ProMED-mail post

Published Date: 2009-04-29 17:00:05
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (2009) (17)
Archive Number: 20090429.1620

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (17)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
Americas
[1] Cholera - Paraguay: PAHO
Africa
[2] Cholera - Zimbabwe: WHO
[3] Cholera - Southern Africa
[4] Cholera - Somalia (Puntland)
[5] Cholera - Somalia (Southern regions)
[6] Cholera - Kenya
Asia
[7] Cholera - Malaysia (Selangor)
[8] Cholera - India: Matlab variant
[9], [10] Cholera - Viet Nam (Ha Noi)
[11] Diarrhea - Viet Nam (Dong Nai)
[12] Cholera - Indonesia (West Nusa Tenggara)
[13] Cholera, possible - Myanmar (Rangoon)

******
[1] Cholera - Paraguay: PAHO
Date: Wed 22 Apr 2009
Source: PAHO, Epidemiological alerts [edited]
<http://new.paho.org/hq/index.php?option=com_content&task=view&id=1239&Itemid=1091>

On 7 Apr 2009, the Ministry of Public Health and Social Welfare of
Paraguay (MSPBS) received laboratory confirmation of a case of
cholera arising from _Vibrio cholerae_ O1 Ogawa, biotype El Tor,
toxin producing, which occurred in a 33-year-old male patient. The
date on onset of symptoms was 6 Mar 2009, originating in the
indigenous community of Ebetoque (Ayoreo ethnic group), located in
the district of Filadelfia in the Paraguayan Chaco region. The case
required a 3 day hospital stay, and the patient has recovered.

On the basis of this confirmed case, an epidemiological investigation
was carried out, in which 3 outbreaks of acute diarrheal disease were
detected (one in the district of Loma Plata, and 2 in the district of
Filadelfia) during the period between epidemiological week (EW) 51,
2008, and EW 15, 2009.

1. The 1st outbreak was reported between EWs 51 and 53, 2008; it
affected the Enchlet community in the district of Loma Plata. The
precise number of persons affected could not be determined, and 1
(adult) death was reported.

2. The 2nd outbreak was reported between EWs 3 and 4, 2009, and
affected the Lengua community in Barrio Obrero (Filadelfia district).
A total of 9 cases were reported, including 2 deaths (in older
adults). The fatality rate was 22.5 percent.

3. The 3rd outbreak was reported between EWs 9 and 10, 2009, and
affected the Ayorea community in Ebetogue (Filadelfia district in the
Paraguayan Chaco region). It was in this community that the
laboratory-confirmed cholera case was identified. A total of 5 cases
were reported, all requiring hospitalization. No related mortality
was reported. In a water sample taken from a reservoir at the site
where the index case was before the onset of symptoms, a strain of
_Vibrio_ was identified.

There have been no reports of similar diarrheal profiles from March
2009 to 16 Apr 2009.

In all the affected communities, the diarrhea outbreaks were
contained following intervention by the regional health authorities,
who took measures of assure safe drinking water in local water
sources (chlorination, boiling water, purchase of mineral water).
There is still no available evidence of the presence of _Vibrio
cholerae_ O1 in water coming from the affected communities. However,
the containment of the outbreaks following the implementation of safe
drinking water strategies leads us to believe that transmission was
waterborne.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[How many of the other cases of diarrhea were cholera is unclear but
it is likely that some were due to _V. cholerae_. This is the 1st
case of cholera reported to the World Health Organization from
Paraguay since 1996 (World Health Organization. Global Health Atlas
(accessed 28 Apr 2009), available at
<http://www.who.int/globalatlas/dataQuery/default.asp>). - Mod.LL]

[The HealthMap/ProMED-mail interactive map of Paraguay is available at
<http://healthmap.org/r/00aS>. - CopyEd.MJ]

******
[2] Cholera - Zimbabwe: WHO
Date: Sun 26 Apr 2009
Source: N Office for Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Government of Zimbabwe; WHO report [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SID/JBRN-7RJJ3B?OpenDocument&rc=1&cc=zwe>

Zimbabwe: daily cholera update and alerts, 26 Apr 2009
------------------------------------------------------
Highlights of the day:
- 11 cases and 0 deaths added today (in comparison with 18 cases and
0 deaths yesterday [25 Apr 2009])
- cumulative cases: 97 198
- cumulative deaths: 4 244 of which 2 606 are community deaths
- 68.3. percent of the reporting centres affected have reported today
[26 Apr 2009] (41 out of 60 affected reporting centres)
- cumulative institutional case fatality rate: 1.7 percent
- daily institutional CFR: 0 percent.

