ProMED-mail post

Published Date: 2008-06-02 19:00:24
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2008 (27)
Archive Number: 20080602.1764

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (27)
**********************************************
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:
Asia
[1] Diarrhea - Turkey (Aksaray)
[2] Cholera - Pakistan (Sindh)

Africa
[3] Cholera - Kenya (Nyanza)
[4] Cholera - Zambia (Northern Province)
[5] Cholera - Guinea Bissau, Guinea Conakry
[6] Diarrhea, cholera - Sudan (south)
[7] Cholera - Congo DR (North Kivu)
[8] Cholera - Uganda (Kibaale)

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[1] Diarrhea - Turkey (Aksaray)
Date: Wed 21 May 2008
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detaylar.do?load=detay&link=142420>

Health officials have stated that the source of more than 4000 cases
of diarrhea seen since last week [12-18 May 2008] in the central
Anatolian city of Aksaray and the town of Sereflikochisar was
contaminated water.

A statement by the Ministry of Health yesterday [20 May 2008]
indicated that after the appearance of the diarrhea cases, which
started on 13 May 2008 in Aksaray and on 16 May 2008 in
Sereflikochisar, the ministry sent a team of specialists to the
region to take water samples from drinking water sources and blood
samples from the patients.

"According to the results of the tests, various viruses including
adenovirus, rotavirus, and norovirus, plus some _E. coli_ bacteria
caused the diarrhea. The outbreak started due to contamination in the
water and grew with person-to-person and other types of
transmission," officials stated.

The statement also noted that in Aksaray water contamination occurred
during repair work on the local pipe system and in Sereflikochisar
the cause was inadequate chlorine levels. "In both regions, chlorine
levels were checked and brought to the required levels," an official
stated.

Hospitals saw more than 4000 people admitted with complaints of
diarrhea, vomiting, and stomach pains early last week [12-18 May
2008]. Aksaray governor Sebati Buyuran said the cases only require
outpatient treatment and that the number of people coming to the
hospitals with similar complaints has gradually been decreasing.

Meanwhile, health teams started taking water samples in the eastern
city of Siirt because of several cases of diarrhea. Officials said
water contamination in the city most likely occurred due to ongoing
replacement of water and sewer pipes. Water quality specialists will
check the levels of chlorine more often in the area and increase it
when necessary, they noted.

After the outbreak in Aksaray, experts from the Health Ministry
advised people to wash fruit and vegetables well before eating them
and to boil water that will be used for drinking purposes. They also
said basic rules of hygiene, including washing hands, should be
observed.

A health official in Konya has said approximately 400 people were
seen in hospitals in the central Anatolian city with symptoms of
diarrhea. Bahaattin Akyurek, deputy manager of Konya City Health
Office, indicated in a written statement that 393 patients applied to
Konya hospitals with diarrhea symptoms and 8 have been hospitalized.
Almost all of the patients had abdominal pain, diarrhea, and
low-grade fever.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

The province and city of Aksaray in central Turkey can be located on a map at
<http://en.wikipedia.org/wiki/Aksaray>. - Mod.LL]

******
[2] Cholera - Pakistan (Sindh)
Date: Tue 20 May 2008
Source: The Nation (Pakistan) [edited]
<http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/Regional/Lahore/20-May-2008/Cholera-not-gastroenteritis-hits-Mirpur-Khas>

Scientists at the University of Health Sciences (UHS) have discovered
the outbreak of cholera in Mirpur Khas, a district of Sindh province.
Addressing a press conference [in Lahore] on Monday [19 May 2008],
UHS Microbiology Department's head Prof Dr Maj Gen (R) Abdul Hannan
claimed that according to the research carried out in this regard,
the district Mirpur Khas was affected by cholera instead of
gastroenteritis. He said that the authorities concerned should pay
special attention towards the outbreak of cholera, which could spread
to the other areas of the province.

