Sudan: New Yellow Fever Cases Registered in Central Darfur

Zalingei — The health minister of Central Darfur announced that new cases of yellow fever have been registered in the state, on Wednesday, 26 December.

However, Issa Mohamed Moussa Yousef explained that all patients come from the gold mining area of Jebel 'Amer, North Darfur, and stressed that Central Darfur has not recorded any new cases of the disease in more than two weeks.

Speaking to Radio Dabanga, the minister disclosed that one person died of yellow fever in the Roakirro locality and that another five people are infected; four of them are hospitalized in Zalingei and the other is being treated in Wadi Saleh.

This brings the total yellow fever death toll to 83 and infection cases to 443, Yousef pointed out.

The minister said that vaccination campaigns have been completed in the localities of Mukjar and Bindissey and added that the third phase of the campaign is about to be finalized in the Umm Dukhum locality.

"End of yellow fever"

Ishaq Ahmed Yaqoub, health minister of West Darfur, announced the "end of yellow fever" in the state.

He spoke with Radio Dabanga from the state's capital, El-Geneina, and asserted that West Darfur has not recorded any new cases of yellow fever for three weeks.

Nevertheless, the minister expressed concern about other diseases affecting the population, such as diarrhea, bronchitis and viral hepatitis.

Alike in Central Darfur, Yaqoub suggested that most yellow fever cases are coming from Jebel 'Amer.

Third phase in South Darfur

In the meantime, Ahmed al-Tayyeb, minister of health of South Darfur, announced the launch of the third phase of the vaccination campaign in the state, which will incorporate the remaining localities in the state by the end of this month.

The minister explained to Radio Dabanga that the second phase of the campaign is scheduled to be completed by 27 December and that by then 70 percent of the localities should have been covered.

According to al-Tayyeb, a total of 20 people have died of yellow fever in South Darfur and 174 were infected. He pointed out these figures were collected more than two weeks ago.

When asked by Radio Dabanga about the emergence of new diseases in the state, the minister divulged that cases of typhoid, hepatitis and schistosomiasis (also known snail fever) have been registered in some places.

He stressed, however, that work in underway to deal with these newly emerging diseases.

"Silent killer"

Bahr Idriss Abu Garda, federal minister of health, acknowledged the outbreak of schistosomiasis in Sudan during a workshop entitled "Schistosomiasis: A Silent killer".

During the workshop he declared that 80 percent of the population of Sudan are vulnerable to contracting the disease.

The minister revealed that about two million people are infected with schistosomiasis in North Kordofan. According to him, this is the highest infection rate in the country, at 70 percent, followed by East and South Darfur, with 64 and 42 percent respectively.

FDA approves 4-Strain Seasonal Influenza Vaccine

The US Food and Drug Administration (FDA) today approved a new 4-strain influenza vaccine for adults and children aged 3 years and older to help prevent disease caused by the seasonal influenza virus subtypes A and B contained in the vaccine.

Fluarix Quadrivalent (GlaxoSmithKline) is the first intramuscular vaccine to offer protection against 4 influenza strains, the company said.

Currently-administered trivalent (3-strain) influenza vaccines help guard against the 2 A virus strains most commonly occurring in humans and the B strain expected to be predominant in a given year, the company noted in a statement.

However, since 2000, 2 B influenza virus strains (Victoria and Yamagata) have cocirculated to varying degrees each influenza season. Various degrees of mismatch have occurred between the B strain included in trivalent vaccines and the B strain that actually circulated, causing an increased risk for influenza-related morbidity across all age groups.

The new 4-strain vaccine continues to help protect against the 2 A strains and also adds coverage against a second B strain.

"Trivalent influenza vaccines have helped protect millions of people against flu, but in 6 of the last 11 flu seasons, the predominant circulating influenza B strain was not the strain that public health authorities selected," Leonard Friedland, MD, vice president and director of clinical and medical affairs at GlaxoSmithKline North America Vaccine Development, said in a statement.

"Fluarix Quadrivalent will help protect individuals against both B strains and, from a public-health standpoint, can help decrease the burden of disease," he concluded.

The company said the vaccine will be available in time for the 2013-2014 influenza season. The company added it will also fulfill orders for its trivalent vaccines.

Fluarix Quadrivalent is not currently approved or licensed in any country outside of the United States.

The full US prescribing information will be available on the manufacturer's Web site.

Source

Comments: Given the inadequate efficacy of the currently available flu vaccine, this new vaccine shows considerably more promise in preventing Influenza. This is likely to benefit travelers especially during epidemics when air travel is a commonly implicated mechanism for rapid spread of illness.