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

[After a very prolonged interval, over the past 6 weeks the outbreak
of cholera in Zimbabwe has slowed to a trickle for now with almost
100 000 reported cases and a very high case fatality rate of almost
4.4 percent. The 26 Apr 2009 full report can be found at
<http://reliefweb.int/rw/rwb.nsf/db900sid/JBRN-7RJJ3B/$File/full_report.pdf>.

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/r/00aK>. - Mod.LL]

******
[3] Cholera - Southern Africa
Date: Thu 23 Apr 2009
Source: CRIENGLISH.com, Xinhua News Agency report [edited]
<http://english.cri.cn/6966/2009/04/23/2041s477667.htm>

The cholera epidemic in southern Africa continues to abate, but
international and local health authorities stress the need to remain
vigilant, the United Nations reported on Wednesday [22 Apr 2009].

"Overall, the duration and magnitude of the epidemic underscores the
need for strengthening surveillance, preparedness and underscores
plans in all countries," according to the UN Office for the
Coordination of Humanitarian Affairs (OCHA). There were a total of
4579 new cases on 3-17 Apr 2009 in the 9 countries, Angola, Botswana,
Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and
Zimbabwe, affected by the often fatal disease since August 2008.
During the 2 weeks preceding 3 Apr 2009, 6460 new cases were
reported, OCHA said.

Authorities warn, however, that cholera could re-appear in the coming
1 to 3 weeks, when waters from flooding in the region, which has
affected more than 1.2 million people, subside and become stagnant.
Those displaced by the deluge lack access to shelter, water, and
sanitation facilities and are at higher risk of contracting the
disease, OCHA said. To prevent that from happening, UN Country Teams
and humanitarian partners plan to expedite their aid to flood
victims. In a number of countries, national cholera policies and
contingency planning is also taking place, in partnership with the UN
World Health Organization (WHO), the UN Children's Fund (UNICEF), and
other organizations.

The cumulative total of cholera cases reported in southern Africa
stands at 155 692, including 96 718 cases in Zimbabwe, the worst
affected country.

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

[A map of Africa showing the affected countries can be found at
<http://www.un.org/Depts/Cartographic/map/profile/africa.pdf>. - Mod.LL]

******
[4] Cholera - Somalia (Puntland)
Date: Mon 20 Apr 2009
Source: Horseed Media [edited]
<http://english.horseedmedia.net/news/17321.shtml>

On Monday [20 Apr 2009], authorities in Bander Bayla town (east
region, Puntland) confirm the death of 5 people in the latest cholera
outbreak. Farah Hoshle, the mayor of Bayla town, told Horseed Media
that the victims were 2 elderly women. More medical staff were sent
to help the local health care centers, said the Mayor.

The latest outbreak comes as the UN is warning about the possibility
of major cholera outbreaks in southern and central Somalia.

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

[Puntland is a region in northeastern Somalia, centered on Garowe
(Nugaal region), whose leaders declared it an autonomous state in
1998. A third of the Somali people live in the province. It is
location can be found at
<http://en.wikipedia.org/wiki/Puntland>.
The HealthMap/ProMED-mail interactive map of Somalia is available at
<http://healthmap.org/r/00aM>. - Mod.LL]

******
[5] Cholera - Somalia (Southern regions)
Date: Tue 14 Apr 2009
Source: Press TV [edited]
<http://www.presstv.ir/detail.aspx?id=91373§ionid=351020501>

At least 20 people died of cholera on Tuesday [14 Apr 2009] with
minors accounting for a major part of the toll. More than 11 children
died in the Bakool region while another 8 fell victim to the virulent
disease in Middle Shabelle and one in Lower Shabelle, a Press TV
correspondent reported.