Prof Dr Maj Gen (R) Abdul Hannan has claimed that he has studied
stool samples of 18 patients from Mirpur Khas district of Sindh who
were supposed to be suffering from gastroenteritis. "8 out of 18
samples of feces are found to be infected with _Vibrio cholerae_, the
cause of cholera," he disclosed.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Sindh province is one of the 4 provinces in Pakistan and is located
in the southeastern part of the country. It can be found on a map at
<http://en.wikipedia.org/wiki/Sindh>. - Mod.LL]

******
[3] Cholera - Kenya (Nyanza)
Date: Wed 28 May 2008
Source: The Times (South Africa), Agence France-Presse (AFP) report [edited]
<http://www.thetimes.co.za/News/Article.aspx?id=774620>

A cholera outbreak has killed 3 people and infected several others in
western Kenya over the past 2 weeks, a newspaper said today [28 May
2008].

The fatalities occurred in Nyanza Province's Ranchuonyo district near
the shores of Lake Victoria, local public health officer Heron Obaye
told the Standard newspaper. Several people were being treated in the
area and the authorities have shut roadside eateries and distributed
water treatment kits, he said.

A previous outbreak in the same region killed at least 64 people and
infected thousands in the recent months.

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

[Nyanza province is located in the southwestern corner of Kenya and
can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/kenya.pdf>. - Mod.LL]

******
[4] Cholera - Zambia (Northern Province)
Date: Wed 28 May 2008
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2008-05/28/content_8270000.htm>

The Zambian health authority has recorded 98 cholera cases in
Mpulungu District, Northern Province, Times of Zambia reported on
Wednesday [28 May 2008]. No deaths, however, have been reported since
the disease broke out early April 2008, Times of Zambia said.

The Health Ministry, together with all stakeholders in Zambia,
resolved to start sensitization programs in the affected areas and
disinfect the water wells in an effort to prevent the disease.

[Editor: Jiang Yuxia]

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

[Northern Province can be found on a map of Zambia at
<http://www.un.org/Depts/Cartographic/map/profile/zambia.pdf>. - Mod.LL]

******
[5] Cholera - Guinea Bissau, Guinea Conakry
Date: Mon 26 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805261233.html>

An outbreak of cholera in a remote fishing village in southeastern
Guinea Bissau has killed 2 people and infected 53, the WHO (World
Health Organisation) reported.

"The outbreak is very localized at the moment. It seems to be
restricted to villages in one sector and we have not received reports
of cases in any other region in Bissau," said Daniel Kertesz, head of
the WHO in Bissau, which provided the figures.

Some 40 cases of cholera have also been reported across the border in
Guinea Conakry and are also being dealt with by local authorities
there. "People in these areas fish all up and down the coast, so it
could potentially spread to other countries, but we have not seen
evidence of that happening yet," Kertesz added.

Guinea Bissau has some of the worst coverage of modern water and
sanitation infrastructure in the world according to the UN (United
Nations). In rural areas less than half of people have access to
clean water and less than 25 percent to modern toilets.

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

[Guinea Conakry (sometimes referred to just as Guinea) and Guinea
Bissau are located in West Africa with a common border, which can be
seen on a map of the area at
<http://www.un.org/Depts/Cartographic/map/profile/westafrica.pdf>. - Mod.LL]

******
[6] Diarrhea, cholera - Sudan (south)
Date: Fri 23 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805230971.html>

The tankers that roar down the streets of the Southern Sudanese
capital of Juba carry precious water, but health experts suspect much
of what they deliver is contaminated. "The sources of the water are
often contaminated, the containers used to ferry it are contaminated,
and the people [do not know] the best way to avoid diseases," an aid
worker in the town said.

Juba has neither a functioning water nor sewage system. Whatever
existed in the 1950s and 1960s was destroyed during more than 2
decades of conflict between the South and North. The situation has
been compounded by generally poor hygiene. Recently there have been
reports of diarrheal disease outbreaks, including suspected cholera
cases.

