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Date: Sat, 27 May 2017 14:34:41 +0200

London, May 27, 2017 (AFP) - British Airways has cancelled all its flights out of major London airports Heathrow and Gatwick after an IT systems failure, a spokesman for the airline said Saturday.   "British Airways have cancelled all flights until 6.00 pm (1700 GMT) from Heathrow and Gatwick today," the spokesman told AFP.
Date: Fri, 26 May 2017 19:41:22 +0200
By Amal JAYASINGHE

Colombo, May 26, 2017 (AFP) - Flooding and landslides killed at least 92 people and left another 110 missing in Sri Lanka as the monsoon set in Friday, dumping record rainfall in many parts of the island, authorities said.   The official Disaster Management Centre (DMC) reported that over 60,000 people were driven out of their homes in the south and western parts of the country.   "There are some areas where we are unable to reach, but relief operations are under way," deputy minister for disaster management Dunesh Gankanda told reporters in Colombo.    Officials said the toll rose to 92 dead, including a soldier who fell to his death from a helicopter while trying to pull a marooned villager to safety. Another 110 people remain missing.

Sri Lanka issued an international appeal for help as reports came in from areas which had been inaccessible earlier in the day, with neighbouring India sending two shiploads of emergency relief supplies as well as medical teams.   "The first Indian ship will dock at Colombo on Saturday," the Sri Lankan government said in a statement.    The highest number of monsoon-related fatalities were from Ratnapura, the island's gem hub, where the Kalu river burst its banks and inundated the main town which is about 100 kilometres (60 miles) east of Colombo.   Nearly 500 homes were either damaged or destroyed due to flooding as well as landslides, DMC director of operations Rear Admiral A. A. P. Liyanage told AFP.    Most of the deaths were due to mountainsides collapsing on homes after heavy overnight rain, he said.

- Evacuation orders -
The met department said the worst of the rains may be over, but there could be downstream flooding in the next few days and the authorities issued evacuation orders for thousands of people.   "The monsoon has firmly established and we could have evening showers at a lesser intensity", met department chief S. R. Jayasekera told reporters in Colombo.   The government arranged temporary shelters in schools and other public buildings for people in low-lying areas to move in, the DMC said.   The military has deployed thousands of troops to reach marooned villagers and the airforce carried out several rescue operations to pluck people from rooftops of flooded homes.   The latest flooding was the worst since May 2003 when 250 people were killed and 10,000 homes destroyed after a similarly powerful Southwest monsoon, officials said.

In the early hours of the day a mountainside collapsed on a women's hostel at a tea plantation at Neluwa in the island's south, killing at least seven women, police said.   DMC officials said the monsoon had been expected on Thursday night and ended a prolonged drought that had threatened agriculture as well as hydropower generation.   The rains filled the reservoirs used for hydroelectric projects after low supplies had raised fears of power shortages in June.   But officials said most reservoirs were now so full they were in danger of spilling over and flooding communities living downstream.
Date: Thu 25 May 2017
Source: Outbreak News Today [edited]

California state health officials said they are working with local public health departments across the state to help control norovirus outbreaks that have increased in the past few weeks, and are occurring in schools and other institutional settings.

"Norovirus outbreaks usually have an annual peak like we are seeing now. They can be particularly large and disruptive in schools, affecting both students and teachers," said CDPH [California Department of Public Health] Director and State Public Health Officer Dr Karen Smith. "Norovirus is very infectious and can spread rapidly wherever people congregate and share food and bathroom facilities. Fortunately, most people with norovirus infection will recover quickly, usually in 1-3 days."

In Yolo County, which has been hit very hard by norovirus, announced the Woodland Joint Unified School District (WJUSD), has decided to close Dingle and Tafoya elementary schools on Fri 26 May 2017, to limit further transmission of the norovirus in these 2 schools, which have experienced particularly high rates of the illness.

Current reported numbers of affected students and school staff in Yolo County since 1 May 2017 is 3374.