According to medics, a total of around 111 women and children have
been sent to regional hospitals in southern Somalia. The cases mainly
have occurred in areas such as Bay and Bakool, and Lower and Middle
Shabelle regions, where aid workers have stopped operating amid
ceaseless hostilities and ongoing tussles between rival factions.

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

[The regions mentioned can be found on a map of the country of Somalia at
<http://www.un.org/Depts/Cartographic/map/profile/somalia.pdf>. - Mod.LL]

******
[6] Cholera - Kenya
Date: Mon 13 Apr 2009
Source: The Standard [edited]
<http://www.eastandard.net/InsidePage.php?id=1144011440&cid=4>

Health experts are warning of a cholera outbreak in Nairobi and
Mombasa, as city dwellers return from the Easter break upcountry. It
is feared that the epidemic, that has claimed 55 lives of the nearly
2000 cases reported countrywide, could also spread to Central
Province that has been free of the disease so far, according to the
Kenya Red Cross. The outbreak is traced to a few cases reported in
Nyanza Province last December 2008. It has spread to 8 other
districts in the region and spilled over to other provinces.

So far, Nairobi and Mombasa appear safe although the Easter
festivities, for which thousands of city residents travelled to their
rural homes, will almost certainly bring cholera to the cities'
doorstep.

Latest statistics from the Ministry of Health, as contained in the
Kenya Red Cross Bulletin Number 3, indicate that there have been 1931
cases reported so far, with 55 casualties:
- in Western Province, the outbreak has been reported in 4 districts:
Bungoma East, Kakamega Central, Busia, and Butere, with 173 reported
cases.
- the most recent outbreak was in Bungoma East where 10 people have
died and a couple of other cases treated at Bungoma District
Hospital, Bokoli Sub-District Hospital, Lugulu Mission Hospital, and
Webuye District Hospital.
- in Rift Valley province, the 1st outbreak was reported in March
2009 in Nandi South at Chemase, Kaptumo, and Nandi Hills Town. The
2nd outbreak was at the Nakuru Prison where 10 cases were reported
and 1 casualty.

[Byline: Peter Orengo]

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

[A map of Kenya showing the areas mentioned can be found at
<http://www.un.org/Depts/Cartographic/map/profile/kenya.pdf>.
The HealthMap/ProMED-mail interactive map of Kenya is available at
<http://healthmap.org/r/00aN>. - Mod.LL]

******
[7] Cholera - Malaysia (Selangor)
Date: Wed 29 Apr 2009
Source: The Star [edited]
<http://thestar.com.my/news/story.asp?file=/2009/4/29/nation/20090429145312&sec=nation>

50 people, including a child, suspected of having cholera have been
admitted to the hospital so far, said Hospital Tengku Ampuan Rahimah
director Dr Ghazali Hasni Md Hassan. One patient is confirmed with
cholera and is still receiving treatment at the hospital.

"We are investigating another 14 patients to see they are also down
with cholera or just suffering from food poisoning," he told
reporters after Selangor Police Chief Datuk Khalid Abu Bakar visited
the hospital in conjunction with the 202nd Police Day celebration. Dr
Ghazali said the patients were from various place in Klang and Shah
Alam and were sent to the hospital after consuming contaminated food.

[Byline: Christina Tan]

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

[A map of Malaysia can be found at
<http://travelmalaysiaguide.com/images/Maps/malaysia-overview-map.jpg>.
The areas mentioned are in the Selangor state where Kuala Lumpur is
located.
The HealthMap/ProMED-mail interactive map of Malaysia is available at
<http://healthmap.org/r/00aO>. - Mod.LL]

******
[8] Cholera - India: Matlab variant
Date: Sat 11 Apr 2009
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/Deadly-cholera-strain-hits-India/articleshow/4386452.cms>

A highly virulent and deadly form of cholera strain "the El Tor
hybrid" [also called the Matlab variant - Mod.LL] has now been found
in India. First discovered in Bangladesh in 2006 and subsequently
found in parts of Africa, this recombinant strain is more dangerous
than the El Tor strain, with the power to kill more people and cause
prolonged outbreaks.

