Wüstenschiff

YELLOW FEVER - AFRICA (07): UGANDA (AGAGO)
******************************************
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 19 Oct 2012
Source: Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


A case of yellow fever was confirmed in the northern district of Agago
---------------------------------------------------------------
In Agago, district officials say, despite a mass vaccination against yellow fever [virus] in the past year [2011], the disease has reoccurred. The deadly disease, which doctors say can kill in one week, is recurring in Uganda after almost 40 years. It was last in Uganda in 1972.

The patient, admitted to Dr. Ambrosoli Hospital in Kalongo on 24 Sep [2012], was earlier suspected to be carrying Ebola virus but he instead tested positive for yellow fever.

Yellow fever is an acute viral hemorrhagic disease transmitted by infected female mosquitoes.

Patients experience fever, muscle and back pain, headache, shivering, loss of appetite and vomiting. Some of the patients develop yellow eyes, abdominal pain and bleeding from the mouth, nose, eyes and stomach.

Dr. Emmanuel Otto, the Agago district Director of Health Officer (DHO) said, "The single case should not be treated as an outbreak, but we are still investigating, it should not panic the population," Dr Otto said. He said a verification team has already been sent to monitor any new cases.

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

[Although the population should not panic as Dr. Otto suggested, the risk of a significant yellow fever (YF) outbreak should not be underestimated. The concern is that there may be other cases, as yet undetected or in the incubation period and not yet showing signs of infection.

The rapid response to the situation by district health authorities is commendable. The statement that Uganda has not had YF cases in 40 years is not correct. In 2010-2011, there was an outbreak in this same area with 224 cases and 53 deaths beginning in the Abim and Agago districts, with later spread to Kitgum and other 10 districts in northern Uganda (see ProMED-mail citations below). At that time, the Uganda Ministry of Health planned a massive YF vaccination campaign in the area. If that campaign was successful, one hopes that the risk of ongoing YF virus transmission is very low, and no additional cases will occur.

ProMED will be interested in further developments concerning the YF situation there, if any additional cases do occur. - Mod.TY]

[Agago District is bordered by Kitgum District to the north, Kotido District to the northeast, Abim District to the east, Otuke District, to the south, and Pader District to the west. It is located 230 miles to the north of Kampala. Agago District is one of the newest districts in Uganda having begun functioning in July 2010. Prior to then it was part of Pader District. It is part of the Acholi sub-region. For a map showing the location of Agago district within the northern region, see http://www.unhcr.org/refworld/type,MAP, ... e12,0.html; for a map with information on the 111 districts of Uganda, see http://reliefweb.int/sites/reliefweb.in ... 061031.pdf. And for the HealthMap/ProMED map showing Agago district, Uganda, see http://healthmap.org/r/3Lpc. - Mod.MPP]

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


Date: Wed 17 Oct 2012
Source: EpiSouth Weekly Epi Bulletin 239 [edited]
http://www.episouthnetwork.org/sites/de ... _10_12.pdf


On 4 Oct 2012, the French National Reference Laboratory for Arboviruses (ERBA) diagnosed one West Nile [virus] neuro-invasive case imported from Algeria. The case was a 74-year-old male resident in France who had travelled to Algeria:

- From 24 Aug to 11 Sep 2012, he stayed only in Jijel, located on the littoral between Alger and Annaba.

- He reported onset of fever on 12-13 Sep 2012 and was hospitalized on 16 Sep 2012 with fever and cognitive disorders. The patient died on 29 Sep 2012.

On 15 Oct 2012, The French National Reference Laboratory confirmed the diagnosis of WNV with seroneutralisation. No other suspect case has been identified among the patient's relatives in France.

This is the 1st reported case infected in Algeria since 1994 (cf. Note on 2010 and 2011 seasons WNV circulation).

In 2011, a sero-prevalence survey in humans showed that among 165 samples, 16 tested positive for WNV antibodies (unpublished study).

This case in Algeria occurs in a context of intensification of WNV circulation in the Mediterranean since 2010.

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

[This is the 1st ProMED-mail report of a West Nile virus infection in Algeria. However, its occurrence is not surprising since the virus has caused human and equine cases around the Mediterranean Basin in recent years, including 2012. In previous laboratory studies, WNV isolates from France in 1965, Algeria in 1968, and Morocco in 1996 belong to the same lineage. - Mod.TY

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

RABIES - GHANA: (KOFORIDUA), CANINE, HUMAN
******************************************
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 21 Oct 2012
Source: Allghana News [edited]
http://www.allghananews.com/general-new ... -koforidua#


5 children admitted at the Koforidua Regional Hospital with dog bites between April and October [2012] have died of rabies virus infection. The children, whose ages ranges between 5 and 7 years, died between 9 hours and 48 hours after admission to the hospital. Apart from one who hails from Koforidua, the rest were referred to the hospital from Obo Kwahu, Suhum, Asamankese, and the Atua Government Hospital near Krobo Odumase.

Commenting on the issue, the Acting Medical Superintendent of the Hospital, Dr Kwame Anim Boamah called on the Municipal and District Assemblies in the Eastern Region to collaborate with the Veterinary Services to embark on mass immunization of dogs and cats in the region against rabies to help reduce the incidence of rabies in the region. He called on the Ghana Education Service to educate school children about the disease to report any case of dog bite for early treatment. Dr Boamah also called on parents to report any dog bite [suffered by] their children [and to bring them] to the nearest health centre for early treatment.

