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Published Date: 2008-01-22 19:00:14
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2008 (06)
Archive Number: 20080122.0274

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (06)
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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:
Africa
[1] Cholera - Angola: (Luanda)
[2] Cholera - Angola: (Cunene)
[3] Cholera, diarrhea - Liberia: (Maryland, Grand Kru)
[4] Bloody diarrhea - Sudan: (Darfur)
[5] Acute watery diarrhea - Sudan: (South)
[6] Cholera - Mozambique: (Tete)
Asia
[7] Diarrhea, dysentery - India:(Orissa)
[8] Gastroenteritis - India: (Orissa)
[9] Cholera-like disease - India: (Manipur)

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[1] Cholera - Angola: (Luanda)
Date: Mon 21 Jan 2008
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-e.asp?ID=590207>

Luanda's Health Department has recorded 191 cases of cholera, including 174
recorded in the localities of Quilunda lagoon, Cacuaco district, since 1
Jan 2008.

Speaking to ANGOP on Monday [21 Jan 2008], the Health Department's
provincial director, Vita Vemba, said that last week there were registered
88 new cases of the disease in localities close to Quilunda lagoon.

Every week the Department reports cases of acute diarrhea, including
cholera, affecting residents of Quilunda lagoon's localities due to
consumption of untreated water and fish caught in that lagoon, said the
health official, who also quoted 4 cases in Samba district, in Mussulo
commune, and Camuxiba ward with 2 each, and 2 cases at Sao Pedro da Barra
ward (Sambizanga district).

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[The area of the capital city and province of Luanda were where the large
2007 outbreak of cholera began spreading throughout the country of Angola.
Luanda can be found on a map of Angola at
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf>. Mod.LL]

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[2] Cholera - Angola: (Cunene)
Date: Tue 22 Jan 2008
Source: Angola Press [edited]
<http://www.angolapress-angop.ao/noticia-f.asp?ID=590612>

The outbreak of new cases of cholera in rural zones will require from the
health officials a detailed study of conducting methods, with a view to
prevent the disease from hitting the southern Cunene province, said the
local health director, Eduardo Haiumba. The official said this at the end
of a working visit of Health Ministry delegation, led by minister Ruben
Sicato, as part of the programme of combat to cholera.

Since the record of new cases on 23 Dec 2007, the Health Department has
already notified 608 cases of cholera (33 fatal) in localities of Evale,
Ondjiva, Nehone, and Kalonga.

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[The southern province of Cunene, bordering on Namibia, can be seen on a
map of Angola at
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf>. - Mod.LL]

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[3] Cholera, diarrhea - Liberia: (Maryland, Grand Kru)
Date: Mon 21 Jan 2008
Source: United Nations Mission in Liberia (UNML) [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/EGUA-7B3QPK?OpenDocument>

Liberia: UNMIL humanitarian situation report No. 134 14-20 Jan 2008
-------------------------------------------------------------------
The latest assessment of the outbreak of acute watery diarrhea/cholera in
Maryland and Grand Kru Counties indicate that the situation has stabilized
and is under control. There is an improvement in information collection and
dissemination. Improved collaboration between health authorities, NGOs
(non-governmental organizations) and the UN has increased the effectiveness
of response.

According to the Ministry of Health and Social Welfare, improving treatment
facilities in the 2 counties is a challenge that will determine the
effectiveness of response to future outbreaks. Unconfirmed reports that
some cases of acute watery diarrhea may have been registered in River Gee
County (which borders Maryland County) have led to intensification of
contingency planning in neighboring Grand Gedeh County. The health
facilities in River Gee County lack adequate drugs and supplies to respond
to outbreaks.

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[The areas discussed are all in south eastern Liberia and can be found on a
map at <http://www.un.org/Depts/Cartographic/map/profile/liberia.pdf>. -
Mod.LL]

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[4] Bloody diarrhea - Sudan: (Darfur)
Date: Tue 22 Jan 2008
Source: WHO [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-7B4KAY/$File/Full_Report.pdf>

Sudan: Morbidity and Mortality Weekly Bulletin - 29 Dec 2007 - 4 Jan 2008
-------------------------------------------------------------------------
Darfur:
Cases of bloody diarrhea (Epidemiologic week 52, 21-28 Dec 2007)
North Darfur 3
West Darfur 168
South Darfur 54

The attack rate of bloody diarrhea, observed during the current week
[unclear if week 52 of 2007 or week 1 of 2008 - Mod. LL], was 3 cases per
10 000, which is lower than the mean attack rate (8/10 000) for 2007. West
and South Darfur have been reporting higher rates as compare to West
Darfur. The mean attack rate for 2005 and 2006 was respectively 14 and 9
per 10 000.

