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Date: Wed 18 Oct 2017 16:19 EDT
Source: Daily Mail [edited]

Health authorities in Spain have revealed the man who died from an outbreak of Legionnaires' in a Mallorcan holiday resort was a British tourist. They also said another 13 of the 19 people now known to have been affected so far in the unresolved outbreak were also holidaymakers from the UK.

The holidaymakers were struck down in Palmanova, which neighbours Magaluf, with 8 people all staying at the same unnamed hotel.

Regional health authority boss Maria Ramos said one British tourist, a man aged 61, was still being treated at Son Espases Hospital in the island capital Mallorca, the hospital where a 70-year-old British man died last [Wed 11 Oct 2017]. The rest of the Brits, aged from 46 to 87 are back in the UK after the end of their holidays.  They are understood to have been given the all-clear or are recovering from their illness, although Mrs Ramos said she was unaware of the evolution of 5 of the British nationals affected.
Health chiefs in Mallorca are now working on trying to locate the source of the outbreak in the Brit-popular resort of Palmanova next to the brash party resort of Magaluf with the help of a specialist lab in Madrid.

Positive samples were detected at an unnamed hotel in Palmanova where 9 of those affected were staying. The hotel has now closed after its water supply was shut down.  [Byline: Gerard Couzens, Rod Ardehali, Paddy Dinham]
====================
[The news report above says that 19 tourists in Palmanova on the island of Mallorca, Spain have developed Legionnaires' disease; 13 of the 19 are from the UK. We are not told over what period of time this event occurred. Another news report said that since mid-September [2017], 17 British tourists who returned from Palmanova developed Legionnaires' disease (<https://www.euroweeklynews.com/3.0.15/news/on-euro-weekly-news/mallorca/146101-travel-warning-issued-after-17-brits-infected-by-legionnaire's-disease-in-mallorca>). Nine of the British tourists with Legionnaires' disease, one of whom died, stayed at the same hotel in Palmanova and samples from this hotel were positive for _Legionella_. The hotel has now closed after its water supply was shut down.

We are not told if all the tourists have the same genotype (which would suggest a common source outbreak) or if the genotypes of the clinical _Legionella_ isolates matched those of the hotel's environmental isolates, which would identify the hotel as the source for the infection for its guests. ProMED-mail would appreciate more information in this regard from knowledgeable sources as it develops in this ongoing investigation.

Palmanova is a major holiday destination for Europeans, especially from Germany and the UK, on the Balearic island of Mallorca [<https://en.wikipedia.org/wiki/Palma_Nova>]. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 19 Oct 2017 09:15
Source: Reliefweb [edited]

As many as 265 people have been found infected with scrub typhus in Chitwan in the last 3 months. According to the District Public Health Office, Chitwan, the number of people infected with the infectious mite-borne disease that is caused by _Orientia tsutsugamushi_ has been on the rise in the district.

Fever, headache, swollen lymph nodes, muscular rash and body pain are among the symptoms of scrub typhus.

_Orientia tsutsugamushi_ is transmitted by a mite that feeds on forest and rural rodents including rats, voles and field mice.
==================
[Chitwan district is in the southwestern part of Province No. 3. A map of Nepal's provinces can be found at <https://en.wikipedia.org/wiki/Province_No._4#/media/File:Provinces_of_Nepal_2015.png>, and a map of Nepal's districts can be found at
<http://tinyurl.com/ydf8ojtj>.

A map of Nepal can be seen at
Date: Wed 18 Oct 2017 12:19 PM EAT
Source: Uganda Virus Research Institute (UVRI) [edited]

Uganda Virus Research Institute [UVRI] has confirmed cases of the deadly Marburg virus in Kween district on the western slopes of Mt Elgon in Eastern Uganda. 2 people have died from the deadly haemorrhagic fever.

The Ministry of Health is sending an emergency response team to the district.

The public is urged to be vigilant and report suspected cases.