Dr Emmanuel Amoah, the head of the Paediatrics Department of the hospital, said that rabies affects the nervous system, and once one contracts the disease, the survival rate is almost nil. He called for the provision of more anti-rabies vaccines at hospitals and clinics in the region to help save people who report with dog bites to the hospitals early enough for appropriate treatment.

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

[The rapid deaths of those children admitted to hospital for treatment after receiving dog bites suggest inadequate surveillance and lack of awareness of the severity of rabies virus infection and the need for rapid reaction.

Koforidua, also popularly known as Kof-town and K-dua, is a town and capital of the Eastern Region of Ghana and is about 2 hours by road from Accra via Nsawam Road through Suhum. Koforidua is the 13th most populous settlement in Ghana, with a population of 127 334 people (2012 census). Koforidua serves as a commercial center for the region and New-Juaben Municipal District. It is regarded as one of the calmest and coolest towns in the country. The town is home to many businesses with the exception of heavy industries. It can be located in the map at: http://en.wikipedia.org/wiki/Koforidua#See_also. - Mod.CP

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

UNDIAGNOSED FEBRILE ILLNESS, FATAL - SUDAN: (SOUTH DARFUR) 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: Tue 23 Oct 2012
Source: China Daily, Xinhua News Agency report [edited]
http://www.chinadaily.com.cn/xinhua/201 ... 17475.html


Khartoum's Al-Sudani daily newspaper reported Tuesday [23 Oct 2012] that 6 people died of and 10 others are infected with unknown fever in various areas in Sudan's South Darfur state.

"Unknown fever appeared in various areas of the state and infected 16 people on Saturday and Sunday [20-21 Oct 2012], and 6 of them died," the paper quoted Hassan Mohamed Abul-Hassan, a local official in the state, as saying.

"As soon as we received reports on the cases, we have contacted the federal Ministry of Health," he said, noting that medical teams have been sent to these areas to investigate the cause of the fever and provide treatment for the infected people.

The local official further said that samples have been taken from the infected people and sent to Khartoum but that the test results have not come out yet.

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

[In the absence of additional information on the clinical presentation of the cases other than fatalities from a febrile illness it is hazardous to attempt to speculate a differential diagnosis at this time. The range of possible diagnoses includes diseases of viral, bacterial, and parasitic origin. With the current ongoing outbreaks of Marburg virus disease in Uganda and Ebola virus disease in the Democratic Republic of the Congo, it is tempting to consider a viral hemorrhagic fever as the etiology of a fatal febrile disease outbreak in Sudan, but not casting the diagnostic net further at this point seems potentially hazardous at best.

Earlier this month (October 2012), ProMED-mail carried a report of an undiagnosed fatal illness outbreak occurring in Zalingei, Central Darfur state. In that report, the description was "most of the victims of the unknown fever are Arab nomads and gold excavation workers. ...the patients suffer from headaches, vomiting, and fatigue". A similar report on that same outbreak carried a few days later on ReliefWeb mentioned there were 7 deaths, and attributed them to poor access to good health care and medications in the region. There was mention of specimens having been sent to Khartoum for testing as well. (http://reliefweb.int/report/sudan/seven ... nown-fever).

Searching maps for locations, the 1st report above refers to deaths occurring "in various areas of the state [South Darfur]." The earlier report refers to the deaths occurring in the "area of Korley, south of Zalingei." Looking at a March 2012 map of Sudan available on Relief Web (http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf) and looking at a map showing the location of Zalingei, the capital of Central Darfur state http://www.myweather2.com/City-Town/Sud ... r/map.aspx, one sees the proximity of the states, it is tempting to wonder whether the 2 outbreak reports might be related events, as the descriptions on both news reports seem similar. Again, this may well be a hazardous speculation as transportation is significantly challenged in these areas.

We await more information from knowledgeable sources in the region.

For the HealthMap/ProMED map of the Sudan, see http://healthmap.org/r/3Nh*. - Mod.MPP]

YELLOW FEVER - AFRICA (08): (NIGERIA) RISK
******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Wed 24 Oct 2012
Source: Leadership [edited]
http://www.leadership.ng/nga/articles/3 ... perts.html


Health experts yesterday [23 Oct 2012] in Abuja [the capital] expressed fears of possible outbreak of yellow fever in the country.

They said 30 years after the last yellow fever epidemic outbreak in the country, no nationwide vaccination had been conducted since, stating that over 101 million Nigerians are at risk of being infected with the disease.

The warning is coming amidst recent outbreak of yellow fever in 6 districts of Cameroon bordering Cross River State [but see moderator comments below], which places Nigeria at risk because it is the only country among 13 in West Africa yet to conduct mass vaccination.

Speaking at a stakeholders' meeting yesterday [23 Oct 2012] in Abuja on the Preparation for Mass Vaccination against yellow fever in high risk states in Nigeria, the Chairman, Expert Review Committee (ERC) on Polio Immunisation, Prof Oyewole Tomori, disclosed that about 377 local government areas in 25 states in the country had been marked out as high risk states [areas].

He warned, "We're a large population and if we don't conduct this mass vaccination, we cannot predict what will happen. We need to put the money where it is important. We don't want a situation where we cure, so let's put the money on prevention."

Tomori also bemoaned Nigeria's reliance on other countries in the world for its vaccine needs. According to him, "There's no reason why Nigeria should be depending on other countries for its vaccine. We had a vaccine-manufacturing firm in Yaba, Lagos in 1994, which has gone under. We need to resuscitate it. Is it not lamentable that a country like Senegal is also one of the countries producing vaccine for us?"

