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Date: Fri 14 Oct 2016
Source: Health Protection Surveillance Centre (HPSC) [edited]

Latest annual reports on HIV and sexually transmitted infections (STIs), and preliminary data for the 1st 6 months of this year [2016], published by the HSE [Health Service Executive] Health Protection Surveillance Centre (HPSC) show increases in notifications of HIV, syphilis, and gonorrhoea in Ireland, particularly among men who have sex with men (MSM) (1,2).

While the number of cases of most STIs [sexually transmitted infections] remained relatively stable in 2015 compared to 2014, the multisectoral national group established early in 2016 to respond to these recent increases has expressed concern about a 50 percent increase in syphilis, and a 30 percent increase in HIV cases in 2015.

Although some of the increase in HIV can be explained by a change in the notification procedures for HIV and an outbreak in people who inject drugs, these increases have largely been seen in men who have sex with men (MSM). MSM account for 4/5 of the syphilis cases, and more than half of the HIV cases.

For HIV, an increasing proportion of MSM born abroad, and particularly from Latin America, who were HIV positive before coming to Ireland, has contributed to this. There are also increases in the number of MSM from abroad who report acquiring HIV in Ireland.

In addition, although gonorrhoea numbers in 2015 were similar to 2014, latest data for 2016 show that gonorrhoea rates in men have risen by 63%. This has been seen only in men, suggesting that this increase is occurring mainly in MSM. In 2015, 55% of cases of gonorrhoea were in this group [MSM].

A recent survey on sexual behaviours in MSM in Ireland (MISI 2015 [Internet Survey Ireland]) (3), reported that 25 percent of men have had condomless anal intercourse with more than one partner in the last year, posing a risk of acquiring or transmitting HIV and STIs. 37 percent of men had never been tested for HIV and 38 percent had never been tested for an STI.

Promoting condom use and regular testing remain key to limiting the spread of HIV and STIs in men who have sex with men.

The Gay Health Network along with the HSE and other partners, including peer groups, are continuing to promote sexual health awareness, encourage testing and support safer sex among MSM through the <> programme. The Gay Men's Health Service is offering a new clinic in Dublin on Monday afternoons, on a pilot basis, to improve access to testing for MSM. Furthermore, in partnership with the Gay Health Network, outreach workers are being employed on a pilot basis to deliver peer support and interventions among the MSM community, in particular among Latin American MSM in Dublin.

Safer sex using condoms is an effective way of preventing HIV and other STIs. Men who have sex with men and who have taken a sexual health risk are encouraged to get tested for HIV and STIs. Details of free HIV and STI testing services, condoms, support, and information are available at <> or from Gay Switchboard Ireland or <>.

1. STI notifications from CIDR (computerised infectious disease reporting system), quarters 1 & 2 2016. 29 Sep 2016

2. HIV in Ireland, quarters 1 & 2 2016 (provisional). 5 Oct 2016

3. Findings from the men who have sex with men (MSM) Internet survey, Ireland (MISI 2015). 10 Jun 2016
[Provisional data for the 1st 6 months of this year (2016) have been published by the Health Protection Surveillance Centre (HPSC) (references 1 and 2 above). For gonorrhea, the number of reported cases increased 58.7 percent in the 1st 2 quarters of 2016 compared to the 1st 2 quarters of 2015, that is, 873 vs 550, respectively; and for HIV, the number of cases increased 34 percent in the 1st 2 quarters of 2016 compared to the 1st 2 quarters of 2015, that is, 273 vs 203, respectively. However, there has been no rise in reported primary and secondary (P&S) syphilis cases; the number of cases of P&S syphilis remained stable in the 1st 2 quarters of 2016 compared to the number in the 1st 2 quarters of 2015, that is, 105 vs 107, respectively. In the 1st 2 quarters of 2016, for gonorrhea, 40 percent of cases occurred in MSM and for syphilis, 82.9 percent occurred in MSM. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri 14 Oct 2016
Source: Vancouver Coastal Health [edited]

Vancouver Coastal Health [VCH] is warning customers not to consume any produce or ready-to-eat foods made in-house at Foody World, at 3000 Sexsmith Road in Richmond, due to possible listeria contamination. So far at least 6 people have been hospitalized due to the illness.

