Wüstenschiff

Rift Valley fever in South Africa- update
04.05.2010 - WHO

As of 27 April 2010, German health authorities reported a laboratory confirmed case of Rift Valley Fever (RVF) in a traveller returning to Germany after a trip to South Africa from 17 March to 8 April 2010. The case, along with three travel companions, visited rural areas and game reserves along the coast of Eastern Cape and Western Cape provinces. On 7 April 2010, the case developed symptoms including fever, headache and a rash (exanthema). Almost concurrently a similar illness was reported in her travel companions. German health authorities are currently investigating the circumstances around infection in the confirmed case.

As of 3 May 2010, the Department of Health of South Africa has reported 172 cases, including 15 deaths since the beginning of the outbreak in Free State Province, Eastern Cape Province, Northern Cape Province, Western Cape, and North West Province. While it is reported that most of these cases have had direct contact with RVF-infected livestock and/or are epidemiologically linked to farms with confirmed animal cases of RVF, there are a number of cases in which the route of transmission is currently unknown. Exposure to infected mosquitoes in these cases cannot be currently ruled out.

The Government of South Africa has implemented public health control measures which include development of key risk reduction messages for at risk population and health worker guidelines for case identification and reporting, laboratory investigations, clinical case management, hospital infection control and the public health measures for prevention and control and animal vaccination in non-affected areas.

WHO advises no international travel restriction to or from South Africa. However, WHO recommends that visitors to South Africa, especially those intending to visit farms and/or game reserves, avoid coming into contact with animal tissues or blood, avoid drinking unpasteurized or uncooked milk or eating raw meat. All travellers should take appropriate precautions against mosquito bites (use of mosquito nets, insect repellents). Travel medicine professionals and travel medicine services should be aware of the current RVF situation in South Africa in order to provide advice and care accordingly.

Robert-Koch-Institut, Epidemiologisches Bulletin Nr. 17 vom 3. Mai 2010

Fallbericht - Aus Südafrika importierte Infektion mit Rifttal-Fieber-Virus

Gruß
Birgitt

RIFT VALLEY FEVER - SAUDI ARABIA: (NAJRAN)
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Date: Thu 6 May 2010
From: Shamsudeen Fagbo <oloungbo@yahoo.com> [edited]


Rift Valley fever virus infection of a resident of Najran
---------------------------------------------------------
A 40 year old Saudi man, a fire fighter by profession and resident in
Najran, was diagnosed with Rift Valley fever on 28 Apr 2010. He first
reported signs of illness on 23 Apr 2010. The same day he presented at a
Ministry of Health facility in Najran, where he was hospitalised and
suspected to be a case of viral haemorrhagic fever. Signs observed included
nausea, vomiting, diarrhea, and epistaxis.

The patient's blood was sent to the Central Laboratory (Riyadh) and tested
for various viral haemorrhagic fevers (Rift Valley fever, Alkhurma
haemorrhagic fever, and dengue fever). All were negative except for Rift
Valley fever, which was detected using real time RT-PCR. Tests for Rift
Valley fever virus IgM and IgG were negative.

At the present time, the exact source and locale of Rift Valley fever virus
infection is not clear and is still being investigated. The patient
travelled extensively in the south western areas of the kingdom of Saudi
Arabia known to be endemic for Rift Valley fever (Tihama, Aseer, and Gizan)
some 45 days before the onset of his present illness. However, this
extended time frame does not seem compatible with the known incubation
period of Rift Valley fever virus (around 2 to 6 days). In addition, the
lack of antibodies (IgM or IgG) adds further doubt to the patient being
infected during that visit. The patient is also known to have visited a
livestock farm where he purchased an animal. It was then slaughtered and
cooked for him at a commercial outlet. He reported not taking part in the
slaughtering or cutting up process.

The Ministry of Health, in coordination with the Ministry of Agriculture
and local municipalities of Gizan, Najran, and Aseer, is conducting
extensive epidemiological and entomological investigations and results are
pending. Active surveillance for human and animal disease is ongoing.
Vaccination of animals with the live attenuated Rift Valley fever virus
vaccine is continuing in the said locales.

--
Ziad A Memish MD, FRCPC, FACP
Assistant Deputy Minister for Preventive Medicine
and
Shamsudeen F Fagbo DVM
Zoonotic Diseases Unit
Directorate of Communicable Diseases
Ministry of Health
Riyadh 11176
Kingdom of Saudi Arabia
<oloungbo@yahoo.com>

[Rift Valley fever is a viral zoonosis that can cause severe disease in a
low proportion of infected humans. The virus is classified in the genus
_Phlebovirus_ of the family _Bunyaviridae_ and causes outbreaks of
abortions and deaths of young livestock (predominantly sheep, goats, and
cattle). Humans become infected from contact with infected tissues of
livestock, and less frequently from mosquito bites. The mosquitoes (and
biting flies) which transmit the virus generally prefer to feed on
livestock outdoors at night.

