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Disease Place Number of Cases

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Published Date: 2017-09-06 12:34:23
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (95): Africa, Asia
Archive Number: 20170906.5296768

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (95): AFRICA, ASIA
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In this update:
Africa
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[1] Cholera - Kenya (Nairobi)
[2] Cholera - Kenya (Nairobi) police
[3] Cholera - Kenya (Tana River county)
[4], [5] Cholera - Nigeria (Borno state) IDPs
[6] Cholera - Sudan
[7] Cholera, diarrhea - Eastern and Southern Africa Region
Asia
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[8] Cholera - Pakistan (Punjab)

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Africa
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[1] Cholera - Kenya (Nairobi)
Date: Mon 4 Sep 2017 9:09 AM EAT
Source: Capital FM [edited]
https://www.capitalfm.co.ke/news/2017/09/cholera-cases-in-nairobi-rise-to-88/

The number of people admitted to various hospitals in Nairobi after testing positive for cholera has now risen to 88. Nairobi Governor Mike Sonko stated that as at 8 pm Sunday night, 3 Sep 2017, Sinai Hospital in Rongai had admitted 50 patients who tested positive, while Nairobi Women's Hospital had 26. Sonko indicated that those admitted to Kenyatta National Hospital were 12 and that "teams from the national and county governments have been on the ground all day." He said that investigations are still ongoing to ascertain and confirm the diagnosis and the sources of the infection.

"The status of all patients is reported to be stable and under control." He further appealed to city residents not to panic, as adequate controls have been put in place to prevent the spread of the disease. "Above all, let's continue observing high standards of hygiene, while ensuring we eat properly cooked food, cleaned vegetables and fruits," he stated.

[Byline: Simon Ndonga]

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[Maps of Kenya can be seen at http://tinyurl.com/kck73tk and http://healthmap.org/promed/p/174. - Sr.Tech.Ed.MJ]

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[2] Cholera - Kenya (Nairobi) police
Date: Mon 4 Sep 2017
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, EstAfrican report [edited]
http://reliefweb.int/report/kenya/more-90-police-officers-hit-cholera-nairobi

At least 95 police officers have been hospitalized in Kenya with suspected cases of cholera. According to the Health ministry, the officers are said to have been infected after taking meals at the Nairobi Area Police Canteen.

On [Sun 3 Sep 2017], some 59 officers were hospitalised in various hospitals in Nairobi with another 36 admitted [Mon 4 Sep 2017], after contracting the disease. They were part of a group of 430 officers deployed to Nairobi ahead of the Supreme Court ruling on presidential poll petition on [Fri 1 Sep 2017]. They were residing at the Multimedia University Hotel in Rongai, about 17 kilometers [10.6 mi] south of the capital.

"Those infected did not get the disease from the Multimedia University since they had their lunch away from the institution. Investigations show that the source is the Nairobi Area Police Canteen," said Dr Ralph Muli, the Nairobi County head of Diseases Surveillance. Consequently, the City has temporarily closed the canteen.

The Health Cabinet Secretary Cleopa Mailu said the officers were in stable condition. Dr Mailu said investigations were underway to establish whether the canteen had outsourced services to cater for the large number of officers. He said the ministry was concerned that instead of eliminating cholera, new cases were emerging.

Nairobi was first hit by the outbreak on 19 May 2017, with 56 cases having been reported.

One of the police officers who requested anonymity said they ate ugali (a Kenyan staple made of maize flour) and meat stew at the canteen on [Sat 2 Sep 2017]. He said he started feeling sick in the evening.

[Byline: Lillian Mutavi]

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[3] Cholera - Kenya (Tana River county)
Date: Mon 4 Sep 2017 10:33 AM
Source: KDRTV News, The Daily Nation report [edited]
http://www.kdrtv.com/21-people-test-positive-for-cholera-in-tana-river/

At least 20 National Youth Service (NYS) officers have been infected with cholera in Tana River county. County health officials said the 20 officers from Bura NYS camp have been admitted to the Bura Sub-County Hospital. According to Oscar Endekwa, the County Director for Public Health, 21 cholera cases have been reported in the county.

Speaking to Nation in his office in Hola, Dr Endekwa said the situation at the NYS camp was under control. "The officers are responding well to treatment. The other case is of a resident and he has been placed under treatment," he said. He added that the symptoms were noted on August 30, though they had not been confirmed, adding that health officials are investigating the cause of the disease.

Besides isolating victims, Dr Endekwa said the county is also sensitizing residents on hygiene and sanitation. "We are trying to combat it before it spreads to a larger population," he added. He asked residents to report any suspicious cases and urged them to drink clean water and wash their hands after visiting toilets.