Mathematical models used in assessing Nigeria's situation suggest an urban area like Lagos could see up to 4.5 million cases along with 128 000 deaths, requiring millions of vaccine doses, which take considerable time to produce.

In his presentation, the chief consultant epidemiologist, Federal Ministry of Health, Dr Akin Oyemakinde, said that an outbreak of yellow fever at this level would have enormous consequence on the economy and on the health system. He added that there would be potential of Nigeria exporting yellow fever to other countries, if there's an outbreak. According to him, Nigeria's last vaccination against yellow fever was in 1995 after an outbreak that lasted 8 years resulted in 20 000 cases and killed more than 5000 people. He noted, "Millions currently have no protection against yellow fever virus, leaving herd immunity low around the country."

The mass vaccination programme is planned to start in 2013 and take up to 5 years to complete because of the country's size. The World Health Organisation has called it "one of the biggest campaigns ever" for which Nigeria has to be ready.

[Byline: Winifred Ogbebo]

--
Communicated by:
Olutayo Olajide Babalobi, DVM, MPVM, PhD; FCVSN
Department of Veterinary Public Health and Preventive Medicine
Faculty of Veterinary Medicine
University of Ibadan
Ibadan
Nigeria

&
Oyewale Tomori, MD
Redeemer's University, Redemption Camp
Km. 46 Lagos-Ibadan Expressway, Ogun State
PO Box 7914
Ikeja, Lagos State
Nigeria


[The statement that, "The warning came amidst a recent outbreak of yellow fever in 6 districts of Cameroon bordering Cross River state..." is not correct because the only yellow fever (YF) cases in Cameroon known to ProMED-mail and WHO were those in the North, miles away from Cross River state. - Mod.JW

However, YF cases in Cameroon did occur in the Northern Region bordering the Nigerian states of Borno, Adamawa, and Taraba, so the warning about the risk of a massive YF outbreak in the country is real. One hopes that the warnings by Profs. Babalobi and Tomori will be heeded. Prevention through vaccination is more humane and cost effective than dealing with an ongoing YF outbreak.

A map showing the location of Nigeria and its geographic relationship to Cameroon can be accessed at http://www.lib.utexas.edu/maps/africa/nigeria_pol93.jpg. - Mod.TY

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

Mauretanien - Rift Valley-Fieber
26.10.2012

Es wurden bisher 30 Verdachtsfälle gemeldet, 13 Personen sind verstorben. In insgesamt 9 Fällen konnte das Virus nachgewiesen werden. Die hochfieberhafte Erkrankung wird überwiegend von Mücken übertragen. Meist sind Tiere betroffen, die Krankheit kann jedoch auch auf Menschen übertragen werden. Dies kann unabhängig von Mückenstichen auch durch Milch und Fleisch infizierter Tiere geschehen. Die Erreger können durch Erhitzen bzw. Braten abgetötet werden. Nahrungsmittelhygiene und Mückenschutz beachten. / Quelle: crm
________________________

Uganda - Marburg Virus
23.10.2012

In Kitumba (Distrikt Kabale, SW) sind neun Verdachtsfälle von Marburg Virus aufgetreten, drei Erkrankungen wurden labortechnisch bestätigt, 5 Menschen sind bereits verstorben. Bisher gibt es seitens der Regierung keine Reise- oder Handelsbeschränkungen. Übertragen wird das Virus durch direkten Kontakt mit Blut von infizierten Affen. Körperflüssigkeiten von infizierten Menschen sind ebenfalls ansteckend. Es verursacht eine akute, hoch fiebrige Erkrankung mit Kopfschmerzen, Muskelschmerzen und weiteren unspezifischen Symptomen. Nach 2-3 Tagen tritt eine Rachenentzündung, Übelkeit, Erbrechen, Durchfall und schwerste Blutungsneigung hinzu. Im weiteren Verlauf kommt es zu Schockzuständen, Organversagen und Delirium. Die Letalität der Erkrankung ist sehr hoch, der Tod tritt 6-9 Tage nach Beginn der Erkrankung ein. Das Blut muss für den Virusnachweis in Hochsicherheitslabors untersucht werden. / Quelle: crm

Gruß
Birgitt

YELLOW FEVER - AFRICA (09): SUDAN (DARFUR)
******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


[1] Date: 31 Oct 2012
Source: MiNews 26 [edited]
http://www.minews26.com/content/?p=20693


A previously unknown disease which has claimed more than 30 lives in Sudan's troubled Darfur region this month [October 2012] has been identified as yellow fever, the World Health Organization (WHO) said on Tuesday [30 Oct 2012]. Preparations for a mass vaccination campaign are now underway.

The outbreak was 1st detected early this month [October 2012] when a number of people in the central and southern regions of Darfur became ill and eventually died. Sudanese media said the victims suffered from a number of symptoms, including diarrhea, vomiting, and bleeding from both the mouth and nose.

Tarik Jasarevic, a spokesman for the World Health Organization (WHO), on Tuesday [30 Oct 2012] said it had been informed by Sudan's Federal Ministry of Health (FMoH) that the outbreak is being caused by yellow fever. Since the 1st week of October [2012], a total of 84 suspected cases, including 32 deaths, have been reported in the districts of Azoom, Kass, Mershing, Nertiti, Nyala, Wadi Salih and Zalingei.

