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Published Date: 2005-09-03 23:50:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2005 (34)
Archive Number: 20050903.2605

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2005 (34)
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In this update:
Asia
[1] Cholera - Afghanistan (Bamiyan)
Africa
[2]-[3] Cholera - West Africa
[4] Cholera - Mauritania
[5] Cholera - Congo DR (North Kivu, military/civilian convoy)
[6] Cholera - Niger (South)
[7] Cholera - Nigeria (Sokoto)
[8] Gastroenteritis - Nigeria (Zamfara)
[9]-[10] Cholera - Guinea-Bissau
[11] Cholera - Guinea-Bissau (Bafata)
Worldwide
[12] Cholera - Worldwide - WHO WER Notifications [none]
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[1] Cholera - Afghanistan (Bamiyan)
Date: Fri, 26 Aug 2005
From: ProMED-mail promed@promedmail.org>
Source: Radio Free Afghanistan [edited]
<http://www.azadiradio.org/en/dailyreport/2005/08/26.ASP>

A cholera outbreak that has gripped parts of Afghanistan has claimed the lives
of 4 children in Bamiyan Province, Afghan Voice Agency reported on 25 Aug 2005.
Residents of Yakawlang District told the news agency that despite the deaths
of these children, government authorities have not taken any steps to help
stop the spread of cholera in the area. Yakawlang medical officials have yet
to announce the outbreak of the disease in the district.
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[2] Cholera - West Africa
Date: Fri, 26 Aug 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2005_08_26/en/index.html>

The current wave of cholera outbreaks started several weeks ago in West
Africa. So far, 31 259 cases and 517 deaths have been reported in 8 countries.
Seasonal factors, such as the rainy season, along with population movements in
the area contribute to this unusually high incidence of cholera.
WHO, with international and national health partners, is providing technical
support to the ministries of health at the country and sub-regional level. WHO
is working to strengthen surveillance activities. Supplies for case management
and chlorination of water have also been dispatched to some of the countries.
Breakdown by country
--------------------
Burkina Faso: 295 cases including 8 deaths (case fatality rate/CFR 2.7
percent) have been reported in Ouagadougou town as of 22 Aug 2005, affecting
sectors of the town with precarious water and sanitation conditions.
Guinea: 571 cases including 32 deaths (CFR 5.6 percent) have been reported
between mid-Jul and 4 Aug 2005. Control efforts are ongoing.
Guinea-Bissau: 9047 cases including 172 deaths (CFR 1.9 percent) occurred
between 6 Jun and 21 Aug 2005 in the country. The regions of Bissau and Bimbo
account for 83 percent of cases; cholera is now spreading to remote areas with
10 regions out of 11 affected.
Liberia: 703 cases including 29 deaths (CFR 4.1 percent) have been reported
for the period from 1 to 21 Aug 2005, including Sinoe County.
Mali: 158 cases including 20 deaths (CFR 12.65 percent) have occurred between
20 Jun and 24 Jul 2005. The situation appears to be under control, although
cholera is an ongoing problem in Mali.
Mauritania: 497 cases including 10 deaths (CFR 2 percent) have been reported
in Nouakchott from 20 Jul to 10 Aug 2005. The country reported a total of 717
cases from early May to 12 Aug 2005 occurring in 4 regions (Brakna,
Guidimakha, Nouakchott, and Traza).
Niger: 125 cases including 15 deaths (CFR 12 percent) have been reported in
Bouza, Tahoua region with 3 districts affected between 13 Jul and 24 Aug 2005.
Control measures are being put in place, although the risk of waterborne
diseases has been exacerbated by the current humanitarian situation.
Senegal: 19 863 case and 231 deaths (CFR 1.1 percent) have occurred during the
outbreak which began in Jan and peaked at the end of Mar 2005. Since mid-June
2005, an average of 400-500 new cases per week have been reported, with 3541
cases reported during the last 2 months.
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[3] Cholera - West Africa
Date: Thu, 1 Sep 2005
From: ProMED-mail <promed@promedmail.org.
Source: Eurosurveillance [edited]
<http://www.eurosurveillance.org/ew/2005/050901.asp#2>