Potentially contaminated items include all ready-to-eat meat products such as BBQ pork and marinated meats, sushi, produce, and baked goods purchased since July 2016. If you have any produce, ready-to-eat or raw food items from Foody World, please dispose of them immediately.

Symptoms of listeriosis include fever, headache, diarrhea, vomiting, and muscle aches. Listeriosis can also cause serious illness such as meningitis or blood infections in pregnant women and newborns, those with weakened immune systems and older adults or seniors. Symptoms typically start within 4 weeks after consuming, but can appear up to 10 weeks later.

If you think you have an infection caused by listeria, see a doctor for testing, advice and treatment. VCH Public Health will follow-up with any patients whose lab results are positive for listeria. Most healthy people require no treatment, however, those at higher risk of serious illness can be treated with antibiotics.

VCH public health inspectors have closed the store and kitchen. The store will be reopened once it meets all health and safety standards.

For more information about the food recall, members of the public can call Vancouver Coastal Health - Health Protection at 604-233-3147 and ask to speak to a senior environmental health officer. Further information is available at the following websites: BC Centre for Disease Control - listeria/listeriosis
HealthLinkBC - listeriosis
HealthLinkBC - Chinese version
Government of Canada - food poisoning
[The news report above fails to identify any specific food product, bought at Foody World, that is suspected to be contaminated by _Listeria monocytogenes_, the cause of listeriosis. More information on this outbreak would be appreciated from knowledgeable sources.

Foody World is an Asian supermarket (<>) located in Richmond, a coastal city that is part of the Metro Vancouver area in the Canadian province of British Columbia; Richmond has an immigrant population of 60 per cent, the highest in Canada, with over 50 per cent of residents identifying as Chinese (<,_British_Columbia#Demographics>).

For discussions about listeriosis, please see my comments in ProMED-mail posts: Listeriosis, fatal - USA: (CO) and Listeriosis, fatal, meat product - Canada: (ON) - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 12 Oct 2016
Source: Dove Press, Vol 10: 3345-3353 [edited]

R E Thomas. Yellow fever vaccine-associated viscerotropic disease: current perspectives.
Purpose: To assess those published cases of yellow fever (YF) vaccine-associated viscerotropic disease that meet the Brighton Collaboration criteria and to assess the safety of YF vaccine with respect to viscerotropic disease.

Literature search: 10 electronic databases were searched with no restriction of date or language and reference lists of retrieved articles.

Methods: All abstracts and titles were independently read by 2 reviewers and data independently entered by 2 reviewers.

Results: All serious adverse events that met the Brighton Classification criteria were associated with 1st YF vaccinations. 62 published cases (35 died) met the Brighton Collaboration viscerotropic criteria, with 32 from the US, 6 from Brazil, 5 from Peru, 3 from Spain, 2 from the People's Republic of China, one each from Argentina, Australia, Belgium, Ecuador, France, Germany, Ireland, New Zealand, Portugal, and the UK, and 4 with no country stated. 2 cases met both the viscerotropic and YF vaccine-associated neurologic disease criteria. 70 cases proposed by authors as viscerotropic disease did not meet any Brighton Collaboration viscerotropic level of diagnostic certainty or any YF vaccine-associated viscerotropic disease causality criteria (37 died).