"FMoH said that the immediate priority is to control the vector, reinforcing the disease surveillance system and raising public awareness on the prevention and control of this disease," Jasarevic said. "Preparations for a mass vaccination campaign are underway to vaccinate the at risk population in Darfur."

According to Darfur radio station Dabanga, however, at least 37 people are believed to have died as a result of the disease, while 125 others have been infected. The radio station quoted a resident as saying that local authorities were slow to react and did not immediately take necessary action to contain the outbreak.

"FMoH, WHO, as well as health partners are working on ground to ensure timely containment of the outbreak," Jasarevic added.

There is no cure for yellow fever, which is an acute viral haemorrhagic disease transmitted by infected mosquitoes. Treatment is aimed at reducing the symptoms for the comfort of patients, and measures often taken include supportive care to treat dehydration and fever and blood transfusion if needed.

"It is a preventable disease with symptoms and severity varying from case to case," Jasarevic explained. "Protective measures like the use of bed nets, insect repellent and long clothing are considered the best methods to contain an outbreak. Vaccination is the single most important measure for preventing yellow fever."

It is estimated some 200 000 people are infected by yellow fever each year, killing approximately 30 000 of them [worldwide estimates]. The virus is endemic in tropical areas of Africa and Latin America, which have a combined population of over 900 million people. Up to half of severely affected persons will die from the disease without treatment.

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

******

[2] Date: 31 Oct 2012
Source: Reuters AlertNet [edited]
http://www.trust.org/alertnet/news/mass ... -in-darfur


The World Health Organization (WHO) is preparing to vaccinate millions of people in Sudan's troubled Darfur region to stem an outbreak of yellow fever that has led to 84 suspected cases, including 32 deaths, since the 1st week of October [2012].

Yellow fever is a viral infection that is transmitted by mosquitoes in tropical regions leading to fever, vomiting, liver inflammation and jaundice. It can cause bleeding from the nose, mouth, stomach or eyes.

Five cases per day have been detected for the last week, according to the WHO representative in Sudan, Anshu Banerjee. "Every day, we have a few new districts that are affected," he told AlertNet. "It has affected a number of localities in Central Darfur. It affected 2 districts in South Darfur, and now we have reports that it also affected 2 districts in West Darfur."

On Wednesday [31 Oct 2012], WHO sent a sample to Senegal to reconfirm the Sudanese ministry of health's diagnosis. Once this is confirmed, which is expected late next week, it will draw up a vaccination plan.

The last outbreak of yellow fever in Sudan was in South Kordofan in 2005, where there were 604 cases including 163 deaths over a 4-month period.

There is no specific treatment for yellow fever, only supportive care to treat dehydration and fever and blood transfusion if needed. Vaccination is the main preventative measure.

War has ravaged Darfur since rebels took up arms in 2003, saying the central government had neglected the region. Conflict has continued despite the presence of the world's largest peacekeeping operation, the United Nations-African Union Mission in Darfur (UNAMID), with humanitarian workers often targeted.

"There are of course a lot of security constraints," said Banerjee. "We sometimes need support from UNAMID escorts, things like that, but it doesn't mean we are actually not able to conduct the campaigns."

It can also be hard to reach remote, mountainous villages in the Jebel Marra region of central Darfur, far from health centres.

Banerjee also said Sudan has a "well-functioning immunisation programme."

It gets significant funding from the Global Alliance for Vaccines and Immunisation and from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In October [2012], a WHO vaccination campaign against meningitis reached the majority of Darfur's 8 million people.

"There is a lot of institutional support from the government," said Banerjee. "The difficulties from a security point of view in Darfur will not prevent us from being able to conduct the campaign."

[Byline: Katy Migiro]

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

[On 8 Oct 2012, ProMED-mail posted a report on an as yet undiagnosed outbreak, with fatalities in Zalingei. At that time, the clinical presentation of the cases was described as headaches, vomiting, and fatigue. There were "at least 10 people who died," with cases also being seen in Korley, Tur Kolmey, and Doudou. Cases occurred among gold miners. On 23 Oct 2012, ProMED-mail posted another report on another undiagnosed outbreak associated with fever, with reports of 16 cases and 6 deaths, occurring in South Darfur state. No additional information on the cases, clinical presentation or epidemiologic studies were provided in that report, but given the ongoing outbreaks of viral hemorrhagic fevers (VHF) in neighboring Uganda and the Democratic Republic of the Congo, a VHF etiology to the 2 outbreaks in Sudan was a possibility.

The southern part of Sudan and South Sudan are in the yellow fever (YF) belt of Africa (see http://www.cdc.gov/yellowfever/maps/africa.html. Given the security constraints in the region, it is not surprising that the identification of yellow fever virus as the etiology of these outbreaks took approximately one month to establish. The remoteness of the involved areas combined with the security challenges and the fact that many of the cases are learned of postmortem (and post burial) means adequate specimens for laboratory testing are difficult to obtain.

The only treatment for yellow fever at present is supportive care, but the disease is a vaccine preventable disease. Hopefully, the security constraints will not impede the needed vaccination campaign to control the outbreak.

For a map of Sudan, see the March 2012 map of Sudan available on Relief Web (http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf). For the HealthMap/ProMED map of Sudan, see http://healthmap.org/promed/index.php?n ... 30.05,5,96. - Mod.MPP]

WEST NILE VIRUS - NORTH AFRICA (02): 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: Tue 30 Oct 2012
Source: AllAfrica, Tunis Afrique Presse (TAP) report [edited]
http://allafrica.com/stories/201210310697.html


So far in the governorate of Kebili, 11 cases of the West Nile virus (WNV) [infections] have been recorded, including one death -- that of an elderly woman suffering from diabetes.