The Centers for Disease Control and Prevention (CDC) estimates that there are between 19-21 million cases of norovirus illness each year in the US. Additionally, CDC estimates that norovirus contributes to 56 000-71 000 hospitalizations and 570-800 deaths each year in the US. The spread of norovirus can be prevented by practicing proper hand hygiene. Important strategies include washing hands with soap and water, especially after using the toilet and changing diapers, and always before eating and preparing or handling food.

Symptoms of norovirus [infection] include fever, nausea, vomiting, diarrhoea, and stomach pain. Symptoms last for 1-3 days. However, after symptoms go away, people are still highly infectious, especially the 1st 48 hours. There is no treatment for norovirus illness. The most important steps to prevent the spread of norovirus is to stay home if you are sick, and for another 48 hours after symptoms go away, and to regularly wash hands.
=====================
[The state of California can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/promed/p/3958>.

Yolo County can be seen on the map at
<http://geology.com/county-map/california-county-map.gif>. - ProMED Sr.Tech.Ed.MJ]

See ProMED mail Norovirus - USA (04): (CA) http://promedmail.org/post/20170513.5034178, which reported 33 cases in students and 5 in teachers early May 2017 in Yolo county, which then increased to 950 cases in Yolo County by 12 May 2017, and now 3374 cases since 1 May 2017, a major increase.

In 2013, the BBC reported a new strain of norovirus may have been the reason for the sharp rise in cases the UK observed (<http://www.bbc.com/news/av/health-20982721/why-has-norovirus-been-so-bad-this-winter>). A new variant, Sydney 2012, became the dominant strain in England and Wales. Because people were less immune to this new strain, it spread quickly. More than a million people are thought to have had norovirus during that outbreak, 63 percent higher than the same time the prior year. Perhaps a change in viral strain is also the reason the outbreak in California is so large this year.

In the US, between September 2013 and August 2016, 2715 genotyped norovirus outbreaks were submitted to CaliciNet. GII.4 Sydney viruses caused 58 percent of outbreaks during these years. Acquisition of alternative RNA polymerases by recombination is an important mechanism for norovirus evolution and a phenomenon that was shown to occur more frequently than previously recognized in the US. The authors concluded that continued molecular surveillance of norovirus strains, including typing of both polymerase and capsid genes, is important for monitoring emerging strains in continued efforts to reduce the overall burden of norovirus disease (excerpted from Cannon JL et al: Genetic and epidemiologic trends of norovirus outbreaks in the US demonstrated emergence of novel GII.4 recombinant viruses, 2013-2016. J Clin Microbiol. 2017; pii: JCM.00455-17. doi: 10.1128/JCM.00455-17; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/28490488?dopt=Abstract>). - ProMED Mod.LK]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 25 May 2017 04:07 IST
Source: The Hindu [edited]

Hospitals in the capital town saw an unusual rush over the past week with several hundred people testing positive for jaundice after allegedly consuming polluted water.

People from numerous suburbs have now complained about the alleged supply of contaminated and non-chlorinated water by the municipal and IPH authorities here. "The authorities are not adding the required bleaching powder to the water sources and muddy water is coming from the taps," complained a resident who had fallen sick, even as many others echoed his concerns.

Bleaching powder or hypochlorite is an inorganic compound used for treating water and is often used by the authorities here. The untimely arrival of rain and a massive hailstorm a few days ago also resulted in the contamination of drinking water sources.

More than 20 people died in the State last year [2016] after the Jaundice epidemic started from Shimla. A major drinking water source of the town, Ashwani Khad was found polluted by the nearby sewerage pipelines.
===================
[There have been multiple media reports in 2016 and early 2017
reporting jaundice cases associated with sewage contamination of water source.

It is possible that the surge being reported is another outbreak linked to contaminated water reservoirs, which could have been precipitated due to heavy rainfall.

Among various infectious causes of jaundice, hepatitis A and hepatitis E viruses are commonly acquired through water. Contaminated water is generally considered the main source of infection. Water may be infected either due to poor personal hygiene of food vendors or to sewage contamination of drinking water.

