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Biological Hazard – Severe cholera epidemic (Update) 2017/10/31: Africa

2017/11/01

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (125): AFRICA
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Published Date: 2017-10-31 20:28:34
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (125): Africa
Archive Number: 20171031.5416115

In this update:
Africa
[1] Cholera – Kenya (Embu County)
[2] Cholera – Congo DR
[3] Cholera – Chad
[4] Cholera – South Sudan
[5] Cholera – Sudan

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[1] Cholera – Kenya (Embu County)
Date: Tue 31 Oct 2017
Source: The Nation [edited]

Two people have died and 26 others hospitalised following cholera outbreak in Embu County. County Director of Health Stephen Kaniaru on Monday said the 2 died in Siakago and Runyenjes Level Four hospitals. He noted that the patients had developed severe diarrhoea and vomiting.

Mr. Kaniaru added that a KCPE (secondary education testing) candidate, who was among those admitted to various hospitals, had been discharged and was fit to sit the examination. Also among the sick is a 2-year-old girl, a 6-year-old boy from Majimbo and a 7-year-old boy from Dallas. Speaking in his office, Dr Kaniaru said 12 patients were recovering at Embu Level Five Hospital and others at Kiritiri, Runyenjes and Siakago Level Four hospitals.

He said health officials had identified the cause of the disease as contaminated water and had sent samples from Thiba, Ena, Rupingazi, Kapingazi and Muchina water project to Water Resources Management Authority (Warma) and government chemist for testing. Dr Kaniaru said most cases had been reported at Maranga, Ngeniari, Thagaiya, Mufu, Kangondi and Ndumari villages in Runyenjes.

In Mbeere South, cases had been detected in Kamurugu and Kirima villages. Other areas include Dallas, Grogon, Don Bosco and Majimbo in Embu West while in Mbeere North, cases had been reported in Kaungu, Riandu and BAT areas.

“We believe the cholera outbreak has been triggered by consumption of contaminated water. Those interviewed suggest they drank contaminated water” Dr Kaniaru said. He said doctors will tour various villages where the patients come from to establish their sources of water and examine the general hygiene.

Dr Kaniaru said the county government had banned food hawking and feasting in ceremonies such as weddings and funerals as health officials try to control the situation. He urged residents to avoid eating food from streets. He also assured residents that they situation would be contained. On [Sun 29 Oct 2017], 21 people were admitted to various hospitals in the county they exhibited cholera symptoms.

County Health Executive Jamleck Muturi said the disease was first detected in Grogon slums in Manyatta and Kanduri village in Runyenjes. He said other cases were later detected in Mbeere South. One of the patients is from Murinduko in the neighbouring Kirinyaga County. The executive said 8 patients were discharged[Mon 30 Oct 2017] evening. “Starting today, we will deploy health officials to check on the hygiene status of hotels and those found unhygienic will be closed,” the official said.

[Byline: Charles Wanyoro]

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

[Embu County is a county of Kenya. The capital of Embu County, Embu town is largely metropolitan since it was formerly the Eastern province headquarters. The county borders Kirinyaga to the West, Kitui to the East, Tharaka Nithi to the North, Machakos to the South and can be seen in central Kenya on a map at https://en.wikipedia.org/wiki/Embu_County. – Mod.LL]

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[2] Cholera – Congo DR
Date: Wed 25 Oct 2017
Source: Doctors Without Borders [in German, machine trans., edited]

Severe cholera epidemic: MSF treats more than 18,000 patients
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Cholera is widespread in the Democratic Republic of the Congo. MSF has already treated more than 18 000 patients in 2017, with 38 000 registered nationwide. It is expected that it will take many weeks to contain the epidemic. While in some parts of the country the number of patients is declining or consistent, this time cholera also occurs in cities where no cases of illness have ever been registered. The ongoing spread of cholera in 21 out of 26 provinces is unprecedented in the history of the country.