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[4] Cholera - Nigeria (Borno state) IDPs
Date: Mon 4 Sep 2017 2:10 AM WAT
Source: Daily Trust [edited]
https://www.dailytrust.com.ng/cholera-outbreak-kills-7-idps-in-borno.html

[On 3 Sep 2017], 7 internally displaced persons (IDPs) were confirmed dead as a result of a cholera outbreak at some IDP camps in Borno State This came just 3 weeks after about 100 others were discharged from Muna and Dala Lawanti Cholera treatment centers. The Médecins Sans Frontières (MSF) in Maiduguri said the cholera outbreak was due to downpours in the last 3 days that caused flood at the affected IDP camps.

The Commissioner of Health in the state, Dr Haruna Mshelia said measures had been taken to contain it from further spread. "I cannot tell you the death toll, as I continue to visit all camps in Maiduguri and ensure that the epidemic does not further spread to claim more lives," he said.

One of the rescue workers at Muna Garage IDP camp told newsmen that for only yesterday [3 Sep 2017], they had admitted over 50 patients.

"We have holistic measures to address this cholera outbreak urgently although people are dying day by day. More than 100 people are affected so far, and 51 people were admitted. In the last 24 hours, we have received over 50 patients at MSF's Cholera Treatment Unit at Dala. Total patients admitted from the start of the outbreak till now is over 200 with 100 discharges and 7 dead," the rescue worker who spoke in confidence, said.

The Medical Director of the Médecins Sans Frontières, Anna Cillers, also told newsmen in Maiduguri measures had been put in place to prevent further spread of cholera across the metropolis and IDP camps.

[Byline: Uthman Abubakar, Ibrahim Sawab, Omirin Olatunji]

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[Maps of Nigeria can be seen at <ttp://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf> and http://healthmap.org/promed/p/12103. - Sr.Tech.Ed.MJ]

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[5] Cholera - Nigeria (Borno state) IDPs
Date: Tue 5 Sep 2017
Source: Medical Xpress [edited]
https://medicalxpress.com/news/2017-09-death-toll-nigeria-cholera.html

The death toll from a cholera outbreak in restive northeast Nigeria has risen to 21, with most of the victims living in a camp for people displaced by Boko Haram violence, the health ministry said [Tue 5 Sep 2017].

On [Sat 2 Sep 2017], the ministry had said the cholera toll was 14 in the town of Maiduguri, with most of the victims living in a camp for people displaced by Boko Haram violence. "As of 4 Sep 2017, 21 deaths have been reported," the Borno state health ministry said, as the toll mounts. "The total number of suspected cholera cases is now 375 in Maiduguri," it said, up from 186 at the weekend. Most of the suspected cases and deaths are in Muna Garage, a camp for displaced people on the outskirts of Maiduguri, while other victims come from neighboring districts, it said.

The government and NGOs are working to contain the outbreak which has spread to the town of Dikwa, 60 kilometres (40 miles) away, where 5 cases had been reported, it added.

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[6] Cholera - Sudan
Date: Mon 4 Sep 2017
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, Radio Dabanga report [edited]
http://reliefweb.int/report/sudan/west-darfur-camp-records-six-cholera-deaths

West Darfur
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A sheikh in Murnei camp for displaced people told Radio Dabanga that by [Sun 3 Sep 2017], a total of 22 patients were admitted to the camp's isolation ward. From 27 Aug until 31 Aug 2017, 17 people reportedly succumbed to cholera. In Zamzam camp, south of El Fasher city, 4 new cases of cholera were recorded on 1 and 2 Sep 2017. A camp elder told this station that the isolation ward was closed on the 1st day of Eid Al Adha [Sacrifice Feast, 31 Aug-4 Sep 2017], "because of the absence of medical personnel, so the 4 new patients had to be transferred to El Fasher for treatment."

Central Darfur
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Isolation centers in Zalingei and Abta village, Central Darfur, recorded 3 deaths and 37 new infection cases from 1-3 Sep 2017, according to the coordinator of camps in the state, El Shafee Abdallah. In Hamidiya camp, 3 cholera patients died and 13 people infected with cholera reported to the isolation centre. Meanwhile in the last 3 days, the Hassahissa, Khamsa Degaig and Teiba camps recorded 17 new cases. The total number of hospitalized cholera cases in the Zalingei Royal Hospital amounted to 76 people as of Sun, 3 Sep 2017.

"From 1-3 Sep 2017, the isolation center in Abta village near Zalingei recorded 7 new cases. The people are from Abta, Tiri, Dirlo, and Kalgo," El Shafee said.

Blue Nile
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In Blue Nile state, 2 people died from cholera and 31 people contracted the disease in the localities Ed Damazin and El Roseires in the last week. A medical source in the area told Radio Dabanga that the Royal Hospital in Ed Damazin received 4 cholera cases of cholera, from Arquette North. "2 of them died on Wed 30 Aug 2017."