Regional Health Director Mustapha Harrabi explained to TAP news agency correspondent in the region, that all the persons who had contracted this disease had left the regional hospital after having been treated.

He added that there are no specific medicines for this viral disease whose symptoms are those of a simple flu, accompanied by a high fever which might in some cases cause brain inflammations and lead to death.

Besides, he asserted that this disease is not contagious but is transmitted by mosquitos or blood transfusion.

However, the official minimised the seriousness of this disease that had been discovered in Tunisia a few years ago, and which is cured [treated] by medicines prescribed for a simple flu or a fever, calling for the combination of efforts to treat the mosquito-breeding waters.

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

[The number of human West Nile virus infections in Kebili governorate has increased from 5 as of 18 Oct 2012 (see the ECDC source cited in ProMED-mail archive no. 20121025.1364837), to 11 in the report above.

WNV has caused human cases in Tunisia in recent years: in 2010, 3 cases (Jendouba and Tataouine governorates); in 2011, 3 cases (Kebili governorate); and to date in 2012, 28 cases (Gabes, Jendouba, Kebili, Mahdia, and Monastir governorates).

It is very likely that WNV is endemic in Tunisia. Although equine animals can be vaccinated against WNV infection, there is no commercially available vaccine for human use, so avoidance of mosquito bites is the only preventive measure available.

Maps of Tunisia can be accessed at http://healthmap.org/r/1*XI and http://www.planetware.com/i/map/TUN/tunisia-map.jpg. - Mod.TY]

YELLOW FEVER - AFRICA (10): SUDAN (DARFUR)
******************************************
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: 5 Nov 2012
Source: Radio Dabanga [edited]
http://www.radiodabanga.org/node/37967


Health Ministry: yellow fever claims 63 lives
---------------------------------------------
Sudan's Federal Health Ministry announced that the number of yellow fever cases in Darfur has increased to more than 143, including 63 deaths, Radio Dabanga has learned on Sunday 4 Nov 2011.

The Ministry confirmed the emergence of new cases among the population in the southern regions west of El-Geneina [sic; must mean east -- see map in Comment] in West Darfur and the adjacent areas in Central Darfur. [El-Geneina is practically on the border with Chad, and surveillance should be carried out for yellow fever in that part of Chad. - Mod.JW].

At the same time, the State Health Ministry of South Darfur disclosed their urgent need for approximately 9 million doses of [yellow fever] vaccine for the people of Darfur in the battle against the 'epidemic disease', adding it could take more than 2 weeks for the vaccines to arrive.

For his part, the Minister of Health of the Darfur Regional Authority, Osman al-Bushra, confirmed the increase of yellow fever cases and its spread from Central Darfur to the east and west, adding that a medical team of doctors and specialists is scheduled to arrive in the affected areas on Sunday [11? Nov 2012].

--
Communicated by
ProMED-Mail

[To quote Mod.MPP's comment in the previous report:

"The southern part of Sudan and South Sudan are in the yellow fever (YF) belt of Africa (see <1http://www.cdc.gov/yellowfever/maps/africa.html>. Given the security constraints in the region, it is not surprising that the identification of yellow fever virus as the etiology of these outbreaks took approximately one month to establish. The remoteness of the involved areas combined with the security challenges and the fact that many of the cases are learned of postmortem (and post burial) means adequate specimens for laboratory testing are difficult to obtain.

The only treatment for yellow fever at present is supportive care, but the disease is a vaccine preventable disease. Hopefully, the security constraints will not impede the needed vaccination campaign to control the outbreak.

For a map of Sudan, see the March 2012 map of Sudan available on Relief Web (http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf). For the HealthMap/ProMED map of Sudan, see http://healthmap.org/r/1A1E. - MPP]

[Yellow fever (YF) is very rare in Sudan -- the last outbreak was in Southern Kordofan state in 2005 (a couple of hundred miles by air east of Central Darfur), which caused 163 deaths out of 604 cases over about 5 months (see ProMED archive below), and the one before that was in the Nuba Mountains (see map below), in that same state in 1940, 65 years earlier.

Radio Netherlands Worldwide reports today [6 Nov 2011]
http://www.rnw.nl/africa/bulletin/darfu ... -un-agency
"As of 5 November 2012, 194 suspected cases have been reported, including 67 deaths," a joint report from the health ministry and the World Health Organisation said. Since the last week of September [2012], cases have been reported from 17 districts in 4 of the Darfur states, but most of them are from Central Darfur state, the report said.

A week ago the health ministry said 84 suspected cases had been reported from 2 states during October and 32 of the patients had died. Officials are awaiting results from a laboratory in Senegal [probably the Pasteur Institute in Dakar. - Mod.JW] to reconfirm the diagnosis as a first step towards beginning a vaccination programme possibly by early December.

There is no specific treatment for the viral illness found in tropical regions of Africa but it can be contained through the use of bed nets, insect repellents and long clothing. "Vaccination is the single most important measure for preventing yellow fever," the WHO said.

It is debatable whether it would be faster to get YF vaccine from the stock in Geneva, Switzerland or from the WHO Regional Office for Africa in Brazzaville, Congo Republic -- although Sudan does not belong to the African Region of WHO, but to the Eastern Mediterranean Region which is unlikely to be carrying a stock of YF vaccine. In any case, speed is essential, because the vaccine is only effective 10 days after it is given, and then only provided it has been kept refrigerated for the whole time from production to application. The poor security situation in the area will certainly complicate matters. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E.]