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[The weekly attack rates of bloody diarrhea for Greater Darfur, Sudan for
the years 2005-2007 can be found in a chart at the source URL. A map of
Sudan showing mentioned areas can be found at
<http://www.un.org/Depts/Cartographic/map/profile/sudan.pdf>. - Mod.LL]

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[5] Acute watery diarrhea - Sudan: (South)
Date: Tue 22 Jan 2008
Source: WHO [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-7B4KAY/$File/Full_Report.pdf>

Sudan: Morbidity and Mortality Weekly Bulletin - 29 Dec 2007 - 4 Jan 2008
-------------------------------------------------------------------------
There has been an increase in the number of acute watery diarrhea (AWD)
cases especially among children under 5 years of age in Yei, Tambura, Juba,
and Wau counties. A total of 250 cases have been reported in this week,
mostly from the latter 3 counties. Samples are being collected for culture.
Cumulative total from 31 Dec 2007 to 6 Jan 2008 is 250 cases and 2 deaths
with an overall case fatality rate of 0.8 per cent.

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[Juba and Yei are located in the state of Central Equatoria, Wau is in
Western Bahr El Ghazal, and Tambura is in Western Equatoria. Acute watery
diarrhea is a term sometimes used instead of cholera. Cholera has occurred
in these South Sudan areas before, including a large outbreak in 2006. The
states can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/sudan.pdf>. - Mod.LL]

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[6] Cholera - Mozambique: (Tete)
Date: Tue 22 Jan 2008
Source: Medecins Sans Frontieres [edited]
<http://www.msf.org/msfinternational/invoke.cfm?objectid=A231D8CF-15C5-F00A-2581DCC184CC743F&component=toolkit.article&method=full_html>

Since the end of 2007, heavy rainfalls have caused floods in different
countries across southern Africa. Although floods are expected this time of
year in Mozambique, the river levels are alarming and much higher than this
time in 2007. MSF teams are intervening to mitigate the health impact of
the floods.

In Mozambique, it is estimated that since December 2007, 65 000 people
living in the Zambezi basin have had to leave their home and resettle in
camps in safer areas. In addition to those, many who had fled last year's
floods have never returned to their home and need support as well.

"Healthwise, the main risks after floods are usually measles, and diarrheal
diseases," says Dr Biot. "We will make sure that most children are
vaccinated against measles, and that there is access to clean water in
camps to avoid the propagation of waterborne diseases."

A total of 4 confirmed cases of cholera have been spotted in Mutarara, and
cholera treatment centers are being put in place to treat these patients
and avoid further spread of the disease. As for clean water, MSF teams have
been using trucks to deliver water to camps, which also meant delivering
tanks in some cases, and are distributing chlorination kits to the
community, so that people can purify river water.

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[Mutarara is in Tete province in north western Mozambique. The state can be
found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/mozambiq.pdf> - Mod.LL]

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[7] Diarrhea, dysentery - India: (Orissa)
Date: Tue 22 Jan 2008
Source: NewIndPress [edited]
<http://www.newindpress.com/NewsItems.asp?ID=IEQ20080121223750&Page=Q&Title=ORISSA&Topic=0>

After a lull, diarrhea is back in Rayagada township in Orrisa with a
vengeance. About 50 people were admitted to local hospitals on Sunday [20
Jan 2008] after they complained of dysentery and vomiting. According to
reports, most of the affected people belong to Gopabandhu Nagar, Brahman,
Dhabi and Paiko streets and Ramkrushna Nagar of the town.

Although the cause of its recurrence is yet to be ascertained, experts
opine that water contamination might be the reason. Sources said cholera,
which was found a few days back in Kasipur and Rayagada town, might have
mixed with water sources in the affected areas. All these areas are close
to the Nagavalli river and people often collect water from the river for
consumption.

Rayagada collector, B J Sharma, who reviewed the situation with senior
doctors and officials after visiting Rayagada hospital on Monday, directed
the health officials to sanitize all the affected areas. He promised to
provide preventive measures to check spread of the disease.

