ProMED-mail post

Published Date: 2009-07-20 16:00:06
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2009 (19)
Archive Number: 20090720.2575

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (19)
**********************************************
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International Society for Infectious Diseases
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In this update:
Asia
[1] Cholera - Pakistan (Federal Capital Territory, North-West
Frontier Province)
[2] Cholera - India (Mumbai)
[3] Diarrhea - India (West Bengal)
[4] Cholera - India (Punjab)
[5] Diarrhea, fatal - Nepal (Mid Western Region)
Africa
[6] Cholera - Angola
[7] Cholera - Kenya (Eastern Province)

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[1] Cholera - Pakistan (Federal Capital Territory, North-West
Frontier Province)
Date: Mon 20 Jul 2009
Source: The News International [edited]
<http://www.thenews.com.pk/print1.asp?id=188937>

National Institute of Health (NIH), Islamabad, has confirmed
existence of the bacterium _Vibrio cholerae_ that causes cholera in
the federal capital and in camps setup for internally displaced
persons (IDPs) at Mardan, Nowshera, and Charsadda [North-West
Frontier Province].

Reliable sources at the NIH informed "The News" that the institute
tested a patient positive for cholera recently. They said the patient
was from Islamabad and underwent treatment at Federal Government
Services Hospital (FGSH) in Islamabad. "A few cases of cholera in the
camps of IDPs in Mardan, Nowshera, and Charsadda have also been
tested positive," the sources added.

Many health experts believe that rapid spread of gastrointestinal
diseases in town could not be controlled so far because the public
has no awareness of how to prevent and control gastroenteritis and
like diseases including cholera.

Experts believe that in most parts of the country, sewerage is
continuously contaminating streams, lake springs, wells, and other
drinking water sources that increase chances of prevalence of
gastrointestinal diseases including cholera.

[Byline: Muhammad Qasim]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Maps of Pakistan showing the area noted can be found at
<http://www.un.org/Depts/Cartographic/map/profile/pakistan.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00tj>. - Mod.LL]

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[2] Cholera - India (Mumbai)
Date: Mon 20 Jul 2009
Source: The Times of India (TNN) [edited]
<http://timesofindia.indiatimes.com/NEWS-City-Mumbai-Only-one-cholera-case-says-BMC/articleshow/4796386.cms>

So far, 3 persons, including 2 children, have tested positive for
cholera in the city [Mumbai] but the BMC officials said on Sunday [19
Jul 2009] that only one of these 3 cases has cholera and the patient
has been transferred to the infectious diseases specialty at Kasturba
Hospital in Chinchpokhli.

"The others are only cases of acute gastroenteritis," said Dr Daksha
Shah, who heads the epidemiological cell of the BMC. "There are 3
hanging drop positive cases in GT Hospital, but the results of this
tests are not as specific as a culture test to prove cholera," said
Dr J Thanekar, chief executive officer of the BMC. The culture test
is considered as the gold standard test for cholera.

Congress corporator from Colaba, Vinod Shekhar, said he had met 2
patients with cholera, one of whom was in a serious condition.
"Everything is being done to see that the disease does not spread,"
he said.

Civic doctors have been visiting the slum since Sat 18 Jul 2009, and
testing people. They have also been distributing tablets. Water
tankers were also supplying fresh water to the slum. The BMC has also
collected 10 water samples from the area.

[Byline: Roana Maria Costa]

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

[A map of the southern city island of Mumbai (Bombay) can be seen at
<http://www.mapsofindia.com/maps/maharashtra/mumbai-map.htm>.
The city's location on the western coast of India can be seen at
<http://www.lonelyplanet.com/mapshells/indian_subcontinent/india/india.htm>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BT>. - Mod.LL]

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[3] Diarrhea - India (West Bengal)
Date: Sat 18 Jul 2009
Source: OneIndia, Asia New International (ANI) report [edited]
<http://news.oneindia.in/2009/07/18/waterbornediseases-rise-in-west-bengal.html>

Residents of several districts in West Bengal, after having endured
the aftermath of cyclone Aila in May 2009, now grapple with an
outbreak of diarrhea. Waterborne diseases are spreading among the 6.8
million people affected by the [25 May 2009] cyclone. So far
diarrhoea has killed 28 persons and another 85 000 diarrhea cases
have been reported from across the state.

