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Published Date: 2005-07-01 23:50:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2005 (25)
Archive Number: 20050701.1854

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2005 (25)
**********************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In these updates:
Africa
[1] Cholera - Uganda (Kampala, Arua, Gulu)
[2] Cholera - Uganda (Internally Displaced Persons' Camps)
[3] Cholera - Zimbabwe (Eastern)
[4] & [5] Cholera - Guinea-Bissau (Bissau)
[6] Diarrhea, cholera - Somalia (Jilib): suspected
[7] Cholera - Ghana (Amenfi East)
[8] Cholera - Kenya (Nairobi)
[9] Cholera - Senegal
Asia
[10] Cholera - Pakistan (Lahore): suspected
[11] Cholera, diarrhea - China
[12] Diarrhea - Indonesia (Tangerang)

[13] Cholera - Worldwide - WHO WER Notifications

*****
[1] Cholera - Uganda (Kampala, Arua, Gulu)
Date: Tue, 28 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: TodayOnline.com [edited]
<http://www.todayonline.com/articles/58482.asp>

Cholera kills 22 in Uganda since start of June
----------------------------------------------
22 people are known to have died as a result of a cholera outbreak in
different parts of Uganda, including a slum in the capital, since the
beginning of Jun 2005, health authorities said.

4 people have died and 5 other cases have been reported in a
congested shantytown north of Kampala city center that houses an
estimated 30 000 people, they said.

A further 10 people have died in the northwestern district of Arua
with a total of 123 cases recorded in villages near the Sudanese
refugee settlement of Rhino Camp.

In the northern Gulu district, a further 5 deaths have been reported
out of 449 cases, while in the northwestern district of Nebbi, 3
people have so far died, they said.

Health ministry spokesman Paul Kaggwa said the problem recurs
annually because the areas in question "have remained dirty and
personal hygiene is poor" adding: "Poor sanitation remains the main
problem."

"Water is the main problem in the (Arua) area. The land is sandy and
this has made it difficult to construct proper pit latrines," Patrick
Anguzu, the head of the district's health services.

"People's hygiene practice remains very poor but we have intensified
health education in the communities," he added.

The WHO representative in Gulu, Vincent Oryem, blamed congestion in
displaced people's camps, which have been hard-hit by cholera, for
making health management and the provision of adequate sanitation
difficult.

He said that in Pabbo, the region's largest displaced camp housing 63
000 people and where 382 cases have been recorded, the problem of
poor sanitation has been worsened by heavy rains and no decrease in
cases is seen.

--
ProMED-mail
<promed@promedmail.org>

******
[2] Cholera - Uganda (Internally Displaced Persons' Camps)
Date, Tue, 28 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: IRIN News [edited]
<http://www.alertnet.org/thenews/newsdesk/IRIN/aae4b629ed8224555e4c22487290a572.htm>

Poor sanitation hampering fight against cholera in IDP camps
--------------------------------------------------
Poor sanitation and congestion in internally displaced persons' (IDP)
camps in northern Uganda is hampering efforts to control a cholera
outbreak that has killed 5 people in Gulu district and infected 449
others, health officials said on Mon, 27 Jun 2005. Vincent Oryem, a
medical doctor working for the WHO in Gulu, said the health agency
was working with local authorities to try and control the epidemic,
but congestion in the IDP camps was making health management very
difficult.

"In Pabbo [the largest IDP camp, housing some 64 000 people], where
we have recorded 382 cases, the poor sanitation problem has been
worsened by the heavy rains and there has been no decrease in cases
reported. In the second largest camp of Amuru [48 000 people], we
have had 35 cases and this keeps on going up," he said. "We hope that
we will be able to control the epidemic better during the dry season
when we shall have fewer rains," Oryem added.

The IDP camps which are scattered across northern Uganda are home to
approximately 1.6 million people displaced by a 19-year war between
rebels of the Lord's Resistance Army and Ugandan government forces.
Several of the camps are near Gulu town, 380 km north of the capital,
Kampala.

