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Published Date: 2007-11-26 15:00:11
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2007 (60)
Archive Number: 20071126.3824

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (60)
**********************************************
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 - Iraq: (Baghdad)
[2], [3] Cholera, diarrhea - Viet Nam
[4] Diarrhea - Indonesia: (Jakarta)
[5] Diarrhea - Philippines: (Northern Samar)
[6] Dysentery, school - Taiwan
[7] Dysentery, school - Russia: (Tyumen)
Africa
[8] Cholera, diarrhea - Djibouti

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[1] Cholera - Iraq: (Baghdad)
Date: Thu 22 Nov 2007
Source: Reuters [edited]
<http://www.reuters.com/article/newsOne/idUSKAM24764720071122?sp=true>

Iraq is facing a health catastrophe in the capital Baghdad, with
reports of cholera rising sharply over the past weeks to more than 80
new cases, the Health Ministry said on Thu 22 Nov 2007. Most of the
new cases have been reported in the eastern part of Baghdad,
especially in poor areas routinely deprived of water and other basic
services, an official at the ministry said.

One cholera death was recorded in November [2007], in addition to
another death in September [2007], said the official, who asked not
to be named. "We have a catastrophe in Baghdad," she said.

In western Baghdad, 6 people at a government home for the disabled
were confirmed to have the disease, she said. Another girl at the
al-Hanan Institute for the Severely Disabled died from the disease.
The Health Ministry official blamed a lack of proper sanitation for
the cholera cases at the institute.

The official said that 6 governmental hospitals suffer from unsafe
water supplies, including Yarmouk, one of Baghdad's chief hospitals.

A 13 Nov 2007 report from the United Nations (UN) reported 22 deaths
from cholera in 2007, and 4569 laboratory-confirmed cases, almost
exclusively in northern Iraq. But the UN also warned that the illness
is on the rise in Baghdad. It reported 49 laboratory-confirmed cases
in the capital as of 11 Nov 2007.

[Byline: Aseel Kami]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The initial case of cholera in the Baghdad area was from 19 Sep
2007, more than a month after the Iraqi outbreak was 1st reported
from Kirkuk in the north on 14 Aug 2007. Baghdad is the only area
outside of the northern provinces that appears to have had cholera
spreading, beginning about 2 weeks after the 1st cases were reported.

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

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[2] Cholera, diarrhea - Viet Nam
Date: Fri 23 Nov 2007
Source: Viet Nam News [edited]
<http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA231107>

The Ministry of Health reported on Wed, 21 Nov 2007, 8 more cases of
acute diarrhea, of these 4 tested positive for cholera. Since the
epidemic's outbreak, the country has reported 1941 cases of acute
diarrhea in northern provinces, of which 261 tested positive for
cholera, according to the ministry. New cases have appeared in Ha Noi
as well as Ha Tay Province.

Deputy health minister Trinh Quan Huan said he was worried about the
scattered cases of cholera in areas that were believed to be
adequately treated. Health preventive centres in Ha Noi and Ha Tay
Province would need to strengthen inspections and treatment in
infected locations, he said.

Reports from the HCM (Ho Chi Minh) City Pasteur Institute, Nha Trang
Pasteur Institute, and Tay Nguyen Institute of Hygiene and
Epidemiology, said cases of diarrhea had popped up in flood-hit areas
in central Viet Nam. According to Nguyen Tran Hien, director of the
National Institute of Hygiene and Epidemiology, the results from
tests on vegetables and water from areas where cases of cholera were
identified found no sign of the cholera bacterium.

However, he said that health workers found the cholera bacterium in
water samples from Dan Hoai Canal in Ha Tay Province's Hoai Duc
District where people eat dog meat at wedding parties and use
untreated night soil to fertilize crops.

Ha Tay is a major supplier of foodstuff and produce to Ha Noi and
neighboring provinces, so it is in danger of becoming a hot spot for
the spread of the epidemic.

Yesterday [22 Nov 2007], health minister Nguyen Quoc Trieu arrived in
Da Nang to determine prevention methods of the acute diarrhea
epidemic. The ministry also provided nylon gloves and disinfectants
to residents of 4 central provinces.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Neither how much cholera and/or diarrhea is occurring in the central
provinces of the country nor which central provinces are affected are
clearly stated.

