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Biological Health Hazard – Cholera Outbreak/Fatal Rotavirus Diarrheal Epidemic (Update): East Africa

2017/03/14

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (09): AFRICA
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Published Date: 2017-03-13 22:45:06
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (09): Africa
Archive Number: 20170313.4898254

In this update:
[1] Cholera – Somalia
[2] Cholera – Somalia (Bay Region)
[3] Cholera – South Sudan
[4] Cholera – Ethiopia (Ogaden)
[5] Cholera – Congo DR

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[1] Cholera – Somalia
Date: Sun 5 Mar 2017
Source: WHO [edited]

Situation Report For Acute Watery Diarrhea [AWD]/Cholera Epidemiological Week 9
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There is a sharp increase in the number of AWD/cholera cases, according to surveillance reports, mostly from inaccessible districts and villages. A total of 1839 AWD/ cholera cases and 48 deaths (CFR­ 2.6%) were reported during week 9 from 45 districts in 11 regions. The most affected districts include Baidoa, G. Burey in Bay region, Burdhuhunle in Bakol region, Wanlaweyne in Lower Shebelle region and Garowe in Nugal region. A 2-day Training-of-Trainers workshop on oral cholera vaccination (OCV) implementation and monitoring was held in Mogadishu for 42 participants from Banadir, Hiran and Lower Juba regions. Each regional team is expected to cascade training among districts vaccination teams in preparation for the OCV campaign.


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

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[2] Cholera – Somalia (Bay Region)
Date: Sat 4 Mar 2017
Source: PM News Nigeria [edited]

Prime minister Hassan Khaire said on Saturday, 4 Mar 2017, that no fewer than 110 people were killed and several left in serious condition after cholera broke out in southern Somalia in the past 2 days. Khaire said the deaths occurred in Bay region amid severe drought across the country while assuring that the government would give it 1st priority to respond to the crisis.

Mohamed Fiqi, Minister of Agriculture for the southwest state in Somalia, said the cholera situation was out of their control and demanded emergency aid from the government and the international community.

“Cholera broke out in Goof-guduud, Awdiinle and Berdale locations in Bay region. Children, women and old people are among the dead; the death toll increases time to time, and our administration can’t help,” Fiqi said.


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

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[3] Cholera – South Sudan
Date: Fri 10 Mar 2017
Source: Associated Press [edited]

The United Nations says South Sudan’s cholera outbreak has reached the country’s 2nd-largest city, as the number of cases nationwide rises beyond 5500. The UN humanitarian agency said on Friday [10 Mar 2017] that cases of the sometimes fatal gastrointestinal disease have been confirmed in Malakal, which has been ravaged by the country’s 3-year civil war.

The UN says cholera now has been confirmed in 14 South Sudan counties, with at least 137 deaths since June 2016. Cholera cases have been reported in the 2 counties recently declared to be in the grip of famine, Mayendit and Leer. Many of the country’s cholera cases have been reported around the capital, Juba.

Cholera is a fast-developing, highly contagious infection that can spread in areas without clean drinking water and with poor sanitation.


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

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[4] Cholera – Ethiopia (Ogaden)
Date: Thu 9 Mar 2017
Source: UNPO [edited]

The population of Ethiopia’s Ogaden region is facing a devastating wave of deaths due to a cholera epidemic. Despite the seriousness of the situation and the despair of the Ogaden people, urgent help is provided to the victims by neither the Ethiopian government nor the regional administration, while no effective action is being taken by international agencies either. The Ogaden National Liberation Front (ONLF) calls for urgent help and support not only from local, regional, and national authorities, but also international actors.

Below is a press release published by ONLF:
“More than 300 people have died of the cholera epidemic in Ogaden during the last 72 hours. Thousands are also at a life-threatening stage with no medicine or health support. Although most of the towns in Ogaden are affected, the disease is creating havoc in the rural areas, where there are no health facilities or emergency provisions. Villagers are reporting that families find their relatives dead in the remote areas while tending livestock. Some are found days later, mauled by wild animals.

The most affected areas are in the regions of Jarar (dhegahbuur); Nogob (tourge), Qorahay (Qabridaharre) and Shabelle. Similar deaths are reported in Doollo, Afdheer and Liibaan regions. Since November 2016, it is conservatively estimated that more than 2000 have died in the remote rural areas in Ogaden. The situation is further exacerbated by the drought and lack of adequate food or water, and people are so emancipated that anyone affected dies quickly.

Although both the UN and the Ethiopian government mention the drought and cholera (AWD) in their reports, no concrete action has been taken. The people are dying from a curable disease. The Somali people in Ogaden have no ability to buy medicine or food in neighbouring countries due to the undeclared embargo on trade and aid, barring access to international NGOs and independent media to most of the Ogaden.