TYPHOID FEVER UPDATE 2012 (12): ZIMBABWE (HARARE)

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20121209.1443859
Date: Wed 5 Dec 2012 
Source: Zimeye [edited]
http://www.zimeye.org/?p=68014

A life threatening typhoid outbreak has been reported in Harare's Dzivaresekwa high-density suburb and surrounding areas, about 10 km from the capital city. An alert was sent out last night [4 Dec 2012] through the Harare Residents Trust issuing caution to people in the area. It is reported that school children at Nhamburiko Primary School have recorded the highest figures of affected people to date.

Harare city council authorities have been blamed for the outbreak due to council's failure to provide clean water supplies to residents. The capital is not new to the bacteria [_Salmonella enterica_ serotype Typhi], and earlier this year [2012], environmental scientists revealed that many water sources across the city have been affected due to sewer spillage.

One Hararian protested against the mayor: "The Mayor looks down upon the poor and the marginalised. He thinks they are lazy and do not want to develop. But give him an opportunity, [and] he is convincing in his presentations but lacks on delivery and relevance to the citizenry."

A statement by the Harare Residents Trust reads: "Alert: There has been a typhoid outbreak in Dzivarasekwa. The local clinic has transferred about 15-16 people to Beatrice Infectious [Diseases] Hospital every day since last week. The most affected are the pupils at Nhamburiko Primary School. Harare City Council's failure to provide clean water to the residents is compounding the situation!"

Presidential Health consultant Dr Timothy Stamps has provided guidance on identifying typhoid as follows:

Typhoid is especially an urban disease. The diagnosis can only be made definitely by either a blood culture (which indicates that the infectious organism has gotten into the blood system) or by rectal swab/faecal culture of the causative organism. Indirect methods such as the Widal titre (O and H antigens) are of limited value, especially as an outbreak progresses.

The classical picture of typhoid fever is a temperature which is intermittent for the 1st week or so of the illness, then becoming persistent and sometimes very high, coupled with vague symptoms such as headache, weakness, sore joints, abdominal pains (especially in the appendix area), and constipation (kufufutirwa) rather than diarrhoea (manyoka).

Most typhoid sufferers react badly to aspirin, headache pills, or powders and in a generalised outbreak should be restricted.

Rose spots, which disappear on pressure, occur on the chest and upper abdomen in the 1st week of the disease; they are not easy to detect in most Zimbabweans.

KYASANUR FOREST DISEASE - INDIA - Confirmed

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20121207.1442844
Date: Mon 3 Dec 2012
Source: Deccan Herald [edited]
http://www.deccanherald.com/content/296184/monkey-fever-confirmed.html

A medical report from the National Institute of Virology in Pune has confirmed that the recent death of monkeys in the Bandipur National Park limits was due to 'Kyasanur Forest disease' (KFD). 

The blood samples were sent to the centre soon after 12 monkeys died of the suspected fever at Alegowdanakatte camp in Maddur division, said Pushkar, the tiger reserve project director.

The daily wage workers of the Forest department too were affected by the epidemic.

Following the report confirming the prevalence of the KFD virus, a meeting of the veterinarians and the officials of the Forest department has been convened to discuss preventive measures. 

Soon, the residents in the surrounding villages will be administered a vaccine to check the spread of the infectious disease, he added. 

UNDIAGNOSED FATALITIES - NIGERIA

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20121207.1442547
Date: Fri 7 Dec 2012

Source: All Africa, Daily Trust report [edited]

http://allafrica.com/stories/201212070831.html
At least 5 people have been confirmed dead, while 70 others are lying critically ill at the hospital following an outbreak of a yet to be diagnosed ailment. It was gathered that over 200 households in the border area of Mubi-South in Adamawa State have been affected.
On Wednesday [5 Dec 2012], Usman Lamorde, member representing Mubi-South in the state House of Assembly, confirmed the death toll, saying the nature of the disease has not been determined.
Speaking on the floor of the House, Usman Lamorde said over 200 households were affected in Nduku-Seranyi village. "This disease comes without warning, and by the time it is discovered, it's too late. The disease is characterized by excessive vomiting, diarrhoea, high fever, and in some instances, coughing, hence the need for urgent intervention," he said.
Following the motion, Speaker of the state Assembly, Umaru Ahmad Fintiri, ordered that health officials be deployed with immediate effect to curtail the spread of the disease.
When contacted, the state's Commissioner for Health, Mrs Lilian Stephen, said disease control personnel have moved to the affected areas, and that the state government is waiting for the outcome of the specimen sent for analysis.
According to her, samples have since been sent to the Federal Medical Centre (FMC) Gombe for analysis.
[Byline: Ibrahim Abdul'Aziz]

