deaths or cases in the rest on 18 Sep 2012, according to the UN Children's Fund (UNICEF).

"I think it doesn't necessarily mean it [the cases] would not go up. It does seem that things are getting better, but we need to be cautious. It's certainly a good sign of the huge amount of work we have been doing," said Nicole Robicheau of the International Federation of Red Cross and Red Crescent Societies.

The outbreak is Sierra Leone's worst in 15 years. The government declared a national emergency in August 2012. The authorities and aid groups have rallied to treat thousands of infected people, educate the population on basic hygiene practices and sanitize water sources. "In the long run cholera prevention is a question of hygiene and sanitation, especially in densely populated areas. Access to safe water and sanitation facilities remains very limited in Sierra Leone," said Angela Griep, UNICEF's external relations chief in Sierra Leone.

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

[A HealthMap/ProMED-mail map of Sierra Leone can be accessed at http://healthmap.org/r/1KlT and a HealthMap/ProMED-mail map of Guinea can be accessed at http://healthmap.org/r/1tx-. - Mod.LL]

******
[3] Cholera - Ghana (Greater Accra, Upper East regions)
Date: Mon 24 Sep 2012
Source: GhanaWeb [edited]
http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=251228


Over 200 cases of cholera have been recorded within 2 weeks in the Greater Accra region, raising concerns about the sanitation situation in the region's busy centers. Health officials say they are marveled by the increase in the figures and say they intend intensifying their sensitization programs.

Last week [week of 17 Sep 2012], there were reports of an outbreak of the disease in parts of the Upper East Region following the floods in the area.

The Disease Control Officer at the regional Ghana Health Service unit, Ato Ashong told XYZ News some drastic measures will have to be taken to reverse the trend.
According to Mr Ashong, the cases have shot up from double figures to more than 200 cases in the last few days.

He said the unit is not certain about what might have caused the sudden upsurge in the disease but assured that it will be liaising with health centers across the region to handle the cases.

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

[A HealthMap/ProMED-mail map of Ghana can be accessed at http://healthmap.org/r/1jUt. - Mod.LL]

******
[4] Cholera - Ghana (Volta region)
Date: Thu 20 Sep 2012
Source: GhanaWeb [edited]
http://www.ghanaweb.com/GhanaHomePage/h ... ?ID=250925


Information reaching Today indicates that 10 people have died from the cholera outbreak in some parts of the Volta Region. According to the sources, 5 of the deaths were recorded in Akatsi South while the 6th death was recorded in Adidome, and 4 were recorded at the Battor-Aveyime Traditional area in the North Tongu District.

Insiders revealed that about 14 electoral areas in the Akatsi District and North and Central Tongu Districts in the region are all battling with the disease, for which several people have been hospitalised at Battor Roman Catholic Hospital, Akatsi, and Sogakope Government Hospital in the region. Speaking on various media networks to confirm the deaths of the people in the region, the Assemblyman for the Wute Electoral Area, Sammy Wuadi, said the cholera outbreak did not come as a surprise and that the people are being reminded to keep their surroundings clean.

Environmental Health Assistant in the Akatsi South District, who pleaded anonymity, told Today that residents in the region are being advised to desist from drinking from the Tordji River, which is believed to have been contaminated. "We suspect that that is the source of the cholera outbreak and we are also educating them to be careful with the food they eat," they said.

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

******
[5] Cholera - Somalia (Lower Juba region)
Date: Tue 18 Sep 2012
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN) News [edited]
http://allafrica.com/stories/201209181341.html


A suspected cholera outbreak has killed about a dozen people in the southern Somali village of Hoosingo, in the district of Badade in Lower Juba, say government and health officials. "One of the biggest problems we have is that we do not [know] what this disease is," Adan Ibrahim Dhaqane, the Hoosingo Village commissioner, told IRIN by telephone. "Schools, madrasas [schools or colleges for the study of the Islamic religion], [and] restaurants are all closed to prevent the disease from spreading," he said.

Dhaqane said that at least 19 people had died since the outbreak started on 5 Sep 2012, with 12 others sick. "We call [on] the aid agencies to help us in the following areas: provision of a steady supply of medicine, [the] identification of the disease, and the setting up of health centres. We have no hospital, no MCH [maternal and child health centre], and no other health facility, simply tents."