The virus was first identified in 1931 during an investigation into an
epidemic among sheep on a farm in the Rift Valley of Kenya, hence its name.
Since then, extensive outbreaks have been reported in sub-Saharan and North
Africa. In 1997-98, a major outbreak occurred in Kenya, Somalia, and
Tanzania and subsequently in September 2000 Rift Valley fever was confirmed
in Saudi Arabia and Yemen (the 1st and only reported occurrence of the
disease out-with the African continent). Currently there is an ongoing
outbreak of Rift Valley fever in South Africa, which has been responsible
for several human deaths.

The source of the Saudi patient's exposure is unclear. Although he had
travelled in virus endemic areas of Saudi Arabia, his infection appears to
have been more recent. The majority of human infections result from direct
or indirect contact with the blood or organs of infected animals, during
the handling of animals, slaughtering or butchering, assisting with animal
births, or from the disposal of carcasses or fetuses. Certain occupational
groups such as herders, farmers, slaughterhouse workers, and veterinarians
are therefore at higher risk of infection. Other routes of transmission
include inhalation of aerosols produced during the handling and slaughter
of infected animals, by consumption of unpasteurized milk, and by insect
bites. No human-to-human transmission of Rift Valley fever virus infection
has been documented, and transmission to health care workers is not a
hazard provided standard infection control precautions are in place.
Further information on the source of the Saudi patient's infection is awaited.

A map of Saudi Arabia showing the location of Najran in the south, near the
border with Yemen is available at <http://www.saudinf.com/main/map.htm>.
The HealthMap/ProMED-mail interactive map of Saudi Arabia can be accessed
at <http://healthmap.org/r/01gJ>. - Mod.CP]

RIFT VALLEY FEVER - SOUTH AFRICA (16)
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Date: Sun 9 May 2010
Source: WeekendPost [edited]
<http://www.weekendpost.co.za/article.aspx?id=560919>


The number of Eastern Cape cases of people infected with deadly Rift Valley
fever (RVF) has jumped from 9 on Monday [3 May 2010] to 13 by yesterday [8
May 2010]. National Health Department spokesman Charity Bhengu said figures
released by the National Institute of Communicable Disease (NICD) indicated
that there were now 183 laboratory confirmed human RVF cases around the
country. On Mon 3 May 2010, there were 166 confirmed cases.

The disease has already claimed 17 lives, 8 from the Free State, 8 from the
Northern Cape, and one from Oudtshoorn in the Western Cape. The Northern
Cape fatalities include the wife of a former Eastern Cape farmer and a
provincial cricketer, originally from Graaff-Reinet.

There are now 13 people infected in the Eastern Cape, 56 in the Northern
Cape, 2 in North West, 107 in the Free State, and 3 in the Western Cape.
Two further cases have not been linked to a particular province. "The
majority of human cases have had mild flu-like symptoms and no
complications," Bhengu said. "There is no human to human spread. The risk
of disease is to persons with direct contact with blood or tissues of
infected animals. The majority of people affected are those working on
farms, veterinary workers and slaughtermen."

[byline: Shaanaaz de Jager]

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

[Since the previous ProMED-mail report of 5 May 2010, the number of cases
has risen from 172 to 183, and the number of fatalities from 15 to 17. The
outbreak remains confined to the same 5 provinces.

A map of the provinces of South Africa can be accessed at
<http://www.sa-venues.com/maps/south-afr ... vinces.htm>. The
HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00vd>. - Mod.CP]

Südafrika - Rift Valley-Fieber
10.05.2010

Das Rift Valley-Fieber breitet sich seit Februar bei Farmtieren in den Provinzen Eastern Cape, Northern Cape, Western Cape und North-West aus. Es wurden bereits auch mehr als 150 Erkrankungen mit 15 Todesfällen beim Menschen bestätigt. Die Übertragung auf den Menschen erfolgt in der Regel durch direkten oder indirekten Kontakt mit erkrankten Tieren (z.B. beim Schlachten), Verzehr von deren ungegartem Fleisch oder unpasteurisierter Milch, aber auch durch Stiche infizierter Mücken. Reisende sollten sich vor tag- und nachtaktiven Mücken schützen und direkten Kontakt mit Schlachtvieh bzw. dessen rohen Produkten meiden. / Quelle: crm

RIFT VALLEY FEVER - SOUTH AFRICA (17): TOURIST, NOT
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Date: Tue 11 May 2010
From: Stephan Gunther [edited]
<stephan.gunther@gmx.net>


Acute illness in a German tourist on returning from South Africa,
update on laboratory findings
-----------------------------------------------------------------------------------------------
The Bernhard-Nocht-Institute (BNI), Hamburg, and the
Robert-Koch-Institute Berlin, Germany, recently released a
preliminary report on a German tourist with acute illness after
returning from South Africa (ProMED-mail Archive Number
20100505.1450, 5 May 2010).