Availability of clean drinking water remains a serious challenge in
the worst affected North 24 Parganas [administrative unit] and South
24 Parganas districts.

After Aila all the tube-wells are under water and the villagers here
are suffering gastronomic problems. Because of a major water crisis
we have got diarrhea and are admitted to the hospital," said a
villager from Ghoshpur.

Health officials have disinfected over 7000 tube-wells and about 15
000 litres of safe drinking water pouches are being distributed in
the affected areas every day. Oral Rehydration Salts (ORS), Halazone
tablets, and bleaching powder solution are being distributed to check
an outbreak of diarrhea.

While the government has deployed 375 medical teams, NGOs and
international agencies, including the UNICEF, are providing aid to
over 50 000 families.

"After Aila a major challenge was to combat waterborne diseases,
which could have come out like the diarrhoea cases. The state and
UNICEF are responding to lessen the impact of these cases," said Anil
Gulati, a spokesman for the local UNICEF office.

At least 275 people died as cyclone Aila hit parts of coastal
Bangladesh and West Bengal state on 25 May 2009, triggering tidal
surges and floods and destroying hundreds of thousands of homes.

--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[West Bengal in eastern India, adjacent to Bangladesh, can be found
on the map at
<http://www.grain.org/articles_files/west-bengal-bird-flu-map.jpg>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BU>. - Mod.LL]

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[4] Cholera - India (Punjab)
Date: Mon 13 Jul 2009
Source: The Indian Express [edited]
<http://www.indianexpress.com/news/112-more-cholera-cases-reported/488591/>

The total number of patients with cholera symptoms crossed the 300
mark in Dera Bassi on Sun 13 Jul 2009. While a total of 95 patients
were reported at the Civil Hospital and over a 100 at various private
clinics in the township through Sat 12 Jul 2009, on Sun [13 Jul
2009], 112 more cases came to light at the Civil Hospital, health
authorities said.

Senior Medical Officer (SMO) Dr Ram Kumar told Newsline that a total
of 207 cases have been reported in the last 3 days, of which 60 were
admitted while the rest were discharged after treatment. Medical
teams are conducting a door-to-door awareness campaign and chlorine
tablets are being distributed for free, he added.

As the number of beds at the Civil Hospital fell short, the
authorities had to arrange extra beds to accommodate the swelling
number of patients. However, 2 or 3 patients were seen sharing a
single bed at the hospital and the authorities also failed to provide
adequate number of bedsheets on the extra beds.

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

[Dera Bassi is a city and a municipal council in Mohali district in
the state of Punjab, India. Maps of India showing the northern state
of Punjab can be found at
<http://www.mapsofindia.com/maps/punjab/punjab-lcoation-map.gif>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BV>. - Mod.LL]

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[5] Diarrhea, fatal - Nepal (Mid Western Region)
Date: Mon 13 Jul 2009
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db900SID/VDUX-7TWQSG?OpenDocument>

Highlights:
- District Public Health Office confirms 96 diarrhea related deaths
in Jajarkot District from 1 May 2009 to 12 Jul 2009
- 19 unconfirmed diarrhea related deaths reported in Rukum District
and 2 deaths in Dailekh District, currently under investigation
- District Line Agencies are coordinating response to outbreak
- Difficult access to remote affected areas delays response of
medical staff and delivery of supplies

Situation overview
------------------
1. The hilly districts of the Mid Western Region have been affected
by a diarrhea outbreak, in particular Jajarkot and Rukum Districts.
Jajarkot District was initially affected, with 96 diarrhea-related
deaths as of 12 Jul 2009, according to the District Public Health
Office (DPHO). Media reports indicate diarrhea related deaths are
increasing in Jajarkot and neighboring Districts, WHO is working with
the DPHOs to investigate the cause of the outbreak and verify the
epidemiological data.

