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Date: Tue, 25 Apr 2017 12:31:25 +0200
By Sebastien BERGER

Masikryong, North Korea, April 25, 2017 (AFP) - Outside a large stone tablet acclaims "the work of Dear Leader Kim Jong-Un who devoted hard work and heart and soul to make our people the happiest and most civilised people".  On the ski fields of Mount Taehwa, groomed pistes snake down wooded hillsides to a luxurious hotel and a giant screen showing a North Korean army choir. But the runs are empty.

Work began on Masikryong ski resort, the only one in the North and the brainchild of Supreme Leader Kim Jong-Un, after Pyeongchang in the neighbouring South was awarded the 2018 winter Olympics.   The impoverished, nuclear-armed nation has ramshackle infrastructure and around 40 percent of its people are undernourished, according to the Global Hunger Index.   But the luxurious resort boasts a wood-panelled reception and statues of winter sports athletes.    Outside a large stone tablet acclaims "the work of Dear Leader Kim Jong-Un who devoted hard work and heart and soul to make our people the happiest and most civilised people".

At a visitor centre packed with pictures of Kim - including one of him using a chairlift, although without skis - guides credit him with giving on-the-spot guidance no fewer than 144 times over the course of construction.   The resort is a three-hour drive from Pyongyang, down a potholed concrete road that passes through unlit tunnels and which civilian work crews clear of snow and ice by hand after fresh falls.   The warm comforts inside are a world away from the scenes outside the entrance checkpoint, where peasant farmers drag sleds loaded with firewood across frozen lakes, and ox-drawn carts are used for transport.   And - aside from the nursery slopes - it is deserted.

- Happy lives -
A second-hand Doppelmayr bubble lift, the ski boxes still stencilled with 'Ischgl', its original Austrian home, takes visitors to the top of Mt Taehwa, where a handful of curious Westerners enjoy the thrill of having almost an entire resort to themselves.

With a 700-metre vertical drop, the skiing compares favourably to other destinations in neighbouring China or South Korea.   At one point on a weekend afternoon in peak season, Swede Patrik Hultberg was the only skier on the slopes, he said. "That's really cool. I wish I could experience it more, hitting new pistes and there's nobody there."

Norwegian software developer Lars Eidnes has previously snowboarded in Iran and Kyrgyzstan. "If you want to escalate from there, then you come to DPRK," he said.   Day passes for foreigners cost almost $100, while for citizens of the Democratic People's Republic of Korea - around 100 of whom were on the single nursery slope - they are priced at the equivalent of about $30 at free-market rates.

By some estimates that approaches an ordinary worker's monthly salary. But most will go on group trips organised by their work unit, school or organisation, at zero or minimal cost.   After trying skiing for the first time, ship's captain Kwak Jong-Song said he found it "refreshing".   "I would like to thank our Supreme Leader Kim Jong-Un who is giving his whole devotion to our people's happy lives," he said.   Ordinary North Koreans normally only ever express officially-sanctioned views when speaking to foreigners.

- White elephant? -
Resort executives say it sees 70,000 visitors a year. Such figures are hard to square with the uncrowded vistas, but hotel director An Song-Ryol insists it is profitable.   "We do not mind the cost if it is for the improvement of the welfare of our people," he said. "We do not calculate."

Pyongyang has a "byungjin" policy of "simultaneous development", meaning pursuing both GDP growth and nuclear weapons at the same time, even though it is subject to multiple sets of UN sanctions over its atomic and missile programmes - among them a ban on luxuries, including snowmobiles and "recreational sports equipment".   At a parade this month for the 105th birth anniversary of founder Kim Il-Sung it displayed an arsenal of devices, including a suspected new intercontinental ballistic missile, as well as floats showing mock-ups of prestige property projects.

Masikryong was part of a regional development plan and driven by authorities' view that a prosperous country should have a ski resort, said Nick Bonner, director of specialist North Korea travel agency Koryo Tours, which offers it among its destinations. "So they built it."   "It's not busy, it's never been busy," he told AFP. "But it's not quite a white elephant either. It's going to take time."   But Andrei Lankov, director of website NK News and professor at Kookmin University in Seoul, said Pyongyang's tourism expectations have been "absolutely unfounded" and "nearly comical".