CONJUNCTIVITIS, TRACHOMA - UGANDA: (KARAMOJA)
***********************************************
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: Tue 6 Nov 2012
Source: New Vision (Uganda) [edited]
http://www.newvision.co.ug/news/637072- ... amoja.html


A severe outbreak of trachoma has been reported in Karamoja [sub-region] with at least 50 000 people in dire need of urgent eye surgery to prevent blindness.

The disclosure was made by the State Minister of Primary Health Care Sarah Opendi in Moroto town. She was officially launching the Karamoja and Busoga sub-regions trachoma elimination programme. "At least one out of every 6 people in Karamoja has trachoma," she noted. Opendi added that that this makes Karamoja the 2nd most trachoma endemic sub-region in the world after the Upper Nile state of South Sudan.

The Minister attributed the outbreak to the lack of toilet facilities in the sub-region adding that [only] a small percentage had facilities for refusal disposal. "Low latrine coverage leads to indiscriminate disposal of human excreta which promotes the breeding of flies," Opendi observed. [Flies are attracted to eyes, spreading the disease. - Mod.JW].

She also said crowded conditions in the family unit increase exposure to infection through close contacts. Others include sharing of clothes, bedding, handkerchiefs and towels.

[Byline: Olandason Wanyama]

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

[The following is extracted from moderator ML's comments in ProMED-mail post Conjunctivitis, trachoma - Sudan: (Jonglei) 20080928.3069:

"Trachoma is a chronic keratoconjunctivitis caused by recurrent infections with ocular serotypes of _Chlamydia trachomatis_, an obligate intracellular bacterium. Infection often begins during infancy or childhood, and, if left untreated, the infection eventually causes the eyelid to turn inwards, which in turn causes the eyelashes to rub on the cornea, resulting in intense pain and scarring of the cornea. This ultimately leads to blindness by the time the person is an adult.

"Trachoma is widespread in the Middle East, North and Sub-Saharan Africa, parts of the Indian subcontinent, Southern Asia, and China, with pockets of trachoma in Latin America, Australia (among native Australians), and the Pacific Islands (http://www.who.int/water_sanitation_hea ... achoma/en/). The regions involved are characterized by poverty, crowding, poor personal and family hygiene, lack of safe water, absence of latrines or toilets, flies, and lack of facial cleanliness.

"Trachoma is spread person-to-person among children and within families by frequent exchange of infected ocular discharge from one child's face to another, by direct contact with secretions of affected individuals, by contact with contaminated inanimate objects, such as towels and/or washcloths, and by flies.

"Surgery is done to correct advanced stages of the disease. Facial cleanliness is emphasized to reduce disease transmission. Improved access to water and proper disposal of human and animal waste are reported to decrease the number of trachoma infections in communities (http://www.who.int/water_sanitation_hea ... achoma/en/).

Antibiotics are given to treat active infection, using one percent tetracycline eye ointment administered to both eyes twice daily for 6 weeks or azithromycin administered as one oral dose (20mg/kg body weight). Tetracycline eye ointment is cheap and is almost universally available, but compliance is often poor, whereas azithromycin is well tolerated but is relatively expensive, unless donated by Pfizer Inc. through the International Trachoma Initiative (Mariotti SP: New steps toward eliminating blinding trachoma. N Engl J Med. 2004 Nov 4; 351(19): 2004-7).

"WHO Guidelines recommend that a district should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to 9-year-old children is greater than 10 percent, and treatment should be repeated annually for 3 years, after which, a repeat district survey is carried out. If the district prevalence in one to 9-year-old children is still 10 percent or greater, annual mass treatment should be continued. If the prevalence is less than 10 percent, surveys should be conducted to determine the prevalence at the community level. Then, in communities in which the prevalence is less than 5 percent, treatment can be stopped, and in communities in which the prevalence is 5 percent or greater, annual treatment should continue until it falls below 5 percent (http://www.who.int/blindness/publicatio ... t_06_1.pdf)."

The Karamoja sub-region is located in northeastern Uganda and is bordered by South Sudan to the northwest, where trachoma is highly endemic (ProMED-mail post Conjunctivitis, trachoma - Sudan: (Jonglei) 20080928.3069). A map of Uganda showing the location of the Karamoja and Busoga sub-regions can be accessed at http://www.lib.utexas.edu/maps/africa/uganda.gif.
- Mod.ML]

[Photo of flies on eyes:
http://webpages.scu.edu/ftp/mrzhao/images/trachoma1.jpg
Corneal damage by trachoma:
http://www.pyroenergen.com/articles/images/trachoma.jpg
- Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3-v4.]

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (47): 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 - Ghana (Western Region)
[2] Cholera - Ghana (Ashanti Region)
[3] Cholera - Sierra Leone (Southern Province)
[4] Cholera - Zambia (Central Province)
[5] Cholera - Angola (Malanje Province)


******
[1] Cholera - Ghana (Western Region)
Date: Tue 6 Nov 2012
Source: MyJoy Online [edited]
http://edition.myjoyonline.com/pages/ne ... /96801.php


Medical officers in Tarkwa Nsuem in the Western Region say they have recorded 63 cholera cases over the past 2 weeks -- 22 females, 41 males. The situation has been attributed to poor hygiene. No deaths have been recorded yet. Medical Superintendent of the Tarkwa Government Hospital Dr Ebenezer Acquah tells Joy News unless attitudes change, the situation will persist.