New polio strain from Pakistan hits Afghanistan

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20121203.1435756
Officials say newly-discovered Sabin-Like ([type]2) [polio virus that is genetically similar to the oral polio vaccine is referred to as a vaccine-derived poliovirus -- VDPV, and when there are 2 or more cases of the same genetically lined virus, it is considered to be a circulating vaccine derived poliovirus -- cVDPV) poliomyelitis originated in Balochistan. 
With the Independent Monitoring Board recommending travel restrictions on polio endemic countries, reports of the transmission of a newly-discovered poliovirus strain from Pakistan to Afghanistan is likely to complicate an already tough situation for Islamabad.
Two Afghan children, living close to the border with Pakistan, have been paralysed by the Sabin Like (2) poliomyelitis [cVDPV2], officials in the Polio Programme told The Express Tribune. The cases were reported from Afghanistan's Kandahar province 2 days ago -- one in Panjwai district and the other in Spin Boldak, they added. The World Health Organisation (WHO) has confirmed the 2 new cases.
According to the officials, genetic sequencing has confirmed the new polio strain originated in Balochistan's Killa Abdullah district. They said Sabin Like (2) [cVDPV2] poliomyelitis develops in children with an extremely poor record of routine immunisation -- a situation rampant in Balochistan.
Since 2006, polio vaccination teams have repeatedly missed an estimated 50 000 children in Killa Abdullah, derailing efforts to eradicate the virus in the country. This is not the 1st case of poliovirus transmission from Pakistan to a neighbouring country either. Last year [2011], 16 children in China's Xinjiang province were paralysed after being infected by a polio strain originating in Pakistan.
"The paramedic association and health department of Balochistan continues to hold the polio-eradication campaign hostage in Killa Abdullah through unfair demands... It has now resulted in embarrassment for Pakistan before the world community," an official of the Expanded Programme on Immunisation (EPI) told The Express Tribune on condition of anonymity.
WHO senior coordinator for polio eradication Dr Elias Durry said the organisation was monitoring the situation in Balochistan closely.
"We are seriously concerned about the new poliovirus strain and are recommending urgent steps to the provincial government to contain the outbreak," said Dr Durry. The only way to contain the spread of the virus is by conducting 3 to 4 high-quality polio vaccination rounds in the infected districts and their nearby areas," he said.
Meanwhile, a special WHO delegation, led by internationally acclaimed polio eradication expert Dr Mohammed Mohammedi, has reached Balochistan and is holding in-depth discussions with the provincial government over ways to combat the outbreak.
"We have asked the provincial government to hold 3 emergency polio campaigns each in Quetta, Killa Abdullah, and Pishin districts during a span of 30 days to control the spread of the virus to other parts of the country," said Dr Mohammedi, adding that the 1st campaign in the 3 districts was scheduled for [10 Dec 2012].
Pakistan has reported a total of 56 polio cases this year [2012] so far. A massive 181 cases were reported in 2011.

CDC / Cholera in the Dominican Republic, update

Center for Disease Control and Prevention: Outbreak notice: November 28, 2012

 

What is the Current Situation?

 

An outbreak of cholera has been ongoing in the Dominican Republic since November 2010. According to the Dominican Ministry of Health (Ministerio de Salud Publica y Asistencia Social [MSP]), as of November 3, 2012, 6,622 suspected cholera cases and 47 suspected cholera-related deaths have been reported for 2012.

What is Cholera?

 

Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food is often contaminated by water containing cholera bacteria or by being handled by a person ill with cholera.

 

How can Travelers Protect themselves?

Most travelers are not at high risk for getting cholera, but people who are traveling to the Dominican Republic should exercise caution to avoid getting sick.

CDC recommends that all travelers prepare a travel health kit when going abroad. If you are planning travel to the Dominican Republic, CDC advises packing the following supplies in your travel health kit to help prevent cholera and to treat it.

• A prescription antibiotic to take in case of diarrhea
• Water purification tablets
• Oral rehydration salts

Dukoral vaccine is not available in USA but is available in Canada.

• Drink and use safe water*
• Wash your hands often with soap and safe water*
• Use toilets; do not defecate in any body of water
• Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables ( Boil it, cook it, peel it, or leave it.)
• Clean up safely in the kitchen and in places where the family bathes and washes clothes

Before departing for the Dominican Republic, talk to your doctor about getting a prescription for an antibiotic. If you get sick with diarrhea while you are in the Dominican Republic, you can take the antibiotic, as prescribed. Also, remember to drink fluids and use oral rehydration salts (ORS) to prevent dehydration.

If you have severe watery diarrhea, seek medical care right away.