“One of the main reasons why cholera cases have risen so much this year [2017] is the drought,” said Francisco Otero, MSF Country Coordinator in the Democratic Republic of the Congo. “The wells have dried up or the water level has been so low that many people have been forced to take water from unsafe sources such as lakes or rivers. The authorities are not in a position to provide the population with clean drinking water.”

This time, densely populated cities are affected. Goma, the capital of North Kivu, also on Kivu Lake, is affected as well as the cities of Minova and Bukavu, the capital of South Kivu. In all these cities MSF teams treat cholera patients.

Terribly, cholera in many cases affects infants, but over the past few days older children have been increasingly brought to treatment centers. “We believe that starting school has contributed to the spread of cholera,” said Innocent Kunywana, MSF operations officer in South Kivu.

Another reason for the spread of cholera is insufficient preventive measures and insufficient information of the population. Cholera is endemic in several provinces of the Congo DR, and sporadic outbreaks are common. However, health care workers sometimes do not know how to treat cholera properly. “We’ve found hospitals where cholera patients are shared with patients with other illnesses,” says Kunywana. “Therefore, the risk of infection for relatives and other patients was very high.”

“According to the Ministry of Health regulations, the treatment of cholera should be free of charge,” adds Otero. “But sometimes the hospitals are not equipped for it. You have to buy the materials and medicines yourself and somehow recover the costs. That’s why they often charge them to the patient.”

Although the population of the 2 provinces of North and South Kivu is suffering from a conflict that has been going on for more than 20 years, there are fewer and fewer NGOs and international relief agencies that can respond to medical emergencies like the cholera outbreak, especially in South Kivu , “We saw that during the measles epidemic this year [2017], we see it as helping the displaced, and now it shows again during the cholera epidemic,” says Otero. “Such outbursts will repeat and worsen if nothing changes. The United Nations has ranked the highest level of humanitarian emergency in the province. We’ll see if that translates into local help.”

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

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[3] Cholera – Chad
Date: Sat 28 Oct 2017
Source: Reliefweb, report from International Federation of Red Cross And Red Crescent Societies [edited]

Chad: Cholera Outbreak – Emergency Plan of Action
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Following the declaration of the Ministry of Public Health (MoPH) about cholera epidemics in the village of Maréna, Koukou Angarana subprefecture, the Red Cross of Chad (RCC) Sila regional committee, informed by the national headquarters, carried out an evaluation mission from [21 to 22 Aug ] in Maréna, Tyéro and Dogdoré villages, where the epidemic seems to have started on [14 Aug 2017].

The epidemic spread on [11 Sep 2017] to the Salamat region, more specifically in the village of Amdjoudoul, Mouraye sub-prefecture in the Salamat region, a locality bordering the region of Sila. The Salamat Regional Committee of the RCC after holding the national headquarters at the disposal of the Regional Health Delegation (RSD) of Salamat a large number of volunteers in the framework of sensitization on the RSD. The Ministry of Health officially announced the cholera epidemic in this region.

For the 2 regions of Salamat and Sila 652 cases of cholera are recorded 59 including the beginning of the epidemic. However, for the region of Sila, the situation seems to be under control. In Salamat, from [11 Sep 2017] to [11 Oct 2017] (epi-week 41) in total 277 cases of cholera were confirmed with 11 deaths with a case fatality rate of 4percent.

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

[Chad is a country in central Africa. The areas involved are close to Sudan where “acute watery diarrhea” has been quite active and can be found on a map at https://en.m.wikipedia.org/wiki/Chad. – Mod.LL]

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[4] Cholera – South Sudan
Date: Fri 27 Oct 2017
Source: Reliefweb, report from WHO and the Government of the Republic of South Sudan [edited]

Republic of South Sudan: cholera situation and response updates
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Epidemic trends:
Cholera transmission reported in 3 counties [Juba, Budi, and Kapoeta East] in the last 4 weeks [epi-weeks 40 -43, 2017].
– 2 cholera cases were confirmed from Napotpot, Kapoeta East after more than 2 incubation periods without cases. Oral cholera vaccination was conducted in the county and there is currently no evidence of active transmission.
– 9 cholera cases were confirmed from Juba in week 43.
– Cholera transmission in Budi has continued to decline.
– 3 suspect cholera cases (all RDT positive) reported from Mayom in the last 4 weeks.