In May 2008, a diarrheal disease outbreak was reported in the Juba
military barracks, a unit that houses about 6000 people, including a
joint integrated force made up of both northern and southern troops.

There have also been suspected cases in Eastern Equatoria. Alfred
Alunyo of the WHO office for Southern Sudan said samples had been
sent to Nairobi for analysis after rapid tests found cholera in 3 out
of 53 suspected cases.

"That is a cumulative number for 4 weeks," Alunyo said. "When we add
on the [suspected] cases from this week [19-25 May 2008], we expect
it to increase to more than 80."

Millions of people across Southern Sudan, especially women and
children, lack access to adequate safe drinking water. While more
than 20 million people lack access to sanitation, 17 million have no
source of safe drinking water, according to UNICEF (United Nations
Children's Fund).

Cases of cholera have been rising, stemming from sharp increases in
the population as people return from being displaced and find few
essential services such as safe drinking water or proper sanitation

As a result, disease outbreaks are rampant. In April 2008, an
outbreak was reported in Yei. According to the NGO (non-governmental
organisation) Medair, diarrheal diseases have become an endemic
problem in Yei town in 2008, with cases rising with the onset of
rains.

Between 12 Mar 2008 and 5 Apr 2008, 118 cases of acute watery
diarrhea were seen in Yei hospital. "Across Southern Sudan, cases of
cholera have been rising in the last 2 years, stemming from sharp
increases in the population, as people return from being displaced
and find few essential services such as safe drinking water or proper
sanitation," the NGO said.

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

[The areas mentioned can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/sudan.pdf>. - Mod.LL]

******
[7] Cholera - Congo DR (North Kivu)
Date: Wed 21 May 2008
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200805210759.html>

An outbreak of cholera in North Kivu province, in eastern Democratic
Republic of Congo (DRC), has claimed more sufferers in the past 2
weeks, medical and humanitarian officials said. The most severely
affected areas are the health zones of Pinga and Mweso in the upper
and forested Masisi North area.

"The cholera epidemic has fluctuated in this zone but over the past
couple of weeks we have seen a dramatic rise in [the number of]
cases," said Gaby Lumangamenga of the UN World Health Organization
(WHO) in the North Kivu capital, Goma.

According to the UN Office for the Coordination of Humanitarian
Affairs (OCHA) in Goma, 12 deaths were reported in Pinga over just
one week in late April 2008, while 159 cases were recorded between 5
and 11 May 2008.

Lumangamenga said Medecins Sans Frontieres (MSF) and Solidarites had
built water chlorination facilities and latrines but the problem
persisted because the residents did not like to drink chlorinated
water.

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

[North (or Nord) Kivu can be found in northeastern Congo DR and can
be located on a map at
<http://www.un.org/Depts/Cartographic/map/profile/drcongo.pdf>. - Mod.LL]

******
[8] Cholera - Uganda (Kibaale)
Date: Wed 21 May 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, Uganda Red Cross report [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/SHIG-7EUDFZ?OpenDocument>

Cholera has killed 4 people and infected 43 in Kibaale district.
According to the Uganda Red Cross Society (URCS) branch field
coordinator for Kibaale District, Mr Abel Muwonge, the disease that
broke out in the district on 17 May 2008, left 25 people admitted at
Kasojo Health Centre II in Mpefu Sub County, 3 admitted at Kagadi
Health Centre IV, while 11 are still at home unattended to.

Mr Muwonge said the most affected areas are fish landing sites. These
include Kitebere, Kabukanga, Kamina, Kamulebe, and Nguse landing
sites. He attributed the big number of infections at the landing
sites to poor sanitation.

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

[Kibaale district is in western Uganda and can be found on a map at
<http://www.un.org/Depts/Cartographic/map/profile/uganda.pdf>.

The outbreaks discussed in this update can also be found on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>. - Mod.LL]

See Also