 

Source: CDC / Cholera in Dominican Republic, update

Meningococcal Disease in Travelers - A review

Purpose of review: Invasive meningococcal disease is a rare but potentially devastating disease in travelers. In the past 5 years, significant progress in vaccine development has been made. The purpose of this review is to provide up-to-date information on the current status of risk of meningococcal disease in travelers and vaccine recommendations. 

Recent findings: More evidence on cases of meningococcal disease in travelers is now available. The main areas of highest risk for travelers continue to be the Hajj pilgrimage and travel to the meningitis belt. Two new tetravalent conjugate vaccines against serogroups A, C, W135 and Y have been licensed in North America, Europe and other countries. Significant progress has been made in the development of serogroup B vaccines. 

Summary: The vaccine of choice for travelers at risk of invasive meningococcal disease is a tetravalent conjugate meningococcal vaccine. Data on the need for re-vaccination schedules are still lacking, and so are data on immunogenicity in very young children and the elderly. The first vaccine against serogroup B may become available in early 2013 thus expanding the options of broadening the protection against more serogroups for travelers. Furthermore, the development of pentavalent vaccines will increase the uptake of meningococcal vaccines in the future.
For more information read at Medscape News
Comments: Given the soon to be available Meningococcal conjugate vaccine in India (Menactra) it is important for doctors (especially travel medicine specialist) to know about this excellent update

Yellow fever shots begin in Sudan's Darfur

Health workers in Sudan's Darfur region have begun vaccinating more than two million people against a rare yellow fever outbreak suspected of killing 124 since late September, medics said on Thursday.
The campaign began on Tuesday in West Darfur state and is expected to continue in other affected areas by Saturday, said a joint report from the Sudanese health ministry and the World Health Organisation (WHO). "As of 20 November, the total number of cases has reached 497, including 124 deaths," it said, adding that most cases are in Central Darfur state. This is the first yellow fever outbreak in Darfur in 10 or 20 years, WHO country representative Anshu Banerjee told AFP last week, adding that cases were concentrated in rural areas among the nomad population. Sudan's impoverished western Darfur region has been plagued by conflict since ethnic minority rebels rose against the Arab-dominated Khartoum government in 2003. The yellow fever virus normally circulates among monkeys but could be linked to more mosquitoes breeding this year after heavy rains and flooding in the region. Mosquitoes can become infected from the primates and transfer the virus to humans, Banerjee said. There is no specific treatment for the illness found in tropical regions of Africa but it can be contained through the use of bed nets, insect repellents and long clothing. Vaccination is the most important preventative measure.
(c) 2012 AFP

Read more at: http://medicalxpress.com/news/2012-11-yellow-fever-shots-sudan-darfur.html#jCp

CDC / Malaria Cases: Greece Update

Center for Disease Control and Prevention: updated November 20, 2012

 

The Centers for Disease Control and Prevention (CDC) has received information that there have been five additional P. vivax malaria cases identified in Greece; four that are locally-acquired cases in Greek residents with no previous travel, and one case in an immigrant.

 

Between January 1 and October 22, 2012, Greece has reported a total of 75 cases of malaria.  Of those 75 cases, 47 were caused by P. vivax (16 are locally acquired, 2 are relapses, and the remainder occurred in immigrants). Cases among immigrants from P. vivax-endemic countries, could have either been imported or acquired locally. The immigrants reported being in Greece from as short as a few days before onset of symptoms to as long as 4 years before the onset of symptoms, therefore these cases could have been either locally transmitted or imported.

The four new locally-acquired cases occurred in locations where malaria had been previously identified.  Three new cases were identified in an agricultural area of Evrotas, Lakonia.  Another case was reported in Sofades, Karditsa.

No new cases have been reported in Markopoulo and Marathon, two areas were cases had been identified during June through August.  No locally transmitted malaria cases have been reported in Athens.

Given that there continues to be new cases of locally transmitted malaria in Lakonia, CDC will continue to recommend preventive antimalarial drugs for travel to the agricultural areas of Evrotas in the Lakonia region.  

With the approach of winter in the coming month, it is fully anticipated that this recommendation will change in the near future.

 

If traveling to the affected areas, discuss the benefits and risks of taking malaria prophylaxis based on your itinerary, duration of travel, and activities--as well as your other medications and health conditions--with a health care provider knowledgeable about travel medicine.

 

Mosquito avoidance measures are also recommended, such as insect repellant and sleeping in either an air conditioned or well-screened setting or under a treated bed-net, to prevent malaria infection. Malaria prophylaxis is not currently recommended for travelers to the affected areas of Karditsa, Marathon, Markopoulo, Viotia, and Xanthi.

 

Travelers to these areas should rely on mosquito avoidance measures to prevent malaria infection.

