Thursday, August 30, 2018

PRO/EDR> Cholera, diarrhea and dysentery update (31): Africa

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (31): AFRICA
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In this update
[1] Cholera - Nigeria, Niger, Cameroon
[2] Cholera - Congo DR, Niger
[3] Cholera - Congo DR (Kasaï Oriental)
[4] Cholera - Somalia
[5] Cholera - Nigeria (Kano)
[6] Cholera - Nigeria (Abuja)

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[1] Cholera - Nigeria, Niger, Cameroon
Date: Fri 17 Aug 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/cholera-threats-persists-west-africas-lake-chad-basin-59543/>


More than 20 000 cholera cases have been confirmed in the Lake Chad
Basin states of Nigeria, Niger and Cameroon since January [2018]. In
its latest epidemiological analysis of the regional cholera outbreak,
the United Nations Children's Fund (UNICEF) said 255 deaths have been
reported since January [2018].

"This is 8 times more than the average cholera case-load in the past 4
years. Nigeria is the most affected, with 18 000 cases. The outbreak
has spread into neighboring Cameroon and Niger. The major cities of
Maradi in Niger as well as Yaounde and Douala in Cameroon have
confirmed cholera cases. More than 5 million people are living in the
outbreak areas," UNICEF said. Further, the organization said the
current outbreak is characteristically similar to the 2010 epidemic
which killed 2610 people and infected 63 000 in Nigeria, Niger, Chad
and Cameroon.

In Nigeria, the outbreak may spread in the 3 states of Kano, Katsina
and Kaduna. In Niger, the disease is likely to spread in the Zinder
and Niamey local government areas, while the cities of Douala and
Yaounde are at risk of larger outbreaks in Cameroon. People in the
disease-endemic areas of Cameroon and Niger are at greater risk as the
2 countries have not run any vaccination campaigns in the past few
years. Heavy rains across the region have created an ideal environment
for the cholera outbreak to spread.

[Byline: Oscar Nkala]

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[2] Cholera - Congo DR, Niger
Date: Thu 16 Aug 2018
Source: AFP [edited]
<https://www.news24.com/Africa/News/cholera-kills-scores-in-drc-niger-20180816>


A cholera epidemic in the Democratic Republic of Congo has killed 127
people since February [2018], while a further 22 have died in Niger,
officials said on [Wed 15 Aug 2018]. "As many as 2100 patients are
currently being treated and since February [2018] we have registered
125 deaths," said Hippolyte Mutombo Mbwebwe, health minister in the
eastern Kasai region. A total of 10 more cases, including 2 deaths,
were confirmed in neighbouring central Kasai, he said.

Meanwhile, in Niger the United Nations said on [Wed 15 Aug 2018], that
22 people had died from cholera in the Maradi region, close to
Nigeria. It said 1351 cases had been registered including the 22
fatalities.

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[3] Cholera - Congo DR (Kasaï Oriental)
Date: Fri 17 Aug 2018
Source: Actualité [in French, trans. Corr.SB, edited]
<https://actualite.cd/2018/08/17/rdc-le-cholera-fait-125-deces-en-six-mois-au-kasai-oriental/>

The cholera epidemic continues to spread in the Kasai provinces of
central DRC. In Kasaï Oriental, the provincial Minister of Health
puts forward a total of 125 people who died after the epidemic, in the
space of 6 months.

"Since the outbreak of the epidemic in February [2018], we have
recorded 125 deaths. Currently, 2100 patients are being cared for,
"said Hyppolite Mutombo Mbwebwe, provincial health minister in Kasai
Oriental. It was in a statement made [Wed 15 Aug 2018], to the press
in Ngandajika. Only one of the 19 health zones in the province is
unaffected by the epidemic. "Cholera continues to wreak havoc; 18 of
the province's 19 health zones are currently affected, "added the
minister. The artisanal diamond mining areas in Kasaï Oriental are
the potential reservoirs of the epidemic.

Central Kasai health officials said a probable case of cholera was
admitted [Wed 15 Aug 2018] at Kananga Provincial Hospital. "We have
taken the samples that we intend to send to the INRB (National
Institute for Biomedical Research), in Kinshasa, for in-depth
examinations. But I am able, in view of the clinical signs that the
patient presents, to confirm that it is cholera, "told Actualite.cd,
Dr. John
Bimvulu, provincial health minister of Kasai Central.