An acute-phase blood sample tested positive for Rift Valley fever
(RVF) virus-specific IgM and IgG at BNI, and therefore it was
considered likely that the case-patient acquired infection with RVF
virus while travelling in South Africa. Additional laboratory
analyses, conducted both in Germany and in South Africa, however,
could not confirm this preliminary diagnosis.

Testing of a 2nd, convalescent serum sample at BNI did not reveal an
increase in anti-RVF virus antibody titres indicating that the
antibodies are not related to the illness following the travel to
South Africa. The serum samples, which were sent to and investigated
at the Special Pathogens Unit, National Institute for Communicable
Diseases of the National Health Laboratory Service (SPU NICD-NHLS),
Sandringham, South Africa, tested negative for RVF virus-specific
antibodies in different tests, including ELISA and virus neutralizing assays.

While the reason for the discrepant findings remains unclear, in 3
laboratories, including BNI and SPU NICD-NHLS, seroconversion to
Rickettsia-specific IgM and IgG was detected, indicating recent
infection with _Rickettsia_ sp. We conclude from these new findings
that the acute illness in the case-patient after returning from South
Africa was caused by infection with _Rickettsia_ and not with RVF virus.

--
Prof. Stephan Gunther
Department of Virology
Bernhard-Nocht-Institute for Tropical Medicine
Bernhard-Nocht-Str. 74, 20359 Hamburg, Germany
<guenther@bni.uni-hamburg.de>

Prof. Janusz T. Paweska
Special Pathogens Unit
National Institute for Communicable Diseases of the National Health
Laboratory Service
Private Bag X4, Sandringham-Johannesburg, 2131
Modderfontein Road 1, Gauteng, South Africa
<januszp@nicd.ac.za>

[ProMED-mail thanks Professors Stephan Gunther and Janusz Paweska for
providing this information concerning the revised diagnosis of the
acute illness suffered by a tourist recently returned to Germany from
a visit to South Africa.

This incident may provide some reassurance for visitors to South
Africa that the probability of contracting Rift Valley fever virus
during recreational travel in that country is low. Nonetheless
visitors should avoid contact with diseased livestock and protect
themselves from mosquito bites. Likewise diagnostic services in
Europe should remain vigilant. - Mod.CP]

Rift Valley fever in South Africa- update 2
12.05.2010 - WHO

On 11 May 2010 Bernhard-Nocht-Institute for Tropical Medicine in Germany reported that additional laboratory analyses conducted both in Germany and South Africa on the German tourist who was preliminarily diagnosed with Rift Valley Fever (RVF) following her return from South Africa, was in-fact infected with Rickettsia and not with RVF virus.

Rickettsia, commonly known as tick fever is a bacterium which can cause many diseases that are transmitted by blood-sucking parasitic arthropods such as fleas, lice and ticks. Symptoms of rickettsial infections include rash, fever, and flulike symptoms. African tick bite fever is caused by rickettsia africae and tends to be a milder illness, with less prominent rash and little tendency to progress to complicated disease. All rickettsial diseases respond to treatment with antibiotics such as doxycycline and tetracycline

As of 10 May, the Government of South Africa has reported 186 confirmed cases of RVF in humans, including 18 deaths, in Free State Province, Eastern Cape Province, Northern Cape Province, Western Cape, and North West Province. RVF is a viral disease that primarily affects animals (such as cattle, buffalo, sheep, goats and camels). The disease can also affect humans. The main mode of transmission of RVF is via direct or indirect contact with the blood or organs of infected animals. Human infections have also resulted from the bites of infected mosquitoes. There is evidence that humans may become infected by ingesting the unpasteurized or uncooked milk of infected animals.

WHO advises no international travel restriction to or from South Africa. However, WHO recommends that visitors to South Africa, especially those intending to visit farms and/or game reserves, avoid coming into contact with animal tissues or blood, avoid drinking unpasteurized or uncooked milk or eating raw meat.

All travelers should take appropriate precautions against bites from mosquitoes and other blood-sucking insects (including the use of insect repellents, wearing long-sleeved shirts and trousers, and sleeping under mosquito nets). Travel medicine professionals and travel medicine services should be aware of the current RVF situation in South Africa in order to provide advice and care accordingly.

Deutschland - Rift Valley-Fieber (importiert)
17.05.2010

Bei der Erkrankung einer 50-jährigen Touristin, die ca. 25 Tage in Südafrika gereist war, handelt es sich nicht - wie zunächst gemeldet - um Rift Valley-Fieber, sondern um eine Rickettsien-Infektion. Weitere Untersuchungen in Referenzlaboren in Deutschland und Südafrika konnten die ursprüngliche Diagnose nicht bestätigen. Mückenschutz sowie Nahrungsmittelhygiene beachten. Außerdem sollten Reisende in Endemiegebieten den Kontakt zu erkrankten Tieren meiden, sowie Besuche von Viehmärkten und Schlachthöfen unterlassen. / Quelle: crm

RIFT VALLEY FEVER - SOUTH AFRICA (19): (EASTERN CAPE)
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Date: Wed 19 May 2010
Source: Daily Dispatch, The Herald/Avusa Group News report [edited]
<http://www.dispatch.co.za/article.aspx?id=402594>


Rift Valley fever is spreading rapidly in the Eastern Cape [province]
and has reached as close to Nelson Mandela Bay as Humansdorp and the
Tsitsikamma area. Senior manager and director for veterinary services
in the Eastern Cape, Dr Cedisa Mnqeta, said there were now 45 farms
in the province which had tested positive for the fever and more test
results were outstanding. There have also been 8 confirmed human
cases in the province. Rift Valley fever can be spread to humans by
handling animals and their blood, and by mosquitoes.