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[The etiology of the gastrointestinal illness in this and the following
post (which may be more of the same illness but described differently) is
not clear and may well be multifactorial.

Last month, ProMED-mail reported (Cholera, diarrhea & dysentery update 2007
(64) 20071213.4015) variants of _V. cholerae_ O1 biotype El Tor in this
area that have some characteristics of the Classical biotype. Described by
Nair et al. (1) from the International Centre for Diarrhoeal Research in
Bangladesh, the strains were obtained from patients with cholera from the
Matlab Hospital and they are often referred to as the Matlab variants.

Formally, the 2 established biotypes can be distinguished from one another
by a number of properties including hemolysis of sheep red blood cells,
agglutination of chicken red blood cells, the Voges-Proskauer reaction as
well as susceptibility to polymyxin B and to biotype-specific viral
bacteriophages. Nair, et al., described 3 Matlab types based on the hybrids
of these phenotypic traits. A hybrid strain has also been found in
Mozambique (2) which had genetic relatedness to the Matlab strains (3).

Importantly, the Matlab variants have been shown to have all the necessary
genes to initiate a pandemic (3).

1. Nair GB, Faruque SM, Bhuiyan NA, et al. New variants of _Vibrio
cholerae_ biotype O1 with attributes of the Classical biotype from
hospitalized patients with acute diarrhea in Bangladesh. J Clin Microbiol
2002; 40: 3296-9.
2. Ansaruzzaman M, Bhuiyan NA, Nair GB, et al. Cholera in Mozambique,
variant of _Vibrio cholerae_. Emerg Infect Dis 2004; 10: 2057-9.
3. Safa A, Bhuyian NA, Nusrin S, et al. Genetic characteristics of Matlab
variants of _Vibrio cholerae_ O1 that are hybrids between classical and El
Tor biotypes. J Med Microbiol 2006; 55: 1563-9.

A map of India showing the location of the north eastern state of Orissa,
bordering the Bay of Bengal, can be found at
<http://www.travelagent-india.com/gifs/map-india.gif>. - Mod.LL]

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[8] Gastroenteritis - India: (Orissa)
Date: Tue 22 Jan 2008
Source: Hindustan Times [edited]
<http://www.hindustantimes.com/StoryPage/StoryPage.aspx?id=bc9262b8-10e4-42d6-897e-081ff508f40e&&Headline=Nearly+200+hit+by+gastro+in+Orissa>

Nearly 200 people in Rayagada, Orissa have been hit by gastroenteritis in
the past 4 days, prompting health authorities to initiate measures to
prevent its spread, official sources said on Tuesday [22 Jan 2008].

"Gastroenteritis has affected nearly 200 people in this district
headquarters town since 19 Jan 2008. The patients are being given medical
treatment at government hospital here," additional district medical officer
Benudhar Nayak said. While some of the patients have been discharged, many
others are undergoing treatment at the hospital, he said. As the disease is
believed to have broken out due to contaminated water, all water sources
including that supplied through the public health department were being
disinfected with proper treatment and spray of chemical agents, he said.

The disease has erupted barely 5 months after cholera and waterborne
diseases claimed around 100 lives in some areas of Rayagada, Koraput and
Kalahandi districts.

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[9] Cholera-like disease - India: (Manipur)
Date: Tue 22 Jan 2008
Source: The Sangai Express [edited]
<http://e-pao.net/GP.asp?src=2..230108.jan08>

Cholera-like disease strikes, claims 2 children
-----------------------------------------------
At least 2 infants have reportedly died while as many as 25 others have
been hospitalized following the outbreak of a unknown disease characterised
by vomiting and loose motion among the children in Challou village under
Chingai Block of Ukhrul district.

According to information gleaned by this paper, a 1 year old boy and a 9
year old girl died from the disease characterized by vomiting and diarrhea
as they could not get medical assistance in time while around 25 other
children suffering from the same symptoms have been admitted either to the
District Hospital at Ukhrul headquarters or to the Leishiphung Hospital.

The report of the death of children from diarrhea at Challou Village has
come about even as ICHAM has been drawing the attention of the authority
concerned to take care of the medical needs of the people living in the
remote village. ICHAM president N Rajendra who was also present during the
press conference lamented over the death of the children due to lack of
adequate health care facilities inspite of having brought the matter to the
notice of the Government.

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[A map of India showing Manipur in the extreme eastern part of the country
can be found at <http://www.whereincity.com/india/images/india-map.gif>.
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