According to a recent Somalia emergency health update by the WHO, some 12 deaths and 107 cases of the disease were reported between 5-13 Sep 2012, the majority of them being children above the age of 5.

Hoosingo is located about 100 km [62 mi] from the Kenya-Somalia border town of Liboi and is not served by any health facilities, notes the WHO update, which expresses concern about the increased risk of a widespread cholera outbreak in Lower Juba Region and along the Kenya-Somalia border.

"Suspected cases have [also] been reported from Waraq, some 70 km [43.5 mi] from Liboi. These areas [Hoosingo and Waraq] are transit points into Kenya, hence the risk of cross-border transmission," stated the emergency health update.

Insecurity in parts of the Lower Juba region has rendered some areas inaccessible. "With the ongoing conflict and subsequent population displacement and disruption of the existing health service access points in the region, the risk of sporadic cholera outbreaks in the Southern zone cannot be excluded," notes the WHO update, urging health and water and sanitation partners to remain vigilant and report any suspected cases of the disease.

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

[A HealthMap/ProMED-mail map of Somalia can be accessed at http://healthmap.org/r/1Ahv. - Mod.LL]

RABIES - NIGERIA: (CROSS RIVER) CANINE, HUMAN, SUSPECTED
********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Sun 30 Sep 2012
From: Bassey Ekong (Ephraim) , via One Health Nigeria [edited]


Rabies deaths in Cross River State
----------------------------------
I think it's high time rabies is given its desired attention as an important health issue in the country [Nigeria]. I'm saying this based on the present situation in my state (Cross River). About 8 persons have died of suspected rabies in the past 4 months. A combined multisectoral team just concluded initial investigation, [and] dog heads [have been] forwarded to the NVRI [National Veterinary Research Institute, Vom, Nigeria] for confirmatory laboratory diagnosis.

We as vets in the state are [conducting] mass vaccination of dogs [in the absence of any form of protection and pre-exposure prophylaxis] because these are not available. Our lives are [on] line, and on a daily basis dog bite cases are reported to the State Veterinary Clinic in Calabar. I think this calls for an urgent intervention.

--
Communicated by:
Shamsudeen Fagbo, DVM

[Shamsudeen Fagbo commented that: "The correspondent has suggested Nigeria should be talking about other health issues that don't seem to be getting desired attention, other than polio. Definitely rabies comes to mind in this respect.

Information on the outcome of the confirmatory diagnostic tests is awaited.

A HealthMap/ProMED-mail interactive map of Nigeria can be seen at http://healthmap.org/r/3BOt. A map showing the location of Cross River state in the south of the country can be accessed at http://www.waado.org/nigerdelta/maps/Ni ... tates.html. - Mod.CP]

MUMPS - EGYPT: VACCINE SHORTAGE
*******************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Mon 1 Oct 2012
Source: The Disease Daily [edited]
http://www.healthmap.org/news/over-100- ... reak-10112


Egyptian Children Face Mumps Outbreak
-------------------------------------
More than 100 children have been affected by a mumps outbreak in Marashda [official name Al Marāshidah located in Qina governorate], Egypt, with 43 cases and 70 infections reported. Officials at the Ministry of Health insist that this is not a serious outbreak. However, many children are not attending school out of fear of infection.

Mumps is caused by mumps virus and is spread when a person comes into contact with infected droplets of saliva or mucus, usually through coughing, sneezing, or sharing dishes. Symptoms of the disease include fever, headache, and fatigue, along with serious complications such as inflammation of the brain and deafness.

Egyptian officials are working to provide treatment for infected youth. However, vaccination is considered the best strategy for avoiding mumps infection. The vaccination for mumps is a combination vaccine for measles, mumps, and rubella, (MMR). It is recommended that children receive 2 doses: one at age 12-15 months and another at age 4-6 years. The 1st MMR vaccine became available in 1967 and has reduced mumps prevalence by 99 percent.

This outbreak has occurred alongside news that Egypt is facing a nationwide vaccine shortage. Administrative delays have prevented the health ministry from replacing expired vaccines. While vaccines are available in private clinics, their costs make them unattainable to most patients. "The longer the government fails to immunize these children, the more vulnerable to disease they are," explained Eman Masoud, head of the Pediatrics Section at Abul Riesh University Hospital in Cairo.

Experts recommend that people experiencing symptoms of mumps contact a provider immediately and avoid situations where they might infect others, such as in a clinic waiting room.