The latest outbreak of the disease has just been confirmed on a
Tsitsikamma dairy farm and the Eastern Cape Veterinary Services
believe this outbreak is potentially very serious as it is unlikely
mosquitoes will die out over winter in this area. Mnqeta confirmed
that farms which tested positive for Rift Valley fever are in the
Cradock, Humansdorp, Middelburg, Hofmeyr, Steynsburg, Graaff-Reinet,
Jansenville, and Tsitsikamma areas.

Of the 8 confirmed human cases, 2 were veterinary services staff
members, 5 were farm workers who worked with animals and one was a
township resident suspected of coming into contact with diseased
meat. There are almost 200 confirmed cases in the country.

Agri Eastern Cape has warned farmers to take preventative measures,
such a vaccinating livestock to prevent the disease from spreading,
which would impact negatively on the province's agricultural economy.
The manager of veterinary services in the western region of the
Eastern Cape, Dr Jane Pistorius, said it was important that farmers
vaccinate their stock, even in areas to which the disease is not
expected to spread. She expressed concern that many farmers did not
report possible outbreaks of the disease because of the fact that
China had stopped importing South African wool because of the disease.

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

[The number of human cases of Rift Valley fever in Eastern Cape
province was reported on Sun 9 May 2010 to be 13 (one of whom was a
fatal case) in contrast to the figure of 8 given in this report. The
reason for this discrepancy is unclear. Indeed, overall this report
lacks quantitative data to support its content.

A set of maps of Eastern Cape Province can be accessed at
<http://www.sa-venues.com/maps/eastcape_atlas.htm>.
The HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00vd>. - Mod.CP]

[The need for vaccination of the livestock is mentioned in the above
article and cannot be understated. - Mods. AS/MPP]

RIFT VALLEY FEVER - KENYA: ALERT, PREVENTION
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Date: Thu 20 May 2010
Source: KBC (Kenya Broadcasting Corporation) [edited]
<http://www.kbc.co.ke/story.asp?ID=64071>


Govt [Kenya] issues RVF outbreak alert
--------------------------------------
The government is on high alert over a possible outbreak of Rift
Valley fever (RVF) epidemic in North Eastern, upper Eastern and Rift
Valley provinces.

Livestock Minister Dr Mohamed Kuti says the 2nd round of the
vaccination campaign is due to begin in the affected regions to
prevent an outbreak of the disease. Kuti said on Thursday [20 May
2010] that his ministry is awaiting response from Treasury for
additional funding to enable it embark on round 2 of the vaccination exercise.

The Minister said already animals in the pastoralist regions are
infected but no deaths have been reported as they had been
vaccinated. "There is high activity of the disease in the animals in
pastoralist areas, but we are on high alert and intend to embark on
the 2nd round of the vaccination exercise so that we do not reach
epidemic levels," said Kuti who addressed a meeting at Kilimo house.

The Minister said already the government undertook a vaccination
exercise for one million heads of cattle to curb any outbreak this
rainy season.

Last year [2009] the government invested some 500 million shillings
[6.41 million USD] to undertake the off-take exercise during the drought.

RVF is a viral hemorrhagic fever which primarily affects animals but
can also infect humans. The disease also results in significant
economic losses due to death and abortion among animals infected.

A probable case occurs when a person or animal has acute fever with
unexplained bleeding in stool, vomit, sputum, gums, nose, skin and
eyes. The vision deteriorates, [mental status becomes] altered [and]
then loses consciousness.

The virus was 1st identified in 1931 during an investigation into an
epidemic among sheep on a farm in the Rift Valley of Kenya.

A major outbreak occurred in the country In 1997-98, during the El-Nino rains.

In December 2006, several deaths were reported in Garissa District.
Other hemorrhagic fevers that occur in sub-Saharan Africa are yellow
fever, Ebola, Crimean-Congo hemorrhagic fever, and dengue viruses.

[Byline: Judith Akolo]

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

[It will be interesting to note if the vaccine used in Kenya is the
live attenuated (Smithburn) vaccine, expected to confer lifelong
immunity after a single vaccination but contraindicated for
application in pregnant animals, or the inactivated vaccine, which
can be used in susceptible animals irrespective of the stage of
pregnancy and lactation but requires a booster vaccination and is
more costly. Further details on both vaccines are available at
<http://www.obpvaccines.co.za/prods/14.htm> (live vaccine) and
<http://www.obpvaccines.co.za/prods/13.htm> (inactivated vaccine).