 

Source: CDC / Malaria cases: Greece update

WHO / Yellow fever in Sudan

World Health Organization: GAR : Global Alert and Response

 

The Federal Ministry of Health (FMOH) in Sudan has notified WHO of a yellow fever outbreak affecting 23 localities in Greater Darfur. As of 11 November 2012, a total of 329 suspected cases including 97 deaths were reported from this outbreak. Central and South Darfur have reported most of the suspected cases.

 

Laboratory confirmation was conducted by WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal, on two samples which tested positive for yellow fever by IgM ELISA test and RT-PCR Differential diagnosis for other flavivirus was negative.

The government of Sudan has requested the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) to provide support for a reactive mass vaccination campaign. The YF-ICG has approved of 2.4 million doses of vaccine, which is expected to arrive in the country shortly. Sudan, with support from WHO is expected to start the emergency mass vaccination campaign in the affected areas in order to protect the at risk populations and stop the spread of the disease.

 

Source: WHO / Yellow fever in Sudan

Darfur yellow fever death toll at 67, measles on the rise too

The number of fatalities associated with theyellow fever outbreak in Central, South and West Darfur, has more than doubled in the past week according to an AFP report Nov. 6.

According to a joint report from the Sudan Ministry of Health (MoH) and the World Health Organization (WHO) Monday, 194 suspected yellow fever cases have been reported, including 67 deaths.

This is up from 84 suspected cases, including 32 deaths on Oct. 29.

In addition, the number of districts reporting cases has increased from nine last Friday to 17 today.

A yellow fever vaccination campaign is slated to begin in early December.

According to the WHO, yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. The yellow fever virus is an arbovirus of the flavivirus genus, and the mosquito is the primary vector. It carries the virus from one host to another, primarily between monkeys, from monkeys to humans, and from person-to-person.

Once contracted, the virus incubates in the body for 3 to 6 days, followed by infection that can occur in one or two phases. The first acute phase usually causes fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting. Most patients improve and their symptoms disappear after 3 to 4 days.

One confirmed case of yellow fever in an unvaccinated population should be considered an outbreak and a confirmed case in any context must be fully investigated, particularly in any area where most of the population has been vaccinated.

There is no specific treatment for the viral illness found in tropical regions of Africa but it can be contained using bed nets, insect repellents and long clothing.

Prevention of this viral disease is through vaccination.

As a side note, in addition to the yellow fever outbreak in Darfur, North Darfur is also reporting a spike in measles in the past week.

Measles cases in North Darfur has increased to 77, as opposed to the 52 cases registered before Eid al-Adha (Oct. 26-28, 2012), according to health officials.

Source

Dengue cases still rising in North India

DENGUE/DHF UPDATE 2012 (57): ASIA
Archive Number: 20121105.1392687
A ProMED-mail post
http://www.promedmail.org

Here are a collection of New reports regarding Dengue cases from North India. Surprisingly, they show no sign of abating even though winters are almost upon us!

Cases in India:

- Delhi area. 4 Nov 2012. Dengue 1135 cases; deaths 2. Increasing.

http://www.dailypioneer.com/sunday-edition/others/townhall/106524-dengue-spreads-tentacles-39-more-infected.html

- Bihar state. 2 Nov 2012. Dengue 250 cases; deaths 3. Affected districts: Bhagalpur (conf.) 152; Patna 67 cases.http://www.indianexpress.com/news/seven-bihar-districts-hit-by-dengue-three-dead/1025426/

- Bokaro, Jharkhand state. 3 Nov 2012. Dengue 80 cases; deaths 4. Increasing.

http://timesofindia.indiatimes.com/city/ranchi/Bokaro-sees-spread-in-dengue-with-80-cases/articleshow/17070604.cms

- Haridwar district, Uttarakhand state. 31 Oct 2012. Dengue (conf.) 58 cases. Increasing.

http://www.dailypioneer.com/nation/105599-haridwar-officials-struggling-to-contain-dengue-outbreak.html

- Maharashtra state. 1 Nov 2012. Dengue (conf.) 931 cases; deaths 34; Pune area since August 2012, 440 cases; deaths 5. Increasing.

http://www.indianexpress.com/news/five-dengue-deaths-in-two-months/1025022/

- Chandigarh area, Haryana/Punjab states. 26 Oct 2012. Dengue 347 cases; deaths, 5. Increasing.

http://www.indianexpress.com/news/despite-chill-cases-of-dengue-rising/1022102/

- Noida, Uttar Pradesh state. 27 Oct 2012. Dengue 151 cases; Increase.

http://articles.timesofindia.indiatimes.com/2012-10-27/noida/34764957_1_combat-dengue-dengue-case-vector-borne-disease