[Byline: Lauren Edmundson]

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

[It is likely that this large outbreak of mumps virus infection is a consequence of disruption of the routine programme of immunisation of children with the combined MMR (mumps, measles and rubella) vaccine due to a temporary shortage of vaccine in Egypt.

Mumps virus was isolated in 1945, and an inactivated vaccine was developed in 1948. This vaccine produced only short-lasting immunity, and its use was discontinued in the mid-1970s. Most vaccines contain the Jeryl Lynn strain of live attenuated mumps virus vaccine. Mumps vaccine produces an inapparent, or mild, noncommunicable infection. More than 97 percent of recipients of a single dose develop measurable antibody. Seroconversion rates are similar for single antigen mumps vaccine or the combined MMR vaccine. A study in the United Kingdom documented vaccine effectiveness of 88 percent with 2 doses. The duration of vaccine-induced immunity is believed to be greater than 25 years, and is probably lifelong in most vaccine recipients. - Mod.CP

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

UNDIAGNOSED FEVER - SUDAN: (ZALINGEI) REQUEST FOR INFORMATION
*************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Sun 7 Oct 2012
Source: AllAfrica via Radio Dabanga (Hilversum) [edited]
http://allafrica.com/stories/2012100800 ... e=acrdn-f3


A number of citizens have passed away as a result of an unknown fever in Central Darfur during the past 2 days. The reports on the exact number of victims are conflicting; eye-witnesses say at least 10 people died, while a medical source from Zalingei confirmed the deaths of 2 people so far. One of the victims comes from the area of Doudou, west of Zalingei, and the 2nd victim was working in Jebel 'Aamer, North Darfur in the gold mines.

[A medical source] said the 2 victims died from injuries [?] caused by measles [virus infection]. The source disclosed they received several reports on the spread of the fever. The areas of Korley, Tur Kolmey, and Doudou have all seen cases of the fever.

The medical source told Radio Dabanga that a team was sent to Korley, south east of Zalingei, to determine the seriousness of the situation and to take samples from patients. Witnesses told Radio Dabanga that most of the victims of the unknown fever are Arab nomads and gold excavation workers. They added that the patients suffer from headaches, vomiting, and fatigue.

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

[Zalingei or Zalinjay is a town and district in western Sudan and is capital of the state of Central Darfur. It is an important hub for humanitarian agencies working in the troubled Jebel Marra area to the east and is itself the location of a large number of people displaced from their homes by fighting and other problems elsewhere in Darfur. The number of displaced persons in Zalingei surpasses the number of its residents. Zalingei also has 3 major Internally Displaced Person (IDP) camps in its vicinity.

The deaths of 2 people have been attributed to measles virus infection. In other cases, vomiting and fatigue are mentioned. Hepatitis E and visceral leishmaniasis are known to be prevalent in the region. Further information is awaited.

The interactive ProMED/HealthMap of Darfur can be accessed at http://healthmap.org/r/3EpA. - Mod.CP]

Cholera in Sierra Leone - update
08.10.2012 - WHO

The Ministry of Health and Sanitation (MOHS) continues to work closely with partners at the national and international levels to step up response to the ongoing cholera outbreak. Twelve of the 13 districts in Sierra Leone have been affected since the beginning of the year.

In the last 2 months, remarkable progress has been made in controlling the outbreak. A steady decline in daily reported cases continues to be observed. As of the 2 October 2012 the national cumulative number for all twelve districts is 20 736 cases, including 280 deaths (case fatality rate or CFR=1.35%). The cumulative CFR declined from an average of 3.2% in July 2012 to below 0.5% in September 2012. Two (2) deaths have been reported in the last 8 days (since 23 September 2012). The western area of the country where the capital city of Freetown is located has been the most affected location with more than 50% of total cases.

In July 2012, the President of Sierra Leone declared the cholera epidemic a ‘’humanitarian crisis’’. A high level Presidential Cholera Task Force was subsequently 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 United Nations Children’s Fund (UNICEF), Oxfam, British Red Cross, Save the Children, Care, Concern, Médecins Sans Frontières (MSF), UK Department of International Development (DFID), UN Office for the Coordination of Humanitarian Affairs (OCHA), International Rescue Committee (IRC), and WHO, the MOHS has scaled 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 also provides information to guide the decision-making of the national task force.