Symptoms of the Marburg virus include nausea and vomiting, diarrhoea (may be bloody), red eyes, raised rash, chest pain and cough, sore throat, stomach pain, severe weight loss, among others.
=====================
[A 19 Oct 2017 announcement issued by the Uganda Ministry of Health (MOH) reported just one fatal case of Marburg disease (see Marburg virus disease - Uganda: (QW) http://promedmail.org/post/20171019.5391580). However, the announcement also indicated that a preliminary field investigation reported that prior to her death, the deceased had nursed her 42-year-old brother, who died on 25 Sep 2017 with similar signs and symptoms. She had also closely participated in the cultural preparation of the body for burial. Perhaps this 2nd case is the brother of the case that the MoH reported earlier.

Cases of Marburg virus infection have occurred sporadically in Uganda over several years. - ProMED Mod.TY]

[Maps of Uganda can be seen at
<http://healthmap.org/promed/p/24918>. - ProMED Sr.Tech.Ed.MJ]
Date: Mon 16 Oct 2017, 6:33 AM ET
Source: Live Science [edited]

In a rare case, a woman contracted a potentially deadly bacterial infection while on a 12-hour flight from Japan to Germany, according to a new report.

Called meningococcal disease, this bacterial infection is generally transmitted only through close contact, for example, by kissing or living in close quarters with someone who is sick, according to the World Health Organization. The new report is only the 3rd case ever reported of this disease being transmitted on an airplane, said Yushi Hachisu, of the Chiba Prefectural Institute of Public Health in Chiba, Japan, who helped investigate the case. Hachisu presented the case on [5 Oct 2017] at IDWeek, an infectious disease conference in San Diego.

Meningococcal disease is caused by the bacteria _Neisseria meningitidis_. About 10 percent of the population carries this bacterium in their nose and throat without showing any symptoms of disease. But the bacteria can cause serious illness if it gets into the blood or the brain. In the brain, the bacteria can cause meningitis -- a swelling of the membranes that cover the brain and spinal cord; in the blood, it can cause and infection called septicemia.

The woman and her husband, both in their 50s, were traveling from Japan to Germany on [8 Aug 2015], according to the report. They happened to be on the same flight as a team of Scottish and Swedish scouts who were returning from the World Scout Jamboree, an international gathering of scouts ages 14 to 17. A total of 6 of the scouts later developed meningococcal disease in an outbreak that was linked to attendance at the jamboree. [See ProMED-mail posts - ProMED Mod.ML]

The married couple did not sit directly next to the scouts, but sat in a row behind and across the aisle from the Scottish scouts. They noticed that one of the scouts seated in front of them was coughing throughout the flight, the report said. Once they arrived in Germany, the couple hopped on another flight to Spain, where they went sightseeing. But a few days later, on [11 Aug 2017], the woman felt tired and developed pain in her throat and a cough. Her husband also developed pain in his throat and a mild fever.

They felt sick for the rest of their trip, but felt somewhat better upon their return to Japan on [16 Aug 2015], the report said. However, on [19 Sept 2015], the woman developed a sudden high fever and chills, as well as pain in her joints. She visited four health care facilities and underwent tests before she was finally hospitalized on [25 Sept 2015]. The fluid in her joints tested positive for _N. meningitidis_ bacteria, which means she had a blood infection with _N. meningitidis_ that spread to her joints. Samples taken from the husband's nose and throat also tested positive for _N. meningitidis_, although he did not develop further symptoms. Both the woman and her husband were infected with the same strain of _N. meningitidis_ that caused the outbreak in the scouts, the report said. The woman was treated with antibiotics and recovered.

Meningococcal disease is rare in Japan, with only about 3 cases per 10 million people, the researchers said.

The new report "strongly suggests that _N. meningitidis_ was transmitted from the Scottish scouts to the Japanese couple during their international flight," the researchers wrote in their report.

Still, the overall risk of transmitting meningococcal disease on an airplane is low, Hachisu said. But it can happen -- in 2005, officials in Australia reported cases of 2 people who got sick with _N. meningitidis_ after traveling on a flight from Los Angeles to Sydney. Officials determined it was likely that one of the infected passengers spread the bacteria to the other passenger, or both of the infected individuals got the bacteria from another person on the flight that wasn't showing symptoms.