Dr Acquah also questioned the quality of the sachet water produced in the area, as well as the kind of food being sold there. He has therefore advised people to be careful when they go out to buy food or water.

Meanwhile, Okatakyei Amankwah Afrifah of Dynamite FM in Tarkwa told Joy News the sanitary situation in Tarkwa has "actually gotten out of hand." He explained that the number of people there have outgrown the sanitary facilities provided by the city authorities.

"The best thing is to start relocating the refuse dumps," which he said are now close to residential areas.

[Byline: Isaac Essel]

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

[Maps of Ghana can be found at http://www.mapmakerdata.co.uk.s3-websit ... /index.htm and http://healthmap.org/r/1jUt. - Mod.LL]

******
[2] Cholera - Ghana (Ashanti Region)
Date: Fri 2 Nov 2012
Source: GhanaWeb [edited]
http://www.ghanaweb.com/GhanaHomePage/h ... ?ID=255195


Within 7 days, 6 people have reportedly died as a result of the cholera outbreak in Ejura in the Ashanti Region. According to a local journalist in the area, Musah Inuwa, the Ejura Government Hospital has recorded more than 26 cholera cases during the week.

An 18-year-old 2nd year student of Ejura TI Ahmadiya Junior High School was among the dead. The rest of the deceased are females.

Musah Inuwa reports that the situation is getting out [of hand] as many of the district assemblies are facing challenges with sanitation.

He indicated that the senior medical doctor at the hospital is blaming the situation on the collapse of the operations of Zoomlion [waste management company] in the area.

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

******
[3] Cholera - Sierra Leone (Southern Province)
Date: Mon 5 Nov 2012
Source: AllAfrica, Concord Times (Freetown) report [edited]
http://allafrica.com/stories/201211051197.html


The Monitoring and Evaluation Officer of the District Health Management Team (DHMT) in Moyamba district has disclosed that about 20 people have died from the cholera outbreak in the district since 25 Jul 2012. Speaking at a sensitization meeting organized by the Social Mobilization Coordinator of the DHMT, Kemah stated that a total of 392 cases were reported in the district including 111 children under 5 [years old].

"151 males and 241 [females] were affected by cholera. Kargboro Chiefdom accounted for 156 cases with 5 deaths; Ribbi Chiefdom had 44 cases with 7 deaths; while Bumpeh and Kaiyamba chiefdoms recorded 55 cases with 3 and 2 deaths respectively," he explained. He disclosed that Bagruwa and Fakunya chiefdoms accounted for 12 and 18 cases respectively with no deaths reported and Kongbora Chiefdom had 17 cases with 2 deaths.

District Social Mobilization Coordinator, Agnes Ngeleh, stated that they have intensified sensitization in all the chiefdoms in the district and that has helped reduce the number of cases reported. She called on all stakeholders present to put the messages they have learned into practice so that others will copy from them.

"I advise you to spread the message of thorough hand washing, environmental hygiene, and the dangers of open defecation to the public," she urged.

[Byline: Hawa Amara, Florence Turay]

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

[A HealthMap/ProMED-mail interactive map of Sierra Leone can be found at http://healthmap.org/r/3-xh. - Mod.LL]

******
[4] Cholera - Zambia (Central Province)
Date: Tue 6 Nov 2012
Source: Zambia Daily Mail [edited]
http://www.daily-mail.co.zm/index.php?o ... Itemid=200


A new case of cholera has been recorded in Lukanga Swamps in Kapiri Mposhi, bringing the total number of cases since September 2012 to 55 in Kapiri Mposhi and Kabwe. Central Province medical officer Dickson Suya said in Kabwe yesterday, 5 Nov 2012, that the latest patient is admitted to Waya Health Centre.

"We have 1 person under treatment in Kapiri Mposhi, and this case brings the cumulative total to 55 for both Kapiri Mposhi and Kabwe," Dr Suya said.
Dr Suya said the Lukanga Swamps are still a problematic area in containing the waterborne disease.

He said medical authorities in Kapiri Mposhi have continued conducting education campaigns in Lukanga Swamps to reach fishermen and fishmongers. He appealed to Central Province residents to observe hygiene, avoid unnecessary handshakes and crowded places to help curb the disease. Meanwhile, medical officials in Kapiri Mposhi and Kabwe have called for closure of all fishing camps in Lukanga Swamps if cholera is to be contained in the 2 districts. Kapiri Mposhi medical officer Charles Mwenuna and his Kabwe counterpart Abel Kabalo say the swamps are the source of cholera in the 2 districts.

"Closing the fishing camps in Lukanga Swamps is the best intervention to contain cholera," Dr Mwenuna said. "It will definitely help a lot."

Dr Kabalo said in a separate interview in Kabwe that with cholera breaking out in the fishing camps before the onset of the rainy season, it could be worse when the rains start so it is best to suspend fishing.

[Byline: Chambo Ng'Uni]

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

[Maps of Zambia can be found at http://www.nmcc.org.zm/images/report_map.jpg and http://healthmap.org/r/3-xF. - Mod.LL]

******
[5] Cholera - Angola (Malanje Province)
Date: Mon 15 Oct 2012
Source: AllAfrica, Angola Press report [edited]
http://allafrica.com/stories/201210160144.html


At least 7 people died of cholera in period between September and October 2012 in Cacuso, 72 km [45 mi] west of the capital of the northern Malanje province. The data were disclosed Monday [15 Oct 2012] by the chief of district division of Health, Cecilia Mateus. The source said that the shortage of drinking water, coupled with poor hygiene and treatment was the main factor for deaths.