[This map of the country shows all the provinces clearly
<http://www.angelfire.com/co/hongnam/vnmap.html>. - Mod.LL]

******
[3] Cholera, diarrhea - Viet Nam
Date: Sat 24 Nov 2007
Source: Viet Nam News [edited]
<http://vietnamnews.vnagency.com.vn/showarticle.php?num=01HEA241107>

Acute diarrhea has raised alarms in the north of the country for a
month, and citizens and doctors are still struggling with how best to
prevent and control the disease outbreak. Doctors and health workers
at a National Hospital for Tropical and Contagious Diseases treatment
facility worked around the clock during the early stages of the
outbreak. The increase in patients, 4 from Dinh Cong, Ha Noi were
hospitalised after eating com hop (an inexpensive rice meal delivered
in boxes), has prompted the hospital to call all doctors and nurses
for night duty.

According to head of the treatment facility Dr Nguyen Tuong Van, her
facility receives 20-30 patients a day, but during an epidemic that
number often increases to 100. At present, the number of inpatients
is 330, and the department must buy more equipment and beds to
accommodate the rise.

In the last month alone, nearly 500 patients have been treated at the
hospital. Most have recovered, and no deaths have been reported.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Diarrhea - Indonesia: (Jakarta)
Date: Sun 25 Nov 2007
Source: Jakarta Post [edited]
<http://www.thejakartapost.com/yesterdaydetail.asp?fileid=20071125.A01>

A clean water crisis is being blamed for a diarrhea outbreak in North
Jakarta that has resulted in the death of a baby in Koja Hospital.
"Yes, the trend of diarrhea cases is increasing, particularly the
numbers reporting to Koja Hospital, due to the lack of clean water,"
Jakarta Health Agency Deputy Director Salimar Salim said Sat, 24 Nov
2007. "The figure seems to be continuously rising."

She said the number of diarrhea patients in Koja Hospital had
increased "tremendously" from 33 on Thu 22 Nov 2007 to 43 the next
day, and 81 the following day, with a 7-month-old infant dying on 23
Nov 2007. The infant, who was suffering from severe dehydration, was
brought "too late" to the hospital, she said.

In all parts of Jakarta, however, the total number of diarrhea cases
decreased. [It went] from 219 at the end of the 1st week of November
2007 to 251 as of the 2nd week, [and then decreased] to 177 as of the
3rd week and 44 as of the past week, said health agency spokeswoman
Feurah Dihan.

According to Salimar, most patients being treated are from Rawa Badak
and Lagoa subdistricts in Koja district, and Tanjung Priok
subdistrict in Tanjung Priok district. "We have deployed our officers
to the subdistricts since Fri 23 Nov 2007, to find the contaminated
wells," she said. She continued that the agency's officers would
chlorinate the wells to prevent further increases in the number of
diarrhea cases.

Earlier, Jakarta City secretary Ritola Tasmaya said that the outbreak
"must have been caused by lack of clean water."

At least 31 subdistricts in the capital have been suffering from a
clean water crisis since last Tuesday [20 Nov 2007], with 29 of the
subdistricts located in North Jakarta.

[Byline: Mustaqim Adamrah]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Jakarta is located on the northwestern part of Indonesia's Java
Island and can be found on a map of the multi-island country at
<http://www.lib.utexas.edu/maps/middle_east_and_asia/indonesia_rel_2002.jpg>.
- Mod.LL]

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[5] Diarrhea - Philippines: (Northern Samar)
Date: Sat 24 Nov 2007
Source: Philippine Information Agency [edited]
<http://www.pia.gov.ph/default.asp?m=12&r=&y=&mo=&fi=p071124.htm&no=15>

At least 47 diarrhea cases from the same barangay [district] in
Mondragon, Northern Samar, were reported by the Provincial Health
Office of Northern Samar to the Regional Disaster Coordinating
Council of Region 8.

The dirty source of drinking water that is also prevalent in the
neighboring municipalities, was pinpointed as the cause of the
diarrhea cases. Several children were the victims, 13 of whom were
confined at the Northern Samar Provincial Hospital in Catarman.

It was reported that open dug wells and jetmatic pumps are the source
of drinking water, all of which are exposed to the elements and
bacteria. More so, these sources of drinking water are not treated
with chlorine.

Because of the continuous rains that were experienced for several
days due to typhoon Lando, the drinking water sources have been
rendered unsafe for drinking. As a safety measure, the Northern Samar
Provincial Health Office advised the villagers to boil or put
chlorine in the water that they use for drinking.