2. Jajarkot is the worst affected District, which is attributed to
poor sanitation and hygiene by local health workers. The winter
drought, delayed monsoon rains, and dried up water sources increased
the risk of consuming contaminated water. Water quality and
availability and latrine coverage figures are unknown at this time.
The DPHO stated that the latrine coverage is very low and open
defecation is a common practice. In early May 2009, DPHO responded to
the initial diarrhea outbreak in remote communities in southern
Jajarkot District, which was difficult due to lack of logistical
access and locally available resources. On 14 May 2009, the Minister
for Health and Population (MoHP) including a team of doctors assessed
the diarrhea affected communities in the Mid Western Region. The
number of diarrhoea related deaths continued to rise. On 24 Jun 2009,
DPHO mobilized available medicine and health teams and requested
additional support from the Regional Health Directorate and MoHP.

3. There are additional reports of diarrhea related deaths in Rukum,
Dailekh, Salyan, and Dolpa Districts. In Rukum District, unconfirmed
reports indicate an estimated 15 diarrhea related deaths, with about
10 VDCs adjoining to Jajarkot and Dolpa Districts affected by the
diarrhoea outbreak. In Dailekh District, the DPHO confirmed 2
diarrhea related deaths in VDCs [Village Development Committees]
bordering Jajarkot District on 25 Jun 2009 and 4 Jul 2009. In Salyan
District, the DPHO stated that there were 2 diarrhea related deaths
in the District on 2 and 3 Jul 2009, however, the situation is under
control. According to sources at the regional medical store, in Dolpa
District headquarters 25 police affected by the diarrhea are under
going treatment and dozens of people are affected in the villages
bordering to the Jajarkot.

4. Due to the logistic difficulties DPHOs are facing challenges to
provide the medical aid to the diarrhea affected population in the
remote villages. There were also shortages of the health workers and
medicine in some of the diarrhoea affected VDCs in Jajarkot and Rukum
Districts, which is being addressed by the DPHOs

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

[The etiology of the outbreak is not stated and may be either
bacterial dysentery or cholera. The districts mentioned in the Mid
Western Region can be found on a map at
<http://ncthakur.itgo.com/map04.htm>.
The HealthMap/ProMED-mail interactive map of Nepal is available at
<http://healthmap.org/r/00BY> - Mod.LL]

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[6] Cholera - Angola
Date: Wed 15 Jul 2009
Source: Angola Press Agency (Angop) [edited]
<http://www.portalangop.co.ao/motix/en_us/noticias/saude/Cholera-claims-lives-countrywide,bd228c69-8909-47f8-8bb5-c101cdbe2e1d.html>

Health authorities have reported 1250 cases of cholera that killed 35
across the country during the 1st half of 2009, Angop learned Wed 15
Jul 2009. The data were released by the Epidemiological Data
Processing Centre (CPDE) of the National Health Department.

The source noted that the country recorded a sharp drop of cholera
cases, judging by the number of the cases reported in the same period
of 2008 (5000), which claimed 125 lives.

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

[Maps of Angola can be found at
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf>
and the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00BZ>. - Mod.LL]

******
[7] Cholera - Kenya (Eastern Province)
Date: Sun 12 Jul 2009
Source: Kenya Broadcasting Corporation (KBC) [edited]
<http://www.kbc.co.ke/story.asp?ID=58523>

Two people have died from what is suspected to be cholera in Isiolo,
Eastern Province. The men aged 35 and 80 died in their homes in
Quarry Kuu village near the border of Isiolo and Imenti North
districts. Eyewitnesses said the victims had earlier complained of
severe stomachache, vomiting, and diarrhea.

Four children from the same village were rushed to hospital with
similar symptoms where one was admitted, and the others aged between
3 through 7 were treated and discharged.

The villages reported the matter to Isiolo medical officer of health
(MOH) Dr Stephen Kiluva who visited the area with a medical team to
ascertain whether the 2 died from cholera and to sensitize residents
on measures to take to ensure the disease does not spread.

More than 20 people have so far died of cholera in Isiolo district
since March 2009.

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

[A map of Kenya showing the Eastern Province 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/00B_>. - Mod.LL]

See Also