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

[A HealthMap/ProMED-mail interactive map of Angola can be found at http://healthmap.org/r/3-xG. - Mod.LL]

Mauretanien - Rift Valley-Fieber
06.11.2012

In West-Mauretanien (Nouakchott) wurden seit Mitte September 34 Verdachtsfälle gemeldet, 17 Personen sind verstorben. In insgesamt 25 Fällen konnte das Virus nachgewiesen werden. Die hochfieberhafte Erkrankung wird überwiegend von Mücken übertragen. Meist sind Tiere betroffen, die Krankheit kann jedoch auch auf Menschen übertragen werden. Dies kann unabhängig von Mückenstichen auch durch Milch und Fleisch infizierter Tiere geschehen. Die Erreger können durch Erhitzen bzw. Braten abgetötet werden. Nahrungsmittelhygiene und Mückenschutz beachten. / Quelle: crm

Gruß
Birgitt

YELLOW FEVER - AFRICA (11): SUDAN (DARFUR)
******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Wed 7 Nov 2012
Source: UN News Centre [edited]
http://www.un.org/apps/news/story.asp?N ... JylWqXDiA0


A yellow fever [YF] outbreak in Sudan's Darfur region has killed 67 people so far, the United Nations health agency said today [7 Nov 2012], adding that the number of cases has more than doubled since the start of the epidemic last month [October 2012].

In a report, the UN World Health Organization (WHO) stated that the outbreak has now affected 17 localities in central, south, west, and north Darfur, with 194 cases reported -- a significant increase from the 84 initial cases reported at the start of the outbreak.

An estimated 200 000 cases of yellow fever, which is caused by a virus spread by mosquitoes, are recorded worldwide each year, with as many as 30 000 deaths reported, according to WHO. Patients experience jaundice, as well as other symptoms, such as fever and vomiting. There is no specific treatment for the disease and vaccination is the single most important measure for prevention.

In addition to monitoring the disease throughout Darfur, WHO said it is training more than 225 health workers in the region on disease surveillance, case management and infection prevention and control.

The health agency is also working with the Sudanese Ministry of Health to dispatch technical teams to help tame the outbreak by conducting investigations on new cases, meeting with local community leaders to raise awareness of the disease, and provide blood bank supplies as well as protective equipment to affected areas.

The report's recommendations also include strengthening disease surveillance in eastern Darfur, continuing laboratory testing of patients from newly affected localities, and finalizing a vaccination plan that identifies resources available as well as partners to implement it.

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

[The YF deaths have increased from 63 on 5 Nov 2012 to 67, 2 days later as reported above. The State Health Ministry of South Darfur indicated the urgent need for approximately 9 million doses of YF vaccine for the people in the affected area of Darfur. The report above indicates that the Ministry of Health is finalizing the YF vaccination plan, but does not indicate if the 9 million doses are on hand or have been ordered. Meanwhile, the outbreak is likely to continue unabated unless vector mosquito control can be quickly implemented while initiation of the vaccination campaign is awaited.

As Mod.JW pointed out in the previous ProMED-mail report of this outbreak (archive no. 20121106.1395260), individual immunity will be achieved 10 days after application of the vaccine, so speed in obtaining the vaccine and initiating the vaccination campaign is critical. The remoteness of some of the affected areas, coupled with insecurity of the general region will complicate control efforts.

For a map of Sudan, see the March 2012 map from UN ReliefWeb at http://www.un.org/Depts/Cartographic/ma ... /sudan.pdf.
For the HealthMap/ProMED map of Sudan, see http://healthmap.org/r/1A1E .
- Mod.TY]

[Refugee camp in Darfur, showing harsh landscape:
http://static.guim.co.uk/sys-images/Gua ... fur372.jpg
- Mod.JW]

The outbreak of Yellow fever in Sudan’s western region of Darfur has so far affected 221 people killing 78 of them, the country’s minister of health reported on Thursday as efforts continue to contain the disease’s deadly spread. [...] According to a joint report issued earlier this week by the World Health Organization (WHO) and the federal ministry of health, surveillance shows that 83.3% of the reported cases are from Central Darfur, 7.2% are from South Darfur, 7.2% are from West Darfur and 2.3% are from North Darfur [...] Tibin told reporters that the authorities have begun a mosquito-fighting campaign and will soon start a vaccination campaign as soon as vaccines arrive in the state [...] Its symptoms, which usually develop 3-6 days after the day of the infection, include headache, muscle and joint aches, fever, flushing, loss of appetite and vomiting. These could also develop to include heart, liver, and kidney failure, bleeding disorders, seizures, coma, and delirium before leading to death if not treated.

Darfur’s Yellow Fever outbreak affects 211 people – minister’s report
08.11.2012 - Sudan Tribune

Gruß
Birgitt

At least 26 refugees in South Sudan’s Upper Nile State have died from Hepatitis E, out of the reported 1,050 cases recorded in various refugee camps within the young nation, the United Nations refugee agency (UNHCR) said on Friday. The virus is contracted and spread through consuming contaminated food and water, causing damage to a persons liver and can be fatal. The risk of infection, according to UNHCR, was high in densely populated settings such as refugee camps, which reportedly worsened in the rainy season due to flooding and poor sanitation.

Hepatitis E kills 26 in S. Sudan’s Upper Nile State
09.11.2012 - Sudan Tribune

Gruß
Birgitt