Another medical source reported that last week [week of 28 Aug 2017], the hospital received 25 cases of cholera from different parts of El Roseires. 4 cases were recorded in Gisan locality. "El Roseires locality recorded the highest number of casualties of all localities in Blue Nile. There is a severe neglect of the number of staff in the isolation wards, because they were off for the Eid Al Adha holiday."

Blue Nile was the 1st state to report cases of cholera in September 2016, or 'acute watery diarrhea' as the Sudanese government has referred to it since the start of the cholera outbreak. A UK-based Sudanese specialist told Radio Dabanga in January [2017] that cholera "seems to be a stigma for the government."

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[Maps of Sudan can be seen at https://en.wikipedia.org/wiki/States_of_Sudan and http://healthmap.org/promed/p/96. - Sr.Tech.Ed.MJ]

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[7] Cholera, diarrhea - Eastern and Southern Africa Region
Date: Thu 31 Aug 2017
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, UNICEF report [edited]
http://reliefweb.int/report/somalia/bulletin-choleraawd-outbreaks-eastern-and-southern-africa-regional-update-31-august

More than 100 780 cholera/AWD [acute watery diarrhea] cases and 1496 deaths (CFR: 1.5 percent) have been reported in 12 of 21 countries of Eastern and Southern Africa Region (ESAR) since the beginning of 2017. These countries include: Somalia, Kenya, South Sudan, Tanzania, Burundi, Malawi, Zimbabwe, Mozambique, Angola, Uganda, Zambia, and Rwanda. Somalia accounts for 76.6 percent of the total cases reported in the outbreak in 2017, followed by South Sudan at 15.7 percent.

In the past 2-3 weeks (weeks 32-34/6-27 Aug 2017), 6 out of the 21 countries in ESAR have reported active transmission of cholera/AWD (Burundi, Malawi, Somalia, South Sudan, Kenya, and Tanzania). Tanzania has recorded the highest CFR (1.8 percent) followed by South Sudan (1.7 percent) in 2017. CFR for Somalia was above 2 percent at the beginning of 2017 but has since dropped to 1.4 percent.

Somalia
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There has been a decrease in the epidemic trend. During week 33 (week ending 20 Aug 2017), 222 new cases and no deaths were reported in the country; compared to 282 cases reported in week 32 (week ending 13 Aug 2017). Out of the 222 new cases, 97 were reported from South Central and 125 were from Somali land. Most affected regions are Banadir, Togdheer, Awdal, Mjeex, and Lower Jubba.

Kenya
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4 out of the 47 counties (Garissa, Nairobi, Turkana, and Nakuru) have an active cholera outbreak. During week 33, 19 new cases were reported compared to 69 cases in week 32.

South Sudan
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Most affected populations are nomadic pastoralists and communities living in hard to reach villages and cattle camps. There has been a decrease in the epidemic trend over the past 3 weeks. During week 32, 30 new cases were reported; compared to 102 cases including 1 death (CFR 1 percent) in week 31 (week ending 6 Aug 2017). Active transmission reported in Kapoeta East, South and North, Tonj East, Yirol East, Nyirol, Ayod, Duk, and Juba.

Tanzania
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An increase in epidemic trend. During week 34 (week ending 27 Aug 2017), 102 new cases have been reported in Tanzanian mainland; compared to 67 cases in week 33. Cases emerged from Mbeya, Iringa, and Katavi regions.

Malawi
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The current outbreak started within the catchment area of the Chikwawa Hospital. 11 new cases have been reported in week 34; compared to 2 cases reported in week 33.

Burundi
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The first case of the current outbreak was identified on 13 Aug 2017 from Democratic Republic of Congo (DRC). Since then there has been an increase in the epidemic trend with 24 cases reported in week 34; as compared to 13 cases reported in week 33. No death has been reported and most of the cases emerged from the city center of Nyanza Lac.

Uganda
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No confirmed case of cholera in 2017, only AWD cases reported.

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[The countries mentioned above can be seen located on the map of Africa at http://healthmap.org/promed/p/6075. - Sr.Tech.Ed.MJ]

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Asia
[8] Cholera - Pakistan (Punjab)
Date: Tue 5 Sep 2017 12:32 AM IST
Source: The Tribune India [edited]
http://www.tribuneindia.com/news/this-day-that-year/cholera-in-lahore/462284.html

We understand that cholera is assuming a virulent form in Lahore [Punjab] and that strong and effective measures are called for to combat and stamp out the disease. In Kucha Kharasian in Haveli Mian Khan it is said 4 persons were taken ill at about noon and died the same day. The next day, 5 persons were taken ill of the same disease. It is, of course, impossible for laymen to make out whether all these cases were of cholera, but the nature of the deaths would seem to suggest the urgent need of effective action.