Drug resistant malaria on the rise along the Thai-Myanmar border

Subject: PRO/EDR> Malaria, artemisinin resistance - Thailand, Myanmar (02) 
Archive Number: 20121103.1389487

MALARIA, ARTEMISININ RESISTANCE - THAILAND, MYANMAR (02)
********************************************************
A ProMED-mail post
http://www.promedmail.org

Date: Fri 2 Nov 2012 
Source: IoLscitech [edited]
http://www.iol.co.za/scitech/science/news/drug-resistant-malaria-on-the-rise-1.1416104#.UJPnZ2-zKSo

The number of artemisinin/mafloquine-resistant cases is on the rise along the Thai-Myanmar border, according to Kanchanaburi health workers.
A girl, age 6, bravely held out her forefinger for a quick jab at the Malaria Post in Tai Muang, 10 kilometres [6.2 miles] from the Myanmar border, in Thailand's Kanchanaburi province.
A month ago, a girl, whose family is from Myanmar's Karen ethnic minority group and lacks Thai citizenship, tested positive for malaria. She was back for a follow-up test after a combined treatment of the anti-malarial drugs artemisinin and mefloquine. "She has tested negative," Malaria Post worker Laksanna Kaewlere said, after checking her blood sample in a test kit. Had she tested positive, she would have joined the growing ranks of patients for whom the most recent drug against the malaria parasite -- artemisinin -- has failed.
Artemisinin is usually used in combination with other anti-malarial drugs, such as mafloquine. The number of artemisinin/mafloquine-resistant cases is on the rise along the Thai-Myanmar border, according to Kanchanaburi health workers. "This year, 41 out of 207 cases of malaria proved resistant to artemisinin/mafloquine treatment," said Wittaya Saiphromsud, head of the Vector Borne Disease Centre in Sai Yok district, Kanchanaburi, 125 kilometres [77.6 miles] west of Bangkok.
Wittaya asks patients with a resistant strain of malaria to go for follow-up treatment at Sai Yok Hospital, but not all do. "Some people don't want to pay the bus fare to the hospital. Others don't have Thai identity papers so they are afraid of being harassed by police if they leave their village, and others are just disobedient," Wittaya said.
By refusing follow-up treatment, malaria carriers increase the risk of transmitting via mosquitoes their drug-resilient malaria parasites to others, including across the border in Myanmar, where health services are rudimentary after decades of neglect.
The rise in drug-resistant malaria is also due to counterfeit or sub-standard anti-malaria drugs, usually made in India or China, in the remote border regions of Myanmar and Cambodia. Sub-standard, or weaker artemisinin, allows the parasite to build up resistance, as it has to previous anti-malaria drugs including chloroquine, sulfadoxin-pyrimethamine and quinine-tetracycline, all of which have lost their effectiveness over the past 6 decades.
There are now growing fears among international health agencies that artemisinin, still widely used and effective in Africa, is losing its punch.
The porous border regions of Thailand, Myanmar and Cambodia, have a long history as the cradle of antimalarial resistance, and have now become the breeding ground for artemisinin-resistant parasites. "The problem is still located in the western part of Cambodia and western part of Thailand," said Charles Delacollet, Thailand director for the World Health Organisation. "These are the only 2 confirmed hot spots for artemisinin-resistant malaria."
The fear is that these artemisinin-resistant malarial strains will migrate across Myanmar to India and eventually Africa, which accounts for about 90 percent of the world's annual death toll of 650 000 malaria victims. "Our country is the gateway for the spread of drug-resistant parasites westward, down to Africa," said Saw Lwin, deputy director-general of Myanmar's Health Department. "If we can't contain the problem at the source of the infection, it can spread to other regions, so this is a global issue," he told a recent seminar in Kanchanaburi.
The appearance of artemisinin-resistant malaria comes at a time when the Global Fund, which contributes 60 percent of the 3 billion dollars spent annually on internationally financed anti-malarial campaigns worldwide, is experiencing a budget crunch. The Global Fund will decide on its new malaria budget next month. The Roll Back Malaria Partnership, set up in 1998 to coordinate international efforts to wipe out malaria, is hoping that new funding will be focused on the hot spots on Thailand's borders to nip artemisinin-resistant malaria in the bud.
"The opportunity to deal with this resistance is relatively short," said Roll Back Malaria's executive director Fatoumata Nafo-Traore. "So what needs to be done is to say now that we have a small window of opportunity to contain the resistance, so let's contain it."
[Byline: Peter Janssen, Reuters]
--
Comment: Providing malaria drugs fee of charge is the only instrument able to ensure that there is no market for counterfeit and substandard drugs and we hope the Global Fund and its donors will find funds available for this, at least for malaria patients in Myanmar (Burma), Thailand and Cambodia. - Mod.EP