Conclusion: Viscerotropic disease is rare in the published literature and in pharmacovigilance databases. All published cases were from developing countries. Because the symptoms are usually very severe and life threatening, it is unlikely that cases would not come to medical attention (but might not be published). Because viscerotropic disease has a highly predictable pathologic course, it is likely that viscerotropic disease post-YF vaccine occurs in low-income countries with the same incidence as in developing countries. YF vaccine is a very safe vaccine that likely confers lifelong immunity.
[It is helpful to have an updated evaluation of YF vaccine safety and the occurrence of viscerotropic post-vaccinal disease (YEL-AVD). Even though the risk of severe disease resulting from YF vaccination is extremely small, public fear can lead to individuals refusing the vaccine. Fortunately, this fear did not appear to be a complication in the current vaccination campaigns in Angola or the DR Congo. RJ Seligman commented (ProMED-mail archive no., "it has been stated that suspicion of yellow fever was ruled out because the patients had been vaccinated. It is certainly true that many causes of illness mimicking yellow fever exist. One of these is the rare occurrence of reactions to the vaccine itself. Such cases have been labeled yellow fever vaccine-associated viscerotropic disease (YEL-AVD) (Seligman SJ. Risk groups for yellow fever vaccine-associated viscerotropic disease (YEL-AVD). Vaccine 2014;32:5769-75). No cases of YEL-AVD have been laboratory-confirmed in Africa. All of the laboratory-confirmed cases of YEL-AVD have occurred either in South America or in prospective travelers. One knows that responding to an ongoing yellow fever epidemic with mass vaccination campaigns and with mosquito control measures is extremely challenging. However, if cases mimicking yellow fever occur in vaccinated persons, specimens should be sent for viral culture and tissue preserved by freezing. If the virus turns out to be vaccine-like rather than yellow fever, the diagnosis of YEL-AVD is confirmed and tissue sent for study to see if there is a genetic immune defect that predisposes to YEL-AVD (Seligman SJ, Casanova JL. Yellow fever vaccine: worthy friend or stealthy foe? Expert Rev Vaccines 2016;15:681-91)." During the YF outbreak in Uganda this year (2016) there was concern about vaccine administration to HIV immunocompromised individuals and there was one YF vaccine associated death reported, but apparently without laboratory confirmation.

YEL-AVD cases are not the only concern. A 4 Jul 2016 study (ProMED-mail archive no. reported to the Vaccine Adverse Event Reporting System from 2007 through 2013 indicated that there were 938 adverse events (SAEs including anaphylaxis, YF vaccine-associated neurologic disease (YEL-AND) and YF vaccine-associated viscerotropic disease (YEL-AVD) following YF vaccination. Of these, 84 (9 per cent) were classified as SAEs for a rate of 3.8 per 100 000 doses distributed. Reporting rates of SAEs increased with increasing age, with a rate of 6.5 per 100,000 in persons aged 60-69 years and 10.3 in persons 70 years or older. The reporting rate for anaphylaxis was 1.3 per 100 000 doses distributed and was highest in persons 18 years or older (2.7 per 100 000). Reporting rates of YEL-AND and YEL-AVD were 0.8 and 0.3 per 100,000 doses distributed, respectively; both rates increased with increasing age.

The YF vaccine in use currently is a very safe one. The risk of death due to YF itself during an outbreak is considerably higher than the risk of adverse vaccine effects. - ProMED Mod.TY]
Date: Thu 13 Oct 2016
Source: Daily News & Analysis (DNA) [edited]

In 2005, India had proudly declared itself free from leprosy. Yet, current figures show that this is far from the truth. According to figures accessed by DNA by the Ministry of Health and Family Welfare (MoHFW) cases of the dreaded diseases have been increasing year by year.

In 2015-16, India recorded 127,326 cases of leprosy, an increase of 1.22 per cent from last year [2014-15] when 125 785 cases of leprosy were detected. In fact since 2005 cases of grade II or permanent disabilities due to leprosy have constantly been rising over the past decade. In 2007-08, 3477 cases of disability were recorded. This has now risen to 5857 cases in 2015-16 -- an alarming 68 per cent. "The rise in cases of disability is a bad sign. This disability occurs when an active case of leprosy infection goes unreported for a long time and is untreated for over two years of active infection," said Dr Anil Kumar, deputy director general (Leprosy), MoHFW.

Leprosy is an airborne infection, which attacks persons with low immunity. It may lead to permanent disability if not detected and treated in time. Doctors say that a case of leprosy will start showing signs of disability like loss of fingers and toes in 2 years since the setting in of the infection. If symptoms like discolouration, oily patches or nodules on the skin are reported early, disability can be avoided by starting timely treatment.

The spike in cases has raised alarm bells in the Indian government. Even as leprosy stood eliminated from India, which means less than one case was recorded in a population of 10 000 or one lakh, the MoHFW is now launching a massive screening campaign to pick up cases of infection in 19 high risk states.

Starting [5 Sep 2016], the MoHFW launched a campaign to screen 32 crore [320 million] persons in Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Maharashtra, Nagaland, Odisha, Tamil Nadu, Uttar Pradesh, Uttarakhand, West Bengal, Chandigarh, Dadra & Nagar Haveli, Delhi, and Lakshadweep.