Cholera in West Africa and risks of imported cases in European countries
---------------------------------------------------
The summer of 2005 has been marked by a wave of cholera outbreaks in West
Africa (1). Several outbreaks of varying intensity are currently occurring in
Senegal, Burkina Faso, Mali, Guinea, Guinea-Bissau, Niger, Mauritania, Liberia
and Nigeria (2). Cases were imported from Senegal to Gambia in the spring of
2005 but there was no reported subsequent large-scale epidemic (3). No
epidemics have been notified in Cote d'Ivoire, Benin, Togo, Ghana or Sierra
Leone since the beginning of 2005.
Although particularly intense and spectacular when compared with recent years,
the outbreaks of 2005 were expected and have occurred within the context of
cyclical patterns of _Vibrio cholerae_ circulation. The outbreaks are a
continuation of the 7th world cholera pandemic, which began in 1961, and is
due to _V. cholerae_ serogroup O1 biotype El Tor (4,5). The pandemic reached
Africa in 1970 (5) and had spread to all countries of the continent by 2001.
In 2004, 56 countries officially notified 101 383 cases (including 2345
deaths) to the WHO (6), of which 95 560 cases were notified by 31 African
countries.
With the exception of Burkina Faso and Mauritania, all the countries with
outbreaks in 2005 had also notified cholera cases to WHO in 2004. Furthermore,
the _V. cholerae_ strains isolated during the various epidemics in 2005 have
stable microbiological and antibiotic resistance profiles (JM Fournier,
personal communication, 23 Aug 2005). Endemic poverty, summer rains, poor
health and living conditions -- and, in some countries, the current food
crisis -- are all probable contributing factors to the particularly high
incidence and/or mortality rates observed.
The situation in West Africa does not require current management or
preparedness protocols to be altered in France. Although the risk of imported
cases is real (7), the likelihood of secondary transmission remains extremely
low in the European context, where sanitation, hygiene, healthcare structures
and surveillance systems are well developed and readily accessible. If
imported cases do occur, they nevertheless require systematic investigation to
identify potential contacts or common sources such as imported non-industrial
foods which may harbor _V. cholerae_ (4,8,9,10).
In France, the epidemiological profile of imported cases has changed over the
past decade. Cases in mainland France in the 1980s were mostly in migrants
returning from the north or sub-Saharan Africa, and were typically diagnosed
at healthcare centers in large French metropolitan areas. Since the end of the
1990s, however, the number of cases has gone down significantly and some cases
have been diagnosed in smaller cities in French nationals returning from
holidays in countries such as Peru, Indonesia, India, Pakistan and sub-Saharan
Africa. It is estimated that under 10 percent of cholera infections present
with symptoms of vomiting and stools resembling rice water; most cases are
associated with few or no clinical signs (4), and clinicians should therefore
consider cholera as a possible diagnosis in any patient returning from abroad
with mild gastrointestinal symptoms.
1. WHO Communicable Disease Surveillance & Response. Cholera in West Africa.
26 Aug 2005.
(<http://www.who.int/csr/don/2005_08_26/en/index.html>)
2. Cholera, diarrhea & dysentery update 2005 (30). In: ProMED-mail [online].
Boston US: International Society for Infectious Diseases, archive no.
20050805.2280, 5 Aug 2005.
(<http://www.promedmail.org>)
3. Cholera, diarrhea & dysentery update 2005 (13). In: ProMED-mail [online].
Boston US: International Society for Infectious Diseases, archive no.
20050408.1013, 8 Apr 2005.
(<http://www.promedmail.org>)
4. Sack DA, Sack RB, Nair GB, Siddique AK: Cholera. Lancet 2004; 363:223-33.
5. Crowcroft NS: Cholera: current epidemiology. Commun Dis Rep CDR Rev 1994;
4:R157-R164.
(<http://www.hpa.org.uk/cdr/archives/CDRreview/1994/cdrr1394.pdf>)
6. WHO: Cholera, 2004. Wkly Epidemiol Rec 2005; 80:26168.
7. CDC: Cholera associated with imported frozen coconut milk--Maryland, 1991.
MMWR Morb Mortal Wkly Rep 1991; 40:844-45.
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00015726.htm>)

8. Ciofi degli Atti M, Finarelli AC, Pompa MG, et al: A case of cholera
imported from Senegal to Rimini, Italy, June 2005. Eurosurveillance 2005; 10:
30/06/2005.
(<http://www.eurosurveillance.org/ew/2005/050630.asp#6>)
9. CDC: Cholera epidemic associated with raw vegetables--Lusaka, Zambia, 2003-
2004. MMWR Morb Mortal Wkly Rep 2004; 53:783-86.
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5334a2.htm>)

10. CDC: Cholera associated with food transported from El Salvador--Indiana,
1994. MMWR Morb Mortal Wkly Rep 1995; 44:385-86.
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/00037127.htm>)
[Byline: Tarantola A (<a.tarantola@invs.sante.fr>), Ioos S, Lapidus N]
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[4] Cholera - Mauritania
Date: Mon, 29 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: Noticias.info [edited]
<http://www.noticias.info/asp/aspComunicados.asp?nid=93742&src=0>

