ProMED-mail post

Published Date: 2014-12-14 21:16:38
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (81): Africa, Asia
Archive Number: 20141214.3032623

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (81): AFRICA, ASIA
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In this update:
Africa
[1] Diarrhea, probable cholera - Somalia (Mogadishu)
Asia
[2] Cholera - Philippines (Cotabato Province)
[3] Cholera - India (Maharashtra State)

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[1] Diarrhea, probable cholera - Somalia (Mogadishu)
Date: Thu 11 Dec 2014
Source: Press TV [edited]
http://www.presstv.ir/detail/2014/12/11/389818/severe-diarrhea-kills-10-in-somalia/

A severe outbreak of diarrhea has killed at least 10 people and hospitalized around 100 others in the Somali capital, Mogadishu, officials say.

The victims, mostly children and old men, are thought to have drunk from wells containing contaminated water, said Dr. Said Mohamed on Thu 11 Dec 2014. The doctor, who was treating some of the patients at a local hospital, blamed poor management of water sites and inadequate toilets for the spread of waterborne diseases.

Humanitarian experts say only 30 percent of Somalis have access to clean water, leaving the majority vulnerable to life-threatening diseases. According to the WHO, some 75 percent of all cases of highly infectious diarrhea in the famine-stricken African country are among children under the age of 5. Among those highly-affected are displaced groups in Mogadishu camps where refugees queue to receive water rations.

Acute watery diarrhea has been a recurrent medical condition in Somalia for over a decade.

The Horn of Africa region has been plagued by wars, poverty and natural disasters including repeated droughts, famine and flooding.

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[Cholera is endemic in Somalia, where "acute watery diarrhea" is often a term used for this infection. - Mod.LL]

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[2] Cholera - Philippines (Cotabato Province)
Date: Sun 14 Dec 2014
Source: GMA Network [edited]
http://www.gmanetwork.com/news/story/392552/news/regions/cholera-outbreak-suspected-in-cotabato-town-as-60-sent-to-hospital

At least 60 people in Cotabato were hospitalized due to suspected cholera, a radio report said late Sunday, 14 Dec 2014. The victims, mostly children and the elderly, were from Sitio Bliss in Barangay Pagangan in Aleosan town, Bombo Radyo reported.

The report said that most of them experienced stomach pains, vomiting, and diarrhea. Nawal said contaminated water in the area could be the cause of the suspected outbreak.

Governor Emmylou Mendoza has ordered the Integrated Provincial Health Office to investigate the incident.

[Byline: Joel Locsin]

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[Cotabato (also North Cotabato) is a landlocked province (http://en.m.wikipedia.org/wiki/Cotabato) of the Philippines located in the Soccsksargen region (Region XII) in Mindanao. Its capital is Kidapawan City. - Mod.LL]

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[3] Cholera - India (Maharashtra State)
Date: Sun 14 Dec 2014
Source: Times of India [edited]
http://timesofindia.indiatimes.com/city/kolhapur/Two-cholera-cases-found-in-city-contaminated-water-to-blame/articleshow/45508676.cms

With 2 cases of cholera reported in 2 days, the civic administration of Kolhapur on Sat, 13 Dec 2014, issued a public notice over the rise of the cases and the precautions to be taken by the citizens to prevent infection from the waterborne disease. The polluted water supply through leaking rusting old pipelines is being blamed for the cholera cases.

Two patients from ward E were admitted at the Chhatrapati Pramila Raje Civil Hospital in last 2 days with cholera. Laboratory tests have confirmed the presence of the _Vibrio cholerae_ bacterium that causes the disease. In addition, private doctors have informed civic health officials that around 20 to 30 suspected cholera cases are being reported every day since the last couple of days.

Since cholera is a notifiable disease, the Kolhapur Municipal Corporation (KMC) health department has directed all the private hospitals to provide the health report of each and every patient admitted with suspected cholera. The civic administration has requested the Food and Drug Administration to check the quality of food sold on road-side stalls.

KMC's chief health officer Dilip Patil said: "The cases of cholera are observed in the areas where contaminated water has been supplied and used for drinking. We have directed the ward level officials to help plug the leakages of the water supply and drainage lines. Also, the family welfare centres across the city have been told to conduct a survey of the patients with diarrhea in the area where cholera has been reported."

Many parts of the city have been receiving contaminated water for the last one month. In the last general body meeting, agitated corporators had expressed anger over the apathy of the civic officials to plug the leakages and blamed the officials for the rise in water-borne diseases.

A recent survey conducted by the health officials showed that major areas in C and E wards such as Bapat Camp, Nagala Park, Takala, Rajarampuri and Daulat Nagar area were receiving polluted water. Both of the cases of cholera have been reported from the E ward.

Around 30 percent of the water supply pipelines are more than 25 years old, and they are in rusted condition. Recently, the civic administration resorted to water cuts to repair the old pipes. The civic activists claim that the city has been under the threat of water borne diseases due improper management of the water supply and drainage network.

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[A recent paper in PLoS Neglected Tropical Diseases underscores the importance of oral rehydration therapy (ORT) in the treatment of cholera. as noted in the paper and historically, most ORT solutions contain glucose to assist in fluid and electrolyte absorption. Kuhn and colleagues present information that, at least in vitro, rice-based starch containing ORT appears to diminish the production of virulence factors of the bacillus in addition to facilitating fluid and electrolyte absorption:

Kuhn J, Finger F, Bertuzzo E, Borgeaud S, Gatto M, et al. (2014) Glucose- but Not Rice-Based Oral Rehydration Therapy Enhances the Production of Virulence Determinants in the Human Pathogen Vibrio cholerae. PLoS Negl Trop Dis 8(12): e3347. doi:10.1371/journal.pntd.0003347:

Abstract:
"Despite major attempts to prevent cholera transmission, millions of people worldwide still must address this devastating disease. Cholera research has so far mainly focused on the causative agent, the bacterium _Vibrio cholerae_, or on disease treatment, but rarely were results from both fields interconnected. Indeed, the treatment of this severe diarrheal disease is mostly accomplished by oral rehydration therapy (ORT), whereby water and electrolytes are replenished. Commonly distributed oral rehydration salts also contain glucose. Here, we analyzed the effects of glucose and alternative carbon sources on the production of virulence determinants in the causative agent of cholera, the bacterium _Vibrio cholerae_ during in vitro experimentation. We demonstrate that virulence gene expression and the production of cholera toxin are enhanced in the presence of glucose or similarly transported sugars in a ToxR-, TcpP- and ToxT-dependent manner. The virulence genes were significantly less expressed if alternative non-PTS carbon sources, including rice-based starch, were utilized. Notably, even though glucose-based ORT is commonly used, field studies indicated that rice-based ORT performs better. We, therefore, used a spatially explicit epidemiological model to demonstrate that the better performing rice-based ORT could have a significant impact on epidemic progression based on the recent outbreak of cholera in Haiti. Our results strongly support a change of carbon source for the treatment of cholera, especially in epidemic settings." - Mod.LL

ProMED-mail HealthMaps for the regions above can be found at
Somalia: http://healthmap.org/promed/p/125,
Cotabato, Philippines: http://healthmap.org/promed/p/2377,
Maharashtra State, India: http://healthmap.org/promed/p/310.]

See Also