The U.S. Centers for Disease Control and Prevention recommends that passengers who sit next to someone with _N. meningitidis_ on a flight that is more than 8 hours long receive preventive antibiotics. A longer flight increases the chance of transmission, Hachisu said.  [Byline: Rachael Rettner]
===================
[From 29 Jul 2015 through 8 Aug 2015, about 34,000 boy scouts and their leaders from 150 countries attended an international Jamboree in Yamaguchi, Japan. Invasive meningococcal disease subsequently developed in 3 scouts and one parent from Scotland and 2 scouts from Sweden after Jamboree ended. The index case was reported to have developed symptoms while returning to Scotland. The strains from all 6 cases were identical and belonged to serogroup W (Kanai M, Kamiya H, Smith-Palmer A, et al. Meningococcal disease outbreak related to the World Scout Jamboree in Japan, 2015. Western Pac Surveill Response J. 2017; 8(2): 25-30. Published online 2017 May 8. <https://www.ncbi.nlm.nih.gov/pubmed/28729922>).

The Japanese woman and her husband, described in the news report above, were traveling by plane from Japan to Germany on 8 Aug 2015, and sat in a row behind and across the aisle from the Scottish scouts, one of whom, presumably the index case, was coughing throughout the flight. Three days later, they both began to feel ill with pain in the throat. About 6 weeks later, the woman developed a sudden high fever and chills, and was subsequently diagnosed with meningococcal septic arthritis. The incubation period for invasive meningococcal disease is 3 to 4 days, with a range of 2 to 10 days; however, this incubation period commonly pertains to meningitis or meningococcemia (<https://www.cdc.gov/vaccines/pubs/pinkbook/mening.html>).

The Japanese woman had primary meningococcal arthritis (i.e., arthritis without signs or symptoms suggestive of meningitis or meningococcaemia), which is rare occurring in as little as 1 percent of meningococcal infections (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628474/>). It is usually preceded by an upper respiratory infection in 50-55 percent of presentations, and patients may appear nontoxic, afebrile, and polyarthralgic. Her husband had pharyngitis from which meningococci were isolated.

Both the woman and her husband were said in the news report above to be infected with the same strain of _Neisseria meningitidis_ that caused the outbreak in the scouts. Presumably both wife and husband became infected with the outbreak strain by exposure to the index case on the 8 Aug 2015 airplane flight. However, we are not told if matching isolates was based on genotyping or just that all the isolates were serogroup W. Most likely genotyping was done.

Meningococci are thought to spread from person to person by exposure to nasopharyngeal secretions, which can happen during close contact (coughing or kissing, living in the same household). Dispersion of large droplets of nasopharyngeal secretions occurs within 3 feet of a coughing patient, such as the few rows directly in front of or behind an ill airplane passenger.

Other respiratory illnesses that have spread onboard air flights include influenza, tuberculosis and SARS (1-5). For active tuberculosis in a passenger, all passengers seated on an airplane in the same row and in the 2 rows in front of and behind the index case are considered contacts (<http://www.who.int/tb/publications/2006/who_htm_tb_2006_363.pdf>).

In addition to the proximity of passengers to the index case, risk to passengers and flight crew members also depends on the flight duration, the ability of a patient to generate an infectious spray of nasopharyngeal secretions, and the number of organisms per ml of respiratory excretion. However, aircraft ventilation systems are believed to be highly efficient at keeping the air free of pathogens, which it does by exchanging the air frequently in passenger cabins and passing the circulated air through high-efficiency particulate-arresting (HEPA) filters (<http://www.who.int/tb/publications/2006/who_htm_tb_2006_363.pdf>).

