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Published Date: 2007-08-04 22:00:12
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2007 (25)
Archive Number: 20070804.2537

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2007 (25)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Cholera - Africa: Kenya (Nyanza)
[2] Cholera - Comoros Islands (Grand Comoros) Asia
[3] Cholera, Burmese migrant workers - Thailand (Tak)
[4] Cholera - Thailand (Tak), Myanmar border, MOH report
[5] Cholera, diarrhea - India (Punjab) Worldwide
[6] Cholera - worldwide, 2006: WHO
*****
[1] Cholera - Africa: Kenya (Nyanza)
Date: Tue 31 Jul 2007
Source: Kenya Broadcasting Corporation [edited]
<http://www.kbc.co.ke/story.asp?ID=44099>

At least 4 people have died in the past 2 days [29-30 Jul 2007] while
2 others were admitted in critical condition following renewed
cholera outbreak in Milambo village, Siaya district.
Siaya District Commissioner Wilson Litole says the 1st victim died
after complaining of stomach ache, vomiting and diarrhea, symptoms of
the disease. But the Local Medical Officer of Health (MOH) Dr.
Elizabeth Okoth, when contacted, denied any outbreak of the disease.
However KNA has established that a team of Public Health officers has
been dispatched to the affected area to investigate and institute
measures of containing further spread of the disease.
About 4 months ago there was an outbreak of cholera in the district,
which was announced by the Director of Medical Services. The outbreak
covered Siaya, Kisumu, Busia and Bondo districts but the Siaya MOH
dismissed the outbreak and came to admit it when already over 7
people had died of the disease.
[Byline: James Rono]
--
Contributed by:
ProMED-mail
<promed@promedmail.org>
[Siaya District is 1 of the 12 districts that comprise Nyanza
Province in the southwest part of Kenya. The location of the province
can be seen on a map at:
<http://www.un.org/Depts/Cartographic/map/profile/kenya.pdf>. - Mod.LL]
*****
[2] Cholera - Comoros Islands (Grand Comoros)
Date: Mon 30 Jul 2007
From: Bernard Gauzere
<ba-gauzere@chd-fguyon.fr>

Through 17 Jul 2007, the number of cholera cases declared since the
beginning of the epidemic (25 Feb 2007): 397
Number of deaths: 9
Moheli Island : 1 case
Anjouan Island: 0 cases
Njazidja Island (Grand Comoros): 396 cases
The period is quite critical in Comoros. The months of July and
August are the times when large weddings or large community meals
occur on a daily basis with their associated flare-ups of cholera.
--
Bernard A Gauzere MD
Intensive Care Unit and
Indian Ocean Center for Research and Surveillance Regional Hospital
Saint-Denis, Reunion island
<ba-gauzere@chd-fguyon.fr>
[According to the submitter, the data were provided to NGO's by the
Comoros Ministry of Health for a mission of assessment of the
situation. Grand Comoros is the largest and most northern and western
of this island nation which is located in the Indian Ocean between
Madagascar and the African continent. The islands can be seen on a
map at:
<http://www.un.org/Depts/Cartographic/map/profile/comoros.pdf>. - Mod.LL]
*****
[3] Cholera, Burmese migrant workers - Thailand (Tak)
Date: Mon 30 Jul 2007
Source: Bankok Post [edited]
<http://www.bangkokpost.com/News/30Jul2007_news08.php>

Public health officials are on red alert for a possible cholera
outbreak along the Thai-Burmese border in Tak as nearly 500 people,
mostly migrant workers, have been treated with severe diarrhea in the
past 2 months. Up to 80 percent of the 492 patients were Burmese migrants.
Of the total, 374 worked in the farming sector, said the head of Tak
public health office Patjuban Hemhongsa. The statistics were
unveiled to permanent secretary for health Prat Boonyawongwirote
during his inspection trip on 29 Jul 2007.
Dr. Prat instructed local officials to map out measures to stop the
disease from spreading, particularly through water. Special attention
should be given to communities of Burmese workers in the province, he said.
All of the 492 patients, except one Burmese worker, have been
released from hospitals in the province. The worker, who is from a
Muslim community in Tak, is currently being treated at Mae Sot
hospital, according to health officials.
Earlier in July 2007, there were reports that hundreds of Burmese
people in border areas opposite Tak province were suffering from
cholera. Many of them were sent to hospitals in Tak's Mae Sot, Tha
Song Yang, Mae Ramat, Phop Phra and Umphang districts. 2 migrants
died during the treatment, the officials said without elaborating.
[Byline: Supamart Kasem]
--
Contributed by:
ProMED-mail
<promed@promedmail.org>
[Tak is one of the northern provinces (changwat) of Thailand. The
western edge of province has a long boundary with Kayin State of
Myanmar (Burma). The location of Tak province can be found at:
<http://en.wikipedia.org/wiki/Tak_Province>. - Mod.LL]
******
[4] Cholera - Thailand (Tak), Myanmar border, MOH report
Date: 4 Aug 2007
From: Dr. Kumnuan Ungchasak <kum@health.moph.go.th>