Emphasis is being placed on hygiene promotion, 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.

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 levels have been 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.

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

Gruß
Birgitt

MUMPS - EGYPT (02): NATIONWIDE
******************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Mon 8 Oct 2012
Source: Examiner.com [edited]
http://www.examiner.com/article/egypt-m ... s-one-week


Egypt mumps outbreak more than triples in one week
--------------------------------------------------
An outbreak of the viral infection, mumps, has spread through schools nationwide in Egypt, according to an Egypt Independent report on Mon 8 Oct 2012. The number of cases reported as of Monday [8 Oct 2012] is 583; this is up from 157 cases reported just one week earlier.

Despite the surge in mumps cases, a spokesman for the Education Ministry said that no schools have been closed due to the outbreak.

According to the report, Giza Governorate has so far reported the most number of cases, with 240. Minya has reported 95, Beni Suef 48, and Fayoum 38, with Cairo reporting only 12.

Last week, Health Ministry undersecretary Amr Qandil projected rising numbers of mumps cases this winter season, but assured it would not be a public health emergency.

Mumps is also an acute viral disease that is characterized by fever and swelling and tenderness in one or more of the salivary glands. Maximum infectiousness occurs between 2 days prior to onset of illness to 4 days afterwards. It is spread from person-to-person by respiratory droplets (for example, when you sneeze) or by direct contact with items that have been contaminated with infected saliva.

Complications to mumps may include: orchitis (which has been reported to be a risk factor for testicular cancer), encephalitis and spontaneous abortion. Sterility in males is a rare possible outcome.

Mumps can be prevented with vaccination. Two doses of mumps vaccine are 88 per cent (range: 66-95 per cent) effective at preventing the disease; one dose is 78 per cent (range: 49-92 per cent) effective.

[byline: Robert Herriman]

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

[Just 7 days ago more than 100 cases of mumps were reported in Qena governorate. Now 583 cases have been reported from 5 other governorates. Giza Governorate has so far reported the most case with 240, followed by Minya with 95, Beni Suef with 48, Fayoum with 38, and Cairo with only 12.

Previously the outbreak in Qena governate was attributed to an interruption in the supply of MMR vaccine. It would seem that the vaccine shortage extends country-wide. If so, a corresponding increase in the prevalence of measles virus infection would be expected also.

A map of the locations of the governorates of Egypt can be accessed at http://en.wikipedia.org/wiki/Governorates_of_Egypt. - Mod.CP

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

WEST NILE VIRUS - NORTH AFRICA: TUNISIA
***************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: 10 Oct 2012
Source: EpiSouth Weekly Epi Bulletin 238 [edited]
http://www.episouthnetwork.org/sites/de ... _10_12.pdf


For the period 3-9 Oct 2012
---------------------------
On 5 Oct 2012, the Ministry of Health in Tunisia reported to EpiSouth 8 new confirmed human cases of West Nile virus [infection] among patients hospitalised from 9-28 Sep 2012. To date, a total of 15 confirmed WNV cases in humans have been reported in 2012, including:

- 2 cases in Monastir governorate (Ksar Helal and Zarmedine)
- 5 cases in Kebili (North Kebili, Kebili and Souk Lahad)
- 8 cases including one death in a 69 year old man in Gabes governorate (El Menara, Gabes, Mareth and Zarat)

Another probable case from Jendouba was positive for West Nile [virus? antibody?], but this case presented underlying pathologies including zona and immuno-depression, which could question the diagnosis. Further investigations are in process for this case.

The last WNV human cases reported in Tunisia dated from 18 Sep 2012. Since 2010, Tunisia has reported the following West Nile virus cases:

- In 2010, 3 cases were reported (Jendouba and Tataouine).
- In 2011, 3 cases were reported (Kebili, cf. eWEB 189).
- In 2012, 15 cases were reported (Monastir, Kebili and Gabes governorates).

The increasing number of reported cases in 2012 compared with 2010 and 2011, in addition to the geographical extension to new areas, are likely to indicate a stronger WNV dynamic in Tunisia this year [2012].

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

[There were ProMED-mail posts from 2003 indicating that there were 20 cases of human WNV infections without fatalities in central Tunisia (see archives cited below). Occurrence of WNV human infection in Tunisia is not surprising because sporadic human and equine cases are reported from countries in the Mediterranean Basin.