Forecasting RVF epidemics is partly based upon remote
sensing/satellite imagery; see FAO's guidelines on "Prevention and
control of Rift Valley Fever"
at <http://www.fao.org/DOCREP/006/Y4611E/y4611e07.htm>.

A useful WHO overview on RVF in humans and animals, revised May 2010,
is available at
<http://www.who.int/mediacentre/factsheets/fs207/en/>. - Mod.AS]

RIFT VALLEY FEVER - SOUTH AFRICA (20) (EASTERN CAPE)
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Date: Thu 24 Jun 2010
Source: The Herald online [abbreviated & edited]
<http://www.theherald.co.za/article.aspx?id=576036>


A 27-year-old veterinarian died at Port Elizabeth's St George's
Hospital last week after a 24-day coma, dashing hopes she would
recover from the disease she fought so hard to combat [in her role
as] Cradock's state veterinarian.

The deceased vet's father said his daughter had taken the utmost
precaution when carrying out autopsies on farm animals suspected of
being infected with the disease. She had been "scared" of contracting
Rift Valley fever, which can be passed on to humans who come into
contact with the tissue of infected animals. He said she had
complained of flu symptoms, but tests had repeatedly come back
negative for the disease [Rift Valley fever], which is spread among
animals by mosquitoes. He recalled that "she would wear a protective
suit and 3 sets of gloves when she was doing autopsies on animals
suspected of dying of Rift Valley fever." But when he called her on
Sat 15 May 2010, she sounded incoherent and slurred. Subsequently,
she was taken to hospital when she was already in a coma. She was
declared brain dead, and her life support switched off on Fri 11 Jun
2010. A colleague said that "it was so hard to see her in the coma,
because only about 2 percent of humans who contract this disease die of it."

The Eastern Cape now has 17 confirmed human cases of Rift Valley
fever. South Africa has 221 human cases of the disease, which has
claimed 23 lives nationally.

[Byline: Barbara Hollands]

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

[Whereas most human cases of Rift Valley fever are relatively mild, a
small percentage of patients develop a much more severe form of the
disease. This usually appears as one or more of 3 distinct syndromes:
ocular (eye) disease (0.5-2 percent of patients), meningoencephalitis
(less than 1 percent) or haemorrhagic fever (less than 1 percent).

In the ocular form of the disease, the usual symptoms associated with
the mild form of the disease are accompanied by retinal lesions. The
onset of the lesions in the eyes is usually one to 3 weeks after
appearance of the 1st symptoms. Patients usually report blurred or
decreased vision. The disease may resolve itself with no lasting
effects within 10 to 12 weeks. However, when the lesions occur in the
macula, 50 percent of patients will experience a permanent loss of
vision. Death in patients with only the ocular form of the disease is uncommon.

The symptoms of the haemorrhagic form of the disease appear 2-4 days
after the onset of illness, and begin with evidence of severe liver
impairment, such as jaundice. Subsequently, signs of haemorrhage then
appear such as vomiting blood, passing blood in the faeces, a
purpuric rash or ecchymoses (caused by bleeding in the skin),
bleeding from the nose or gums, menorrhagia and bleeding from
venepuncture sites. The case-fatality ratio for patients developing
the haemorrhagic form of the disease is high at approximately 50
percent. Death usually occurs 3-6 days after the onset of symptoms.
The virus may be detectable in the blood for up to 10 days, in
patients with the hemorrhagic icterus form of RVF.

The onset of the meningoencephalitis form of the disease usually
occurs one to 4 weeks after the 1st symptoms of RVF appear. Clinical
features include intense headache, loss of memory, hallucinations,
confusion, disorientation, vertigo, convulsions, lethargy and coma.
Neurological complications can appear later (over 60 days). The death
rate in patients who experience only this form of the disease is low,
although residual neurological deficit, which may be severe, is
common. It is evident that the young Eastern Cape vet experienced
this form of the disease, and the fatal outcome was unexpected. It is
surprising that according to this account, diagnostic tests were
negative during the course of her illness.

A set of maps of Eastern Cape Province showing the location of
Cradock can be accessed at
<http://www.sa-venues.com/maps/eastcape_atlas.htm>. The
HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00vd>. - Mod.CP]

[RVF is extremely contagious and doesn't pick and chose. You don't
want to be anywhere nearby when an RVF animal is being necropsied; in
an incident in Somalia in the early 1980s everyone within 25 paces of
a field necropsy came down with it. This case is a tragedy but it
will be bring home that RFV is a threat to all, not just indigenous
villagers. - Mod.MHJ]

RIFT VALLEY FEVER, HUMAN - NAMIBIA (05): SUSPECTED
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Date: Fri 3 Sep 2010
Source: Nabian [edited]
<http://www.namibian.com.na/index.php?id ... no_cache=1>


At least 3 Namibians are suspected to have been infected with the deadly
Rift Valley fever (RVF) [virus]. This comes close to 5 months after tens of
Namibian animals were infected with RVF [virus] in the 1st outbreak of the
disease in the country since 1985.

