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Published Date: 2009-11-25 13:00:02
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2009 (30)
Archive Number: 20091125.4044

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (30)
************************************************
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 - Thailand (Pattani)
[2] Cholera - Malaysia (Sabah, Terengganu)
[3] Cholera - Malaysia (Terengganu)
[4] Cholera - Papua New Guinea (East Sepik)
[5] Cholera - Papua New Guinea (Madang)
Africa
[6] Cholera - Zimbabwe (Mashonaland East)
[7] Cholera - Uganda (Kasese)
[8] Cholera - Uganda (Bugiri)
[9] Cholera - Tanzania (Dar es Salaam)
[10] Cholera, prisoners - Kenya (Nairobi)
[11] Cholera - Kenya (Central province)
[12] Cholera - Nigeria (Borno, Taraba)

******
[1] Cholera - Thailand (Pattani)
Date: Fri 13 Nov 2009
From: Pasakorn Akarasewi <pasakorn.sewi@gmail.com> [edited]

Status of current cholera outbreak in Pattani province
-------------------------------------------------------
According to the most recent information available to us from the
Pattani health care team and the SRRT [Surveillance Rapid Response
Team], from mid-October [2009] till today [13 Nov 2009], there have
been 93 people identified to have _Vibrio cholerae_ O1 El Tor Ogawa
infection. Most of the infected people were fishermen and their
family members, who live in fishery communities on the Pattani
riverbanks. Among these 93 people, 33 patients sought treatment at
local hospitals (28 in Pattani, 4 in Kok Poh hospital, and 1 in Sai
Buri hospital).

Pattani Health Care teams, SRRTs as well as FETP [Field Epidemiology
Training Program] team conducted outreach activities aimed at further
case detection in the communities. The outreach teams did house to
house surveys and interviews. Approximately 500 people (who were at
risk of infection) were reached and 393 rectal swabs were collected.
Subsequently, 60 positive cultures [_Vibrio cholerae_ O1 El Tor
Ogawa] were detected. Of these, 46 culture positive individuals never
had any diarrhea, and 14 had a mild watery diarrhea.

Active investigations and food and water samples were collected for
laboratory testing. Household drinking water of the patients (2
samples) tested negative and 20 samples from ice water and ice used
for fish cold storage were all negative. Among 7 food samples, 2
positives were identified, and drinking water samples taken from in
the fishing vessels/boats (8 samples) had 3 positives identified.

The isolated _Vibrio_ organism had the following antibiotic profile:
norfloxacin 100 percent sensitivity, amoxicillin 63 percent,
cotrimoxazole 8 percent, and tetracycline 7 percent (as for
comparison).

The clinical finding indicates mild disease, with a high proportion
of asymptomatic infections and no deaths. However, the bacterium has
a profile of high resistance to tetracycline antibiotic. Even though
the infection/outbreak mostly are located in the fishery communities,
along the Pattani river there is a high possibility of widespread
extension among the communities and it can potentially be transmitted
to other villages as well as cross infection among the different
boats when they go out to sea and move to other ports for fish trade.

The Pattani health officials made every effort to educate the whole
communities, provide soap and concentrated chlorine water, and
provide education materials in the local language and in different
foreign languages as many of fishermen are non-Thai immigrants,
mostly from Myanmar and Cambodia. With cooperation from the fishing
boat owners and the fish market operators, surveillance and active
case screening have been ongoing. Plans are for continuous monitoring
for food safety, and testing for level of chorine in drinking water.
Coordinated operations by health authorities have been set up and
daily responses have been implemented.

We expect to have a better understanding of the scope of the
epidemic, population at risk, and risk factors for infection soon
with the coverage of community surveillance.

As with HIV/AIDS seafarers' experiences, fishermen often go very far
and away from home and they can further spread _Vibrio_ infections.

