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Published Date: 2007-11-05 19:00:11
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2007 (54)
Archive Number: 20071105.3595

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (54)
**********************************************
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 this update:
Asia
[1] Cholera - Viet Nam
[2] Diarrhea, fatal - Yemen: (Hodeidah, Hajja), possible cholera
[3] Cholera - Iraq: WHO update
[4] Diarrhea, fatal - Nepal: (Central region)
[5] Cholera - Thailand
[6] Cholera - Thailand: clarification
Africa
[7] Cholera - Uganda: (Nebbi)
[8] Diarrhea - South Africa: (Mpumalanga)

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[1] Cholera - Viet Nam
Date: Mon 5 Nov 2007
Source: VietNamNet Bridge [edited]
<http://english.vietnamnet.vn/social/2007/11/753159/>

A diarrhea epidemic has spread to 11 provinces and cities of Viet Nam and
up to 15 per cent of hospitalized patients are positive for cholera.
According to the Health Ministry, an additional 148 patients were brought
to hospitals for diarrhea Sun, 4 Nov 2007, raising the total number to 581.
Of them, 76 were positive for cholera.

At present, 11 provinces and cities are on the cholera epidemic list:
Hanoi, Ha Tay, Hai Phong, Vinh Phuc, Thai Binh, Phu Tho, Hung Yen, Bac
Ninh, Hai Duong in the north, and Thanh Hoa and Nghe An in the central
region. The cholera patient in Nghe An is a student who ate shrimp paste in
Hanoi before returning to his hometown. Hanoi still has the highest number
of diarrhea patients, 359, who come from all 14 districts of the city.

Nguyen Hong Ha, deputy director of the National Contagious and Tropical
Diseases Institute, said that the institute is treating 286 patients, 50
per cent of whom are in serious condition. Just 4 patients have been
discharged. The hospital is now overloaded. The situation is the same at
other hospitals in Hanoi, such as Dong Da, Military Hospital 103, Thanh
Nhan and Saint Paul. So far, there have been no deaths.

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[The number of cases and the provinces involved have increased quickly. A
map of Viet Nam showing the areas involved can be found at
<http://en.wikipedia.org/wiki/Provinces_of_Vietnam>. - Mod.LL]

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[2] Diarrhea, fatal - Yemen: (Hodeidah, Hajja), possible cholera
Date: Sat 3 Nov 2007
Source: News Yemen [edited]
<http://www.newsyemen.net/en/view_news.asp?sub_no=3_2007_11_03_6956>

Since the beginning of October 2007, 30 people have in Azzahrah, Luhaih,
Qanawes, and Zaidia districts of Hodeidah province and in Meidi, Mostaba,
Khairan al-Mahraq, Haradh, and Abs of Hajja due to diarrhea sources thought
to be cholera. People in the districts said the cases of "fatal diarrhea"
are increasing and that infected people die after 24 hours.

Some people in Hodeidah also told NewsYemen that other cases of severe
sensitivity in eyes appeared in some areas as infected people cannot see
light and feel the need to scratch their eyes. People in Hodeidah refer
such strange diseases to the volcanic clouds resulted from volcanic
explosion that took place on Jabal al-Tair island, off Hodeidah, early last
October [2007].

"There is no relation between the diseases and the volcanic explosion. This
is the season of diarrhea and other diseases," the manager of the Health
Office in Hodeidah, Ahmad Borji, told NewsYemen.

--
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[A map of Yemen can be found at
<http://www.un.org/Depts/Cartographic/map/profile/yemen.pdf>. Hodeidah and
Hajja are regions of western Yemen near the Red Sea. - Mod.LL]

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[3] Cholera - Iraq: WHO update
Date: Wed 31 Oct 2007
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, WHO report [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/SIRU-78N7ZC?OpenDocument&rc=3&cc=irq>

New laboratory confirmed cholera cases reported during 29-31 Oct 2007 (3
days):
- Kirkuk: 7 (of 122 samples tested) 6 per cent
- Sulaymaniyah: 1 (number of samples tested not yet reported)
- Erbil: 2 (of 184 samples tested) one per cent
- Ninawa: 0 (of 396 samples tested) 0 per cent
As of 31 Oct 2007 (week 44), 45 districts, 28 in northern Iraq and 17 in
the center and south have reported laboratory-confirmed cases of cholera.
In northern Iraq, 13 out of the 14 districts of Sulaymaniyah governorate,
all 5 districts of Kirkuk governorate, 6 of 7 districts of Erbil
governorate, and 4 districts in Dahuk. As for the centre and South; the
affected districts are: 4 districts in Baghdad, and 3 districts each of
Tikrit, Mosul, and Diyala; 2 districts in Basra as well as one district in
each of Wasit and Anbar. The results of the samples of _Vibrio cholerae_
isolates from Sulaymaniyah were received by the USA Naval Medical Research
Unit No. 3 (NAMRU-3) laboratory, Cairo. NAMRU-3 results confirmed
Sulaymaniyah- and Central Public Health Laboratory (CPHL) results, showing
_V. cholerae_ O1 El Tor Inaba.

