Published Date: 2006-06-09 00:00:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2006 (24)
Archive Number: 20060609.1614
CHOLERA, DIARRHEA & DYSENTERY UPDATE 2006 (24)
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In this update:
Africa
[1] Cholera - Angola
[2] Cholera - Angola
Asia
[3] Cholera - Bangladesh: Single-dose azithromycin therapy
[4] Cholera - Worldwide - WHO WER Notifications
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[1] Cholera - Angola
Date: Fri, 9 Jun 2006
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2006_06_09/en/>
As of 6 Jun 2006, Angola has reported a total of 43 076 cases and
1642 deaths (overall case-fatality rate (CFR) 3.8 percent). In the
last 24 hours, 280 new cases including 8 deaths have been reported.
Out of 18 provinces, 14 are affected; of all cases, 51 percent have
occurred in Luanda and 18 percent in Benguela province. The CFR,
broken down by province, ranges between 1 and 30 percent. Although
current trends show a decline in most provinces, a daily incidence of
around 200-280 cases is still being reported.
The trend to decline continues in the provinces of Kwanza Norte,
Bengo, Malange, and Luanda. The provinces with higher numbers of
daily cases are Luanda (48 perent), Namibe (17.6 percent)[the 14th
province to be affected - Mod.LL], Kwanza Sul (4.9 percent), Huila
(4.9 percent) and Uige (4.4 percent).
A plan of action for cholera has been drawn up and agreed upon by all
partners at country level, for a short, medium and long-term
response. WHO continues to provide support in surveillance, water
and sanitation, social mobilization and logistics together with the
Ministry of Health.
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[A map of Angola showing the provinces can be found at:
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf>.
Namibe is located in the southwest corner of the country, bordering
Namibia. This is the first province reportedly affected in this
outbreak to be located on the southern borders of Angola. The
provinces yet to be reported involved are: Cunene, Cuando Cubango,
Moxico and Lunda Sul. - Mod.LL]
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[2] Cholera - Angola (Namibe)
Date: Wed, 7 Jun 2006
From: ProMED-mail <promed@promedmail.org>
Source: AllAfrica.com and Angola Press Agency (Luanda) [edited]
<http://allafrica.com/stories/200606070790.html>
In the last 2 days at Ngola Kuimbanda Hospital and in the pediatric
hospital of the southwestern Namibe Province, 14 new cholera cases
were registered, luckily without deaths, provincial health director
Pedro Viyayayuka announced this Wed, 7 Jun 2006.
He stressed that the illness has already affected Tombwa
municipality, Lucira commune and 5 April ward, making a total of 196
cases in Namibe Province.
Tombwa municipality is the most affected with 80 cases and 23 deaths.
To control the disease, health authorities and partners are educating
the population to follow preventive measures.
--
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*****
[3] Cholera - Bangladesh: Single-dose azithromycin therapy
Date: Thu, 8 Jun 2006
From: ProMED-mail <promed@promedmail.org>
Source: New England Journal of Medicine [edited]
<http://content.nejm.org/cgi/content/short/354/23/2452>
[This article in this week's New England Journal of Medicine reports
the successful use of single-dose azithromycin in adults with cholera
in a situation where there was substantial resistance against the
comparator ciprofloxacin - Mod.LL]:
Background:
Single-dose azithromycin is effective in the treatment of severe
cholera in children, but its effectiveness in adults has not been evaluated.
Methods:
We conducted a double-blind, randomized trial comparing the
equivalence of azithromycin and ciprofloxacin (each given in a single
1-g dose of two 500-mg tablets) among 195 men with severe cholera
caused by _Vibrio cholerae_ O1 or O139. Patients were hospitalized
for 5 days. A stool culture was performed daily. Primary outcome
measures were clinical success (the cessation of watery stools within
48 hours after drug administration) and bacteriologic success (the
inability to isolate _V. cholerae_ after 48 hours).
Results:
Therapy was clinically successful in 71 of 97 patients receiving
azithromycin (73 percent) and in 26 of 98 patients receiving
ciprofloxacin (27 percent) (P less than 0.001) and bacteriologically
successful in 76 of 97 patients receiving azithromycin (78 percent)
and in 10 of 98 patients receiving ciprofloxacin (10 percent) (P less
than 0.001). Patients who were treated with azithromycin had a
shorter duration of diarrhea than did patients treated with
ciprofloxacin (median, 30 vs. 78 hours); a lower frequency of
vomiting (43 percent vs. 67 percent); fewer stools (median, 36 vs.
52); and a lower stool volume (median, 114 vs. 322 ml per kilogram of
body weight). The median minimal inhibitory concentration of
ciprofloxacin for the 177 isolates of _V. cholerae_ O1 was 0.25
microg per milliliter, which was 11 to 83 times as high as that in
previous studies at this site.
Conclusions:
Single-dose azithromycin was effective in the treatment of severe
cholera in adults. The lack of efficacy of ciprofloxacin may result
from its diminished activity against _V. cholerae_ O1 strains
currently circulating in Bangladesh.
--
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******
[4] Cholera - Worldwide - WHO WER Notifications
Date: Fri, 9 Jun 2006
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: WHO Epidemiological Record [edited]
<http://www.who.int/wer/2006/wer8123/en/index.html>
Notifications of cholera received from 2 to 8 Jun 2006
--------------------------------------------------------
Country/Dates/Cases/Deaths
Africa
Angola 26 May-4 Jun 2006/ 2877/ 139
Cameroon 1 Jan-21 May 2006/ 334/ 7
Kenya 23-30 May 2006/ 58/ 1
Liberia 8-21 May 2006/ 44/ 0
Mozambique 8-21 May 2006/ 250/ 0
Niger 1-14 May 2006/ 83/ 12
Zimbabwe 8-21 May 2006/ 70/ 9
--
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See Also
Cholera, diarrhea & dysentery update 2006 (23) 20060602.1538Cholera, diarrhea & dysentery update 2006 (22) 20060530.1512
Cholera, diarrhea & dysentery update 2006 (21) 20060519.1416
Cholera, diarrhea & dysentery update 2006 (20) 20060512.1352
Cholera, diarrhea & dysentery update 2006 (19) 20060505.1298
Cholera, diarrhea & dysentery update 2006 (18) 20060430.1259
Cholera, diarrhea & dysentery update 2006 (17) 20060421.1164
Cholera, diarrhea & dysentery update 2006 (16) 20060414.1111
Cholera, diarrhea & dysentery update 2006 (15) 20060407.1043
Cholera, diarrhea & dysentery update 2006 (10) 20060303.0675
Cholera, diarrhea & dysentery update 2006 (01) 20060106.0040
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