Kim Jong-Un went to school in Switzerland, he pointed out. "He just decided to emulate what he saw there," he said. "He saw wonderful mountains in Korea, which are indeed beautiful, and he said why not make our country into a tourist destination like Switzerland so we can make a lot of money like Switzerland does."   The incongruity of the situation is not lost on some Masikryong visitors.   Norwegian Eidnes, 29, said he had been treated "like a king" at Masikryong.   "It's very opulent, things are very nice," he added. "That's a sharp contrast to normal life for everyone. It's been on our minds."
Date: Tue, 25 Apr 2017 08:11:48 +0200

Seoul, April 25, 2017 (AFP) - South Korea's tourist industry has been hammered by China's boycott over the deployment of US missile defence system, with visitor numbers from the Asian giant plummeting 40 percent in March, statistics showed.   Beijing banned Chinese tour groups from visiting the South from March 15 in a spat over the US Terminal High Altitude Area Defense (THAAD) system.   Washington and Seoul say it is for purely defensive purposes, but Beijing fears it could undermine its own nuclear deterrent and has reacted with fury, imposing a series of measures seen as economic retaliation.   Normally more than half of tourists to the South are from China, but little more than 360,000 visited last month, compared to just over 600,000 a year earlier.

Total visitor numbers fell 11.2 percent year-on-year to 1.23 million, the state Korea Tourism Organization (KTO) said.   The falls in tourism from China have also dealt a blow to duty-free shops in South Korea, with Chinese customers accounting for 70 percent of their total sales, a Lotte spokeswoman said.   Lotte Duty Free has seen sales to Chinese customers fall 40 percent on-year since the group tour ban in mid-March.   The South Korean retail giant has had to shut down 85 of its 99 stores in China due to boycott calls after the group agreed to provide a golf course in South Korea as a site for THAAD.   Its accumulated losses as a result are reportedly expected to hit $1 billion in the first half of this year alone.

South Korea has been struggling to fill the gap with promotion campaigns to attract more visitors from other countries, mainly from Japan and those in Southeast Asia.   But rising regional tensions over the nuclear-armed North have nipped in the bud an increase in the number of Japanese travellers.   Yonhap news agency said a tourism ministry tally showed Japanese visitors rising some 20 percent year-on-year up to early April, but the growth rate fell to between two and three percent after tensions spiked.   "Japanese tourists are putting off their trips to this country, apparently because of overblown Japanese media reports about tensions on the Korean peninsula," Yonhap quoted a KTO official as saying.
Date: Tue, 25 Apr 2017 01:30:21 +0200

Santiago, April 24, 2017 (AFP) - A strong 6.9-magnitude earthquake rattled central Chile on Monday, US geologists said.    The quake, which struck at 6:30 pm (2130 GMT), was centred about 38 kilometres (60 miles) off the coast of the resort city of Valparaiso.   It had a depth of 9.8 kilometres (six miles), according to the US Geological Survey.   The USGS originally said the quake measured 7.1, but later downgraded it.   Authorities urged residents to evacuate coastal areas as a precaution shortly after the quake, but cancelled the order when no large waves were generated.

Meanwhile, ONEMI, Chile's national emergency agency, said there were no immediate reports of damage or injuries.  Chile lies on what is known as the "Ring of Fire" -- an arc of fault lines that circles the Pacific Basin and is prone to frequent earthquakes and volcanic eruptions.   The north of the country was struck by an 8.3-magnitude temblor followed by a tsunami in September 2015, killing 15 people.   In 2010, a quake measuring 8.8 in magnitude was also followed by a tsunami. It struck the centre and south of the country, killing more than 500 people.
Date: Mon 24 Apr 2017 01:22 PM CDT
Source: ABC17 News [edited]

The number of confirmed cases of salmonella in a central Missouri region has reached 36 according the Cole County Health Department.

Kristi Campbell, the department's director, said 14 of those that contracted the infection ate at the same restaurant and that the Missouri Department of Health and Senior Services is working with the Jefferson City Environmental Health Division to investigate that establishment.

'The way it works is information is reported to the County Health Department from patients or their caregiver," said David Grellner with the Jefferson City Environmental Health Division. "The Communicable Disease Office at the County confirms this information and interviews the patients who reported ill to get a history to see if they can pinpoint a source."

Campbell also said that all of the confirmed cases of salmonellosis had the same pulsed-field gel electrophoresis (PFGE) pattern, indicating that the infection came from the same or a similar source, in this case, eggs or chicken. The name of the restaurant at which 14 of the infected ate is not being released by the Cole County Health Department.  [Byline: Joe McLean]
======================
[The number of cases has increased, a potential restaurant source has been identified and all the isolates appear to be microbiologically linked - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon 24 Apr 2017, 2:12 AM IST
Source: Deccan Chronicle [edited]

Nearly 40 cases of hepatitis A were reported so far as on [Sun 23 Apr 2017], from Kalamassery Municipality with 21 cases being reported from the Ernakulam Medical College alone. Meanwhile the Food Safety Department carried out raids at eateries and collected water samples for examination.