99 per cent of Iraq's cholera cases were reported from Kirkuk,
Sulaymaniyah, and Erbil, northern Iraq. Sporadic cases with definite
history of travel and food consumption in Kirkuk were reported from Tikrit
province; however, isolated cases with no epidemiological link to northern
Iraq were also confirmed in Mosul, Wasit, Baghdad, Anbar, and Basra.

One of the important features in this outbreak is that most of the cases
seen have mild to moderate signs and symptoms. The traditional signs and
symptoms of severe dehydrating diarrhea were seen only very occasionally,
out of the 4479 laboratory-confirmed cholera cases; 22 deaths were
reported, most of the deceased had other, serious underlying morbidity.

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[The full report can be found at
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/SIRU-78N7ZC/$File/Full_Report.pdf>.
It contains these updated statistics on laboratory-confirmed cholera in Iraq:
Province / Districts Affected / Date of 1st case / Deaths / Confirmed cases
Kirkuk / 5 / 14 Aug 2007 / 5 / 2977
Sulaymaniyah / 13 / 23 Aug 2007 / 14 / 1227
Erbil / 6 / 5 Sep 2007 / 0 / 237
Dahuk / 4 / 7 Sep 2007 / 0 / 6
Tikrit / 3 / 12 Sep 2007 / 0 / 5
Mosul / 3 / 15 Sep 2007 / 1 / 3
Baghdad-Resafa / 3 / 19 Sep 2007 / 1 / 12
Basra / 2 / 19 Sep 2007 / 0 / 2
Wasit / 1 / 20 Sep 2007 / 0 / 3
Anbar / 1 / 3 Oct 2007 / 1 / 2
Diyala / 3 / 3 Oct 2007 / 0 / 5
New provinces with confirmed cases: none
Total confirmed cases: 4479 (up slightly from 4467 in the last posted
situation report 28 Oct 2007)
Total deaths reported: 22 (no change since last posted situation report 28
Oct 2007)

A map of Iraq showing the provinces can be found at
<http://www.un.org/Depts/Cartographic/map/profile/iraq.pdf>. - Mod.LL]

******
[4] Diarrhea, fatal - Nepal: (Central region)
Date: Sun 4 Nov 2007
Source: The Rising Nepal [edited]
<http://www.gorkhapatra.org.np/content.php?nid=29692>

The number of deaths from diarrhea in Dhanusha district has reached 21, [11
of whom were children]. The epidemic is seen in Mansingh Patti, Sabaila,
Balakbakhar, Makhnaha, Dhanauji, Chakkar, Lohana, Bisarbhora, Balahakathal,
Kanakpatti, Umaprempur, Bajhai, Bahedabela, Sonigama, Bhatiyahi,
Pachaharba, Yadukuha, Dhabauli, Raghunathpur, Harine, Balahagoth, Khajuri,
Lakhauri, Devdiha, Sinurjoda, Hathipur, Hadwada, Nanupatti, Nauwakhor,
Parsahi, and Prakhe Maduwa VDCs [village development committees].

The causes of the epidemic are consumption of small, polluted fishes of the
paddy fields, dried fish, lack of use of toilets, and lack of awareness.

In a press meeting organized by the District Public Health Office, office
chief Bijaya Kumar Jha said some 14 000 people were affected from this.

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[The Dhanusha district in the posting can be found on a map of Nepal at
<http://ncthakur.itgo.com/map04.htm>. It is located in the extreme
southeastern corner of the Central region. - Mod.LL]

******
[5] Cholera - Thailand
Date: Sat 3 Nov 2007
Source: Bangkok Post [edited]
<http://www.bangkokpost.com/041107_News/04Nov2007_news05.php>

The Department of Health has advised the public to take extra care with
personal hygiene and ensure all food is cooked properly before eating it
following cholera outbreaks in 34 provinces. Frequent handwashing, always
using a separate serving spoon for communal dishes, and eating properly
cooked food are important measures to guard against the disease, the
department said.