--
Dr Pasakorn Akarasewi
Director, Bureau of Epidemiology
Ministry of Public Health
Thailand
<pasakorn.sewi@gmail.com>

[This was originally posted on PRO/MBDS. A map of the 76 provinces of
Thailand can be found at
<http://en.wikipedia.org/wiki/Provinces_of_Thailand>.
Pattani is close to the Thai border with Malaysia where cholera is
also active. - Mod.LL]

******
[2] Cholera - Malaysia (Sabah, Terengganu)
Date: Mon 23 Nov 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-11/23/content_12525741.htm>

Sabah, a state in East Malaysia, is confirmed to be the 2nd state in
the country to have recorded a cholera outbreak, a Malaysian official
said on Mon 23 Nov 2009. There were 18 cases reported in the state,
said Malaysian deputy health minister Rosnah Abdul Rashid Shirlin
after launching the Second International Conference on Rural Medicine
2009 at KotaKinabalu, Sabah's state capital.

While 2 states in Malaysia had reported cholera cases, Rosnahsaid the
ones in Terengganu, an eastern state in Malaysian peninsula, were
caused by different bacterial strains, requiring different
antimicrobial agents for treatment.

Noting that the situation in Sabah State was under control, Rosnah
advised the public to look after their health and hygiene, and to be
careful when handling food.

The 1st cholera case in the recent outbreak was reported on 11 Nov
[2009] at Kuala Terengganu, the state capital of Terengganu State and
as of Sunday [22 Nov 2009], a total of 185 confirmed cases were
reported in the state.

[Editor: Lin Zhi]

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

[A map of Malaysia showing the distinct geographical separations
between Terengganu and Sabah can be found at
<http://www.lonelyplanet.com/maps/asia/malaysia/map_of_malaysia.jpg>. - Mod.LL]

******
[3] Cholera - Malaysia (Terengganu)
Date: Thu 19 Nov 2009
Source: Malaysian National News Agency [edited]
<http://www.bernama.com/bernama/v5/newsgeneral.php?id=456648>

The outbreak of cholera in Terengganu which was first reported on 11
Nov 2009, has now recorded 174 cases with 1 death. Health minister
Datuk Seri Liow Tiong Lai said 116 cholera cases detected from 451
patients being treated for diarrhoea in hospitals while 56 cases were
contact cases involving 1074 people.

He said the disease spread through contaminated food and drinks
because of unhygienic food handling. He said, as for preventive and
control measures, the Terengganu health department had inspected 65
premises with 12 premises, including an ice factory, ordered to close
because of unsatisfactory cleanliness.

36 wells had been chlorinated and 304 toilets and garbage disposal
areas disinfected, he said, adding that the outbreak in Terenagganu
this time involved a strain that some antimicrobial agents were
ineffective against it.

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

******
[4] Cholera - Papua New Guinea (East Sepik)
Date: Fri 20 Nov 2009
Source: The National [edited]
<http://www.thenational.com.pg/?q=node/3121>

The East Sepik provincial administration and health authorities
confirmed the outbreak in Angoram district. In a statement released
on 19 Nov 2009, provincial administrator Samson Torovi said more than
90 people had been confirmed with cholera with 5 people having died
from it. The update superseded the figures released by Wewak General
Hospital chief executive officer Dr Louis Samiak in the morning,
which stood at 70 confirmed cases and 3 deaths.

The worst affected areas are Kambaramba village, the Biwat area,
Angoram town, and the Gavien Resettlement area. Mr Torovi said people
from these areas were frequent travelers to Madang province via the
Sepik River and they may have contracted the disease there.

A cholera outbreak was declared in Madang 4 weeks ago, and the number
of people suspected to be infected there has risen to 400, with 10
confirmed cases.

Dr Samiak said samples of all reported cases were flown to Port
Moresby for laboratory testing by a surveillance officer and the
results were expected to be made known later.

Cholera was first reported in Morobe province in August 2009, where
an outbreak was declared. Some deaths in Eastern Highlands and Gulf
provinces were linked to the disease, but not confirmed. It spread to
Madang, where an outbreak was declared in October 2009, and now to
East Sepik.