In cholera treatment centres in Mauritania, the health authorities and
Medecins sans Frontieres (MSF) have now received over 1000 patients. Though
not all of them were suffering from cholera, the vast majority were, and the
high number illustrates how serious the current outbreak is.
The situation is made worse because the bacterial disease has attacked slums
in the capital, Nouakchott. The 1st cholera treatment centre (CTC), now
closed, was located just south of the city. The current CTC is in the slum
area where the disease is now centered. With many people crowded together,
much waste lying around and a problematic water supply, control of the
epidemic is extremely complex.
"The 1st case of cholera in the capital area was found in a hospital in
Nouakchott," said Maria Theresa de Magelhaes Vilhena, member of the MSF
emergency pool. "When we arrived at the end of Jul 2005 for a nutritional
assessment in Mauritania, there were 10 patients in a hastily constructed
cholera camp in Riyad, just south of the capital. With no shelter from the
sun, the patients were scrambling for a bit of shade. People were just walking
in and out, the sand on the ground mixed with vomit of the patients, and the
latrine was overflowing. It was a disastrous situation and the provincial
health authorities accepted our offer to help out."
MSF constructed shelter, hygienic barriers, taps and drainage, and hired staff
for cleaning and waste management. In the days that followed, only a couple of
new patients came in each day. But a sudden peak of admissions raised the
suspicion that water sources would have been contaminated; on Sun, 7 Aug 2005,
137 new patients came in. The vast majority came from the El Mina slum, which
has an estimated population of over 100 000 people.
"Peaks after the one of 7 Aug 2005 are related to rainfall," said De Magelhaes
Vilhena. "It's very basic: it rains roughly once a week and 2 days later many
new patients come in. The rains are expected to continue for some time yet. In
addition, we now see people arrive from neighboring slum areas, particularly
Sebhka and Arafat. Also, we know from experience that an attack rate of 1
percent, meaning 1 in 100 people in affected areas get infected, tends to mark
the height of a cholera outbreak. In El Mina that rate is now 0.6 percent. So
yes, we expect worse to come yet."
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[5] Cholera - Congo DR (North Kivu, military/civilian convoy)
Date: Mon, 29 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: monoc.org [edited]
<http://www.monuc.org/news.aspx?newsID=8134>

Congolese Defense Minister Adolphe Onusumba has confirmed a cholera outbreak
among government troops in Goma, in North Kivu. The Minister specified that 10
soldiers of the 4th army brigade have died and 150 are infected.
The army brigade of 3200 men was headed in the past 3 days toward Ituri.
Onusumba added that antibiotics and health material has been sent.
There is no official data on any cases among civilians in Goma, but UN
officials have reported at least 16 dead and 300 infected in a convoy of
soldiers and their families en route from Goma to Bunia, adding that some of
the sick have been left in villages along the road, increasing the risk of
expanding the outbreak.
--
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[6] Cholera - Niger (South)
Date: Tue, 30 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: TodayOnline.com [edited]
<http://www.todayonline.com/articles/69423.asp>

Weakened by food shortages and months of tilling sandy fields, the men, women
and children of several villages in the south of Niger must now face an even
deadlier threat: a cholera outbreak, the 2nd in as many months.
Reported to the larger district hospital in Birni nKonni, these cases of
cholera have proven difficult to control because the source of the illness is
a large river, the Maggia, flowing through much of the south of the country
and into Nigeria.
Cholera outbreaks in southern Niger could threaten Nigeria and are dangerous
because of the vulnerable state of the area's population, hungry and weak
after months of food shortages and heavy labour in the fields.
Sheibu Ibrahim, director of epidemics for the Ministry of Health in Niger,
stated that there were 135 confirmed cases of cholera in the country, and that
15 deaths had been recorded.
Salissou Abdou, epidemiologist for the district of Konni, confirmed that the
cholera strains were coming from the Maggia.
20 out of the 27 cases confirmed in Gounfara, an isolated village at the end
of a bumpy track in the south of the country, are elderly women, Women are
responsible for fetching and carrying water and carrying out all household
duties, including 2 highly contaminating activities: washing clothes and
preparing food.
--
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[7] Cholera - Nigeria (Sokoto)
Date: Wed, 31 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: Reuters [edited]
<http://www.alertnet.org/thenews/newsdesk/L31417031.htm>
At least 33 people have died and hundreds have been hospitalized following an
outbreak of cholera in the remote northwestern Nigerian state of Sokoto,
officials said on Wed, 31 Aug 2005. The victims, including women and
children, died over the past 3 days in 3 villages in the Sabon Birni district,
officials said.
"Following the outbreak, 19 people died in Gidan Gero village and 2 others in
Maruda village," said Abdullahi Muhammed, director of health in Sabon Birni
district.
A government spokesman said 12 others died in Faru village, and that the
disease had spread to 2 other districts, but casualties there were unknown.
At least 150 Nigerians have died of cholera since Apr 2005 when the rainy
season began. Nigeria's health care system is one of the worst in Africa, and
2/3 of its 140 million population lives on less than a dollar a day.
--
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[8] Gastroenteritis - Nigeria (Zamfara)
Date: Mon, 29 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and This Day (Lagos) [edited]
<http://allafrica.com/stories/200508290268.html>