There is an ongoing outbreak of cholera in Tak, a northern province,
which has the border area with Myanmar starting from June [2007] this
year. As of 27 Jul [2007] there are:
- 77 patients who were treated at the Thai district hospitals and in
the Migrant camp.
- On every case diagnosed in the hospital, a Surveillance and Rapid
Response Team (SRRT) was sent out to do active case finding by
examining and doing rectal swab cultures on family members and
neighborhood contacts. We found another 120 confirmed cases who had
diarrheal symptoms. We also found 283 asymptomatic carriers. Adding
these 3 categories there are a total of 480 persons with [positive]
rectal swab cultures of which all were treated with antibiotics. So
far there have been no deaths confirmed attributable to cholera.
- Most of the cases (84 percent) are ethnic migrant workers who work
in the small farms or factories and can easily cross the Thai-Myanmar border.
- Major risk factors [for infection] are unsanitary living
conditions, drinking from unsafe water sources and eating without
proper hand washing.
The Thai Ministry of Health has exchanged this information with the
Ministry of Health of Myanmar and the WHO. On this coming Monday,
[6 Aug 2007], during the annual meeting of the Ministries of Health
of Thailand and Myanmar, both Health Ministers will discuss the
necessary collaboration and assistance to achieve the goal of control
of this outbreak.

Yours sincerely,
--
Dr. Kumnuan Ungchusak
Director, Bureau of Epidemiology
Department of Diseases Control. Ministry of Public Health
Tivanonda Road, Nonthaburi 11000 Thailand
<kum@health.moph.go.th>
[ProMED-mail would like to thank Dr. Kumnuan Ungchusak for providing
this detailed information on the ongoing outbreak of cholera on the
Thailand-Myanmar border region in Tak Province.
Borrowing from the moderator comment accompanying a similar posting
on the ProMED-MBDS list:
"In Hoge et al (see ref 1 below), while comparing the epidemiology of
the then newly introduced _V. cholera_ O139 with the pre-existing _V.
cholera_ O1 el tor, Ogawa, found that 366 patients with cholera
identified at Samutsakorn Hospital (Thailand) (of which 165 were
infected with V. cholera O139 Bengal, 191 were infected with V.
cholera O1 el tor, Ogawa, and 10 were infected with both V cholera O1
el tor, Ogawa and -V cholera_ O139), 354 cases identified were among
hospitalized patients and only 12 where identified among outpatients,
suggesting the majority of infections were significantly clinically
ill. A case-control study was conducted using age and sex matched
controls randomly selected from persons hospitalized or visiting the
hospital for reasons other than diarrhea, and who had not had
diarrhea within the previous 2 weeks. Risk factors for disease
included consumption of untreated water, ice, food sold by street
vendors, uncooked or partially cooked seafood, and attendance at a
group gathering (festival or party) where food was served within 3
days before onset of illness. Contact with other persons with
diarrhea in the 2 weeks before illness (either within the same
household or outside the household) was also associated with disease.
The study concluded that risk factors for disease with _V cholera_ O1
et tor, Ogawa did not significantly differ from those for _V cholera_
O139. The authors did not discuss whether controls had rectal swabs
to ascertain if they had asymptomatic infections.
The finding that the majority of identified infections were
asymptomatic (283 asymptomatic vs 197 symptomatic) in the current
outbreak in Tak Thailand led this moderator to a pub med search to
see if other studies have identified similar high proportions of
asymptomatic cases.
In Harris et al (see ref. 2 below), the objective of the study was to
look at the possible relationship between ABH histo-blood group
antigens and susceptibility to and severity of infection with _V.
cholera_. The study group was comprised of 269 patients and 793
household contacts. Of these household contacts, 260 (33 percent)
were found to be infected with _V. cholera_. Looking at the data
another way, of the 529 _V. cholera_ infected individuals, 260 (49
percent) were asymptomatic at the time of initial identification of
the _V. cholera_ infection. Of the 260 identified 'asymptomatic'
infected household contacts, 150 (58 percent) ultimately developed
watery diarrhea. With respect to the focus of the study, Table 2
(page 7425 in the below referenced article) -- Risk of infection and
severe diarrhea if infected in a cohort of household contacts of
index patients -- demonstrated that ABH histo-blood group O was
associated with a protective effect against infection with both
_Vibrio cholerae_ O1 and O139 in household contacts of cases (blood
group O was associated with protection from infection with _V.
cholerae_ O1 (Odds ratio OR = 0.67; 95 percent CI, 0.53 to 0.85; P =
0.0008)). Among those contacts who were infected, the odds ratio for
severity of disease was 2.4 times that seen in individuals with blood
group O than in those with non-type O blood group (95 percent
confidence interval CI 1.2 to 4.7, p = 0.01). When stratified by
specific _V. cholera_ organism identified, the odds ratio for
severity of disease for _V. cholera_ O1 was 2.3 (CI 0.98 to 5.6)
p=0.055 and for _V. cholera_ O139 was 2.3 (CI 0.86 to 6.2) p = 0.10.
One suspects that the rapid intervention of the SRRTs in Tak Thailand
are significantly impacting on the overall transmission of disease by
identifying as yet asymptomatic infectees and treating these
infections. We look forward to updates on the situation as well as
information on the cholera activity in Myanmar.
Tak province is bordering with Myanmar and can be seen at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/thailand_admin_2005.jpg>.
References:
1. Hoge CW, Bodhidatta L, Echeverria P, Deesuwan M, Kitporka P.
Epidemiologic study of Vibrio cholerae O1 and O139 in Thailand: at
the advancing edge of the eighth pandemic. Am J Epidemiol. 1996 Feb
1;143(3):263-8. Available at
<http://aje.oxfordjournals.org/cgi/reprint/143/3/263>
2. Harris JB, Khan AI, LaRocque RC, Dorer DJ, Chowdhury F, Faruque
AS, Sack DA, Ryan ET, Qadri F, Calderwood SB. Blood group, immunity,
and risk of infection with Vibrio cholerae in an area of endemicity.
Infect Immun. 2005 Nov;73(11):7422-7. Available at
<http://iai.asm.org/cgi/reprint/73/11/7422>
- Mod.MPP']
*****
[5] Cholera, diarrhea - India (Punjab)
Date: Fri 3 Aug 2007
Source: Express India [edited]
<http://cities.expressindia.com/fullstory.php?newsid=249049>