If jaundice occurs in a large population around the same time, we should suspect contamination of the drinking water with sewage water.  Infectious jaundice can also develop after drinking contaminated bore well water, or by drinking stream water directly without purification. The spread of water borne infections such as hepatitis A can be reduced by:
 - Adequate supplies of safe drinking water;
 - Proper disposal of sewage within communities; and
 - Personal hygiene practices such as regular hand-washing with soap and safe water. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 25 May 2017
From: Sher Bahadur Pun <drsherbdr@yahoo.com> [edited]

On 23 May 2017, as many as 50 people from AdamTar-6, Dhading district [Province Three], fell ill after consuming food (Prasad) in a ceremony known as Shradh Puja. On 24 May 2017, 22 of them, were admitted to Sukraraj Tropical and Infectious Disease Hospital (STIDH), while remaining patients are also expected to reach to STIDH soon. According to patients, close to 100 relatives participated in the ceremony on that day. Symptoms such as watery diarrhoea, vomiting, stomach pain, headache, fever developed 8-12 hours after eating Prasad. They are now in stable condition and are currently under medical care.

Every year, several foodborne outbreaks are reported in Nepal. However, identification of the cause of these outbreaks has never been attempted or achieved by the concerned authorities.
---------------------------------------
Dr Sher Bahadur Pun, MD, PhD
Clinical Research Unit
Sukraraj Tropical and Infectious Disease Hospital
Kathmandu
Nepal
=======================
[As written by Dr Pun who ProMED thanks for his submission, it is not likely that an etiology will be identified, but with fever associated with vomiting and diarrhea, an etiology such as salmonellosis may be behind the episode. Bacterial toxin associated enteric diseases, such as those linked to _Staphylococcus aureus_ or _Clostridium perfringens_, are not generally associated with fever. - ProMED Mod.LL]

[Maps of Nepal can be seen at
<http://healthmap.org/promed/p/18543>. - ProMED Sr.Tech.Ed.MJ]
Date: Wed 24 May 2017 10:30 PM NPT
Source: The Himalayan Times [edited]

[DL], 32, had gone to Dolpa [Province Six] in 2016. After staying there for about 3-4 months he was back in Kathmandu on [11 Oct 2016]. Upon his return, he noticed blisters on his nose and cheeks. Dismissing it as pimple, he bought a pimple cream from a local pharmacy in Bhaktapur but the cream didn't work. Rather the size of the blisters increased. In an attempt to treat it, he squeezed making them more reddish, and the shape changed too. So, he visited a hospital in the Capital [Kathmandu] where he was given medicines for tuberculosis. But that medicine worsened the infection. Later he was referred to Sukraraj Tropical and Infectious Disease Hospital, Teku [Kathmandu] and its Consultant Tropical Medicine Physician Dr Anup Bastola diagnosed it as 'cutaneous leishmaniasis'.

"It was quite an unusual skin infection. After some tests it was discovered that he was suffering from cutaneous leishmaniasis," the doctor informed. "Leishmaniasis is caused by the protozoan leishmania parasites. They are transmitted by the bite of an infected female phlebotomine sand flies. And among the 3 main forms of leishmaniasis, [DL] was diagnosed with the most common one -- cutaneous leishmaniasis, CL. There are about 20 species of _Leishmania_ that may cause cutaneous leishmaniasis."

As per Dr Bastola, this is an emerging disease in the country. He informed, "The cases of cutaneous leishmaniasis have been seen in areas like Dharan [Province One], Makwanpur and Dhading [Province Three], Tanahun [Province Four], Nepalgunj [Province Five], and Dolpa [Province Six] in the country. From 2016 till February 2017, 4 such cases have been identified in the Teku-based hospital. In addition, 8 cases have also been reported from the far western development region while 2 cases from Dharan."

As an emerging disease, they are still researching about the species of _Leishmania_ that is infecting people here.