The U.S. CDC employs a passive surveillance system by which local health departments report suspected cases of air-travel-associated meningococcal disease. In 2001, the CDC reported that from February 1999 through May 2001, it received 21 reports of cases of air-travel-associated invasive meningococcal disease, an average of one report every 6 weeks (<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a2.htm>). Approximately half of these cases were reported to a CDC airport quarantine station, and the rest were reported to CDC headquarters. The mean time between the completion of the flight and the onset of illness was 1.9 days (range: 0--10 days). As many as 5 case-patients had onset of illness before arrival, but the others had onset of illness after the flight had landed and the exposed passengers had dispersed. The CDC noted at the time that no secondary cases among air travel contacts of persons with meningococcal disease had been reported to the CDC, perhaps because of difficulties in subsequently tracing exposed passengers.

Because the attack rate among close contacts of patients with meningococcal disease is an estimated 500--800 times greater than the general population, antimicrobial chemoprophylaxis is recommended for contacts that are exposed to the respiratory secretions of the index patient to prevent secondary cases of meningococcal disease. The assessment of risk to passengers and flight crew members should be based on the flight duration and seating proximity to the index case-patient. The CDC recommends that household members traveling with an index case-patient, persons traveling with an index case-patient who have had prolonged close contact (e.g., roommates), and, for flights more than 8 hours, including ground time, anyone having direct contact with a patient's oral secretions should also be identified and the need for antimicrobial chemoprophylaxis evaluated (<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a2.htm>).

In the CDC communication (<https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a2.htm>), because of the absence of data at the time about increased risk to other passengers, the CDC limited their recommendations for chemoprophylaxis to those passengers seated in either seat next to an index case-patient. However, we now have data that risk extends to passengers in adjacent rows. Because the risk for illness in the close contacts is highest during the 1st few days after infection, chemoprophylaxis should be administered as soon as possible (ideally within 24 hours) after exposure to an index case-patient (<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a2.htm>). Chemoprophylaxis administered later than 14 days is probably of limited or no value.

References
----------
1. Moser MR, Bender TR, Margolis HS, Noble GR, Kendal AP and Ritter DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979;110:1-6.

2. Kenyon TA, Valway SE, Ihle WW, Onorato IM and Castro KG. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N Engl J Med 1996;334 (15):933-8, available at:

3. Exposure of passengers and flight crew to Mycobacterium tuberculosis on commercial aircraft, 1992-1995. MMWR Morb Mortal Wkly Rep 1995;44:137-140 [erratum, MMWR Morb Mortal Wkly Rep 1995;44:175.], available at:

4. Olsen SJ, Chang H-L, Cheung TY-Y, et al. Transmission of the Severe Acute Respiratory Syndrome on Aircraft. N Engl J Med 2003; 349 (25):2416-22, available at:

5. Wenzel RP. Airline travel and infection. N Engl J Med 1996;334:981-982, abstract available at:

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 19 Oct 2019
Source: Uganda Media Centre, Ministry of ICT and National Guidance,
Republic of Uganda [edited]

Ministry of Health Press Statement on Marburg Virus Disease
-----------------------------------------------------------
The Ministry of Health would like to inform the general public that there is a confirmed case of Marburg virus disease (MVD) in the country. This followed laboratory tests conducted by the Uganda Virus Research Institute (UVRI) which confirmed on [17 Oct 2017] that one person died of Marburg virus disease, a type of viral haemorrhagic fever (VHF).

As at [19 Oct 2017], only one case has been confirmed. The confirmed case was a 50-year-old female from Chemuron village, Moyok Parish, Moyok sub county, Kween District in Eastern Uganda. She presented with signs and symptoms suggestive of a viral hemorrhagic fever (VHF) and unfortunately passed on during the night of [11 Oct 2017] at Kapchorwa Hospital, having been referred from Kaproron Health Center IV in Kween district.

Preliminary field investigations indicated that prior to her death; the deceased had nursed her 42-year-old brother, who had died on [25 Sep 2017] with similar signs and symptoms. She had also closely participated in the cultural preparation of the body for burial. The deceased's brother was reported to be a hunter who carried out his activities where there are caves with heavy presence of bats. However, no samples were taken off his body prior to his death.