For a country as diverse and populous as India, elimination of leprosy at 'national' level can be misleading. In the recent most mass screening, MoHFW notes that it intends to cover all districts in high-burden states that have a prevalence rate of more than one leprosy case in a population of 10,000 in the past 3 years. Health officials admit that certain pockets in such districts record a prevalence of as high as 8 cases of leprosy in a population of 10,000.

'Elimination' means recording less than one case of prevalence of a disease in a population of 10 000. On the other hand, 'eradication', means reducing the incidence of the disease to zero and not recording any more cases of that disease. According to available data, 3 in every 10 000 persons in Chhattisgarh are actively infected with leprosy, while in Odisha 2 in every 10,000 persons are infected. In Delhi, Chandigarh and Gujarat, the prevalence is more than 1 case in a population of 10,000.  [byline: Maitri Porecha]
[Although India achieved nationally what WHO refers to as "the elimination of leprosy as a public health problem" (that is, a prevalence of less than one case per 10 000 population) in December 2005 (<>), leprosy has not been eradicated in India. In 2015 India contributed 60.4 per cent of new cases of leprosy detected worldwide (<>).

In 2015, 51.3 per cent of new cases in India had multibacillary [infectious] leprosy, which is an indication of the proportion of new cases with contagious disease in the community; 8.9 per cent of new cases occurred in children, which is an indication of ongoing disease transmission; and 4.2 per cent of new cases of leprosy had chronic deformities and disability, which reflects problems in case finding (<>).

For a discussion of the problems of leprosy control in India, see my ProMED moderator comments in ProMED-mail posts Leprosy - India (03): (GJ) increased incidence, comment, Leprosy - India (02): (GJ) increased incidence, and Leprosy - India (05): (MH) comment - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 22 Sep 2016
Source: The Kathmandu Post [edited]

_Vibrio cholerae_, the bacterium that causes cholera, has been found among the diarrhoea patients of Koiladi, Saptari [district, Province Two].

Bijaya Kumar Jha, a senior health administrator at the district public health office, said 2 of the 4 stool samples tested positive for cholera. "2 samples tested positive during the laboratory test at Sagarmatha Zonal Hospital. The preparation is on to send some samples to the national public health laboratory in the capital," said Jha. Scores of people in Koiladi are suffering from diarrhoea, officials said. A medical team provided treatment to 74 seriously ill people on [20 and 21 Sep 2016].

"We are trying our best to control the disease. Health teams have been deployed in the affected area. We have arranged treatment at the zonal hospital for the seriously ill," said Jha.

Health experts from the epidemiology and disease control division and WHO have also arrived in the district to study the disease.
[A HealthMap/ProMED-mail map of Nepal can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]

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

As cited in Lutwick LI, Preis J: Cholera. In: Tropical pediatrics. Roach RR, Greydanus DE, Patel DR, Homnick DN, Merrick J (eds), 2014, Nova Science Publishers, 2015, oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

"As reviewed by Richard Guerrant and colleagues (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 first 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, references 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 (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 reference 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; available at
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; available at
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, et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4): 197-205; available at
5. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009; 104(10): 2596-604;
6. WHO. The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005; available at

An illustration (supplied by ProMED Mod.JW) of how to make a "home brew" oral rehydration solution can be found at
Date: Tue 11 Sep 2016 12:10
Source: [in Spanish, machine trans., edited]

WHO announced today, 11 Oct 2016, that it has detected at least 11 cases of cholera in the capital, Sana'a, and another 143 cases of severe diarrhoea, which include 17 people who may have contracted the disease. Omar Saleh, responsible for emergencies at the WHO Office in Sana'a, explained at a press conference that a total of 1243 epidemic recording centres are now collecting information nationwide to determine the spread of cholera.

The supervisor of the Department of Epidemiological Isolation at the Al Sabain Hospital in Sana'a, where patients have been treated, told Efe [news agency] that among them there are 8 people from the same family suffering from acute diarrhea, vomiting, and fatigue.

Yuber Sadiq said that these are the 1st cases that have reached the hospital, where they are surprised by the appearance of cholera, which spreads very fast through water and vegetables.