The infection is transmitted by infected phlebotomine sand flies. "Sand flies become infected by sucking blood from an infected animal or person. As the parasites are found in rodents, these sand flies feed on them and when they bite a healthy person, they transmit the infection," Dr Bastola shared. Nepal has a favourable climate for its survival, the sand flies are found here too, which puts people at risk.

 "When someone is infected with leishmaniasis, a red lesion starts as a papule or nodule at the site where the sand fly has bit. It grows slowly and increases in size. In the early stage it seems to be like a pimple," clarified Dr Bastola.

He added, "A crust develops centrally. The patient feels mild itching in the infected area, red juicy plaque-like crusting too are likely to appear. However, at times it can be asymptomatic and can be destructive too. It depends upon the species of leishmania you are infected with."

With the medicines and diagnostic tools currently available in the country, adequate control of leishmaniasis is possible, Dr Bastola said. However, he insisted that dermatologists must be aware about the infection in advance so that they can diagnose the disease in its early stages.

For others, the doctor advised to "keep surroundings clean, try not to come out in the evenings unless necessary, wear full sleeved clothes, not to forget to use mosquito repellents to be safe from the bites of sand flies".
=====================
[Leishmaniasis is endemic in Nepal. Visceral leishmaniasis is endemic in a few provinces in Southern Nepal bordering India, with one district reporting 5-10 cases per 10,000 population and the rest 1-5 or less than one (see map and graphs with annual reported number of cases at <http://www.who.int/leishmaniasis/resources/NEPAL.pdf>), and cutaneous leishmaniasis (CL) is very rare (see archive no. http://promedmail.org/post/20161002.4531103).

The _Leishmania_ from a previous case of cutaneous leishmaniasis in Nepal was typed as _L. major_. Cutaneous leishmaniasis in the Western Himalayas is known to be caused by. _L. major_ and _L. donovani_ (Katakura K: Molecular epidemiology of leishmaniasis in Asia (focus on cutaneous infections). Curr Opin Infect Dis. 2009; 22(2): 126-30; abstract available at <https://www.ncbi.nlm.nih.gov/pubmed/19276879>).

Cutaneous leishmaniasis is common in Afghanistan and Pakistan, but was until recently considered rare in Indian Kashmir. However, a study from 2015 reported a new focus of CL in the Kashmir Valley (Wani GM et al: Clinical study of cutaneous leishmaniasis in the Kashmir Valley. Indian Dermatol Online J. 2015; 6(6): 387-92); available at  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693348/>.

The present report of many cases of CL in the Kathmandu valley indicates that CL has spread further from Kashmir into Nepal. - ProMED Mod.EP]

[Maps of Nepal can be seen at
<http://healthmap.org/promed/p/2877>. - ProMED Sr.Tech.Ed.MJ]
Date: Thu 25 May 2017
Source: Outbreak News Today

While the cholera epidemic rages in Yemen with more than 32,000 cases reported since the beginning of the month [May 2017], across the Gulf of Aden, the 2 largest countries on the Horn of Africa are also battling increases in the gastrointestinal bacterial infection.

In Somalia during the 1st 4 months of the year, 36,066 suspected cholera cases, including 697 deaths (CFR: 1.9 percent). The areas most heavily affected include Bay, Bakol and Lower Shabelle, Middle Juba and Gedo, all in the south. This compares to 15 619 suspected cholera cases including 531 deaths in all of 2016.

In neighboring Ethiopia since the beginning of the year [2017], a total of 33,145 acute watery diarrhea (AWD) cases and 776 deaths (CFR 2.3 percent) have been reported in the country from 6 regions of Somali, Oromia, Amhara, Afar, SNNP and Tigray. A total of 91 percent of these cases and 99 percent of the deaths were reported in Somali Region. Fortunately, the WHO says the outbreak situation in Somali region has greatly improved following the upgrading of the event and subsequent scaling up of response interventions. Access to safe water has increased to large populations including provisions of other essential health care services.