A 5-year-old child, a resident of Ambedkar Colony in Balongi, who was
admitted to PGI for treatment a few days back, has been declared to
be suffering from cholera. Following the detection of the case,
health department teams are on an alert to prevent an outbreak of
cholera in the Mohali slums.
At the same time, more than 2 dozen children have been treated at the
Civil Hospital Mohali for diarrhea. Of these, only 5 have been
admitted to the hospital.
According to the information, at least 3 deaths that occurred in
village Madanpur village are suspected to be due to diarrhea although
this is yet to be confirmed. To contain any possibility of the
disease breaking out, the administration has removed the handles of
the handpumps in the areas where there are alternative sources of
water. In the areas where there is no other source of water, it has
advised the residents to boil water before drinking.
When contacted, District Health Officer Dr. S P Surila said health
department teams were regularly visiting the slums and no case of
cholera or diarrhea had been detected. He said that the child was
responding to the treatment and would be discharged soon from the
PGI. He said that prevention from these waterborne diseases was
mainly in the hands of the residents of these slums. He added that
the teams of health department were providing medicines and spreading
awareness amongst the residents regarding this.
--
Contributed by:
ProMED-mail
<promed@promedmail.org>
[The village of Balongi is located in the northwestern Indian state
of Punjab. The state can be found on a map of India at:
<http://www.mapsofindia.com/maps/punjab/punjab-lcoation-map.gif>- Mod.LL]
*****
[6] Cholera - worldwide, 2006: WHO
Date: Fri 3 Aug 2007
Source: World Health Organization (WHO) Weekly Epidemiological Record
(WER) [edited]
<http://www.who.int/wer/2007/wer8231.pdf>

Since the WER issue of 15 Jun 2007 and the use of the 2005
International Health Regulations, the official notification of
cholera is no longer mandatory. This issue of WER, however, contains
a summary of worldwide cholera cases for 2006.
Highlights of the issue include:
Year/ Total Cases/ Deaths/ Case Fatality Rate
2006/ 236 896/ 6311/ 2.66 percent
The total number of cases worldwide increased by 79 percent from 2005.
The total number of deaths worldwide increased 3-fold from 2005.
The CFR increased from 1.72 percent in 2005.
Africa:
- reported 99 percent of all reported cases
- total increased by 87 percent from 2005
- reported almost all the deaths (CFR 2.7 percent)
- 4 countries reported 80 percent of the African cases (Angola, Congo
DR, Ethiopia, Sudan)
Asia:
- reported cases decreased nearly 3-fold from 2005
- India reported 78 percent of the total
Americas:
- all reports from North America
- Canada - 2 imported cases
- USA - 4 imported cases and 4 indigenous (Gulf Coast area) cases
[Although WER will no longer routinely report cholera cases, ProMED
will continue to post cholera updates. The reader is referred to the
original URL for the entire report. - Mod.LL]
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

See Also