Ten other cases with 2 deaths were confirmed in the Mwetshi Health
Zone in the Dimbelenge (Central Kasai) area. To stop the epidemic,
Minister Bimvulu recommends the population to strictly observe the
rules of hygiene.

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[4] Cholera - Somalia
Date: Sun 19 Aug 2018
Source: Reliefweb, a WHO, Government of Somalia report [edited]
<https://reliefweb.int/report/somalia/situation-report-acute-watery-diarrhoeacholera-epidemiological-week-33-13-19-august>


Situation report for acute watery diarrhoea/cholera, epidemiological
week 33 (13 - 19 Aug 2018)
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Highlights
- A total of 39 new cases AWD/cholera were reported in week 33
compared to 53 cases week 32.
- A total of 8 (21 percent) cases were reported from flood affected
regions of Lower Jubba region.
- No new death was reported in week 32 and week 33.
- A cumulative total of 6169 cases including 41 deaths have been
reported since December [2017].
- The new AWD/cholera cases reported in Beletweyne started in December
[2017].
- In 2018 new outbreaks were reported in Banadir, Kismayo, Jowhar,
Bulobarde, Merka, Brava, Kurtunwarey and Afgoye.

Key Figures
- 39 new cases with no new death in week 33.
- 54 percent of the new cases were female.
- 72 percent of the cases were 5 years and below.
- Cases reported in week 33 did not receive cholera vaccine in 2017.
- 20 districts in 4 regions have reported new AWD case since December
[2017].
- 6169 cumulative case including 41 deaths since December [2017] (CFR
0.7 percent).

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[5] Cholera - Nigeria (Kano)
Date: Thu 16 Aug 2018
Source: Khmer Times [edited]
<https://www.khmertimeskh.com/50523254/cholera-claims-28-lives-in-nw-nigeria/>


At least 28 lives have been confirmed dead following the outbreak of
cholera across Nigeria's northwest state Kano in the past seven7
months, an official said [Tue 14 Aug 2018]. The state recorded 400
suspected cases of acute watery diarrhea with 50 confirmed cases of
cholera across the 33 local government areas, Kabiru Getso, state
commissioner for health, told reporters in Kano city.

Out of 50 the confirmed cases, 28 deaths were recorded, he added,
noting that the state had instituted several control measures to
combat the outbreak. He said other measures include mounting of
continuous surveillance for all epidemic-prone diseases as well as
active search for cases of diarrhea and vomiting.

Cholera is a highly virulent disease characterised in its most severe
form by a sudden onset of acute watery diarrhea that can lead to death
by severe dehydration. Such outbreaks are common in Nigeria due to the
poor water supply systems, especially in densely populated areas.

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[6] Cholera - Nigeria (Abuja)
Date: Wed 15 Aug 2018
Source: Anadolu Agency [edited]
<https://www.aa.com.tr/en/africa/cholera-outbreak-kills-7-in-nigerian-capital-/1231185>


A cholera outbreak killed at least 7 people in the Nigerian capital
Abuja over the past few days, an official said. "So far, there has
been 7 deaths from across 6 communities here in Abuja while efforts
are on to reverse the trend," Humphrey Okoroukwu, head of the Health
Department in the capital, told Anadolu Agency on [Tue 14 Aug 2018].

In a news briefing on [Mon 13 Aug 2018], Okoroukwu had said the health
workers have been dispatched to various communities to teach locals on
how to manage the outbreak.

In July [2018], the country's Center for Disease Control (CDC) put
death toll from the latest cholera outbreak at 116 across 12 states.
The report said at least 13 006 cases have been reported in hospitals.


Cholera is a yearly phenomenon in many parts of Nigeria largely
because of poor water system and improper hygiene especially in hugely
populated areas.

[Byline: Rafiu Ajakaye]

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[The mortality from cholera and most diarrheal illnesses is related to
non-replacement of fluid and electrolytes from the diarrheal illness.