The warning comes after more than 900 people across 34 provinces have been
hit by cholera so far in 2007. The north east has had the highest number of
cases of cholera, with most instances thought to have come from eating raw
food, fermented meat, and freshwater clams.

The Public Health Ministry reported last month [October 2007] that 2 people
had died of dehydration caused by the illness and that it was concerned by
the significant rise in infections since July 2007.

The department has emphasized the importance of using a separate serving
spoon for each dish. A public health survey in 2003 showed that only 43.3
per cent of respondents knew how to use a serving spoon. A 2005 survey,
showed only 39.6 per cent of restaurants provided serving spoons to customers.

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[A map of Thailand can be found at
<http://www.un.org/Depts/Cartographic/map/profile/thailand.pdf>. - Mod.LL]

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[6] Cholera - Thailand: clarification
Date: Mon 5 Nov 2007
From: Kumnuan Ungchusak <kum@health.moph.go.th>

[There is a discrepancy between the number of cases of cholera reported by
the newswire above and the number of cases of cholera on the Ministry of
Public Health (MOPH) surveillance website. Dr Kumnuan Ungchusak, director,
Bureau of Epidemiology, MOPH Thailand sent the clarification below. - Mod.MPP]

For surveillance purposes we use hospitalized cases to track the trend and
identify priority areas [for intervention]. The 605 reported cases that
appeared in the data of the MOPH reflect the number of hospitalized cases.
With every single case reported, a surveillance and rapid response team
(SRRT) of the province will go out for investigation in the community.
Since the beginning of the year [2007] we have also identified 388
diarrheal cases in the community with culture positive for _Vibrio
cholerae_. This is a normal disease spectrum. The newswire presented the
combined number of hospitalized cases and those cases detected in the
community [that were not hospitalized].

--
Kumnuan Ungchusak
Director, Bureau of Epidemiology
Department of Diseases Control
Ministry of Public Health
Tivanonda Road
Nonthaburi 11000
Thailand
<kum@health.moph.go.th>

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******
[7] Cholera - Uganda: (Nebbi)
Date: Mon 5 Nov 2007
Source: The Monitor [edited]
<http://www.monitor.co.ug/news/reg11055.php>

A fresh outbreak of cholera has hit 3 Nebbi subcounties of Panyimur,
Parombo, and Akworo and has left 42 infected.

The Nebbi District health educator, Mr Obima Kits told Daily Monitor on Fri
2 Nov 2007, that a soldier from Angumu detach in Panyimur and a Congolese
national were the 1st victims of the outbreak. "These sub counties have
poor sanitation, that is why the disease keeps on causing havoc. The only
way is to improve on the sanitation and hygiene if we are to contain the
disease," Mr Obima said. He said the most affected parishes include Parwo
and Pangere in Parombo, Uguta and Kituna in Akworo.

[byline: Warom Felix Okello]

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[The Nebbi district of Uganda in the northwest, bordering on Congo DR, can
be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/uganda1.pdf>. - Mod.LL]

******
[7] Diarrhea - South Africa: (Mpumalanga)
Date: Fri 2 Nov 2007
Source: Mail & Guardian [edited]
<http://www.mg.co.za/articlePage.aspx?articleid=323850&area=/breaking_news/breaking_news__national/>

A total of 150 people were treated for diarrhea in the Nkangala area in
Delmas since the outbreak last week, Mpumalanga provincial minister of
health and social services Sipho Lubisi said on Fri 2 Nov 2007. "150 cases
have been reported to outpatient facilities for treatment. At this point in
time, no deaths linked to diarrhea have been reported."

Addressing journalists, Lubisi said that since the outbreak of diarrhea was
noted, various laboratory tests had been carried out to identify the
presence of any bacteria that might be responsible for the disorder. The
area was hit by a typhoid outbreak in September 2005 and 4 people died as a
result. However, the provincial minister said the current situation could
not be linked to the previous one. He said, however, that if such evidence
was obtained through various tests currently under way, the public would be
informed.

--
communicated by:
ProMED-mail rapporteur Brent Barrett

[Mpumalanga province is located in the northeastern part of the country and
can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf>.

The outbreaks discussed in this update can also be located on the
HealthMap/ProMED-mail interactive map at <http://www.healthmap.org/promed>.
- Mod.LL]

See Also