Published Date: 2008-12-29 23:50:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2008 (56)
Archive Number: 20081229.4094
CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (56)
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A ProMED-mail post
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ProMED-mail is a program of the
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In this update:
Africa
[1] Cholera - Zimbabwe (latest statistics)
[2] Cholera - Zimbabwe (WHO)
[3] Cholera - Zimbabwe (WHO Outbreak Report)
[4] Cholera, prisons - Zimbabwe
Asia
[5] Cholera - China (Hong Kong) ex India
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[1] Cholera - Zimbabwe (latest statistics)
Date: Mon 29 Dec 2008
Source: International Herald Tribune [edited]
<http://www.iht.com/articles/ap/2008/12/29/news/UN-UN-Zimbabwe-Cholera.php>
The number of people who have died in Zimbabwe's cholera outbreak has
risen to 1564, an increase of almost 50 deaths from the 1518 reported
over the weekend, the United Nations said Monday [29 Dec 2008].
The latest figures, dated 28 Dec 2008, also show that the number of
cholera cases since the start of the outbreak has reached 29 131,
World Health Organization spokesman Gregory Hartl said.
The WHO said Saturday that by 25 Dec 2008, 1518 people had died since
the start of the outbreak in August 2008. More than 2/3 of the
deaths occurred in December 2008 alone.
Hartl cautioned that the figures may not reflect the full extent of
the outbreak. "Not all districts are reporting," he told The
Associated Press. "We don't know how many cases are out there."
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The number of cases of cholera in this catastrophic situation in
Zimbabwe continues to rise dramatically, underscoring the need for
rapid intervention. Since ProMED's last posting on 23 Dec 2008, there
were 5419 more cases reported, with 344 more deaths. The following
item [2] provides the data from which this report is derived.
[A map of Zimbabwe with provinces can be found at:
<http://www.un.org/Depts/Cartographic/map/profile/zimbabwe.pdf>.
The HealthMap/ProMED-mail interactive map of Zimbabwe is available at:
<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]
*****
[2] Cholera - Zimbabwe (WHO)
Date: Sun 28 Dec 2008
Source: World Health Organization [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db900sid/MCOT-7MSCG7/$File/full_report.pdf>
Highlights of the day:
- 227 cases and 3 deaths added today (0.8 percent in comparison to
cases added previous day). The 3 deaths were reported in Masvingo.
- Reports received from 8 out of 52 affected districts (29.4 percent)
- 84 percent of districts reported to be affected (53/62 districts)
- Follow up established that there were 1851 cumulative cases and
139 deaths in Chegutu on 27 Dec 2008, making the overall total 28 904
up to 27 Dec 2008. No report for Chegutu for 28 Dec 2008
- Cumulative case-fatality rate (CFR) of 5.3 percent (far above the
1 percent which is normal in large outbreaks), with range 0 percent
to 71.4 percent.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The high CFR reflects the conditions in Zimbabwe and the lack of any
medical care in most cases. - Mod.LL]
*****
[3] Cholera - Zimbabwe (WHO Outbreak Report)
Date: Fri 26 Dec 2008
Source: WHO Outbreak Reports [edited]
<http://www.who.int/csr/don/2008_12_26/en/index.html>
As of 25 Dec 2008, a total of 26 497 cases, including 1518 deaths,
have been reported by the Ministry of Health in Zimbabwe. Cases are
now being reported from all 10 of the country's provinces. Harare,
particularly Budiriro suburb in the southwest, accounts for the
majority of cases, followed by Beitbridge in Matabeleland South and
Mudzi in Mashonaland East. The current outbreak is the largest ever
recorded in Zimbabwe and is not yet under control. In fact, the
epidemiological week ending 20 Dec 2008 saw more than 5000 new cases,
an increase in the number of weekly cases relative to previous weeks,
and an increase in deaths outside treatment/health centres.
The overall Case Fatality Rate (CFR) has risen to 5.7 percent, far
above the 1 percent which is normal in large outbreaks, and in some
rural areas it has reached as high as 50 percent. Mortality outside
of health care facilities remains very high. This is a clear
indication that better case management and access to health care is
needed, in particular an increased use of oral rehydration therapy
with Oral Rehydration Salts in communities very early after onset of
the disease.
The current situation is closely linked to the lack of safe drinking
water, poor sanitation, declining health infrastructure, and reduced
numbers of health care staff reporting to work. Other current risk
factors include the commencement of the rainy season and the movement
of people within the country, and possibly across borders, during the
Christmas season.
The WHO, together with the Ministry of Health and partners from the
health and Water and Sanitation clusters, has established a cholera
outbreak response coordination unit in order to strengthen the
reporting and early detection of cases, improve the response
mechanism and access to health care and ensure proper case
management. The WHO has also deployed experts in public health, water
and sanitation, logistics and social mobilization. In light of the
extent and pace of expansion of the outbreak, reinforcing all control
activities across the country is critical.
Given the current dynamic of the outbreak and the context of the
collapsed health system, a cholera vaccination is not recommended.
Moreover, the use of the internationally available WHO prequalified
oral cholera vaccine is not recommended once an outbreak has started
due to its 2-dose regimen and the time required to reach protective
efficacy, high cost and the heavy logistics associated to its use.
The use of the parenteral cholera vaccine has never been recommended
by the WHO due to its low protective efficacy and the occurrence of
severe adverse events.
In controlling the spread of cholera, the WHO does not recommend any
special restrictions to travel or trade to or from affected areas.