A notice about the 3 affected farmers was published in the weekly
newsletter of the Namibia Agricultural Union (NAU) last Friday [27 Aug
2010]. Until yesterday [2 Sep 2010], however, Dr Jack Vries, chairperson of
the Ministry of Health and Social Service's National Health Emergency
Management Committee, had not been officially informed about the cases.
Vries told The Namibian that none of the country's 2 laboratories had made
any positive diagnoses. This, he said, could be as a result of patients
being tested in South Africa or not being tested at all.

A Dorper sheep farmer, in the south of the country, yesterday [2 Sep 2010]
said that he accidentally injected himself whilst he was busy immunising
his sheep about 3 weeks ago. "I accidentally injected myself that Friday
afternoon. By 1900 [that evening], I realised there was big trouble."
According to him, he could by then not even talk anymore. Apart from this,
he experienced a high fever, an increased heart beat and painful urination.
"I also had terrible headaches. My urine was golden yellow, and it was
painful when I urinated. And the heartbeats, it feels like your heart wants
to run away." It was only by Saturday afternoon that he could talk again,
he said. The farmer said that he decided not to go to a doctor. Instead, he
spent a week in bed. A veterinarian he spoke to told him that it "must be"
RVF, he said.

In its newsletter, the NAU urged farmers "to be very cautious when animals
are vaccinated against RVF. If one gets pricked by the needle, the disease
can be contracted through the vaccine." The union issued this warning
"following the confirmation of 3 farmers in the south of Namibia who were
identified with the dreaded RVF."

Dr Cleopas Bamhare, acting chief veterinary officer in the Ministry of
Agriculture, Water and Forestry, earlier warned people to wear rubber
gloves and face masks when they come into close contact with sick animals,
aborted foetuses, blood and other body fluids, especially during handling,
slaughtering, butchering and milking, to avoid human infections. Meat
intended for human consumption needs to be chilled and matured at 2 C for
at least 24 hours. This, he said, will inactivate the virus if it is
present. The past week, Bamhare said no new animal infections have been
reported to his office.

Earlier this year [2010], it was reported that close to a 100 animals were
affected in Namibia. Half of these died. Namibian farmers lost millions of
dollars as a result of export bans that were in place when the outbreak was
rife. More than 20 humans and hundreds of animals died in neighbouring
South Africa during a recent RVF outbreak there.

Bamhare also earlier warned Namibians that RVF could cause a widespread
epidemic in the next rainy season.

According to Vries, the man would have landed in the intensive care unit
(ICU) had it been RVF. However, another doctor The Namibian spoke to said
it is "definitely possible" for the farmer to have contracted the virus
through the live vaccine. The farmer confirmed that it was the live vaccine.

[byline: Denver Kisting]

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

[The statement of the Namibia Agricultural Union that RVF virus infection
in the 3 farmers was confirmed is not supported by other information, nor
by the statement that samples were not tested by either of the country's 2
laboratories. The vaccine that the affected farmer used for vaccinating his
sheep was the live, attenuated Smithburn product. Presumably, it might
infect a human following needlestick injury.

Possible exposures of the other 2 farmers is not given. Conceivably, the
farmers may have been bitten by transovarially infected mosquitoes carrying
the virus that remained in the area following the last outbreak earlier
this year (2010). Several bunyaviruses, including RVF virus, can be
transovarially transmitted in _Aedes_ mosquitoes, and the virus-containing
eggs may remain viable for long periods of time in low-lying areas
("dambos" in East Africa). However, in the absence of cases in livestock,
this possibility seems unlikely. ProMED-mail would appreciate receiving
further information confirming or ruling out RVF virus infection.

An OIE map showing the location of the previous livestock cases of RVF can
be accessed at
<http://www.oie.int/wahis/public.php?pag ... ortid=9258>. A
HealthMap/ProMED-mail interactive map of Namibia can be accessed at
<http://healthmap.org/promed/en?v=-22.1,17.2,5>. - Mod.TY]

RIFT VALLEY FEVER, LIVESTOCK, HUMAN - MAURITANIA
***********************************************
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: Thu 2 Dec 2010
Source: Romandie, Agence France-Press report [in French, trans.
Corr.SB, edited]
<http://www.romandie.com/infos/news2/101 ... dv24sl.asp>


An outbreak of Rift Valley [fever] has erupted in the Mauritanian
town of Aoujeft (North), causing loss of life amongst people and
cattle, Mauritanian officials said Thursday [2 Dec 2010]. The
Independent press, quoting from official sources, speaks of 17 deaths.