Because of the ongoing humanitarian crisis in the Horn of Africa- Gulf of Aden region, resulting in disruptions in water supplies and sanitation, and in the displacement of populations to overcrowded camps, the number of cholera cases detected each week may remain high or even increase, the European Centre for Disease Prevention and Control (ECDC) states.  [Byline: Robert Herriman]
=================
[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.
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.
3. Gore SM, Fontaine O and 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 and Simpson TW. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med. 1973; 132(4): 197-205.
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.
6. WHO. The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 24 May 2017, 3:00 pm
Source: The Star [edited]

A total of 4 people have died from cholera since the outbreak earlier in May 2017, the Health ministry has reported. Medical services director Jackson Kioko said the 4 were among a total of 146 infected people. This was figure as at [Sun 21 May 2017]. Kioko said the 1st 2 cases were reported in Mathare, Nairobi where a total of 21 cases and 1 death have been recorded. There are 88 cases in Garissa, 15 cases and 2 deaths in Vihiga, 2 cases in Mombasa, a case in Kiambu and 11 cases and a death in Murang'a. "Some of the cases reported in Nairobi, Mombasa and Vihiga are associated with a wedding in Karen over a week ago," Kioko said in a statement on [Wed 24 May 2017].

The director said the government is working with counties and partners to end infections. Health workers were asked to keenly monitor suspected cases, follow cholera management guidelines and set up treatment centres. The ministry has also heightened surveillance for acute watery diarrhoea by conducting active case searches and contact tracing.

"We are also carrying out awareness on prevention and control [through measures such as] treating or boiling of water, use of latrines for safe disposal of fecal matter and early treatment of any signs of diarrhea," Kioko said.

Other various measures include:
- Reactivating the Multi-Sectoral Outbreak Management Technical Working Group and Rapid Response Teams, both at the national level and in affected counties.
- Urging the public to take the initiative of drinking plenty of water with oral rehydration salts when they experience diarrhoea.
- Provision of water treatment chemicals, laboratory supplies and information on the disease.
- Strengthening law enforcement; county environmental health officers have been asked to close or issue closure notices to hotels or eating premises that do not meet basic hygiene standards.
- Strengthening the diagnostic capacity at the national and sub-national level, including county referral hospitals.  [Byline: Nancy Agutu]
Date: Wed 24 May 2017
Source: Gurtong.net [edited]

The Minister of Health in Tonj State, Lual Adhal has said cholera has killed more than 20 people in the last 2 weeks in Tonj State while detected cases are on daily basis increasing with admissions of 135 more at different localities.

"A total of 4 emergency serving centres have now been opened in Palieng, Makuac, Mabara and Paweng to deal with the reporting cases and number of admitted patients", said Adhal. "We in the State and the national government are in coordination with the Red Cross and UNICEF in providing medical support to the health centres," he said.

Adhal said last week, in Makuach County, Rialjok Akuecbeny 6 people in a cattle camp died from cholera, while 6 others with signs and symptoms of cholera were admitted at Marial-Lou hospital. He said that 62 people have been affected so far in Makuac Payam and 32 others in Mabara village while 16 in Paweng bringing the total to 135 in the State.  [Byline: James Deng Dimo]
Date: Thu 25 May 2017
Source: All Africa, Radio Dabanga report [edited]

Cholera continues to spread in Sudan's eastern states, with more fatalities and infections reported across White Nile state, North Kordofan and Sennar. The federal authorities are beginning to respond, however Khartoum continues to refer to the outbreak as 'acute watery diarrhoea'. The official Sudan News Agency (SUNA) reports that Sudan's First Vice-President and National Prime Minister, Lt. Gen. Bakri Hassan Salih, has given a directive to provide "all necessary means for containing the watery diarrhea cases in the White Nile state through urgent and effective interventions".

Salih met with Minister of State for Health, Dr Ferdos Abdulrahman at the Republican Palace on [Wed 24 May 2017], to discuss health situations in the country and in the White Nile in particular and efforts of the Federal Ministry of Health in this connection.