Overall cholera trends
– Since the start of the current outbreak on [18 Jun 2016], a total of 21 268 cases have been reported from 26 counties. The most affected counties include Ayod, Tonj East, Yirol East, Fashoda, Kapoeta East, and Kapoeta South.

The most affected populations in these locations include: Landing sites/ towns along River Nile; cattle camp dwellers; populations living on islands – no social services; and IDPs – recently displaced with inadequate access to WASH.

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

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[5] Cholera – Sudan
Date: Mon 30 Oct 2017
Source: All Africa, Radio Dabanga report [edited]

Following more than a year of intensive efforts by the Sudanese Ministry of Health, the World Health Organization (WHO), the UN Children’s Agency (UNICEF), and other health partners managed to mitigate the outbreak of Acute Watery Diarrhoea (AWD), the number of cases in the country dropped significantly during the past weeks. The UN Office for the Coordination of Humanitarian Affairs (OCHA) in Sudan reports in its latest bulletin that to stop the spread of AWD completely, the response must continue until no cases are reported in the country for 3 consecutive weeks.

Only 78 new cases and 2 related deaths were reported between [8 and 14 Oct 2017], down from a peak of nearly 2000 new cases at the end of June 2017. A total of 8 states reported active case transmissions and the only state reporting 2 AWD-related deaths was South Kordofan. The Health Ministry continued to lead an active scale-up of interventions to ensure a final stop to the spread of AWD.

One key measure -which the Health Ministry is considering to end the current outbreak- is a renewed Oral Cholera Vaccine (OCV) campaign. The Ministry, in consultation with WHO and other stakeholders, has decided to explore the need and possibility of introducing OCV in the high-risk states in Sudan, namely White Nile, Kassala, West and South Darfur, and South Kordofan, the OCHA bulletin reads.

Risk assessments are currently ongoing in these states to determine target areas and groups. Teams are investigating success factors such as accessibility and availability of health services, disease surveillance capacity, water, sanitation and hygiene, capacity to implement mass vaccination campaigns, cold-chain capacity at central and field levels, and monitoring and evaluation.

The possible OCV campaign, paired with ongoing and intensified activities in WHO’s 6 other key response areas (health capacity building, AWD case management, provision of key medicine and medical supplies, water quality control, vector control, and hygiene promotion), are hoped to stop the AWD outbreak in Sudan.

In spite of numerous independent confirmations (conducted according to WHO standards) that the disease which broke out in Blue Nile state in August 2016 turned out to be cholera, the Government of Sudan and several international organizations still refuse to refer to it by this name.

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

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

As stated in Lutwick LI, Preis J, Choi P: Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J (eds). NY: Nova Bioscience, 2017 (in press), 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 percent to 3.6 percent (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
———-
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; available at:
http://cid.oxfordjournals.org/content/37/3/398.long.
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; available at:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full.
3. Gore SM, Fontaine O and Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91; available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4): 197-205; available at:
http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf.
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; abstract available at:
http://www.ncbi.nlm.nih.gov/pubmed/19550407.
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005; available at:
http://whqlibdoc.who.int/publications/2005/9241593180.pdf.
– Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/3264.]

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………………………………………….sb/ll/ao/lm

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


Sadly, Africa is full of a mentally deranged and diseased people. Why would anyone in their right mind want to expose their own people and nations to that same mentality, poverty, and disease? Who exactly are these group of “leaders” that are really supposed to be looking out for their own countrymen and women? 

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