"Cases of fever Rift Valley [fever] have caused losses of (human)
lives and of livestock," stated the Mauritanian News Agency (l'Agence
mauritanienne d'information, AMI), without specifying the total.
According to local independent media, the epidemic has already killed
17 people, and the sick were sent to hospitals including those in Nouakchott.

The Minister of Health and Interior visiting the region has given
strict instructions to the population of the Adrar (the region where
Aoujeft is situated) that they must refrain, in response to these
[Rift Valley] fever cases, from consuming locally produced meat and
milk, says AMI. These restrictions on meat and milk, 2 essential
commodities in the diet of the people, must last at least until the
investigation is finished and the results of laboratory tests
conducted since Thursday [2 Dec 2010] by veterinary specialists on
infected animals are confirmed says AMI.

Rift Valley fever is a disease that primarily affects animals but can
also infect humans. The infection can cause severe disease in both
animals and humans. The deaths and abortions in cattle infected with
the disease also result in substantial economic losses.

There is no specific treatment, and no human vaccine is available
against the disease, which is transmitted by mosquitoes and affects
mainly young men in contact with infected cattle.

Rift Valley fever bears the name of the region of Kenya where it was
identified in 1931. The disease has hit Kenya, Somalia and Tanzania
in the years 1967/68, and the last major outbreak was reported in
2000 in Yemen and Saudi Arabia [and Mauritania in 2003; see
ProMED-mail archive references below].

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

[Mortality on this scale is unusual for local outbreaks of Rift
Valley fever. The text of this press report suggests that a precise
diagnosis has still to be confirmed. Further information is awaited.

Rift Valley fever (RVF) is a viral zoonosis that primarily affects
animals but also has the capacity to infect humans. Infection can
cause severe disease in both animals and humans. The disease also
results in significant economic losses due to death and abortion
among RVF-infected livestock.

RVF virus is a member of the _Phlebovirus_ genus, one of the 5 genera
in the family _Bunyaviridae_. The virus was 1st identified in 1931
during an investigation into an epidemic among sheep on a farm in the
Rift Valley of Kenya. Since then, outbreaks have been reported in
sub-Saharan and North Africa [Mauritania]. In 1997-98, a major
outbreak occurred in Kenya, Somalia and Tanzania, and in September
2000, RVF cases were confirmed in Saudi Arabia and Yemen, marking the
1st reported occurrence of the disease outside the African continent.

The vast majority of human infections result from direct or indirect
contact with the blood or organs of infected animals. The virus can
be transmitted to humans through the handling of animal tissue during
slaughtering or butchering, assisting with animal births, conducting
veterinary procedures, or from the disposal of carcasses or fetuses.
Certain occupational groups such as herders, farmers, slaughterhouse
workers and veterinarians are, therefore, at higher risk of
infection. The virus infects humans through inoculation, for example
via a wound from an infected knife or through contact with broken
skin, or through inhalation of aerosols produced during the slaughter
of infected animals.

There is some evidence that humans may also become infected with RVF
by ingesting the unpasteurized or uncooked milk of infected animals.
Human infections have also resulted from the bites of infected
mosquitoes, most commonly the _Aedes_ mosquito. Transmission of RVF
virus by hematophagous (blood-feeding) flies is also possible. To
date, no human-to-human transmission of RVF has been documented, and
no transmission of RVF to health care workers has been reported when
standard infection control precautions have been put in place. There
has been no evidence of outbreaks of RVF in urban areas.

While most human cases are relatively mild, a small percentage of
patients develop a much more severe form of the disease. This usually
appears as one or more of 3 distinct syndromes: ocular (eye) disease
(0.5-2 percent of patients), meningoencephalitis (less than one
percent) or haemorrhagic fever (less than one percent).

The total case fatality rate has varied widely between different
epidemics but, overall, has been less than one percent in those
documented. Most fatalities occur in patients who develop the
haemorrhagic icterus form.

More detailed information can be obtained from the WHO website at:
<http://www.who.int/mediacentre/factshee ... index.html>.

The HealthMap/ProMED-mail interactive map of Mauritania can be
accessed at: <http://healthmap.org/r/0hQ0>. - Mod.CP]

RIFT VALLEY FEVER, HUMAN - FRANCE: ex ZIMBABWE (MASHONALAND EAST)
FIRST REPORT
******************************************************************************

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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Wed 19 Oct 2011
From: Guillaume Vesin [edited]


A 21 year old Caucasian traveller returning from Zimbabwe, where she
visited the rural region of Marondera [Mashonaland East province] from
17 Jul to 11 Aug 2011, was seen in our department on 5 Sep 2011 for
major asthenia and violent headache. She acknowledged that the next
day after return she experienced fever that resolved within a week.

Laboratory investigations for malaria, Lyme disease, rickettsiosis,
dengue, chikungunya, and West Nile fever viruses were all negative
whereas Rift Valley fever virus serology using Elisa testing was
positive for IgM.