MALARIA, PLASMODIUM VIVAX - GREECE (06): UPDATE

A ProMED-mail post
http://www.promedmail.org
Archive Number: 20121101.1384772
Date: Wed 31 Oct 2012

Source: EpiSouth Weekly Eli Bulletin [edited]

http://www.episouthnetwork.org/sites/default/files/bulletin_file/eweb_241_31_10_12.pdf

On 22 Oct 2012, the Hellenic Centre for Disease Control and Prevention (KEELPNO) reported 5 new malaria _Plasmodium vivax_ autochthonous cases in Greece.
- 2 cases are located in Karditsa regional unit, Thessaly region (cf. map 1 [available at the source URL above]). It is the 1st time that this area is reporting autochthonous malaria _P. vivax_ cases. According to KEELPNO, these cases are considered to have a direct epidemiological relation with a cluster of 8 imported cases.
- 3 other cases were reported in Laconia regional unit, Peloponnese region. These 5 cases had onset of symptoms between weeks 38 and 42 (between 17 Sep and 21 Oct 2012).
- To date, a total of 16 autochthonous cases infected in 2012 has been reported in 4 different regions in Greece:
4 in East Attica regional unit. The 1st autochthonous malaria case was reported on 18 Jun 2012 (cf. eWEB no. 224; [http://www.episouthnetwork.org/sites/default/files/bulletin_file/eweb_224_04_06_12.pdf]). 8 in Laconia regional unit, Peloponnese region. 1 in Xanthi regional unit, East of Macedonia and Thrace region. 2 in Karditsa regional unit, Thessaly region.


Comment
-------
The occurrence of new cases in Laconia regional unit was not unexpected considering the establishment of a local transmission cycle of _P. vivax_ malaria in this area.
On 1 Oct 2010, one case was reported in Xanthi regional unit. It was the 1st time that this area reported _P. vivax_ autochthonous cases.
The report of a _P. vivax_ malaria case in the new area of Karditsa regional unit strongly suggests an extension of the circulation of malaria in other areas in Greece.

Uganda - Double whammy as Yellow Fever outbreak joins Marburg Fever

UGANDA (eTN) - Uganda’s tourism industry is in jitters since the announcement that Marburg Fever has been identified as the cause of death of at least four people in the Kabale District in Southwestern Uganda. The situation was made worse when it became known that at least one case of Yellow Fever has also been identified in Northern Uganda, besides an outbreak of deadly hepatitis in the Northeast of the country. The Marburg outbreak follows hot on the heels of an Ebola outbreak in Uganda’s Kibale district which scared potential visitors and led to the denial of a visa for Uganda’s Muslim faithful who wanted to go for the Haj pilgrimage only to be told they were banned over Ebola fears.

Current visitors to Uganda, though most unlikely to come anywhere near the area where the Yellow Fever outbreaks were recorded, will now be well advised to get their own Yellow Fever inoculations as the certificate could be demanded from them when getting home or traveling elsewhere after a visit to Uganda.

Said a regular commentator from Kampala yesterday evening when the added bad news was announced: “This was to be a year of celebration. Lonely Planet made us their top destination for 2012. We celebrated 50 years of independence. Business generally was on the upswing. But it ended up as far from normal. We are reassuring our tourists that they need not worry as those places in the North are far from tourist routes, but the Kabale thing is, of course, at the crossroads to Kisoro and Mgahinga and to Bwindi, and that is not so good. Still let me say that our visitors are safe and need not worry.”

As reassuring as that may sound, ahead of the busy high season, this is not something Uganda needed to go through. The international media are now also highlighting the fighting right across the borders in Congo, where militias and the regime army are battling for supremacy to control the area rich in minerals and oil and the spillover of tens of thousands of refugees once again, besides warming up the old stories on disease outbreaks in the past. It never rains but pours it seems, but the time is now to stand up and tell the world about the bright sides of our country and why we are after all called “The Pearl of Africa.”

Source

Nigeria: 100 Million At Risk of Yellow Fever Outbreak

Over 100 million Nigerians are at the risk of yellow fever infection due to government's failure to conduct vaccination, the National Primary Health Care Development Agency (NPHCDA) has warned.

Health experts at a stakeholders meeting for yellow fever preventive campaign in Abuja said the disease outbreak is imminent as no mass vaccination has been conducted in the nation since the last outbreak 30 years ago.

Speaking at the event, chairman Expert Review Committee on polio eradication and routine immunization, Professor Oyewole Tomori said Nigeria is already endangered with a recent outbreak in nearby Cameroun.

Some 377 local government areas in 25 states have been marked as high risk areas, an assessment survey of the country.