The above URL for the EpiSouth report provides maps showing the locations of the Tunisian governorates where the WNV cases occurred. - Mod.TY

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

RABIES - NIGERIA (02): (CROSS RIVER), CANINE, HUMAN, OIE
********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 12 Oct 2012
Source: OIE's WAHID interface, Weekly Disease Information 25 (42) [edited]
http://www.oie.int/wahis_2/public/wahid ... rtid=12363


Rabies, Nigeria
---------------
Information received on [and dated] 12 Oct 2012 from Dr Joseph Nyager, director/CVO, Federal Department of Livestock, Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria

Summary
-------
Report type: immediate notification
Date of start of the event: 12 Apr 2012
Date of pre-confirmation of the event: 20 Jun 2012
Reason for notification: unexpected increase in morbidity or mortality of a listed disease

Summary
Description: a suspected case of rabies in a human with a history of dog bite 3 months earlier died with classical signs of rabies. Several more human deaths have occurred since then in Cross River State, South Eastern Nigeria.
Manifestation of disease: clinical disease
Causal agent: Rabies virus
Serotype: not typed
This event pertains to a defined zone within the country.
Outbreaks: there are no new outbreaks in this report.

Epidemiology
Source of the outbreak(s) or origin of infection: unknown or inconclusive
Epidemiological comments: the affected zone/state is known for trade of dogs and consumption of dog meat. These dogs come from various parts of the country including from neighbouring countries. There have been 8 human deaths traced to dog bites, and the dogs were disposed of before reports got to the veterinary authorities. Samples from the dogs were not submitted.

Increased distribution
Disease impact: incidence and mortality in dogs in the Cross River state increased x3.

Control measures
Measures applied: vaccination in response to the outbreak(s); no treatment of affected animals
Measures to be applied: no other measures

Future reporting: the event is continuing. Weekly follow-up reports will be submitted.

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

[The above notification may have been triggered by the recent submission by Dr Shamsudeen Fagbo, circulated in ProMED-mail's posting 20121002.1320026, which included concerning data on about 8 people who have died of suspected rabies in the past 4 months in Cross River. According to Dr Fagbo's information, the suspected dogs' heads have been forwarded to the NVRI [National Veterinary Research Institute, Vom, Nigeria] for confirmatory laboratory diagnosis. His alarming information was accompanied by Mod.CP's commentary, which concluded: "Information on the outcome of the confirmatory diagnostic tests is awaited." The current immediate notification does not include the results and details of laboratory investigations.

According to Nigeria's reports to the OIE, the annual number of reported rabies cases in dogs were the following: 2007 -- 2; 2008 -- 23; 2009 -- 24; 2010 -- 5; 2011 -- 11; during the 1st 6 months of 2012 -- 6 cases. Cases were reported from Cross River only during 2011; this may be indicative of underreporting.

Human rabies cases were reported to the OIE every year without quantitative data.

Subscribers are referred to Dr Fagbo's significant observations. - Mod.AS

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

MALARIA - SOUTH SUDAN: (NORTHERN BAHR-EL-GHAZAL)
***********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 12 Oct 2012
Source: Medecins Sans Frontieres [edited]
http://www.msf.org.uk/articledetail.asp ... n_20121012


South Sudan: malaria cases triple in Aweil
------------------------------------------
Since last year [2011], the number of malaria cases in Northern Bahr-el-Ghazal state, South Sudan, have tripled. Medecins Sans Frontieres/Doctors Without Borders (MSF) teams are currently tackling this crisis in the town of Aweil.

Interview with Dr Andre Munger:
What is the scale of this crisis? Between March and August 2012 MSF teams have admitted more than 1000 children suffering from malaria -- 3 times more than in the year before.

Since 2010, the number of people MSF has admitted for malaria has continued to rise and this year is now far worse than previous years. What has caused this surge in cases? In Aweil Civil Hospital, MSF works together with the Ministry of Health to try and reduce maternal and paediatric mortality, treat malnutrition and respond to emergencies.

There were many more mosquitoes in the region not only because the rainy season began earlier than usual but also because the rains were particularly heavy. Also, this year there were no distributions of mosquito nets, which are the best means of prevention.

After severe rains and flooding, some areas became isolated limiting people's access to health services. On top of that, medical stocks to treat malaria ran out for a 2-month period as 2 million anti-malarial treatment kits expected by the Ministry of Health did not arrive until July [2012].