Due to the crowded nature of the camps, little space remained to
build pit latrines, Oryem explained. Decongesting the camps by moving
residents to other locations had proved problematic. "We have
identified a number of sites. The army has agreed to give them
security and we have encouraged people to go there, but all these
places are lacking social services like schools, health centers and
water facilities," he said.

Many of the water points at the camps were contaminated with cholera,
Oryem observed. WHO had initiated a bucket-chlorination program -- a
process of treating water with chlorine to kill harmful organisms.

Together with local authorities, he added, WHO was also mobilizing
people through radio talk shows advising them to observe good hygiene
and sanitation practices. With water distribution limited to 5 liters
per person per day, however, few people felt they could afford to use
what little water they had to wash their hands after visiting the
toilet.

--
ProMED-mail
<promed@promedmail.org>

******

[3] Cholera - Zimbabwe (Eastern)
Date: Tue, 28 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: IRIN News [edited]
<http://www.irinnews.org/report.asp?ReportID=47860&SelectRegion=Southern_Africa&SelectCountry=ZIMBABWE>

Cholera outbreak claims 14 lives
--------------------------------
At least 14 people have died and 203 have been hospitalized in
eastern Zimbabwe as authorities battle to control a cholera outbreak
that began in early May 2005. Zimbabwe has warned that it might not
be able to control the disease without cooperation from the
government of Mozambique, where the outbreak is thought to have
originated.

In an interview with IRIN, Deputy Health Minister Edwin Muguti said
preliminary investigations suggested that the epidemic could have
been caused by the use of water from a heavily contaminated river
that flowed from Mozambique through 3 large communal areas in
Zimbabwe.

"The disease is coming from Mozambique, which is why we need to
cooperate with them: fighting cholera on the Zimbabwean side would be
futile if the causes in Mozambique are not dealt with," Muguti told
IRIN.

He said Mozambican communities were using the river for various
domestic purposes and dumping raw waste into it, while the Zimbabwean
communities downstream were using the water for consumption and
cooking.

Muguti added that they had approached the Mozambican government and
were in the process of negotiating a control strategy to address the
causes and impact of the disease on both sides of the border.

He denied allegations by field staff that containment efforts were
being hampered by the shortage of basic medicines in Zimbabwe, saying
the government had adequate resources and would ensure that more were
provided to fight the disease.

Zimbabwe has battled to control a number of epidemics that have
affected people and livestock due to a shortage of medicine and human
resources since 2001.

--
ProMED-mail
<promed@promedmail.org>

******
[4] Cholera - Guinea-Bissau (Bissau)
Date: Tue, 28 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and IRIN News [edited]
<http://allafrica.com/stories/200506280186.html>

Cholera epidemic continues to rage with 50 new cases per day
--------------------------------------------------
The cholera epidemic sweeping Bissau, the capital of Guinea-Bissau,
became more serious last week, with over 300 new cases reported, said
Tome Ca, the government's Director General of Health.

The outbreak began on 11 Jun 2005 and Ca said 602 cases of the highly
water-borne disease had been reported by 26 June, up from 290 just 4
days earlier, he told reporters on Mon, 27 Jun 2005.

Local hospitals were receiving about 50 new cholera cases each day,
but the epidemic had not so far spread to the interior of this small
West African country, he added.

7 people have died so far in the epidemic, but Ca said there were no
new deaths last week. This is the 1st cholera epidemic to hit Bissau
for 3 years.

The current epidemic coincides with the start of the rainy season,
which has polluted wells in this city of 300 000 people and made the
quality of drinking water in its leaky pipes even more unreliable.

--
ProMED-mail
<promed@promedmail.org>

******
[5] Cholera - Guinea-Bissau (Bissau)
Date: Thu, 30 Jun 2005
From: Alfonso Rodriguez <ajrm_msds@yahoo.es>
Source: Yahoo News [edited]
<http://news.yahoo.com/news?tmpl=story&u=/afp/20050629/hl_afp/gbissauhealthcholera_050629211449>

10 dead, 1000 ill in Guinea Bissau cholera outbreak
---------------------------------------------------
About 10 people have died and 1000 have been taken ill in a cholera
outbreak in the west African state of Guinea Bissau, sources at the
capital's central hospital said.