On 17 Oct 2011 she is still complaining of headache although no
relapse in fever was noted. To the best of our knowledge, this is the
1st report of human Rift Valley fever from Zimbabwe.

--
Guillaume Vesin

Dr Receveur, Pr Malvy
Service de medecine tropicale
CHU de Bordeaux
France

[ProMED-mail thanks Guillaume Vesin for forwarding this interesting
account of the detection of the 1st known human case of Rift Valley
fever virus (RVFV) infection in Zimbabwe.

Rift Valley fever (RVF), a mosquitoborne zoonotic disease among humans
and ruminants, is caused by Rift Valley fever virus, a virus belonging
to the family _Bunyaviridae_, genus _Phlebovirus_. RVF is endemic to
sub-Saharan African countries and has caused major outbreaks in
several countries including Kenya, Tanzania, Somalia, South Africa,
Madagascar, Egypt, Sudan, Mauritania, Senegal, Saudi Arabia, and
Yemen. Pregnant ruminants infected with RVFV typically are subject to
high-rate abortions, fetal malformation, and subclinical-to-fatal
febrile illness, while newborn lambs usually die by acute hepatitis.
RVFV infection in humans primarily causes a self-limiting febrile
illness; however, some patients develop haemorrhagic fever,
neurological disorders, or blindness after the febrile period. In
endemic areas, _Aedes_ mosquitoes, such as _Ae. mcintoshi_ or _Ae.
vexans_ serve as vectors, and the virus can be transmitted into
offspring transovarially. Heavy rainfall or flooding of river banks
due to construction of dams increases the number of permanent fresh
water species of mosquitoes such as _Culex pipiens_, which play a role
in amplifying RVFV among mosquitoes, ruminants, and humans (see
Ikegami T, Makino S. The pathogenesis of Rift Valley fever. Viruses.
2011; 3(5): 493-5;
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111045/).

The vast majority of human infections result from direct or indirect
contact with the blood or organs of infected animals. The virus can be
transmitted to humans through the handling of animal tissue during
slaughtering or butchering, assisting with animal births, conducting
veterinary procedures, or from the disposal of carcasses or fetuses.
The aerosol mode of transmission has also led to infection in
laboratory workers. There is some evidence that humans may also become
infected with RVFV by ingesting the unpasteurized or uncooked milk of
infected animals. To date, no human-to-human transmission of RVF has
been documented, and no transmission of RVF to health care workers has
been reported when standard infection control precautions have been
put in place (see
http://www.who.int/mediacentre/factshee ... index.html).

Although the human case described above may be the 1st record of human
infection in Zimbabwe, phylogenetic analyses of RVF viruses isolated
in Zimbabwe has revealed the presence of multiple virus lineages
indicating that the spread of distinct RVF virus genotypes is an
ongoing process and can occur over large geographic distances (see
Bird, et al. J Virol. 2007 March; 81(6): 2805-16;
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865992).

Marondera is a town and district in Mashonaland East, Zimbabwe,
situated about 72 km (45 mi) east of the capital Harare. It can be
located in the HealthMap/ProMED-mail interactive map of Zimbabwe at
http://healthmap.org/r/1m1w. - Mod.CP]

RIFT VALLEY FEVER, HUMAN - FRANCE (02): ex ZIMBABWE (MASHONALAND EAST)
NOT
**************************************************************************

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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Tue 29 Nov 2011
From: Marc Grandadam [edited]



Rift Valley Fever, France ex Zimbabwe: not confirmed
----------------------------------------------------
On Thu 20 Oct 2011, a case of Rift Valley fever (RVF) imported into
France from Zimbabwe was reported by ProMED-mail (Rift Valley fever,
human - France: ex Zimbabwe (ME) 1st Archive Number: 20111020.3132).
As reporting of RVF is mandatory in France, the patient's samples were
sent to the National Reference Laboratory for Arboviruses for
confirmation.

The 1st serum, obtained at day 25 after symptom onset was
reinvestigated for the presence of anti-arbovirus antibodies (i.e.,
Dengue; Chikungunya; West Nile; Rift Valley fever). Only a borderline
IgM reactivity against RVF virus antigen was detected. A 2nd sample
obtained at day 67 after onset was found negative for both IgM and IgG
for all antigens tested. The lack of enhancement of IgM response and
no IgG seroconversion led us to conclude that the transient IgM
response in the initial sample was a non-specific reaction.
Consequently RVF infection has been classifies as 'not confirmed.'

Diagnosis of imported cases has proven to be valuable for the global
surveillance of arboviruses. Thus, clinicians should be aware that
pathologies (case definition; diagnostic procedures including
interpretation criteria), especially where mandatory reporting at the
national or the international levels, is required.

--
Dr Marc Grandadam
National Reference Centre for Arboviruses
Institut Pasteur
Paris
France

and
Dr Deny Malvy
Service de Medicine Tropicale
CHU de Bordeaux
France

[ProMED-mail thanks Drs Grandadam and Malvy for providing this
information and correcting the record. - Mod.CP
]