June 3, 2014
Cholera In Sudan, Ebola Threat In Sierra Leone, MERS Invades Algeria
Lawrence LeBlond for redOrbit.com - Your Universe Online
The Ministry of Health of South Sudan declared a cholera outbreak in Juba on May 15, 2014 after four cases were laboratory confirmed following tests conducted by the African Medical Research Foundation in Nairobi, Kenya. The first case identified with onset of illness was on April 23.
As of May 25, a total of 586 cholera cases had been reported, including 22 deaths – 13 hospital and 9 community deaths. The majority of hospital deaths were those that occurred upon arrival. Cases had been reported from 15 sub-counties (payams) within Juba, with the most affected payam being Muniki, reporting 25 percent of all cases.
As of June 2, the total case count was at 1,106, noted UN Humanitarian Coordinator Toby Lanzer, as reported by Radio Tamazuj. He said that new cases have been confirmed in Kajo Keji in Central Equatoria and Kaka in Upper Nile State. Medical reports suggest the outbreak is being contained in some areas, while in others it is spreading unchecked.
The total number of deaths from cholera now stands at 27, as of May 31, according to the Ministry of Health. As well, the MOH reported that 896 patients were discharged after successful treatment.
In response to the cholera outbreak, MOH officials have developed a cholera response plan and established a Cholera Response Task Force which coordinates both health and Water, Sanitation and Hygiene (WASH) activities. The MOH also plans to establish a Cholera Command and Control Center (C4) in Juba. C4 will strengthen the coordination efforts of the outbreak response and support the emergency response task forces in all 10 states.
The World Health Organization and its partners are supporting the MOH in its cholera coordinating response. As well, the WHO and partners are working to conduct rapid assessments, alert and outbreak investigations and confirmation; establish Cholera Treatment Centres and infection prevention and control; engage in active surveillance as well as supervising safe burial of the deceased.
The MOH, with the support of WHO, UNICEF, MSF, and Medair, have conducted oral cholera vaccination campaigns in February 2014, achieving more than 80 percent vaccine coverage in Tomping and Juba camps of 33,000 internally displaced persons (IDPs) in an effort to prevent a possible cholera outbreak among those IDPs.
Despite efforts to corral the outbreak, the sheer number of rising cases in Juba paint a worrisome picture for health officials.
“There is a risk of the outbreak spreading to other surrounding counties and villages if community interventions are not rigorously conducted,” WHO said in a statement, as cited by Radio Tamazuj. “Plans and budgets for community level interventions have been developed, however their implementation is challenging due to financial constraints.”
Health officials warn that most cholera cases being contracted are coming from drinking from unsafe water sources, eating foods from roadside markets, or practicing poor hygiene. It can also be contracted from contact with the body of someone who died from the disease.
According to WHO, new cases and deaths attributed to Ebola virus disease (EVD) outbreak continue to be reported from new (Telimele and Boffa) and already-affected districts (Conakry and Macenta). These districts had previously been report-free for more than 42 days. Since the last update on May 28, 10 new cases and seven new deaths have been reported.
As of May 28, a total of 291 clinical cases of EVD, including 193 deaths have been reported. The classification of these cases are as follows: 172 confirmed cases and 108 deaths; 71 probable cases and 62 deaths; 48 suspected cases and 23 deaths. Gueckedou has by far seen the most cases with 179, including 133 deaths, followed by Conakry, Macenta and others.
As of May 29, one suspected case was reported in Liberia. The case, reported from the Foya district, resulted in death. The case is currently under investigation by Liberia and Sierra Leone officials.
In Sierra Leone, a total of 34 new cases (seven confirmed, three probable, and 24 suspected) were reported as of May 29, 2014. One suspected death has also been reported from the five affected districts. The cumulative number of clinical cases of EVD in Sierra Leone is now at 50, including six deaths.
The rise in new EVD cases in Sierra Leone has concerned staff from British-owned and operated London Mining, resulting in a number of “non-essential” employees at its Marampa mine to pack up and leave the country. The firm has restricted some travel to the area but said production in the mine was unaffected.
The company said it was working with local and international agencies to monitor the situation.
The 50 clinical cases in Sierra Leone is troublesome, given that the disease is highly contagious and incurable, and also the fact that neighboring Guinea has seen more than 100 deaths since the outbreak began.