Marburg virus disease (MVD) is caused by the Marburg virus, a rare but severe type of viral hemorrhagic fever which affects both humans and non-human primates like monkeys, baboons. The reservoir host of Marburg virus is the African fruit bat [Egyptian fruit bat _Rousettus aegyptiacus_]. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) are vulnerable to contracting the Marburg virus, which is known to have a very high mortality.

In Marburg [virus disease] outbreaks, the 1st person normally gets infected through contact with infected bats or animals (normally monkeys/baboons). Once the 1st person (index case) gets infected with the Marburg virus, human to human transmission of Marburg virus disease (MVD) then occurs through contact with the body fluids (blood, vomitus, urine, faeces, etc) of already infected persons. Close contacts to already infected people (like close family members of already infected people) and health workers are particularly at increased risk of getting infected with the Marburg virus.

A person suffering from Marburg [virus disease] presents with sudden onset of high-grade fever accompanied by any of the following symptoms:
1. Headache
2. Vomiting blood
3. Joint and muscle pains
4. Unexplained bleeding through the body openings including the eyes, nose, gums, ears, anus and the skin.

There is no specific treatment or vaccine available for Marburg [virus disease] for now, but patients are given supportive treatment which supports the natural recovery process of the body and this improves tremendously the patient's survival chances. However, treatment outcomes are better for those who seek care early.

To mitigate the current threat of Marburg virus disease, the Ministry of Health is undertaking the following measures to control the spread of the disease:
- Ministry of Health has deployed a Rapid Response Team comprising of highly experienced epidemiologists, risk communication experts, case management, infection control and prevention experts, ecological environmental experts, laboratory specialists, among others to Kween and Kapchorwa districts. The team will support District Rapid Response Teams to investigate and assess the magnitude of the threat and to institute appropriate control measures to avert the Marburg virus disease threat.
- An isolation ward at the Kapchorwa District Hospital and Kaproron Health Center IV in Kween District has been established to handle cases.
- Preparations are underway to train all health workers, particularly from Kapchorwa Hospital, and Kaproron Health Centre IV on VHF Infection Prevention and Control. Infection Prevention and Control measures have been heightened in all health facilities in Kapchorwa and Kween districts.
- Personal Protective Equipment (PPE's) and other supplies have been mobilized to support response in the affected facilities.
- The National Medical Stores is delivering emergency supplies to the affected health facilities.
- Increasing awareness in affected communities and among health-care providers on the clinical symptoms of patients with Marburg virus disease.

Marburg virus disease has the potential to spread over wide areas affecting many people especially health workers and family members nursing Marburg viral disease patients.

The Ministry of Health therefore appeals to the general public to remain alert and observe the following precautions to control the spread of the Marburg virus:
- Report any suspected patient immediately to a nearby health facility.
- Avoid direct contact with body fluids of a person presenting with bleeding tendencies or symptoms suggestive of Marburg virus disease.
- Health workers are further reminded to wear gloves and appropriate personal protective equipment when taking care of ill patients or suspected cases.
- Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
- Avoid contact with persons who have died from the disease.
- Allow health workers perform dignified burials among victims who might have succumbed to the disease, so as to minimise its spread to others.

The Ministry of Health calls upon the general public to remain calm but be on alert amidst this epidemic.
--------------------------------------------
Communicated by:
Jas' Mantero, MD MPH PhD
=========================
[Cases of Marburg virus infection have occurred sporadically in Uganda over several years. A case was confirmed in Mpigi district early in October 2014. A larger outbreak occurred in 2012 in Uganda that resulted in 20 probable or confirmed cases and 9 deaths in 4 districts of the country (see ProMED-mail archive number http://promedmail.org/post/20121123.1422035). Ugandan health officials are responding quickly and comprehensively to the occurrence of the above case. That timely response is critical for prevention of additional cases from contact with this index case.