Dr Abdulrahman affirmed in press statements a decrease of cases in many localities of the State due to efforts of Federal State Health Ministries and partners. She appreciated support provided by the Governor of White Nile State to health teams working for combating the disease.

White Nile
----------
However, these official statements are widely contradicted by reports reaching Radio Dabanga from the areas affected by the disease, which repeated tests according to WHO standards show to be cholera. There have been calls to declare a State of Emergency. The Governor of the White Nile, Abdelhameed Kasha, says 53 people have died in the state. In a statement to the Council of States in Khartoum on [Tue 23 May 2017], Kasha said 2755 people and 129 villages have been infected in the 'watery diarrhea' epidemic.

The Sudanese Doctors' Central Committee announced the death of 40 people and infection of more than 1800 people with 'acute watery diarrhea' in the White Nile in the recent weeks. In a statement on [Wed 24 May 2017], the committee confirmed the spread of the epidemic to the outskirts of Khartoum and El Gezira states amid deterioration in the health conditions, government secrecy in dealing with the disease and neglecting the known health procedures. The Committee announced spread of the disease in Asalaya, El Duweim, Kosti, Rabak, El Gitena, El Gezira Aba, El Jabelein and Tendelti in White Nile state

The Committee called on the State and Federal Ministry of Health to officially acknowledge the existence of a health disaster in the White Nile State and take health isolation measures. On [Tue 23 May 2017], the Governor of the White Nile said that he cannot announce a State of Emergency because that is not his mandate which must be done by the WHO.

Governor Kasha said also that currently, White Nile state hosts 122,000 South Sudanese refugees in 8 camps and 50 000 others in various areas in the state.

Kosti
-----
Journalists reported to Radio Dabanga that the medical isolation centre at Kosti Ophthalmology Hospital received 26 new cholera cases yesterday, [Wed 24 May 2017]. Tahir Ishag El Doma told Radio Dabanga from Kosti that the medical isolation centre of Block 54 in the town received 56 new cases on [Wed 24 May 2017].

He explained that the high rate of infection has prompted the authorities to open a new medical isolation centre at the Abushareef district in the town where the centre received 18 new infection cases on [Wed 24 May 2017]. He explained that the government began to deal with the disease by providing intravenous solutions and mobilizing the medical staff.

El Gezira Aba
-------------
The head of civil society organizations, Abdelrahman El Siddig, reported the death of 5 people of cholera in villages in El Gezira Aba on [Tue 23 and Wed 24 May 2017]. He told Radio Dabanga that on [Wed 24 May 2017], the number of hospitalized rose to 40. There is a shortage of medical staff and Asalaya hospital is overcrowded with patients. He said police have been deployed to the areas where pumps are drawing water from the Nile to prevent people from using it. El Siddig called on the authorities to close the factories that dispose of their waste in the Nile.

El Obeid
--------
El Obeid hospital in North Kordofan has received 55 cases of acute watery diarrhea during the week. Dr Amer Adam, the deputy family medicine specialist and head of the hospital's doctors committee told Radio Dabanga that he attributed the outbreak of the disease to the contamination of drinking water and vegetables. Dr Adam called for banning the vegetables coming from White Nile state. He pointed out to the transmission of infection to the city from the White Nile state. He called on the authorities to chlorinate drinking water, provide intravenous solutions, prepare the newly opened isolation centre and raise awareness of people of the dangers of the spread of the disease.

Sennar
------
Yesterday, [Wed 24 May 2017], workers in the health sector told Radio Dabanga that cholera is increasing in the areas of Mazmum and Abuareef in Sennar state. A worker in the health sector said that Mazmum area recorded 2 new cases of the disease at a time Abuareef health centre was overcrowded with patients yesterday, [Wed 24 May 2017]. He confirmed that the total number of deaths from cholera at Abuareef area has amounted to 6 cases since the beginning of May 2017.