However, neighboring countries are encouraged to reinforce their
active surveillance and preparedness systems. Mass chemoprophylaxis
is strongly discouraged, as it has no effect on the spread of
cholera, can have adverse effects by increasing antimicrobial
resistance and provides a false sense of security.
--
Communicated by:
ProMED Rapporteur Marianne Hopp
<promed@promedmail.org>
*****
[4] Cholera, prisons - Zimbabwe
Date: Sat 27 Dec 2008
Source: Zimbabwe Times [edited]
<http://www.thezimbabwetimes.com/?p=9237>
Cholera has hit Zimbabwe's prisons with more than 200 inmates said to
have died in the country's prisons over the past week alone. There
are reports that the government now contemplates the closure of some
of the country's prisons because of the epidemic.
Poor sanitary conditions and the generally deplorable state of the
country's prisons are hampering efforts by health officials to
control the disease. More than 20 inmates have died in Masvingo
Remand Prison over the past 5 days. A cholera treatment camp has
since been established at the prison. At Mutimurefu Prison also in
Masvingo Province 9 inmates succumbed to the epidemic while at Hwahwa
prison in the Midlands Province 16 are reported to have died.
Although figures of inmates who died in other prisons could not be
obtained, Justice Legal and Parliamentary Affairs minister Patrick
Chinamasa yesterday [26 Dec 2008] confirmed the outbreak of the
disease, adding that cholera treatment camps had since been
established at the affected institutions.
[Byline: Owen Chikari]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
*****
[5] Cholera - China (Hong Kong) ex India
Date: Sat 20 Dec 2008
Source: EmaxHealth [edited]
<http://www.emaxhealth.com/2/39/27861/hong-kong-confirmed-cholera-case.html>
The Centre for Health Protection (CHP) of the Hong Kong Department of
Health is investigating a confirmed case of cholera and reminds
people to observe good personal, food and environmental hygiene,
whether in Hong Kong or traveling abroad.
The case involved a 35-year-old woman who developed vomiting and
diarrhea on 10 Dec 2008 and was admitted to a private hospital the
following day. She is now being isolated in Princess Margaret
Hospital for treatment and in stable condition. Laboratory tests
showed that her stool specimen yielded a positive result for _Vibrio
cholerae_ Ogawa.
CHP's investigation revealed that she had traveled to India from 27
Nov 2008 to 8 Dec 2008 with 4 family members. This is the 6th case of
cholera reported in 2008. There were 3 cholera cases in 2007, 1 in
2006, 5 in 2005, 5 in 2004 and 7 in 2003.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Most, but not all, of the Hong Kong cholera cases are imported. As a
short review, the flagellar (H) antigens of _V. cholerae_ are shared
with many water vibrios and, therefore, are of no use in
distinguishing strains causing epidemic cholera. The O (somatic)
antigens, however, do distinguish strains of _V. cholerae_ into 139
known serotypes. Almost all of these strains of _V. cholerae_ are
nonvirulent. Until the emergence of the Bengal (O139) strain (which
is "non-O1"), a single serotype, designated O1, has been responsible
for epidemic cholera.
There are 3 distinct O1 biotypes, named Ogawa, Inaba, and Hikojima,
each of which may display the "classical" or El Tor phenotype. The
biotypes are distinguished by their expression of surface antigens A,
B, and C. Ogawa contains antigens A and B; Inaba antigens A and C;
and Hikojima antigens A, B, and C. The latter serotype is relatively rare.
A map of Hong Kong can be found at
<http://www.hong-kong-hotels.ws/maps/images/hong-kong-map-small.gif>.
- Mod.LL]
See Also
Cholera, diarrhea & dysentery update 2008 (55) 20081223.4040Cholera, diarrhea & dysentery update 2008 (54) 20081218.3988
Cholera, diarrhea & dysentery update 2008 (53) 20081216.3949
Cholera, diarrhea & dysentery update 2008 (52) 20081215.3940
Cholera, diarrhea & dysentery update 2008 (51) 20081212.3906
Cholera, diarrhea & dysentery update 2008 (50) 20081208.3854
Cholera, diarrhea & dysentery update 2008 (40) 20081014.3253
Cholera, diarrhea & dysentery update 2008 (30) 20080702.2019
Cholera, diarrhea & dysentery update 2008 (20) 20080404.1240
Cholera, diarrhea & dysentery update 2008 (10) 20080212.0563
Cholera, diarrhea & dysentery update 2008 (01) 20080104.0047
2007
----
Cholera, diarrhea & dysentery update 2007 (67) 20071231.4200
Cholera, diarrhea & dysentery update 2007 (60) 20071126.3824
Cholera, diarrhea & dysentery update 2007 (50) 20071023.3450
Cholera, diarrhea & dysentery update 2007 (40) 20070924.3164
Cholera, diarrhea & dysentery update 2007 (30) 20070830.2856
Cholera, diarrhea & dysentery update 2007 (20) 20070511.1509
Cholera, diarrhea & dysentery update 2007 (10) 20070302.0737
Cholera, diarrhea & dysentery update 2007 (01) 20070105.0047
2006
----
Cholera, diarrhea & dysentery update 2006 (52) 20061229.3646
Cholera, diarrhea & dysentery update 2006 (50) 20061215.3528
Cholera, diarrhea & dysentery update 2006 (40) 20061006.2862
Cholera, diarrhea & dysentery update 2006 (30) 20060724.2037
Cholera, diarrhea & dysentery update 2006 (20) 20060512.1352
Cholera, diarrhea & dysentery update 2006 (10) 20060303.0675
Cholera, diarrhea & dysentery update 2006 (01) 20060106.0040
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