As stated in 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), oral
rehydration therapy can be life-saving in outbreaks of cholera and
other forms of diarrhea:

"As reviewed by Richard Guerrant et al (1), it was in 1831 that
cholera treatment could be accomplished by intravenous replacement,
and, although this therapy could produce dramatic improvements, not
until 1960 was it 1st recognized that there was no true destruction of
the intestinal mucosa, and gastrointestinal rehydration therapy could
be effective, and the therapy could dramatically reduce the
intravenous needs for rehydration. Indeed, that this rehydration could
be just as effective given orally as through an orogastric tube (for
example, refs 2 and 3) made it possible for oral rehydration therapy
(ORT) to be used in rural remote areas and truly impact on the
morbidity and mortality of cholera. Indeed, Guerrant et al (1)
highlights the use of oral glucose-salt packets in war-torn
Bangladeshi refugees, which reduced the mortality rate from 30 percent
to 3.6 percent (4) and quotes sources referring to ORT as "potentially
the most important medical advance" of the 20th century. A variety of
formulations of ORT exist, generally glucose or rice powder-based,
which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhea to
approximate volume and fluid losses can be found in ref 6 below. Those
with severe hypovolemia should be initially rehydrated intravenously
with a fluid bolus of normal saline or Ringer's lactate solution of
20-30 ml/kg followed by 100 ml/kg in the 1st 4 hours and 100 ml/kg
over the next 18 hours with regular reassessment. Those with lesser
degrees of hypovolemia can be rehydrated orally with a glucose or
rice-derived formula with up to 4 liters in the 1st 4 hours, and those
with no hypovolemia can be given ORT after each liquid stool with
frequent reevaluation."

References
----------
1. Guerrant RL, Carneiro-Filho BA and Dillingham RA. Cholera,
diarrhea, and oral rehydration therapy: triumph and indictment. Clin
Infect Dis. 2003;37(3):398-405; available at:
<http://cid.oxfordjournals.org/content/37/3/398.long>.
2. Gregorio GV, Gonzales ML, Dans LF and Martinez EG. Polymer-based
oral rehydration solution for treating acute watery diarrhoea.
Cochrane Database Syst Rev. 2009;(2):CD006519. doi:
10.1002/14651858.CD006519.pub2; available at:
<http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full>.
3. Gore SM, Fontaine O and Pierce NF. Impact of rice based oral
rehydration solution on stool output and duration of diarrhea:
meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91;
available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/>.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al. Oral fluid therapy
of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4):
197-205; available at:
<http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf>.
5. Atia AN and Buchman AL. Oral rehydration solutions in non-cholera
diarrhea: a review. Am J Gastroenterol. 2009; 104(10): 2596-604, doi:
10.1038/ajg.2009.329; abstract available at:
<http://www.ncbi.nlm.nih.gov/pubmed/19550407>.
6. WHO. The treatment of diarrhea, a manual for physicians and other
senior health workers. 4th ed. 2005; available at:
<http://whqlibdoc.who.int/publications/2005/9241593180.pdf>.
- Mod.LL

HealthMap/ProMED map available at:
Africa: <http://healthmap.org/promed/p/6075>]

[See Also:
Cholera, diarrhea & dysentery update (30): Africa (Algeria)
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http://promedmail.org/post/20180308.5672462
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http://promedmail.org/post/20180301.5658608
Cholera, diarrhea & dysentery update (08): Africa, Asia
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Cholera, diarrhea & dysentery update (06): Africa, Asia, Oceania
http://promedmail.org/post/20180216.5633227
Cholera, diarrhea & dysentery update (04): Africa
http://promedmail.org/post/20180127.5567857
Cholera, diarrhea & dysentery update (02): Africa, Asia
http://promedmail.org/post/20180107.5543138
Cholera, diarrhea & dysentery update (01): Africa, Asia
http://promedmail.org/post/20180103.5533961
2017
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http://promedmail.org/post/20171209.5490077
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http://promedmail.org/post/20171127.5467914
Cholera, diarrhea & dysentery update (128): Africa, Asia, Americas
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http://promedmail.org/post/20171015.5376068
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http://promedmail.org/post/20171011.5370768
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http://promedmail.org/post/20171004.5359863
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Cholera, diarrhea & dysentery update (104): Africa, Asia
http://promedmail.org/post/20170927.5344097]
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