Finally, large numbers of South Sudanese who were living in Sudan have returned to Aweil, South Sudan, since the country's independence. These people have less immunity to malaria and are more likely to develop the disease.

Mortality rates among children with malaria has surged since July due to a lack of medication and because gravely ill children were brought in for treatment too late. Hence, we saw an exceptional mortality rate of 8 per cent in the beginning of September [2012], which came back down to "acceptable" numbers very quickly.

How is MSF combating this spike in malaria cases? More MSF staff have been sent to the area and this extra capacity means more people are able to be hospitalised and cared for in severe cases. In addition MSF is providing support to the outpatient and antenatal services of the Ministry of Health-run sections of Aweil hospital. MSF has been working in Aweil Civil Hospital, in Northern Bahr-el-Ghazal State, since 2008. It is the only hospital in the state, serving a population of about 750 000 people. Takuro Matsumoto/MSFA mobile clinic was set up Maperkot where we already have an ambulatory treatment centre for malnutrition. In the outlying areas of Northern Bahr-el-Ghazal, MSF is providing support to 4 health structures in Arroyo, Akuem, Malek Alel, and Bar Mayen. In just one month, 3180 people presented with symptoms of malaria, such as high fever, and thanks to rapid tests 2064 cases were confirmed as malaria.

MSF also supports 5 health facilities supported by other organisations, as well as 3 non-governmental organizations (NGOs) involved in the fight against the malaria peak. Working with the Ministry of Health, we have transported 93 000 malaria treatment kits to Northern Bahr-el-Ghazal, distributing them in 87 health facilities in the region. Finally, Epicentre, MSF's epidemiological centre, set up a system of surveillance and data collection on the rise in cases.

What can we expect in the months and years to come?
Spikes of malaria generally start in May and begin to subside in September and October, hitting their lowest point in December. However, at the moment there is still flooding in the area and therefore a high number of mosquitoes. Because malaria cases are usually lower at this time of year MSF's activities are correspondingly reduced. However, as there are more cases this year we will continue to combat the outbreak. Thanks to the diverse measures MSF teams have taken to combat this spike in malaria cases, the global mortality has fallen to 5 per cent, which is "reasonable" in an epidemic like this.

MSF in Aweil, South Sudan
Since 2008, MSF has been working in Aweil, a city of around 40 000 inhabitants and the capital of Northern Bahr-el-Ghazal state. In Aweil hospital, the only secondary-care hospital for all of Northern Bahr-el-Ghazal, MSF is supporting the paediatric services (intensive care, tetanus treatment, neonatal care, and nutritional support) and obstetric and gynecological care. Our objectives are to reduce maternal and infant mortality and to respond to emergencies, such as this malaria epidemic.

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[South Sudan is highly endemic for malaria. The resistance situation was discussed in our previous posting (Malaria - South Sudan: (Unity): 20111002.2968) and treatment is based on artemisinin combination therapy, ACT. Long-term control probably rests on impregnated bed nets, but the bed net coverage in Sudan and South Sudan are not mentioned in the World Malaria Report for 2011 (http://www.who.int/malaria/world_malari ... annex4.pdf). This probably indicates that coverage is low. - Mod.EP

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

Ägypten - Mumps
12.10.2012

In ägyptischen Schulen wurden bis zum 8. Oktober 583 Mumps-Infektionen gemeldet, noch 1 Woche zuvor waren nur 157 Schüler erkrankt. Impfschutz beachten. / Quelle: crm

Gruß
Birgitt

LEISHMANIASIS, VISCERAL - SOUTH SUDAN (03): (JONGLEI)
*****************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Sun 14 Oct 2012
Source: Sudan Tribune [edited]
http://www.sudantribune.com/spip.php?article44187


At least 10 people have died and 42 others admitted in to hospital following the recent outbreak of kala-azar [visceral leishmaniasis] in Ayod County in South Sudan's Jonglei State, local leaders say.

According to Nelson Kuach Thoat, a member of Jonglei State Legislative Assembly representing Ayod, 7 people died in Pagil Payam [district] while 3 died in Jech Boma [sub-district].

Cases of kala-azar are common in the water-logged remote areas of Ayod, Pigi, and Fangak counties of northern Jonglei state. Annual reports of death and hospitalization from the disease during the rainy season are not new but little has been done to combat the situation.