Isolated cases of the disease have been reported in the Biombo
region, close to the capital, and the small town of Bula, 35
kilometers (22 miles) from Bissau.

Local authorities have begun a major campaign to warn people of the
danger, with 10 minutes in every hour of radio broadcasts devoted to
the issue. Joao Mario Vaz, mayor of the capital, said Wed, 29 Jun
2005, that its main market should be closed for disinfection.

Portugal, the former colonial power, has answered a call for help by
sending 15 tonnes of medical supplies.

--
Alfonso Rodriguez, M.D.
<ajrm_msds@yahoo.es>

******
[6] Diarrhea, cholera - Somalia (Jilib): suspected
Date: Wed, 29 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: Deutsche Presse Agentur [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/VBOL-6DTJ66?OpenDocument>

Diarrhea kills at least 15 children in Somalia
----------------------------------------------
More than 15 children died in one day in Somalia in diarrhea
outbreaks which followed annual floods, health officials said on Wed,
29 Jun 2005. The victims came from the Jilib district, about 380 km
south of Mogadishu, the capital city of Somalia.

Health officials told Deutsche Presse-Agentur (DPA) that the number
of children dying of dehydration and other treatable diseases such as
malaria and influenza is increasing.

Nurro Hashi, a medical assistance in Mother and Child Health care
(MCH) in Jilib, said "we registered a number of victims of malaria,
influenza and diarrhea, but the numbers dying are from diarrhea",
adding that "we are getting help from the Red Cross and other
international NGOs but this is not enough."

Dr. Mohamed Omar, a specialist in pediatrics, warned that the
diarrhea may be caused by cholera, a serious bacterial infection of
the small intestine that is carried in dirty water.

The district commissioner of Jilib, Abdulahi Moalim Hussein, told DPA
that "after the floods hit we requested the international community
and local businessmen to help the victims" and received some
materials to make shelters from the Red Cross and the Somali Red
Crescent Society (SRCS). However, he added that "the people don't
have all basic needs and live outdoors."

[Byline: Abukar Albadri]

--
ProMED-mail
<promed@promedmail.org>

******
[7] Cholera - Ghana (Amenfi East)
Date: Thu, 30 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: Ghana News Agency [edited]
<http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=84746>

Cholera outbreak in Amenfi East confirmed
-----------------------------------------
Dr Maame Pokua Amo-Addae, Amenfi East District Director of Health
Services, has confirmed the outbreak of cholera in the district and
advised the people to observe strict personal hygiene to avoid
contracting the disease. They should cover their food properly, boil
water before drinking and also avoid the eating of cold food,
especially from vendors. Speaking to the Ghana News Agency at
Wassa-Akropong on Tue, 27 Jun 2005, Dr. Amo-Addae identified poor
sanitation as the main cause of the disease.

2 people, including a nursing mother from nearby Jedua died about a
week ago when they were rushed to the Wassa-Akropong Hospital,
vomiting and passing watery stool. 6 others, who were admitted to
the hospital for vomiting and passing frequent watery stool were said
to be responding to treatment.

Dr. Amo-Addae advised the people not to hesitate to go to the
hospital or send their relatives who show symptoms of the disease --
which are acute diarrhoea and vomiting -- to the hospital immediately
for treatment She said the people depended on untreated water for
drinking and domestic use and appealed to the Amenfi East District
Assembly to provide the community with potable water and a place of
convenience [functional latrines or other sanitary facilities] to
improve sanitation in the community.

--
ProMED-mail
<promed@promedmail.org>

******
[8] Cholera - Kenya (Nairobi)
Date: Sun, 26 Jun 2005
From: Dr S K Sharif <sksharif@ikenya.com>

The Ministry of Health has confirmed a total of 4 deaths due to
cholera in Motherland Slum in Eastleigh Division in Nairobi, Kenya.
The outbreak started on 7 Jun 2005. A total of 155 patients with
diarrhea were treated at the cholera center by 25 June. Out of all
cases who had presented with diarrhea, 20 were confirmed to have
cholera after rectal swabs were taken for bacteriology. The last
positive case was on 14 Jun 2005.