In Yemen, thousands of families live in unsanitary conditions in camps for displaced persons since the resurgence of the war in March 2015, when the Arab coalition led by Saudi Arabia against Shiite rebels intervened in the country. In May 2015, the NGO Oxfam reported that nearly 2/3 of the Yemeni population, about 16 million people, had no access to drinking water, due to aerial bombing, fighting, and lack of fuel in the Arab state, which is the poorest in the region.

According to Oxfam, the population is being forced to drink unsafe water. Because of the destruction of infrastructure, which increases the risk of diseases potentially life threatening, such as malaria, cholera, and diarrhoea.
[A HealthMap/ProMED-mail map of Yemen can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]
Cholera - Yemen
Date: Fri 7 Oct 2016
Source: UNICEF (United Nations Children's Fund) [edited]

Health authorities in Yemen confirmed a cholera outbreak on Thu 6 Oct 2016, posing an increased health risk to the population -- especially children -- given the crumbling health system in the country. "This outbreak adds to the misery of millions of children in Yemen. We are supporting health centres to prevent and treat cholera cases and will continue working with partners to scale up the response and stem this dangerous disease," said UNICEF representative in Yemen, Julien Harneis.

Health authorities announced that cholera cases have been confirmed in the capital, Sana'a, while others are suspected in the south western city of Taiz. UNICEF and partners are working to establish the exact scale of the outbreak. If not treated, severe cases of cholera can kill up to 15 per cent of people affected in just a few hours.

"Children are at a particularly high risk if the current cholera outbreak is not urgently contained, especially since the health system in Yemen is crumbling as the conflict continues. Mr Harneis said. "We appeal to all donors to support health facilities across Yemen so that civilians in need get medical assistance."

UNICEF in partnership with the World Health Organization is supporting the response to the outbreak through delivering and securing safe water and water purification supplies. UNICEF has in place 57 diarrheal disease kits, each containing medicine, including oral rehydration salts (ORS), enough to treat 100 severe or 400 mild cases of cholera. In addition, 20 000 hygiene kits with soap, towels, shampoo, and washing powder are ready to be distributed.
Date: Thu 22 Sep 2016
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb [edited]

An initial 3 cholera cases were reported in So-Ava [Atlantique Department] and an outbreak was declared on 16 Aug 2016 by local government authorities. Reported and verified cases were few in the early weeks and considered manageable by local authorities, but a sharp and heightened spike in the number of confirmed cases between 25-30 Aug 2016 in the 3 main areas of Cotonou [Littoral Department], Savalou [Collines Department] and So-Ava resulted in a request from Benin Red Cross Society to IFRC [International Federation of Red Cross and Red Crescent Societies] for support through DREF [Disaster Relief Emergency Fund] to respond. As of 4 Sep 2016, a total of 281 cases and 9 deaths were recorded with a 3.20 per cent case fatality rate, with Cotonou the most affected area to date. (IFRC, 12 Sep 2016)

As of 22 Sep 2016, 13 districts out of 77 and 6 departments out of 12 have registered cases of cholera, for a total number of 508 cases. (UNICEF, 22 Sep 2016)
[A HealthMap/ProMED-mail map of Benin can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]
Date: Thu 22 Sep 2016
Source: PM News [edited]

Lagos State Government says it has recorded 6 deaths from cholera outbreak out of 45 cases in some communities in Isolo Local Council Development Area (LCDA). Dr Jide Idris, the state commissioner for health, who made the disclosure on [Thu 22 Sep 2016] at a news conference in Lagos, however, was not specific about the timing of the incident. Idris said that state government was already taking appropriate measures and had contained the outbreak.

According to him, the ministry was notified of an upsurge of diarrhoea diseases in some communities in Isolo LCDA. "Following this, 45 cases were line-listed by the epidemiology unit of the ministry. 6 deaths were recorded among the 45 cases. Most of the cases did not present with the classical rice-water stool, rather they presented with atypical diarrhoea and vomiting. Ano-rectal swabs were collected from 15 cases and taken to the Central Public Health Laboratory, Yaba. Initially, there were no growths; however, continuous culture yielded _Vibrio cholerae_ from 7 out of the 15 samples," he said.