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[Maps of Pakistan can be seen at http://www.mapsofworld.com/pakistan/pakistan-political-map.html and http://healthmap.org/promed/p/2128. - Sr.Tech.Ed.MJ

Aggressive interventions to stem outbreaks of cholera include providing sources of clean water and a vaccination campaign. The following is extracted from 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):

"For a variety of logistic, financial, and historical reasons, vaccines have not been available for cholera control programs outside of Viet Nam. Given as 2 or 3 dose courses, efficacy can be as high as 60-80 per cent for at least 2-3 years but much shorter protection lengths in children younger than 5 years of age. Cost-effectiveness, especially once an outbreak has occurred, had remained unproven until reports from Guinea (57) and Haiti (58) demonstrated utility.

"The current vaccines prequalified for use by WHO (59) are:
- Dukoral (produced in Sweden) that contains several biotypes of O1 with recombinant cholera toxin B subunit, which also offers some protection against enterotoxigenic _E. coli_;
- Shanchol (produced in India) that contains biotypes of both O1 and O139 without the recombinant B unit. In a large study in Kolkata, India, a cluster-randomized, double blind, placebo-controlled study of this product (60), the cumulative efficacy of the vaccine at 5 years was 65 per cent (95 per cent CI 52-74, p less than 0.0001). A locally-produced vaccine similar to this vaccine (mORCVAX) is produced in Viet Nam;
- Euvichol (produced in South Korea) that, like Shanchol, contains both O1 and O139 without recombinant B subunit. This vaccine has been reported to be non-inferior to Shanchol in a Philippine study (61).

"In June 2016, the US FDA for the 1st time approved a cholera vaccine for use locally in travelers to cholera-endemic areas. This vaccine, Vaxchora, is an oral live, attenuated biologic (62) that is a reformulation of a previous product. This product, a single dose immunization also referred to as CVD 102-HgR, must be stored in the frozen state and as a live, attenuated bacterial vaccine is not given until at least 14 days after antibacterials were used and should be given at least 10 days before oral chloroquine antimalarial prophylaxis. Single dose use is an advantage over the older inactivated products which are given in 2 doses. Studies, however, have suggested that one dose of these inactivated oral vaccines can be effective when the vaccines are in short supply in both endemic and outbreak situations (63, 64).

"References
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57. Luquero FJ, Grout L, Ciglenecki I, et al. Use of _Vibrio cholerae_ vaccine in an outbreak in Guinea. N Engl J Med. 2014; 370(22): 2111-2120; http://www.nejm.org/doi/full/10.1056/NEJMoa1312680.
58. Sévère K, Rouzier V, Anglade SB, et al. Effectiveness of oral cholera vaccine in Haiti: 37-month follow-up. Am J Trop Med Hyg. 2016; 94(5): 1136-1142; http://www.ajtmh.org/content/journals/10.4269/ajtmh.15-0700.
59. Bhattacharya SK, Sur D, Ali M, et al. 5 year efficacy of a bivalent killed whole-cell oral cholera vaccine in Kolkata, India: a cluster-randomised, double-blind, placebo-controlled trial. Lancet Inf Dis. 2013; 13(12): 1050-1056; http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70273-1/fulltext.
60. WHO. WHO prequalified vaccines. https://extranet.who.int/gavi/PQ_Web/.
61. Balk YO, Choi SK, Olveda RM, et al. A randomized, non-inferiority trial comparing two bivalent killed, whole cell, oral cholera vaccines (Euvichol vs Shanchol) in the Philippines. Vaccine 2015; 33(46): 6350-65; https://www.ncbi.nlm.nih.gov/pubmed/26348402.
62. Freedman DO. Re-born in the USA: another cholera vaccine for travellers. Travel Med Infect Dis. 2016; 14(4): 295-6; abstract available at http://www.travelmedicinejournal.com/article/S1477-8939(16)30087-4/abstract.
63. Qadri F, Wierzba TF, Ali M, et al. Efficacy of a single dose, inactivated oral cholera vaccine in Bangladesh. N Engl J Med. 2016; 374(18): 1723-32; http://www.nejm.org/doi/full/10.1056/NEJMoa1510330.
64. Azman AS, Parker LA, Rumunu J, et al. Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study. Lancet Global Health 2016; 4(11): e856-e863; http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30211-X/fulltext."
- Mod.LL]

Annotations

by : Timothy Muokadisease : Cholera place : Africa Number of cases : unknown

by : Walter Ndegwadisease : Cholera place : Africa Number of cases : unknown

by : Stephen Mutuvidisease : Cholera place : Worldwide Number of cases : 88

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