The source of contamination was a water pond which was contaminated
by raw sewage. The Motherland Slum has a population of 4000 people.
The biotype isolated was Inaba and it was sensitive to tetracycline,
erythromycin and ciprofloxacin.

--
Dr S K Sharif
Chief Medical Specialist
Kenya Ministry of Health
<sksharif@ikenya.com>

[ProMED thanks Dr. Sharif for this information. - Mod.LL]

******
[9] Cholera - Senegal
Date: Thu, 23 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: IRIN News [edited]
<http://www.irinnews.org/report.asp?ReportID=47799&SelectRegion=West_Africa>

Senegal - cholera makes a comeback
--------------------------------------
The number of cholera cases in Senegal has risen sharply this month
after a 2-month lull in a lingering epidemic that began in 2004, the
Health Ministry said on Thu, 23 Jun 2005. Figures released by the
ministry showed a total of 1790 new cases and 31 deaths countrywide
between 6 and 22 Jun 2005.

Given the situation, the Ministry of Health and Preventive Medicine
has decided to reinforce measures to battle against the disease, the
ministry said in a statement. These measures would include the
distribution of more drugs, a higher-profile public information
campaign, and the redeployment of medical staff to deal with the
resurgence of the disease, it added.

The main focus of the epidemic continues to be west-central Senegal.
The ministry said the worst-hit areas in Jun 2005 were the Diourbel
region about 150 east of Dakar and the Fatick region 200 km southeast
of the capital.

Diourbel region is home to the Muslim holy city of Touba, where more
than a million pilgrims congregated for an annual festival in late
Mar 2005 during an earlier peak in the epidemic. The massive
gathering led to an explosion of cholera cases in the Diourbel region
and the epidemic then spread right across Senegal as infected
pilgrims carried the water-borne disease home with them.

The epidemic began in Dakar in Oct 2004, when the city of 4 million
people suffered its 1st cholera outbreak in 8 years. By Dec 2004,
the authorities managed to contain the disease, which is usually
caused by poor sanitation and dirty drinking water. However, it
resurfaced in Feb 2005 in Diourbel region and hit a peak on 2 Apr
2005 when 785 new cases of cholera were registered in a single day.

Since then, the number of new cases has declined from over 3000 per
week to about 500, the ministry said. The latest upsurge in the
disease became evident in the week to 12 Jun 2005, when 783 new cases
and 8 deaths were recorded. The number of new cases remained high in
the following week, ending 19 Jun 2005, when there were 746 new cases
and 19 deaths.

--
ProMED-mail
<promed@promedmail.org>

******
[10] Cholera - Pakistan (Lahore): suspected
Date: Wed, 29 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: Pak Tribune [edited]
<http://paktribune.com/news/index.php?id=111051>

Cholera epidemic kills 17 in Lahore
-----------------------------------
A sudden breakout of cholera has resulted in 17 deaths in a short
span of 2 days in the Ravi Town localities of Marzipura, Amin Colony,
Chiragh Park and adjacent areas. The toll is expected to increase.
According to details, the epidemic is spreading at an abnormal level,
infecting almost every household of these localities, and threatening
scores of children, older persons and other citizens alike. This is
being caused by supply of contaminated water, due to mixing of water
from sewerages with water for regular use.

According to the local dwellers, numerous reports have been lodged
with the authorities regarding complaints about contaminated toxic
water being supplied for everyday use, but no heed was ever paid to
it, ultimately culminating in this nightmarish result.

According to details provided, under the directives of Chief
Minister, The Provincial Minister for Health, Dr. Tahir Ali Javed and
Minister for Minority Affairs, Mrs. Joyce Roufen Julius and District
Nazim visited the emergency camp, set up by the District
Administration in Government Girls Degree College.

The doctors and mobile teams are actively involved in dispensing
medical assistance including ORS medication to every household. DDO
health was also present along with his team for any assistance.

--
ProMED-mail
<promed@promedmail.org>

[Other reports have not stated that the illness is cholera . - Mod.LL]

******
[11] Cholera, diarrhea - China
Date: Sun, 26 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: XinHuaNet [edited]
<http://news.xinhuanet.com/english/2005-06/26/content_3136317.htm>

Ministry calls for vigilance against cholera
---------------------
China's Ministry of Health recently issued a circular calling for
higher vigilance against intestinal infectious diseases, particularly
cholera.