The commissioner said that the "_Vibrio cholerae_ was later confirmed to be Ogawa strain". He said, "The main suspected source of infection is the salad called 'Abacha', a staple food of the residents of Isolo LCDA and adjourning LGAs [Local Government Area]/LCDAs. Some domestic wells within the communities are also suspected. Samples of the 'Abacha salad' and well water were collected and sent to the Lagos State Drug Quality Control Laboratory for analysis. The report of the analysis revealed the presence of _Vibrio cholerae_, _Salmonella_ species, and _Escherichia coli_ in 'Abacha' and one of the 2 well water samples."
[A HealthMap/ProMED-mail map of Nigeria can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]
Date: Sun 25 Sep 2016 19:05 WAT
Source: Radio Okapi [in French, machine trans., edited]

The governor of Maniema province, Pascal Salumu Tutu, said [Sat 24 Sep 2016] the cholera outbreak in the city of Kindu. The outbreak was confirmed after analysis of samples carried out by the National Institution of Biomedical Research (INRB) in Kinshasa, he said to reporters.

>From epidemiological week 29 [week ending 22 Jul 2016], the health area has recorded 51 cases and 2 deaths due to diarrhea, according Tutu Salumu. It was after the analyses of samples taken and sent to the INRB Kinshasa in epidemiological week 36 [week ending 9 Sep 2016] that "_Vibrio cholerae_ serogroup O1, serotype Ogawa, was isolated, which confirms this epidemic" in Kindu. "I declare a cholera outbreak in the city of Kindu and seek the support of the central government, development and humanitarian partners, as well people of goodwill", said governor Salumu.

The head of the provincial executive recommends people consult the nearest health center in case of severe dehydration from acute diarrhea with or without vomiting. Indeed, the source said, "is all we have to fight effectively to defeat cholera." The provincial government has 2 ambulances to bring all suspected cases in the town and surrounding areas to the hospital and ensure rapid support to infected patients. For quick and effective response against the spread of the disease in the region, UNICEF is working with the provincial government and NGO partners for appropriate emergency measures, indicate local health sources.
[A HealthMap/ProMED-mail map of Congo DR can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]
Date: Wed 5 Oct 2016
Source: UN OCHA (Office for the Coordination of Humanitarian Affairs) [edited]

The 2016 cholera outbreak in South Sudan has now affected 6 counties, with Fangak being the latest to have confirmed cases. As of [3 Oct 2016], 2450 cases and 37 deaths with a case fatality rate (CFR) of 1.51 per cent have been reported compared with 1814 cases and 47 deaths (CFR 2.59 per cent) at the same time in 2015. Although deaths and the CFR are lower in 2016 than in 2015, affected areas have increased.

Other affected areas include Juba and Terekeka in Central Equatoria, Duk and Fangak in Jonglei, Pageri in Eastern Equatoria, and Awerial in Lakes. In Awerial, the outbreak, which began at Mingkaman Internally Displaced Persons (IDP) camp, has spread to the host community, with 4 cases including one death reported in Kalthouk. The 2015 outbreak was confined to Juba in Central Equatoria and Bor in Jonglei. Juba is the worst affected area in 2016, as in 2015.

The spike in conflict in July 2016 and subsequent displacement contributed to the spread of cholera and left many people with inadequate sanitation facilities and insufficient access to clean water, while people exposed to the disease carried it to new areas as they fled. Continued population movement due to the ongoing conflict in the Greater Equatoria has further spread the outbreak to other locations and across the border to the refugee camps in Uganda. IDP camps reporting cases in 2016 include UN House PoC, Tongping UNMISS transit site, Gorom refugee camp, Mahad, Mangatain, and Gumbo in Juba and Nimule.

To contain the outbreak, health and WASH [Water, Sanitation and Hygiene] partners have set up cholera treatment centres and units (CTC/U) and oral rehydration points (ORP) in the affected counties. Health and hygiene promotion among communities are on-going, together with the distribution of water purification sachets and tablets, soap and oral rehydration salts (ORS). 17 radio channels are reaching 2 million people per day with messages on cholera. Local mobile networks are disseminating prevention information to subscribers through bulk messages, while the toll free line -- 1144 -- remains open for the public to report cases and get information.

A total of 29 291 people in the parts of Juba that are worst affected by the outbreak received a single dose of the oral cholera vaccine each between [17 and 20 Sep 2016].
[A HealthMap/ProMED-mail map of South Sudan can be accessed at
<>. - ProMED Sr.Tech.Ed.MJ]