What's worse, scientists at the National Institute of Cholera and
Enteric Diseases (NICED) in Kolkata fear that almost 100 percent of
all new cholera infections in West Bengal and Orissa are being caused
by this strain.

"Usually in cholera, with proper oral rehydration therapy, case
fatalities shouldn't exceed one percent. Alarmingly, with the El Tor
hybrid, case fatalities in Ghana is 24 percent and 8 percent in
Orissa," said NICED director Dr G B Nair, who had actually discovered
the strain in Bangladesh in 2006.

ICMR [Indian Council of Medical Research] director general Dr V M
Katoch said the present strain has better survival techniques in the
environment. "El Tor hybrid has higher case fatality rates, higher
surviving power in the environment, and the ability to cause
prolonged outbreaks," Dr Katoch said.

The most severe warning about the risks of the El Tor hybrid,
however, came from Dr Nair. According to him, the classical strain
was more virulent and less infectious while El Tor was less virulent
and more infectious. "The El Tor hybrid has picked up both attributes
and is more virulent and more infectious," Dr Nair said.

[Byline: Kounteya Sinha]

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

[Formally, the 2 established biotypes of _Vibrio cholerae_, classical
and El Tor, can be distinguished from one another by a number of
phenotypic properties including hemolysis of sheep red blood cells,
agglutination of chicken red blood cells, the Voges-Proskauer
reaction, as well as susceptibility to polymyxin B and to
biotype-specific viral bacteriophages. Hybrid biotypes, so-called
Matlab variants, are also described (Nair GB, Faruque SM, Bhuiyan NA,
et al: New variants of _Vibrio cholerae_ O1 biotype El Tor with
attributes of the classical biotype from hospitalized patients with
acute diarrhea in Bangladesh. J Clin Microbiol 2002; 40(9): 3296-9;
abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/12202569>.)

The HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/008o> - Mod.LL]

******
[9] Cholera - Viet Nam (Hanoi)
Date: Tue 28 Apr 2009
Source: Viet Nam News (VNS) [edited]
<http://vietnamnews.vnagency.com.vn/showarticle.php?num=02SOC280409>

A 2nd cholera patient in 2009 was admitted to hospital on Sunday [26
Apr 2009] after suffering acute diarrhea. The patient, who tested
positive for the _Vibrio cholerae_ bacterium, was a 91-year-old man
from Phung Hung Street, Hoan Kiem District, [Hanoi]. The Ministry of
Health said the man suffered serious diarrhea after eating dog meat,
shrimp sauce, and raw vegetables.

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

[A map of Viet Nam showing Hanoi in the north can be found at
<http://www.angelfire.com/co/hongnam/vnmap.html>.
The HealthMap/ProMED-mail interactive map of Viet Nam is available at
<http://healthmap.org/r/00aI> - Mod.LL]

******
[10] Cholera - Viet Nam (Hanoi)
Date: Sat 25 Apr 2009
Source: Thanh Nien News [edited]
<http://www.thanhniennews.com/healthy/?catid=8&newsid=48198>

Local authorities closed four [Hanoi] dog meat shops after confirming
that 2009's 1st cholera patient had eaten at one of the restaurants,
said an official in the capital. All 4 of the venues received their
dog meat from the same supplier, said Nguyen Huu Khiem, chairman of
the Xuan Dinh Commune People's Committee in Ha Noi.

Viet Nam confirmed its 1st cholera case for the year [2009] after the
man ate dog meat, shrimp sauce, and uncooked vegetables. The patient
was discharged from hospital after his condition improved, said Khiem.

"There is substantial risk of another cholera outbreak this year
[2009]," said Nguyen Huy Nga, director of the Department of
Preventive Medicine and a health ministry spokesman. "We have asked
local governments to be on high alert to prevent the spread of summer
epidemics."

The nation had its worst cholera outbreak in a decade in 2008. The
disease had infected 722 people in Viet Nam by 20 Aug of 2008, the
country's health ministry said 26 Aug [2008].