[Byline: Gabriel Fito]

--
Communicated by:
ProMED-mail
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[A map of Papua New Guinea showing the relationships of the 3
provinces mentioned can be found at
<http://www.un.org/Depts/Cartographic/map/profile/papua.pdf>. - Mod.LL]

******
[5] Cholera - Papua New Guinea (Madang)
Date: Tue 17 Nov 2009
Source: Radio New Zealand International [edited]
<http://www.rnzi.com/pages/news.php?op=read&id=50364>

The Madang health department in Papua New Guinea is still waiting for
national funding to help fight a cholera outbreak which it says is
now affecting over 400 people.

The Madang provincial health director says about 20 people a day are
coming through the Modilon hospital to seek treatment. Mark Kachau
says they have so far only received help from the provincial
government, the World Health Organization and other aid agencies.

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

******
[6] Cholera - Zimbabwe (Mashonaland East)
Date: Tue 24 Nov 2009
Source: AllAfrica, The Herald (Zimbabwe) report [summ., edited]
<http://allafrica.com/stories/200911240030.html>

A total of 6 suspected cholera cases have been recorded in Mabvuku,
Harare, as the municipality battles to provide sufficient water to
residents in the eastern and western parts of the city. Speaking at a
press conference in Harare yesterday, 23 Nov 2009, Health and Child
Welfare minister Dr Henry Madzorera said no deaths had been recorded.

Countrywide, authorities had recorded 143 suspected cholera cases by
the afternoon of 23 Nov 2009 which 21 were confirmed after laboratory
tests.

Since the 1st cases were reported in September 2009, 5 people have
died from cholera. Dr Madzorera said the case-fatality rate stood at
4.3 percent.

According to international norms, a controlled cholera outbreak
usually leads to a fatality rate of not more than 1 percent. The 5
deaths were recorded in Chegutu (2), Gokwe North (2), and Makonde (1).

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

[The location of Harare in Mashonaland East can be found on the
HealthMap/ProMED-mail interactive map of Zimbabwe at
<http://healthmap.org/r/00*d>. - Mod.LL]

******
[7] Cholera - Uganda (Kasese)
Date: Fri 20 Nov 2009
Source: The New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/13/701828>

Cholera has broken out in Kasese district with 2 cases reported in
Hamukungu fishing village in Lake Katwe sub-county on Tue 17 Nov 2009.

The district health officer, Dr Peter Mukobi, said 584 cases with 10
deaths have been registered in the district since the beginning of
2009. He added that most of the cases were from the sub-counties
neighboring the Democratic Republic of Congo.

[Byline: Bernard Masereka]

--
Communicated by:
ProMED-mail
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[Uganda's Kasese district in the southwestern part of the country can
be seen on the district map at
<http://www.coetzee-uganda.com/index_files/District_Map_of_Uganda.htm>.
- Mod.LL]

******
[8] Cholera - Uganda (Bugiri)
Date: Mon 16 Nov 2009
Source: Uganda Pulse [edited]
<http://www.ugpulse.com/articles/daily/news.asp?about=Cholera+kills+2+in+Bugiri+&ID=13554>

The outbreak of cholera has claimed 2 people in Bugiri district in 1
week and about 10 others are bedridden in hospitals. The endemic
broke out in the area in September 2009 and it has so far killed more
than 18 people.

Dr Kirya Bulolo, the district medical officer of Bugiri says cholera
has hit mostly Muwayo trading centre in Buluguyi Sub County. He says
the cholera outbreak has been caused by too much rain in the district.

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

[Uganda's Bugiri district is in the eastern part of the country as
seen on the map at
<http://www.coetzee-uganda.com/index_files/District_Map_of_Uganda.htm>.
- Mod.LL]

******
[9] Cholera - Tanzania (Dar es Salaam)
Date: Fri 20 Nov 2009
Source: This Day [edited]
<http://www.thisday.co.tz/?l=10187>

Cholera continues to spread in Dar es Salaam Region as a total of 211
cases have been reported so far. The statistics show the highest
number of reported cholera cases in Temeke District, where 73 cases
have been recorded, while Kinondoni District has 68 cases, according
to records available on Wed 18 Nov 2009.

The acting Dar es Salaam regional commissioner, Evans Balama,
confirmed that Temeke is leading in the number of recorded cases and
that 4 new cases were recorded in Ilala District raising the total
number of cases recorded in that district so far to 70.