Statistics of the ministry show 42 epidemics of 3672 cases of
intestinal infectious diseases, which included cholera, dysentery,
typhoid, paratyphoid and infectious diarrhea, occurred from 1 Jan to
25 May 2005. The official said 37 of these cases were cholera.
Compared with 2004, cholera epidemic occurred earlier.

According to the official, the incidence of intestinal infectious
disease has been kept at a relatively low level in recent years. The
incidence of cholera, in particular, have subsided markedly for 3
consecutive years to historical lows.

The circular urged various localities to beef up work at medical
departments of infectious diseases and strictly abide by the epidemic
reporting system. Meanwhile, they should step up epidemiology probe
into intestinal infectious diseases and closely monitor epidemic of
such diseases.

It called for closely monitoring epidemic among catering service
workers, schools and urban areas that accommodate large numbers of
migrant population and construction sites and beefing up sample
checks of marine and aquatic products.

--
ProMED-mail
<promed@promedmail.org>

******
[12] Cholera, diarrhea - Indonesia (Tangerang)
Date: Mon, 27 Jun 2005
From: ProMED-mail <promed@promedmail.org>
Source: Jakarta Post [edited]
<http://www.thejakartapost.com/detailcity.asp?fileid=20050627.H08&irec=7>

Poor sanitation triggers diarrhea outbreak
----------------------------
Only about 5 kilometers west of Indonesia's international gateway, at
least 329 people, mostly children, are struggling against a deadly
but preventable disease: diarrhea.

Since the epidemic hit on 8 Jun 2005 the Sepatan and Pakuhaji
districts in Tangerang regency -- the area where the Soekarno-Hatta
International Airport is located -- at least 16 children and one
adult have died from the disease.

The head of communicable diseases prevention at Tangerang Health
Agency, Yuliah Iskandar, revealed laboratory results that showed that
_Escherichia coli_ and _Vibrio cholerae_ bacteria, the latter being
the cause of cholera, were found to be the cause of the diarrhea. The
germs, she said, are commonly found in unhygienic environments and
can contaminate food and water.

Health agency head Bachtiar Oesman corroborated Yuliah's analysis,
saying that patients interviewed told his officials that they got the
disease after consuming snacks and orson syrup mixed with ice that
are commonly sold on the streets. "The street snacks and syrup are
just the media ... the main cause of the outbreak is the unhygienic
water that locals use for cooking and drinking," he said on Fri, 24
Jun 2005.

Bachtiar added that his agency had asked heads of the 2 district
administrations to halt production of street snacks and syrup as they
were causing the disease to spread.

Currently, the Sepatan public health center is treating 33 of the
total 182 diarrhea patients in the district, while the remainder were
given outpatient care. At the Pakuhaji public health center, 13 of
99 patients were still being treated, while 16 others were being
treated at the Kedaung Barat subdistrict public health center in
Sepatan.

The remaining 32 patients from the 2 subdistricts, who were
considered to need more intensive treatment, were transferred to the
Tangerang General Hospital. Hospital director Bambang Wisnubroto
said that none of the patients would be charged for their treatment.

[Byline: Multa Fidrus]

--
ProMED-mail
<promed@promedmail.org>

******
[13] Cholera - Worldwide - WHO WER Notifications
Date: Fri, 1 Jul 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Epidemiological Record, 1 Jul 2005 2005 [edited]
<http://www.who.int/wer/2005/wer8026/en>

Notifications of cholera received from 24 to 30 Jun 2005
------------------------------------------------
country / dates / cases / deaths
Africa
Cameroon 9 May-20 Jun 2005/153/ 0
Guinea-Bissau 11-22 Jun 2005/296/ 7
Mozambique 17 May-12 Jun 2005/106/ 3
Zimbabwe 18 May-12 Jun 2005/5/ 1
Asia
Tibet 25 Jun 2005/5/ 2

--
ProMED-mail
<promed@promedmail.org>

See Also