An image of the Egyptian fruit bat can be accessed at:
Date: Wed 18 Oct 2017 6:58 AM AT
Source: Canadian Broadcasting Corporation (CBC) News [edited]

Janes Pub Style Chicken Burgers and Pub Style Snacks Popcorn Chicken have been recalled because of possible _Salmonella_ contamination, as part of an investigation of an illness outbreak. The burgers carry a best before date of 12 May [2018] with UPC code 0 69299 12491 0 and the popcorn chicken 18 May [2018] with UPC code 0 69299 12542 9, with both in the 800-gram size. The frozen food products were sold at stores across Canada. The recalled products should be thrown out or returned to the store where they were purchased.

In its food recall warning, the Canadian Food Inspection Agency [CFIA] said the recall was triggered by findings during an investigation of a foodborne illness outbreak. It did not say if there were cases of illness directly related to these products.

The Public Health Agency of Canada is also involved in the investigation. In September 2017, the agency issued a notice it was investigating 13 cases of salmonellosis in eastern Canada, including Ontario, Quebec, New Brunswick, and Nova Scotia. The Public Health Agency warned that salmonella is commonly found in raw chicken, and that all chicken should be fully cooked in order to make it safe to eat. The investigation is continuing, says the CFIA, and that could lead to more recalls.  [Byline: Kevin Yarr]
===================
[I have placed this posting in the ongoing thread but it is not entirely clear that the recalled product is a source of the outbreak of _S._ Enteritidis strain. More information would be appreciated. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sat 14 Oct 2017
Source: Angola Online [in Portuguese, machine trans., edited]

According to information from the health authorities of Zaire, of the more than 60 islands inhabited in the province, of a total of 120, most are affected by the outbreak of cholera that has killed at least 15 people out of 214 registered cases.

The lack of clean water on the islands and poor housing conditions are pointed out by the health authorities of the province of Zaire as the causes of the outbreak, so last week campaigned for mobilization and awareness, and distributed filters to purify water.
====================
[Maps of the West African country of Angola can be seen at
<http://healthmap.org/promed/p/23901>. Zaire province is located in the extreme northwest of the country.

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, 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
Date: Mon 16 Oct 2017
Source: Times of Zambia [edited]

The number of cholera cases in Lusaka, where one death has so far been reported in the recent outbreak, has reached 69, with the source of the outbreak being attributed to contaminated water. Kanyama cholera treatment centre has the highest number of cholera patients standing at 25.

Ministry of Health Permanent Secretary for administration Kennedy Malama said the number had shot up from 37 previously reported on 12 Oct 2017. "Yes, the number of patients has increased, but in terms of their condition, we are describing all of them as being stable. The update as of today [15 Oct 2017] is that on our line-list, we have a total of 69 cholera patients," he told journalists after tour of Bauleni and Kanyama Cholera treatment centres. Dr Malama said about 70 percent of the cholera patients were children under the age of 5. At Kanyama cholera treatment centre, there were 25 patients undergoing treatment while at Bauleni clinic only 1 patient was admitted.

Dr Malama, however, said from yesterday's [15 Oct 2017] treatment of the patients, there was significant improvement as all of them were in a stable condition, citing the children who were able to suck from their mothers, which was a positive gesture. Dr Malama was confident that from the intensified treatments by health workers, the majority of patients could be discharged soon.

On its part, the Ministry of Health would continue with health promotions and distribution of chlorine for chlorination of drinking water. Dr Malama advised people to take precautions such using chlorine or boiling water for drinking to reduce the risk of cholera breaking out.

He hailed stakeholders working closely with the ministry to fight cholera, but called for provision of more assistance citing chlorine.

One death, of a 3-month-old baby, has been reported so far.

In 2016, 1170 cumulative cases of cholera were reported in Zambia of which 192 were laboratory-confirmed with 31 deaths reported.
==================
[Zambia, officially the Republic of Zambia, is a landlocked country in Southern Africa, neighbouring the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique, Zimbabwe, Botswana and Namibia to the south, and Angola to the west. The capital city is Lusaka, in the south-central part of Zambia.

