UNDIAGNOSED DEATHS, HUMAN, LIVESTOCK - COTE D'IVOIRE: REQUEST FOR INFORMATION
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Date: Tue 27 Feb 2007
From: Naomi Bryant <naomi.bryant@uclh.nhs.uk>
Source: All Africa / UN Integrated Regional Information Networks (IRIN) 
[edited]
<http://allafrica.com/stories/200702270341.html>


Health authorities in Cote d'Ivoire are investigating an acute illness in a 
northern village that has claimed the lives of 31 people and sickened at 
least 73 others.

People began to fall ill in the village of Diobala in the 3rd week of 
December [2006], with symptoms including headache, high fever, neck and 
chest pain, and respiratory problems, according to a report by the Ministry 
of Health and Public Hygiene obtained by IRIN [UN Integrated Regional 
Information Networks.] The illness progressed rapidly over the course of 3 
to 5 days and the 1st death was reported on [18 Dec 2006], the report said.

Villagers delayed reporting the illnesses to health authorities until [5 
Feb 2007]. By then, 31 people had died among the 104 who had fallen ill, 
the report said. Victims in the village of 1500 included men and women, 
young and old.

"Almost every family was touched" in the village, an official with the 
Seguela health department told IRIN. Seguela, 44 km. [27 miles] away, is 
the largest town near Diobala. Seguela is 450 km. [280 miles] north of the 
main city, Abidjan.

Local health authorities reported the deaths to officials in Abidjan and 
investigators went to Diobala [13-17 Feb 2007]. The team included 
specialists from the Pasteur Institute and the Ministry of Health and 
Public Hygiene.

They discovered that beginning in October [2006] animals in the village had 
begun falling ill. The report said 90 per cent of the village's poultry, as 
well as about 500 goats and sheep, had died. Villagers ate sick animals, 
but it was not immediately clear if this was how humans contracted the 
illness. Health authorities said patients treated with antibiotics 
responded well.

"They did an investigation and took blood samples and nasal swabs of the 
people, the poultry, the goats and the sheep," the Seguela health official 
said. Water samples were also taken. "Surveillance is continuing to see if 
other cases come up," he said.

The last cases of human illness were reported on [14 Feb 2007]. There have 
been no reports of illness in neighbouring villages. People in the area 
have been told to quickly report any illnesses to local health authorities.

Cote d'Ivoire has been divided between a rebel-held north and 
government-run south since a brief civil war in 2002. As a result, 
humanitarian agencies say health and sanitary conditions in the north have 
deteriorated.

-- 
Naomi Bryant
Information Officer
National Travel Health Network and Centre (NaTHNaC)
<naomi.bryant@uclh.nhs.uk>


[Given the above description of a livestock die-off (including poultry, 
sheep, and goats) preceding morbidity and mortality of the human 
population, one automatically thinks of zoonotic diseases that might be 
consistent with this picture. Adding to the picture is a reported case 
fatality rate (CFR) of 30 per cent (31/104), with an estimated attack rate 
of 7 per cent (104/1500) with all age groups affected. When one checks 
GIDEON (Global Infectious Disease and Epidemiology Network 
<http://www.gideononline.net>) for the clinical picture associated with 
contact with animals, one gets 3 main possibilities -- Q fever, ornithosis, 
and bunyaviridae. Of the bunyaviridae family, one does think of Rift Valley 
fever (RVF) as consistent with this clinical picture, but the involvement 
of poultry rules this out, as the RVF virus does not affect avians. Gideon 
also gives a "1st case scenario", where it "ignores" the geographic 
location of the outbreak in the event that this is a new geographic 
extension of an otherwise known pathogen. In this case, the GIDEON program 
suggested Congo-Crimean hemorrhagic fever (CCHF).

The above report mentions individuals improving with antibiotics. This 
suggests a clinical diagnosis of a bacterial disease, such as Q fever, but 
the reported CFR in this outbreak is way above that seen with Q fever (Q 
fever has a 1-2 per cent mortality associated with untreated cases).

If one decides that the animal outbreak information is a red herring, and 
repeats the GIDEON search omitting an ongoing epizootic, the following 
comes up as most likely candidates: Leptospirosis, Q fever, legionellosis, 
Ebola, Lassa fever, ornithosis, and brucellosis to mention a few -- and 
when one looks at the "1st case scenario" plague is on the list.

Anthrax is not on the list provided by GIDEON, but it too could possibly 
meet the clinical definition, although one might expect to hear of more 
gastrointestinal symptoms.

This moderator has now "mused out loud" probably more than would have been 
prudent, so at this point appeals to sources knowledgeable on the findings 
of the investigation to enlighten and educate us on what has been going on. 
- Mod.MPP]

..................mpp/mj/sh


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