Monday, September 10, 2018

PRO/EDR> Cholera, diarrhea & dysentery update (34): Africa

CHOLERA, DIARRHEA AND DYSENTERY UPDATE (34): AFRICA
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In this update:
Africa
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[1] Cholera - Zimbabwe (Harare)
[2] Cholera - Nigeria (Borno State)
[3] Cholera - Ethiopia (Tigray Region)
[4] Cholera - Cameroon

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[1] Cholera - Zimbabwe (Harare)
Date: Sun 9 Sep 2018
Source: Reuters [edited]
<https://wsau.com/news/articles/2018/sep/09/cholera-outbreak-kills-10-people-in-zimbabwe/>


A cholera outbreak has killed 10 people in Zimbabwe's capital Harare
after they drank contaminated water, a city health official said on
Sunday [9 Sep 2018]. Harare city council has struggled to supply water
to some suburbs for more than a decade, forcing residents to rely on
water from open wells and community boreholes.

Clemence Duri, Harare city's health director, said more than 300
people had been hospitalized after contracting the waterborne disease,
which causes severe diarrhea and dehydration. The outbreak was 1st
reported on Friday [7 Sep 2018]. "The death toll has risen to 10. We
have established that the outbreak was caused by a burst sewer pipe
that contaminated borehole water," Duri said, adding that the pipe had
been replaced.

Zimbabwe suffered its biggest cholera outbreak in 2008 at the height
of an economic crisis when more than 4000 people died and another 40
000 became sick.

[Byline: MacDonald Dzirutwe]

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[2] Cholera - Nigeria (Borno State)
Date: Mon 10 Sep 2018
Source: Punch [edited]
<https://punchng.com/18-persons-now-killed-by-cholera-in-borno-un-agency/>


The United Nations Office for the Coordination of Humanitarian Affairs
said on Sunday [9 Sep 2018] that 680 cases of suspected cholera were
recorded in 8 local government areas (LGAs) of Borno State, out of
which 18 victims had died. The UN agency said it was coordinating
medical aid to the affected communities alongside the Borno State
Ministry of Health, noting that the 1st suspected cases of cholera
were recorded on Sun 19 Aug 2018.

The UNOCHA, in a statement by its National Information Officer,
Abiodun Banire, said a 100-bed cholera treatment centre had been
opened in Dala and in the Magumeri LGA. He noted that additional
ambulances had also been deployed in the affected LGAs to transport
those seeking treatment.

The UN gave the breakdown of the epidemic in the LGAs as follow: Jere,
218, including 2 deaths; Magumeri, 156, including 4 deaths; Maiduguri
Metropolitan Council, 141, including 5 deaths; Chibok, 85, including 3
deaths; Konduga, 38, including 3 deaths; Kaga, 28, including one
death; Damboa, 8 cases; and Shani, 6 cases.

The UN, in the statement, said, "A cholera outbreak was declared in
Borno State on Wed 5 Sep 2018 by the state ministry of health. A total
of 680 cases of suspected cholera have been recorded, including 18
deaths, as of Fri 7 Sep 2018. This represents a fatality rate of 2.6
percent.

"The ministry of health, with the support of humanitarian partners, is
coordinating the response through the Emergency Operation Centre.
Coordination meetings are currently held twice a week at the EOC and
daily at the LGAs."

[Byline: Olaleye Aluko]

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[3] Cholera - Ethiopia (Tigray Region)
Date: Sat 8 Sep 2018
Source: News24 [edited]
<https://www.news24.com/Africa/News/holy-water-blamed-for-cholera-outbreak-in-ethiopia-report-20180908>


A cholera outbreak in Ethiopia's northern Tigray region has reportedly
been blamed on holy water after at least 10 people died over the past
2 weeks, while more than 1200 people have contracted the disease.
According to BBC, authorities have blamed the spread of the acute
water diarrhea to poor hygiene and the drinking of unsafe water.

The authorities have also identified contaminated holy water in some
of the region's monasteries as being behind the outbreak. It was
believed that the water is being taken from rivers that carry the
disease.

Interfering in religious affairs is a very sensitive matter in the
region, but the local government is working with religious leaders to
temporarily stop the use of holy water, said the report. The
authorities say that the disease is under control, but efforts to
contain it need to continue until it disappears altogether.

