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Published Date: 2017-05-30 18:39:19
Subject: PRO/EDR> Cholera, diarrhea & dysentery update (40): Africa
Archive Number: 20170530.5071407
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Cholera - Kenya (Turkana county)
[2] Cholera - Tanzania (Zanzibar)
[3] Cholera - South Sudan

[1] Cholera - Kenya (Turkana county)
Date: Sat 27 May 2017
Source: Daily Nation [edited]

Refugees in Kakuma camp have been treated for cholera following an outbreak. Turkana County health and sanitation executive Jane Ajele said the 25 inhabitants were treated at Kakuma Mission Hospital. Among the patients was a child who had experienced bouts of diarrhea. "We received around 25 suspected patients and when samples were sent to the Center for Disease Control and Prevention they turned out to be cholera positive. But no death has been recorded," she said. Ms Ajele said some of the hospitalized patients were isolated to prevent further spread of the disease.

Following the outbreak, some of the measures the Joseph Nanok-governed county has taken to stanch further infections include shutting down 20 restaurants in Kakuma town because they did not meet the required health standards. The Health executive added that overcrowding and poor sanitation are to blame for the outbreak within the camp. "Our surveillance team is on high alert and we have even dispatched a team to Nadapal on the border of Kenya and South Sudan to screen all new arrivals from South Sudan. "A member of the host community admitted at Kakuma Mission Hospital for diarrhea tested negative [for cholera]," she added.

The disease situation is not limited to Turkana only, on [Thu 18 May 2017] in Nairobi's Karen suburb 3 people tested positive for the disease. They had attended a wedding; and the county's health executive Bernard Muia said they might have contracted the infection from western Kenya. Dr Muia added that more cases were reported in Murang'a and Garissa counties.

Treatment centres are now on high alert and locals have been advised to visit health facilities when they show symptoms such as diarrhea.

[byline: Sammy Lutta]

communicated by:

[Turkana County is a county in the former Rift Valley Province of Kenya. Turkana is the 2nd largest (after Marsabit County) and also the north western-most county in Kenya. It is bordered by the countries of Uganda to the west; South Sudan and Ethiopia, including the disputed Ilemi Triangle, to the north and north east; and Lake Turkana to the east. Its location can be seen on a map at https://en.wikipedia.org/wiki/Turkana_County. Active outbreaks of cholera are certainly occurring in South Sudan and Ethiopia. - Mod. LL]

[2] Cholera - Tanzania (Zanzibar)
Date: Sat 28 May 2017, 1:36 PM
Source: XinHua Net [edited]

Tanzania's semi-autonomous Zanzibar archipelago has banned street food vendors following a fresh outbreak of cholera. Acting minister of health and social welfare in Zanzibar Riziki Pemba Juma blamed poor sanitation on floods caused by heavy rains hitting the archipelago for the last month.

She said apart from banning street food vendors, the Zanzibar government has also restricted people from inviting and sharing the iftar -- the evening meal when Muslims end their daily Ramadan fast at sunset. During the holy month, it is common for people to invite and share food with those less fortunate.

Riziki said that the ban came after the discovery of 23 new cases of cholera in Muslim-majority Zanzibar. The new cholera outbreak has compelled the Zanzibar government to establish special camps to deal with cholera victims, the minister said. "We are encouraging people in their localities to observe hygiene and take precautions on the disease as well as ensuring that once they diagnose someone with symptoms of cholera to take him/her to the nearby health facility for treatment," she said, adding that the government has all the medication needed to cope with a possible epidemic.

Mohammed Dahoma, director of hospital services in Zanzibar, said that a 3 month old infant is among the 23 patients. In 2016, at least 68 people died out of 4330 who were infected with the disease.

communicated by:
ProMED-mail from HealthMap Alerts

[Zanzibar is a semi-autonomous part of Tanzania in East Africa. It is composed of the Zanzibar Archipelago in the Indian Ocean, 25-50 km (approx. 16-31 mi) off the coast of the mainland, and consists of many small islands and 2 large ones: Unguja (the main island, referred to informally as Zanzibar) and Pemba. A map can be found at: https://en.wikipedia.org/wiki/Zanzibar. - Mod.LL]

[3] Cholera - South Sudan
Date: Sat 28 May 2017, 10:15 PM
Source: XinHua Net [edited]

At least 248 people have died from cholera outbreak across 19 counties in South Sudan since the initial outbreak was reported in June 2016, the UN says. The UN Office for Coordination of Humanitarian Affairs (OCHA) said as of [15 May 2017], 8160 cholera cases had been reported since the initial case was recorded on [18 Jun 2016].

"While the outbreak initially spread to counties along the River Nile, counties most recently affected are increasingly distant from the River. As many as 9 out of the 19 counties affected by the cholera outbreak since June 2016 have reported cholera cases in the past 4 weeks and are considered to have active transmission of the disease," OCHA said in its latest report released in Juba.