Maps of Zambia can be seen at
Date: Tue 17 Oct 2017
Source: AllAfrica, Radio Dabanga report [edited]

The total number of reported cases of 'acute watery diarrhoea' [AWD] across 18 states of Sudan has reached over 35,000 people -- including 800 related deaths since August 2016 -- according to the latest update from the WHO and the Sudanese Ministry of Health. "The outbreak is affecting all demographics, with females constituting 54 percent of the cases and children below 5 years of age accounting for 8 percent," the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported in its latest bi-weekly bulletin. Acute watery diarrhoea (AWD) is the term the Sudanese government and international humanitarian organisations active in Sudan, have referred to.

The bulletin continues that "active transmission of AWD is ongoing in all 18 states of Sudan with the exception of West Kordofan and Northern states, where the last reported cases were on 13 Aug 2017 and 12 Sep 2017, respectively.

"The source of infection is believed to be contaminated open water sources combined with poor sanitation and hygiene practices. The report indicated that the case fatality ratio, which peaked [at the end of August 2017] at 4.75 percent, has come down to 1.53 percent."

Sudan's first cases of cholera were recorded in Blue Nile state in August 2016. Since then, the disease spread in eastern Sudan, and later to the Northern State and central Sudan's El Gezira. In April 2017, sources in White Nile state reported a rapid spread of cholera. The disease then spread to North Kordofan, and fully hit Khartoum in May 2017. Throughout Sudan medical sources and people who have volunteered in campaigns to combat the spread of cholera regularly report on the number of cholera victims in specific areas.

Human rights and civil society advocates, organisations, and activists have written in a letter to the WHO to quickly intervene and effectively address the cholera epidemic in Sudan after Khartoum would declare the existence of cholera in the country. The organisation has not replied to Radio Dabanga's repeated requests to elaborate on this position.

The WHO, as well as the United Nations Children's Fund (Unicef) are responding to the 'acute watery diarrhea' disease by establishing health facilities in a number of Sudan's affected states, and training medical staff, a recent humanitarian news bulletin reported.
==================
[In some countries in east Africa, acute watery diarrhoea is used as a euphemism for cholera.

The Sudan or Sudan, also known as North Sudan since South Sudan's independence and officially the Republic of the Sudan, is a country in Northern Africa. It is bordered by Egypt to the north, the Red Sea, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the southwest, Chad to the west, and Libya to the northwest. It is the 3rd largest country in Africa and can found on a map at <https://en.m.wikipedia.org/wiki/Sudan>.

Maps of the country can be seen at <https://en.wikipedia.org/wiki/States_of_Sudan>
and <http://healthmap.org/promed/p/96>. - ProMED Mod.LL]
18th Oct 2017
http://www.who.int/mediacentre/news/releases/2017/seychelles-plague-negative/en/ 

Samples from patients in Seychelles suspected to be ill with pneumonic plague tested negative at a World Health Organization (WHO) partner laboratory in Paris, France on Tuesday (17 October).
 
The ten samples were shipped by the Seychelles Ministry of Health and WHO to the collaborating centre for Yersinia at the Institut Pasteur to confirm the status of several suspected and one probable case – a 34-year-old Seychelles national who had returned from Madagascar with plague-like symptoms.

WHO is working with the Seychelles health authorities to reduce the risk of plague spreading from neighbouring Madagascar, which faces an unprecedented outbreak that has killed more than 70 people since August. No plague cases have been confirmed in the Seychelles.
Alongside support for laboratory testing, WHO has deployed experts and medical supplies to the 115-island country. The Organization is also providing guidance for the tracing and treatment of contacts of people who are suspected to have been infected.

“We are working with health authorities to reduce the risk of the spread of plague in the Seychelles by improving surveillance and preparedness,” said Dr. Ibrahima Soce Fall, WHO Regional Emergencies Director for the Africa region.

WHO is advising the Government of Seychelles on the implementation of public health measures that are in line with the WHO International Health Regulations, such as enhanced surveillance, isolation and treatment of suspect cases, contact tracing and prophylactic treatment of potential contacts.

WHO currently assesses the risk of spread of plague in the Seychelles to be low.