No fewer than 25 people have lost their lives due to the outbreak of
gastroenteritis in Lilo village in Gusau council area of Zamfara state.
The News Agency of Nigeria (NAN), reports that 500 people, mostly children,
were currently receiving treatment at a camp constructed at the center of the
village.
According to health sources, the cause of the outbreak may be connected with
the use of infected water from the stream by the villagers, because of lack of
potable water in the area.
When NAN visited the village weekend 10 health personnel were seen busy
treating affected persons at the camp.
NAN recalls that about 3 months ago, a similar incident occurred in Gusau,
which allegedly led to the death of about 50 persons.
--
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[9] Cholera - Guinea-Bissau
Date: Wed, 31 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: News24.com [edited]
<http://www.news24.com/News24/Africa/News/0,,2-11-1447_1762425,00.html>

A cholera epidemic raging in the West African state of Guinea-Bissau since
June 2005 has now killed 230 people, with 10 780 reported cases, the head of
public health in the health ministry, Tome Vaz, said on Tue, 30 Aug 2005. The
latest figure showed a sharp rise in the death toll, which was put at 170 a
week ago.
The capital city is the worst affected area, where 57 people have died and
8000 cases have been reported, said Vaz.
Health authorities have banned public gatherings such as baptisms, marriages
and funerals and closed many restaurants in a bid to contain the infectious
disease, which thrives in dirty, unsanitary conditions.
--
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[10] Cholera - Guinea-Bissau
Date: Thu, 1 Sep 2005
From: ProMED-mail <promed@promedmail.org>
Source: XinHuaNet.com [edited]
<http://news.xinhuanet.com/english/2005-09/01/content_3430941.htm>

A total of 222 people have died of cholera and more than 11 000 others were
affected since the disease epidemic erupted in Guinea-Bissau in June 2005,
according to reports reaching here from Bissau on Thu, 1 Sep 2005.
Guinea-Bissau's Health Ministry officials were quoted as saying that the
capital city Bissau remains the hardest-hit area, accounting for 6054 of the
total 11 129 cases reported by Tue, 30 Aug 2005, and 54 of the deaths.
The officials said there was a "slowdown" in the number of new cases being
reported but that the number of victims continued to rise daily. However, the
officials were worried about the problem that some 20 cholera patients, mostly
youths, "fled" hospitals daily before complete recovery.
--
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[These above 2 reports offer slightly different numbers, presumably from
different sources of information. - Mod.LL]
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[11] Cholera - Guinea-Bissau (Bafata)
Date: Fri, 26 Aug 2005
From: ProMED-mail <promed@promedmail.org>
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=369031>

Cholera broke out in Bafata (Guinea-Bissau's 2nd largest city), with 8
reported cases including 2 deaths, the Director General of Epidemiology at the
health ministry, Tome Ca, affirmed here Thu, 25 Aug 2005.�
According to him, since the outbreak of the disease, on 11 Jun 2005, Bafata
and Gabou were spared by the epidemics. He added, however, that nationwide
medical authorities recorded more than 100 cases of cholera per day,
specifying that from Jun 2005 to date, there were 9207 cases including 177
deaths.
The village of Ntchale, in northeastern Bissau, was [hit] on 24 Aug 2005 by
this epidemic, which killed 5 people he told a news conference.
In Jul 2005, according to the local press, the inhabitants of the district of
Bisassema de Baixo, in the island of Bolama, had to totally abandon their
houses and pets to settle elsewhere, after the cholera epidemic had killed
about 10 people within 24 hours.
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[12] Cholera - Worldwide - WHO WER Notifications
Date: Fri, 2 Sep 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Epidemiological Record, 2 Sep 2005�
<http://www.who.int/wer/2005/wer8034/en>

Notifications of cholera received from 26 Aug to 1 Sep 2005
-----------------------------------------------------------
country / dates / cases / deaths
No notifications reported.
--
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[Elsevier reference:
J. Sanchez & J. Holmgren 2005. Virulence factors, pathogenesis and vaccine
protection in cholera and ETEC diarrhea. Current Opinion in Immunology
17(4): 388-398.]

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