Health experts have highlighted that the number of cases recorded could be as little as 10 per cent of the overall number of cholera cases occurring during the outbreak. According to OCHA, children and young adults under 30 years are the most affected, constituting 70 per cent of the cases.

According to the UN, there are concerns that the outbreak will intensify and spread during the upcoming rainy season due to continued conflict, displacement and inadequate access to clean water and sanitation. This is the longest, most widespread and most deadly cholera outbreak since South Sudan became independent.

In the 2014 outbreak, 6421 cases were reported, including 167 deaths, over 8 months, while in 2015, the cholera outbreak lasted 5 months and affected 1818 people, including 47 deaths, in 3 counties.

"The response has been challenging, however, due to the locus of many outbreaks in cattle camps, remote and militarized locations, ongoing population displacement, and insecurity in areas affected by the outbreak," said OCHA. It said with the rainy season approaching and displacement continuing, it is expected that the disease will continue to spread.

communicated by:
ProMED-mail from HealthMap Alerts

[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 per cent to 3.6 per cent (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."

1. Guerrant RL, Carneiro-Filho BA, Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis. 2003;37(3):398-405.
2. Gregorio GV, Gonzales ML, Dans LF, 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.
3. Gore SM, Fontaine O, Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, Bhattacharya AK, Simpson TW. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med. 1973; 132(4): 197-205.
5. Atia AN, 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.
6. WHO. The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/201.]

See Also

Cholera, diarrhea & dysentery update (39): Asia (Yemen) 20170530.5069905
Cholera, diarrhea & dysentery update (38): Asia (Yemen) 20170526.5062038
Cholera, diarrhea & dysentery update (37): Africa 20170525.5061495
Cholera, diarrhea & dysentery update (36): Czech Republic ex Tanzania 20170525.50
Cholera, diarrhea & dysentery update (35): Africa, Asia 20170524.5059018
Cholera, diarrhea & dysentery update (34): Asia (Yemen) 20170523.5057682
Cholera, diarrhea & dysentery update (33): Africa 20170523.5056047
Cholera, diarrhea & dysentery update (32): Asia (Yemen) 20170522.5053352
Cholera, diarrhea & dysentery update (31): Africa 20170520.5045580
Cholera, diarrhea & dysentery update (30): Asia (Yemen) 20170519.5047675
Cholera, diarrhea & dysentery update (29): Asia (Yemen) 20170517.5043339
Cholera, diarrhea & dysentery update (28): Africa (Horn of Africa) 20170517.5040909
Cholera, diarrhea & dysentery update (27): Asia (Yemen) 20170515.5037318
Cholera, diarrhea & dysentery update (26): Asia (Yemen) 20170514.5034914
Cholera, diarrhea & dysentery update (25): Asia (Yemen) 20170513.5034230
Cholera, diarrhea & dysentery update (24): Africa, Asia 20170510.5026111
Cholera, diarrhea & dysentery update (23): Asia (Yemen) 20170509.5024479
Cholera, diarrhea & dysentery update (22): Asia 20170508.5018280
Cholera, diarrhea & dysentery update (21): Asia (Yemen) 20170506.5016310
Cholera, diarrhea & dysentery update (20) Africa, Americas 20170505.5015480
Cholera, diarrhea & dysentery update (19): Africa 20170504.5012967
Cholera, diarrhea & dysentery update (18): Americas (Haiti) 20170503.5010507
Cholera, diarrhea & dysentery update (17): Americas (Haiti) 20170428.5001853
Cholera, diarrhea & dysentery update (16): Africa (Horn of Africa) 20170425.4994572
Cholera, diarrhea & dysentery update (15): Africa, Asia 20170423.4989180
Cholera, diarrhea & dysentery update (14): Americas, Asia 20170418.4974872
Cholera, diarrhea & dysentery update (13): Asia 20170417.4974438
Cholera, diarrhea & dysentery update (12): Africa 20170416.4974364
Cholera, diarrhea & dysentery update (11): Africa, Asia 20170402.4942849
Cholera, diarrhea & dysentery update (10): Africa 20170323.4916153
Cholera, diarrhea & dysentery update (09): Africa 20170313.4898254
Cholera, diarrhea & dysentery update (08): Asia (Yemen) 20170308.4887994
Cholera, diarrhea & dysentery update (07): Americas 20170227.4866520
Cholera, diarrhea & dysentery update (06): Africa 20170217.4846873
Cholera, diarrhea & dysentery update (05): Africa, Asia 20170216.4841639
Cholera, diarrhea & dysentery update (04): Asia (Yemen) 20170125.4790713
Cholera, diarrhea & dysentery update (03): Americas (Haiti) 20170113.4763806
Cholera, diarrhea & dysentery update (02): Africa 20170113.4751889
Cholera, diarrhea & dysentery update (01): Asia (Yemen) WHO 20170105.4742075

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