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[4] Cholera - Cameroon
Date: Tue 4 Sep 2018
Source: Journal of Cameroon [edited]
<https://www.journalducameroun.com/en/cholera-outbreak-cameroon-seventeen-die-far/>


Seventeen people have died of cholera in Cameroon's center and
northern regions since the outbreak was declared in mid-July 2018, the
country's public-health ministry said Mon 3 Sep 2018. In the same
regions, where the cholera case fatality rate is 1.6 percent and 9.9
percent, respectively, 235 suspected cases were reported, of which 23
were confirmed, while 5 other regions are considered at "high risk."

Faced with growing risks, Cameroonian authorities, with the support of
the World Health Organization (WHO) and the United Nations Children's
Fund (UNICEF), say they are updating the linear list, continuing
prevention, surveillance, investigations and sanitation operations,
and strengthening the capacities of medical staff. However, the
authorities have expressed concerns related to the supply of inputs,
the follow-up of contacts in the country's 10 regions, and the launch
of an immunization campaign in the Minawao refugee camp, opened in
July 2013 to respond to the massive influx of Nigerian refugees
fleeing Boko Haram.

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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 lifesaving 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, 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 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. doi: 10.1086/376619.
<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.
<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;
<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;
<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;
<http://whqlibdoc.who.int/publications/2005/9241593180.pdf>.
- Mod.LL

HealthMap/ProMED-mail maps:
Harare, Zimbabwe: <http://healthmap.org/promed/p/46291>
Borno State, Nigeria: <http://healthmap.org/promed/p/621>
Jere, Borno, Nigeria: <http://healthmap.org/promed/p/54973>
Maiduguri, Borno, Nigeria: <http://healthmap.org/promed/p/12103>
Chibok, Borno, Nigeria: <http://healthmap.org/promed/p/45272>
Tigray State, Ethiopia: <http://healthmap.org/promed/p/19431>
Cameroon: <http://healthmap.org/promed/p/65>]

[See Also:
Cholera, diarrhea & dysentery update (33): Africa (Algeria)
http://promedmail.org/post/20180831.5999950
Cholera, diarrhea and dysentery update (31): Africa
http://promedmail.org/post/20180830.5969536
Cholera, diarrhea & dysentery update (30): Africa (Algeria)
http://promedmail.org/post/20180827.5990110
Cholera, diarrhea & dysentery update (25): Africa, Asia
http://promedmail.org/post/20180719.5911527
Cholera, diarrhea & dysentery update (20): Africa
http://promedmail.org/post/20180522.5812298
Cholera, diarrhea & dysentery update (17): Africa, Asia
http://promedmail.org/post/20180418.5730408
Cholera, diarrhea & dysentery update (12): Africa
http://promedmail.org/post/20180313.5678176
Cholera, diarrhea & dysentery update (11): Africa
http://promedmail.org/post/20180308.5672462
Cholera, diarrhea & dysentery update (10): Africa
http://promedmail.org/post/20180301.5658608
Cholera, diarrhea & dysentery update (08): Africa, Asia
http://promedmail.org/post/20180222.5640697
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
----
Cholera, diarrhea & dysentery update (136): Africa, WHO
http://promedmail.org/post/20171224.5521418
Cholera, diarrhea & dysentery update (134): Africa
http://promedmail.org/post/20171209.5490077
Cholera, diarrhea & dysentery update (133): Africa
http://promedmail.org/post/20171205.5480457
Cholera, diarrhea & dysentery update (131): Africa
http://promedmail.org/post/20171127.5467914
Cholera, diarrhea & dysentery update (128): Africa, Asia, Americas
http://promedmail.org/post/20171107.5427842
Cholera, diarrhea & dysentery update (125): Africa
http://promedmail.org/post/20171031.5416115
Cholera, diarrhea & dysentery update (121): Africa
http://promedmail.org/post/20171021.5393277
Cholera, diarrhea & dysentery update (120): Africa
http://promedmail.org/post/20171018.5388369
Cholera, diarrhea & dysentery update (118): Africa, Asia
http://promedmail.org/post/20171015.5376068
Cholera, diarrhea & dysentery update (116): Africa
http://promedmail.org/post/20171011.5370768
Cholera, diarrhea & dysentery update (111): Africa, Asia
http://promedmail.org/post/20171004.5359863
Cholera, diarrhea & dysentery update (109): Africa, Asia
http://promedmail.org/post/20171002.5353515
Cholera, diarrhea & dysentery update (107): Africa
http://promedmail.org/post/20171001.5349664
Cholera, diarrhea & dysentery update (104): Africa, Asia
http://promedmail.org/post/20170927.5344097]
.................................................sb/ll/tw/jh
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