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

******
[11] Diarrhea - Viet Nam (Dong Nai)
Date: Mon 27 Apr 2009
Source: Thanh Nien News [edited]
<http://www.thanhniennews.com/healthy/?catid=8&newsid=48253>

An acute diarrhea outbreak, which occurred in southern Dong Nai
Province's Xuan Loc District and affected more than 500 locals, is
now under control officials say. Cao Trong Nguong, director of the
southeastern province's Preventive Health Department, said Sunday [26
Apr 2009] that water samples in the area had been taken for testing.
As well, blood tests were being conducted on local residents.

According to the Xuan Loc District Preventive Health Bureau, the
outbreak began on 20 Apr 2009 in Gia Ui Village of Xuan Tam Commune
and Trang Tao Village of Xuan Thanh Commune. It spread quickly and
caused a total of 513 locals to suffer diarrhea, fever, and vomiting.

[Byline: Hoang Tuan]

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

[The etiology of this outbreak is unknown at this point. Dong Nai is
located in the country's southern area and can be found on a map at
<http://www.angelfire.com/co/hongnam/vnmap.html>.
The HealthMap/ProMED-mail interactive map of Viet Nam is available at
<http://healthmap.org/r/00aw>. - Mod.LL]

******
[12] Cholera - Indonesia (West Nusa Tenggara)
Date: Fri 24 Apr 2009
Source: The Jakarta Post [edited]
<http://www.thejakartapost.com/news/2009/04/24/cholera-outbreak-east-lombok-kills-two.html>

The West Nusa Tenggara Health Office has declared a cholera outbreak,
which has killed 2 residents and infected 255 others in East Lombok
regency. "The decision to declare the extraordinary occurrence was
taken because of casualties and the number of people infected by the
disease jumped over the last 2 weeks," I Ketut Pasek, head of the
local health office, said in Mataram on Wednesday [22 Apr 2009]. The
cholera outbreak was recorded to have infected residents in 5 of the
20 districts in the regency since 14 Apr 2009.

"Most of those infected by the disease are adults, only several of
them were children below 5," Pasek said, adding that the 2 who died
suffered from acute dehydration and were not treated in time.

"The 5 districts affected by the disease are located along the same
river below Mt Rinjani. The habit of the people to take a bath, cook
and wash kitchen utensils in the river has apparently help speed up
the spread of the disease," he added.

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

[West Nusa Tenggara is a province in south-central Indonesia. It
covers the western portion of the Lesser Sunda Islands, except for
Bali and can be found on a map at
<http://en.wikipedia.org/wiki/West_Nusa_Tenggara>.
The HealthMap/ProMED-mail interactive map of Indonesia is available at
<http://healthmap.org/r/00aQ> - Mod.LL]

******
[13] Cholera, possible - Myanmar (Rangoon)
Date: Thu 23 Apr 2009
Source: The Irrawaddy [edited]
<http://www.irrawaddy.org/article.php?art_id=15524>

The diarrhea epidemic that has plagued Rangoon's North Okkalapa
Township recently has not abated, raising concerns about an outbreak
of cholera, said sources in the former Burmese capital. Government
and NGO health officials are maintaining a 24 hour emergency response
center in the northern township after more than 100 residents were
admitted into local hospitals suffering from severe diarrhea within
the last week.

A physician who runs a private clinic in North Okkalapa told The
Irrawaddy on Thursday [23 Apr 2009] that he had sent more than a
dozen patients with diarrhea to the response center. Speaking on
condition of anonymity, the doctor said, "As far as I know, some
patients have been diagnosed with cholera." However, no other medical
sources have confirmed cases of cholera in North Okkalapa Township.

Outbreaks of diarrhea have also been reported in South and North
Dagon Myothit, Thaketa, Dawbon, and Thanlyin townships in Rangoon
Division. Local residents claimed that some deaths have occurred;
however, officials at the Ministry of Health as well as several
hospitals in Rangoon, including the North Okkalapa General Hospital,
declined to comment on the issue.

[Byline: Wai Moe]

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

[Rangoon, also spelled Yangon, can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/myanmar.pdf>.
The HealthMap/ProMED-mail interactive map of Myanmar is available at
<http://healthmap.org/r/00aR>. - Mod.LL]

See Also