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

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[5] Cholera – Congo DR
Date: Thu 9 Mar 2017
Source: CAJ News Africa [edited]

Strife-torn Democratic Republic Congo is bearing the worst brunt of a deadly cholera crisis sweeping through Central and West Africa since the beginning of 2017.

The water-borne disease has claimed the lives of 103 people from 3635 cases recorded in the DRC in 2017. This represents over 96 percent of the death toll in the 2 regions, where a total of 107 deaths have been reported from 3685 cases recorded.

Humanitarian agencies noted that the cholera incidence remained very high in the beginning of 2017, notably in the provinces around the Congo River, from Maniema to Equateur, and through Mongala and Bas Uele Provinces. The case fatality ratio in these provinces was particularly high in the regions. There was a notable decrease in Tanganyika province.

Cholera is adding to the DRC’s woes, with militancy in the northeast displacing thousands of civilians. The inhospitable conditions that the victims live under have been identified as the major cause of disease.

[Byline: Jean Kassongo]


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

[The mortality from cholera is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated in Lutwick LI, Preis J: Cholera. In: Tropical pediatrics. Roach RR, Greydanus DE, Patel DR, Homnick DN, Merrick J (eds), 2014, Nova Science Publishers, 2015; oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

“As reviewed by Richard Guerrant et al. (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs. 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact on the morbidity and mortality of cholera. Indeed, Guerrant et al. (1) highlights the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30 per cent to 3.6 per cent (4) and quotes sources referring to ORT as “potentially the most important medical advance” of the 20th century. A variety of formulations of ORT exist, generally glucose- or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

“The assessment of the degree of volume loss in those with diarrhea to approximate volume and fluid losses can be found in ref. 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer’s lactate solution of 20-30 ml/kg followed by 100 ml/kg in the 1st 4 hours and 100 ml/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 liters in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation.”

References
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1. Guerrant RL, Carneiro-Filho BA and Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis. 2003;37(3):398-405.
2. Gregorio GV, Gonzales ML, Dans LF and Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev. 2009;(2):CD006519. doi: 10.1002/14651858.CD006519.pub2.
3. Gore SM, Fontaine O and Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, Bhattacharya AK and Simpson TW. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med. 1973; 132(4): 197-205.
5. Atia AN and Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009; 104(10): 2596-604, doi: 10.1038/ajg.2009.329.
6. WHO. The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005. – Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/6075.]

See Also

Cholera, diarrhea & dysentery update (08): Asia (Yemen) 20170308.4887994
Cholera, diarrhea & dysentery update (07): Americas 20170227.4866520
Cholera, diarrhea & dysentery update (06): Africa 20170217.4846873
Cholera, diarrhea & dysentery update (05): Africa, Asia 20170216.4841639
Cholera, diarrhea & dysentery update (04): Asia (Yemen) 20170125.4790713
Cholera, diarrhea & dysentery update (03): Americas (Haiti) 20170113.4763806
Cholera, diarrhea & dysentery update (02): Africa 20170113.4751889
Cholera, diarrhea & dysentery update (01): Asia (Yemen) WHO 20170105.4742075

2016
—-
Cholera, diarrhea & dysentery update (33): Americas 20161021.4575535
Cholera, diarrhea & dysentery update (31): Americas (Haiti) post-hurricane 20161014.4560289
Cholera, diarrhea & dysentery update (29): Americas (Haiti) 20161012.4555242
Cholera, diarrhea & dysentery update (27): Americas 20160917.4495933
Cholera, diarrhea & dysentery update (23): Americas, PAHO 20160725.4368049
Cholera, diarrhea & dysentery update (22): Americas (Cuba) 20160624.4307018
Cholera, diarrhea & dysentery update (21): Americas 20160606.4266872
Cholera, diarrhea & dysentery update (13): Africa, Americas 20160329.4123551
Cholera, diarrhea & dysentery update (10): Africa, Americas 20160318.4102278
Cholera, diarrhea & dysentery update (09): Africa, Asia, Americas 20160314.4089721
Cholera, diarrhea & dysentery update (01): Americas 20160108.3921129
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Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


Note:

Rotavirus is a contagious virus that can cause gastroenteritis (inflammation of the stomach and intestines). Symptoms include severe watery diarrhea, often with vomiting, fever, and abdominal pain. Infants and young children are most likely to get rotavirus disease. They can become severely dehydrated and need to be hospitalized and can even die.

Vibrio cholerae, and Cryptosporidium parvum are several water safety threats classified as potential Category B bioterrorism pathogens that can cause Rotavirus symptoms. These are the second highest priority organisms/biological agents.

Pathogenic organisms and toxins such as these may persist in food and water supplies. Humans are also a source of infection.

Food or waterborne pathogens that may be used as bioterrorism agents:
Salmonella species
Shigella dysenteria
Escherichia coli 0157:H7
Giardia lamblia
Vibrio cholerae
Cryptosporidum species
Campylobacter species

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