London Mining said essential staff would continue to travel in and out of the country and it would carefully continue to monitor the health of all its employees. So far, the company reported that eight employees have already departed the country.
"Following consultation with the relevant authorities, [London Mining] has imposed restrictions on travel in the region and continues to work with employees to promote awareness of the disease, including the provision of information on how it is transmitted and the signs and symptoms,” the mining firm said in a statement to the BBC. "A number of non-essential personnel have left the country due to voluntary restrictions on non-essential travel.”
"London Mining has also established proactive health monitoring of the workforce, including working with trained personnel to screen all staff and visitors entering our sites, and has ensured the Marampa facility has the appropriate medication and equipment to manage any potential occurrences of the disease,” it added. "Production at Marampa is not currently affected."
Ebola is spread from person to person by contact with infected blood, body fluids or organs or through contact with contaminated environments. While Sierra Leone is doing what it can to limit the spread of the disease, families of several infected patients went to a rural clinic and forcibly removed their relatives, stating they wanted traditional African care for their families.
It is this contact and removal of infected patients that may have resulted in further spread of the disease, according to BBC international development correspondent Mark Doyle.
WHO and its partners have deployed experts to both Sierra Leone and Guinea to support the outbreak response. Tasks include coordination, disease outbreak investigation, risk assessment, establishment of treatment facilities, case management, infection prevention and control in the newly affected districts, and social mobilization targeting the resistant communities.
In Sierra Leone, WHO and partners have established a treatment center in Koindu and are coordinating lab testing of samples from Kailahun district, Sierra Leone to be tested in Gueckedou, Guinea.
Middle East respiratory syndrome-coronavirus (MERS-CoV) continues its wrath in Saudi Arabia, with six new cases between May 31 and June 2, 2014. The new cases occurred in Jeddah, Al Jawf, Mecca, and Qunfudhah. Five of the patients were men with ages between 31 and 57 years of age. The 31-year-old patient had contact with another MERS patient before getting sick himself, according to the Saudi Arabian Ministry of Health.
In one case, a 42-year-old man from Al Jawf died from the illness. As well, the MOH reported two deaths in previously reported cases, one in a 55-year-old man from Riyadh and another in a 45-year-old woman from Jeddah. As well, one case reported from Jordan has resulted in death of the patient – a 69-year-old man who had diabetes, dying on May 28, five days after hospitalization. His death raised Jordan’s death toll from MERS to six since the outbreak began in April 2012.
For the most part, MERS has largely been contained to the Middle East. However, some cases have been confirmed outside the region, with just a few cases each in several neighboring countries, such as France, Italy, Germany, and Tunisia, all confirmed in 2013.
In 2014, the first American case of infection from MERS was reported one month ago. Since then, two other people have reportedly been infected with the SARS-like disease, with only one other being confirmed and making a full recovery after showing only limited symptoms.
Shortly thereafter the disease was discovered in the Netherlands, with at least two patients confirmed as having the deadly disease.
Now, the disease has shown up for the first time in another country in Africa. The first African case was confirmed in Tunisia last fall.
WHO reported on May 31 that two men from Algeria who had gone on an Umrah pilgrimage to Saudi Arabia have contracted MERS. WHO’s Regional Office for Africa said the two Algerian cases involved a 66-year-old man and a 59-year-old man who were both in Saudi Arabia but had not traveled together.
The 66-year-old sought care for fever and dyspnea after arriving in Algeria from Mecca on May 23. The younger man got sick with flu-like illness and diarrhea while in Saudi Arabia on May 23. Upon return to Algeria he was hospitalized on May 29.
A MERS-CoV diagnosis was given to both men on May 30, according to the WHO statement. No additional details about the men’s conditions were given, their possible exposures while in Saudi Arabia, or who they had contact with and if monitoring was being conducted.
Algeria is the 21st country to report MERS. Iran also reported two cases last week in women who had also gone on a pilgrimage to Saudi Arabia, according to CIDRAP.
The World Health Organization has maintained a presence in each of the countries infected with the all three outbreaks. In response to all outbreaks – cholera, Ebola and MERS-CoV – WHO does not currently recommend any trade or travel restrictions within any country or region affected by one or more of the outbreaks.