[Byline: Sayuni Kimaro]

--
Communicated by:
ProMED-mail
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[Dar es Salaam is located in northeastern Tanzania bordering the
Indian Ocean and can be seen on a maps at
<http://www.un.org/Depts/Cartographic/map/profile/tanzania.pdf>
and
<http://healthmap.org/r/00*f>. - Mod.LL]

******
[10] Cholera, prisoners - Kenya (Nairobi)
Date: Mon 23 Nov 2009
Source: Kenya Broadcasting Corporation (KBC) [summ, edited]
<http://www.kbc.co.ke/story.asp?ID=61117>

The government has contained the outbreak of cholera at the Kamiti
Maximum Prison, which left 10 inmates dead and scores hospitalized,
vice president Kalonzo Musyoka has said.

The VP said tests have ruled out the prisons water system or food as
the cause of the epidemic, adding that it was suspected the disease
was introduced into the facility by a new inmate, who had contracted
it from one of the affected estates in Nairobi.

[Byline: Margaret Kalekye]

--
Communicated by:
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[The prison is located in Nairobi, which can be seen on the maps of Kenya at
<http://www.un.org/Depts/Cartographic/map/profile/kenya.pdf> and
<http://healthmap.org/r/00*g>. - Mod.LL]

******
[11] Cholera - Kenya (Central province)
Date: Thu 19 Nov 2009
Source: Kenya Broadcasting Corporation (KBC) [edited]
<http://www.kbc.co.ke/story.asp?ID=61047>

So far 2 people have been confirmed dead and 9 others admitted in
serious condition following cases suspected to be a cholera bout in
Ruiru. Ruiru district public health officer Francis Mwangi said the 2
succumbed while on their way to hospital. 14 cases have so far been
confirmed.

The PHO said the victims, who hail from Murera, Gatong'ora, and
Gitambaya villages, had consumed contaminated water from the Ruiru
river. He said samples of the water have been taken for testing and
advised residents to boil river water before drinking it.

In October 2009, 2 other people died of suspected cholera in
Gatuanyaga area of Thika East district. At least 250 others were
treated for symptoms of the disease after they drank dirty water from
Athi River.

[Byline: Judy Maina]

--
Communicated by:
ProMED-mail
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[Ruiru (<http://en.wikipedia.org/wiki/Ruiru>) is a town in the Thika
District of Kenya's Central Province. Located within 3 kilometers (2
mi) of Nairobi's city boundary. Ruiru is a dormitory town for the
nation's capital, and is connected by both rail and road. - Mod.LL]

******
[12] Cholera - Nigeria (Borno, Taraba)
Date: Wed 18 Nov 2009
Source: AllAfrica, Daily Trust report [summ., edited]
<http://allafrica.com/stories/200911180459.html>

A fresh outbreak of cholera in parts of Maiduguri and Jere Local
Government Area of Borno State claimed 6 more persons between 16 and
17 Nov 2009, bringing to 78, the number of persons who died in one
month as a result of the disease. This is besides an earlier outbreak
in Biu Local Government Area of the state in October 2009 which
killed nearly 100 people.

Records at a treatment and isolation camp established for victims at
Ngaranm-bulabulin ward in Maiduguri showed that 795 cases were
recorded between 16 Oct 2009 and 17 Nov 2009 out of which 78 persons
have died, bringing the average death toll to 2 persons per day.
Following the fresh outbreak at the weekend [14-15 Nov 2009], over 20
people reported to the camp out of whom 3 died on 16 Nov 2009 and
another 3 died on 17 Nov 2009.

In a related development, 3 persons have been confirmed dead while 11
others are in critical condition as a result of a cholera outbreak in
Karim-Lamido Local Government Area of Taraba State. The 11 victims of
the epidemic are currently receiving treatment at Karim-Lamido
Comprehensive Health Centre.

[Byline: Isa Umar Gusau, Yahaya Ibrahim]

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

[A map of Nigeria showing these eastern states can be found at
<http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf>. - Mod.LL]

See Also