Over 50 people died of kala-azar last year [2011] in Fangak and Ayod between May and June. Local leaders have blamed the recent heavy rains for this year's kala-azar cases. The MP said that on 9 Oct 2012 it rained for almost 24 hours straight.

Kala-azar is a parasite-carried infectious disease transmitted by sand flies. The disease is fatal if not treated after few days. The Commissioner of Ayod, James Mawich Makuach, told UN Radio Miraya in a phone interview on Wednesday [10 Oct 2012] that shops and residential areas have been swept away by floods in Ayod and called on the UN and government to help.

Jonglei State's Minister of Health, Jehan Makuei Deng, says an assessment to area will commence soon but flooded roads have made Twic East, Duk, and Ayod County inaccessible.

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

[For a review of the data on leishmaniasis in Sudan and South Sudan see the comments to the ProMED-mail posting from 16 Sep 2012 (Leishmaniasis, visceral - South Sudan (02): (UY) 20120916.1295988). Leishmaniasis is highly endemic in Sudan and South Sudan. Leishmaniasis is not an acute disease and the statement that it is fatal within a few days if not treated suggests that other diseases, especially malaria, could also play a role in the outbreak. Malnutrition in the population probably contributes to the number of clinical cases of visceral leishmaniasis. Information about Jonglei State and its location can be found at http://en.wikipedia.org/wiki/Jonglei. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3I94.]

UNDIAGNOSED FATALITIES - DEMOCRATIC REPUBLIC CONGO: (KASAI OCCIDENTAL), REQUEST FOR INFORMATION
***********************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: 16 Oct 2012
Source: Radio Okapi [trans Mod.MPP, edited]
http://radiookapi.net/regions/2012/10/1 ... nue-mweka/


More than 10 people have died of an unknown illness during the last 2 weeks at the state post of Lubanga, over 70 km from the city of Mweka in the province of Kasai Occidental. The chief of the state zone indicated that 170 cases of this disease were reported during the same period.

The head doctor of the Mweka health zone, Dr. Honore Lukunku, indicated that the cases presented with symptoms of fever and vomiting blood. He said he sent specimens to the National Institute of Biomedical Research (INRB) in Kinshasa.

The epidemiologist of the World Health Organization (WHO) in Kananga confirmed this information.

--
Communicated by:
ProMED-FRA


[The brief description of the illness in the above newswire report suggests this may be an outbreak of one of the viral hemorrhagic fevers (VHF). Noteworthy is the relatively low reported case fatality rate (less than 6 percent) along with "170 cases in 2 weeks" that makes the known viral hemorrhagic diseases such as Ebola virus disease seem less likely, as the VHFs tend to be reported when there are fewer cases and more fatalities. It is noteworthy that Kasai Occidental is to the southwest of Oriental province where there is currently an ongoing outbreak of Ebola virus disease, one of the known hemorrhagic fevers to occur in the Democratic Republic of the Congo (DRC).

In 2008/2009, there was an outbreak of Ebola virus disease in Mweka, and in 2007, there was an outbreak of Ebola virus disease in Kampungu zone to the southeast of Mweka. In March 2010, there was an as yet undiagnosed outbreak of a hemorrhagic fever in Kasai Orientale province, in Kitule Health Zone. Information on the etiology of that outbreak is as yet unknown to ProMED-mail. But equally interesting is that in September 2012, the etiology of another undiagnosed viral hemorrhagic fever outbreak in 2009 in Bas Congo province of the DRC was finally identified as a novel rhabdovirus, newly named "Bas Congo virus" (see ProMED prior posts Bas-Congo virus - Congo DR: (BC), viral hemorrhagic fever, 2009, RFI 20120928.1314067 and Undiagnosed fatalities - Congo DR: (BC), hem fever susp, RFI 20090626.2326 for the original report). Kasai Occidental province is to the east of Bas-Congo Province. (see map of the DRC with provinces at http://www.mapsofworld.com/democratic-r ... al-map.jpg.

More information on the clinical presentations of the cases, results of epidemiologic investigations, and, when available, laboratory studies would be greatly appreciated by ProMED-mail.

For the HealthMap/ProMED map showing the location of Mweka, DRC see http://healthmap.org/r/3Kf3. - Mod.MPP]