A diarrhea outbreak was also reported in the municipality of Gamay in
Northern Samar in the early part of November 2007. This was caused by
a dirty source of drinking water.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Northern Samar is a province of the Philippines located in the
Eastern Visayas region. It is located at the northern portion of the
island of Samar and can be found on a map at
<http://content.answers.com/main/content/wp/en/f/fc/Ph_locator_map_northern_samar.png>.
- Mod.LL]

******
[6] Dysentery, school - Taiwan
Date: Fri 23 Nov 2007
Source: Taiwan Headlines [edited]
<http://www.taiwanheadlines.gov.tw/ct.asp?xItem=95933&CtNode=39>

The Taiwan Centers for Disease Control (CDC) has confirmed a cluster
of bacillary dysentery cases at Beitun Elementary School in the
central city of Taichung and has taken preventive measures in
collaboration with local heath and educational authorities, a CDC
official said Fri 23 Nov 2007. Shih Wen-yi, deputy director of the
CDC under the Cabinet-level Department of Health, made the remarks
after the elementary school reported a new case of bacillary
dysentery the day before [22 Nov 2007].

As of 16 Nov 2007, a total of 11 confirmed cases of the disease had
been reported from the school since the 1st case was reported on 3
Nov 2007, Shih said, adding that to date, more than 100 students have
showed diarrhea and other suspected symptoms and 200-plus samples
have been sent for analysis. The 1st victim has recovered after being
hospitalized for treatment. The remaining 10 students have been
placed in home quarantine and have been receiving medical treatment
at home, Shih noted.

Contaminated water is suspected as the source of infection, Shih
said, citing a preliminarily investigation showing a ground water
supply system at the school was contaminated and the system lacks the
chlorine equipment necessary to disinfect the water. Shih said that
local health agency has cut off the system and the city government is
closely monitoring and controlling the outbreak.

[Byline: YL Kao]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[A different article
<http://www.cctv.com/english/20071125/101467.shtml> mentioned that 2
of the 11 confirmed cases were in food handlers and several cases
appear to have occurred in people not associated with the school.
Although not mentioned by name, bacillary dysentery is caused by
_Shigella_, an organism transmissible with a very low inoculum of
bacteria, which facilitates person-to-person spread.

A map of Taiwan showing the location of Taichung can be found at
<http://www.holidaycity.com/taiwanhotels/map.gif>. - Mod.LL]

*****
[7] Dysentery, school - Russia: (Tyumen)
Date: 19 November 2007
Source: ANN news [in Russian, trans. Corr.ATS, edited]
<http://www.annews.ru/news/detail.php?ID=139349>

An investigation has been launched in Tyumen related to an outbreak
of dysentery at a boarding school in Tyumen. The 1st cases appeared
on 13 Nov 2007 when only 4 children were referred to the hospital. By
the evening of 17 Nov 2007 the number of affected children had grown
to 51. The preliminary diagnosis was announced as acute dysentery and
all the children received appropriate treatment. Quarantine is on
place in this boarding school for children with mental disabilities.

--
Communicated by:
ProMED-RUS
<promed@promedmail.org>

[The definitive etiology here is probably shigellosis, if a bacterial
cause of the dysentery is found.

Tyumen is a city in Russia, located on the Tura River 2144 km (1332
mi) east of Moscow. It is the administrative center of Tyumen Oblast
(region) in the Urals Federal District. Its location can be found at
<http://www.tigress.co.uk/multimedia/maps/tyumen_map.jpg>. - Mod.LL]

******
[8] Cholera, diarrhea - Djibouti
Date: Fri 23 Nov 2007
Source: PR Newswire [edited]
<http://sev.prnewswire.com/health-care-hospitals/20071123/CLF02523112007-1.html>

The American Agency for International Development (USAID) is
providing USD 100 000 in emergency funding to the UN Children's Fund
(UNICEF) for medical supplies and to facilitate an intensive health,
sanitation, and hygiene campaign to prevent the further spread of
diarrhea in Djibouti.

Since January 2007, limited access to safe drinking water and poor
sanitation and hygiene conditions led to a surge in diarrhea and
cholera in Djibouti, primarily affecting Djibouti city and nearby
Dikhil and Tadjourah districts, according to the Djibouti Ministry of
Health. A total of 3 surges in reported cases of diarrhea and cholera
in January, April, and September 2007 have drained the resources of
local government and relief agencies to adequately respond. The
ministry reported more than 1000 diarrhea cases since early September
2007 and reports over 40 new cases per day.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[A map of Djibouti in northeastern Africa can be found at
<http://www.merriam-webster.com/maps/images/maps/djibouti_map.gif>. - Mod.LL]

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