Tomori said, "We are sitting on a tinderbox due to our population, if we have not done a mass vaccination campaign; it means we have a large number of people who are vulnerable."

He pointed out that a recent outbreak of yellow fever in six districts of Cameroun bordering Cross River State has placed Nigeria at risk because it is the only country among 13 other countries in West Africa yet to conduct mass vaccination.

Source

Acute Waterborne Encephalitis - a new type of unknown brain fever now killing children in Eastern UP

A ProMED-mail post
http://www.promedmail.org

Date: Mon 22 Oct 2012

Source: The Times of India [edited]

http://articles.timesofindia.indiatimes.com/2012-10-22/india/34652749_1_handpump-india-mark-ii-encephalitis

When a man had a little money saved, over 10 years ago, he installed a handpump outside his small house in Badhariya village. The 1st he heard of the handpump being too shallow was when his 9-year-old daughter died of encephalitis this year [2012] and the grieving father was told it was because of the water she had drunk from the handpump.

With water-borne acute encephalitis syndrome (AES) now making up close to 95 per cent of the encephalitis cases across eastern Uttar Pradesh, there is a renewed focus on the water the area's children are drinking. "The big problem in this area is that since it is low-lying and surrounded by rivers, the water table is very high, which makes contamination easier," says Gorakhpur's district magistrate Ravi Kumar NG.

Milind Gore, who heads the National Institute of Virology's Gorakhpur research unit, says water samples taken by them near handpumps in affected areas have shown the presence of enteroviruses, which can cause AES.

An important part of the administration's work to prevent encephalitis is discouraging people from using these handpumps and installing India Mark II pumps. "We have been sanctioned Rs 160 crore [USD 34 309 018] for improving drinking water, through which 4600 handpumps are being installed in Gorakhpur district alone," says Kumar.

But while the shallow handpump is now accepted as the villain in the piece, residents say they had to take no permissions while installing handpumps, many of them up to 25 years ago. "We got the contractor to put in a handpump, and when he hit water, he stopped. How would village people know how deep to put it in?" says a man, whose brother lost his infant daughter to AES 12 days ago.

"No one has ever told us there is any problem with our handpump," says a woman of Bargadahi village in Gorakhpur. Her 6-year-old daughter was hospitalized with AES a month ago but has largely recovered. The entire family still drinks water from the same handpump outside their house.

In other villages, some of the deeper handpumps installed by the government are located inside the compounds of the better off, often upper caste, residents of the village, a problem the district administration too acknowledges. Against this backdrop, the Centre's continued insistence on improved handpumps in an area in which groundwater poses problems seems fraught with danger.

Commentary: It is still saddening to see that we do not even know what diseases are children are dying off! While authorities in Saudi Arabia are able to identify 1 person with a new type of viral infection, in India thousands of children die every year due to viral brain fever without any known causes!! I hope that our large medical institutions like ICMR, and big hospitals like AIIMS, SGPGI (Lucknow) should look in to this shameful finding and try to find the cause of these serious illnesses so that we can try to save these unfortunate children.

Dengue outbreak hits Tricity

The annual dengue epidemic is peaking and sufferers are pouring in to the tricity’s hospitals. Figures available from the UT Nodal Officer for Dengue indicate 118 cases from Chandigarh  alone 118. When patients from outside the city are added in, the figure rises to 187. The majority of the cases are from Mauli Jagran, Hallo Majra, Maloya Colony and other slum areas of the city.

The Nodal Officer said all three city hospitals are fully equipped with medicines and doctors to tackle the patients. Moreover, these medicines are administered free of cost. He claimed that Health Department volunteers are going door to door to tell people what they must do to prevent mosquitoes from breeding. Dengue is spread by mosquitoes.

Neighboring Mohali is likewise beset by dengue. Dr Rajiv Challa, Senior Medical Officer of the Phase Six Civil Hospital said that he has 100 confirmed cases and about another 100 cases of suspected dengue. Bhalla mentioned elaborate arrangements to tackle the disease and he too warned people to take steps to prevent mosquito breeding. However, data from the National Vector Borne Disease Control Programme reveals that in 2011 33 people died of dengue. The number of dengue deaths in the state has been steadily on the rise since 2007. In Panchkula, out 33 suspected cases, 7 are confirmed as dengue.

Doctors strictly warn against self medication. If you have fever consult a doctor, and complete the treatment he prescribes. In some people, dengue is moderate and goes away on its own after a few days of fever depending on their immunity. To protect yourself from dengue, wear full sleeved shirts or kurtas, and use repellent creams and mosquito coils.

Dengue is spread by the bite of an infected aedes Egypti mosquito. The symptoms include high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash and mild bleeding.

Source