"The number of cases reported from the Ernakulam Medical College alone is 21, though the disease has also been reported from other areas, too. In most of the cases, the patients are those who eat from outside on a regular basis, like street food vendors. For instance the NUALS hostel from where 9 cases were reported," said N. K. Kuttapan, district medical officer.

"An intensive raid was conducted by the Food Safety Department in and around Kalamasserry area in connection with the reports of hepatitis A outbreak. The squads collected water samples from various sources for chemical and microbiological examination. A total of 3 hotels including 'Pallath' Restaurant, Kalamasserry, are directed to close down and take rectification measures immediately," said Shibu K. V., assistant food safety commissioner. The Health department authorities have already issued an alert as the hostels of the MBBS students of Medical College and that of NUALS (National University of Advanced Legal Studies) were closed.

The public has been warned against using contaminated water for cooking and cleaning utensils. Hotels, canteens and catering units have been instructed to use only boiled water for drinking. Health card is mandatory for all employees, especially those who cook or handle food items. Uncooked salads, ice creams and cool drinks being sold in unhygienic condition from outside should be avoided. The authorities have also asked to chlorinate wells and warned against using water from un-chlorinated wells.
======================
[Since more than half of the reported cases are from a medical college, clearly cases are occurring in adults. Assuming the diagnoses have been made serologically (by the presence of IgM anti-HAV), it is likely that those infected came from areas of India where clean, safe water was available. Seroprevalence rates in the developing world for past HAV can be as high as 100 percent by age 10. Because of this, large waterborne outbreaks of viral hepatitis have been hepatitis E. - ProMED Mod.LL]
Date: Sun 23 Apr 2017
Source: Dr.Sher Bahadur Pun <drsherbdr@yahoo.com> [edited]

An average of 30 rat-bite victims, who seek treatment, visit to OPD of the Sukraraj Tropical and Infectious Disease Hospital (STIDH) everyday. The majority of these victims are only concerned about rabies. Currently, STIDH does not provide anti-rabies vaccine to rat-bite victims as per the national guidelines. However, no information is available, as to whether or not diseases that can be directly or indirectly transmitted by rodents to humans in Nepal. Rat-bite issue is vastly neglected and is an unnoticed public health problem in Nepal. A baseline survey is needed to track rodent-borne diseases that have potential for future outbreaks in Nepal.
----------------------------
Sher Bahadur Pun, MD, PhD
Clinical Research Unit Sukraraj Tropical and Infectious Disease Hospital Kathmandu, Nepal
drsherbdr@yahoo.com
==========================
[Rat bite fever is certainly the classical infection associated with the rat bite and exposure to rat urine is associated with a variety of diseases including leptospirosis and some of the hemorrhagic fevers. The following information was found regarding rats and rabies at <http://www.ratbehavior.org/WildRatDisease.htm#Rabies>:

"Are wild rats ever found to carry rabies?
--------------------------------------------------------------
Very few rats infected with rabies have ever been found in the United States. Winkler (1973) reviewed the literature on rodent rabies in the United States. He found that during the 18-year period of 1953 and 1970, a small number of rabid rats (39 rats) were found in the United States. The numbers were extremely small: only 11 rabid rats were found in the USA during the 3 year period of 1953-1955.

The number of rabid rats declined during the period of time covered by the review, and by the 3 year period of 1968-1970 only 2 rats were found to be rabid. This decline in the number of rabid rats is probably due to an improvement in diagnostic techniques which led to fewer false positives. In Thailand, 4.7 percent of Norway rats (9 rats out of 192) were found to be carrying rabies (Smith et al. 1968).

However, no rats were found to be infected with rabies in surveys of wild rat populations in Sri Lanka (Patabendige and Wimalaratne 2003), Poland (Wincewicz 2002), and Bangkok, Thailand (Kantakamalakul 2003).

"Have rats ever caused rabies in humans?
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Rats and other small rodents have never caused a single case of human rabies in the United States (CDC). A very few cases of humans infected with rabies by rats have been reported in countries such as Poland, Israel, Thailand and Surinam. In Poland, out of 9998 cases of human rabies from 1990 to 1994, 4 were caused by rats (0.04 percent), while the vast majority was caused by foxes (Zmudziñski and Smreczak 1995, described in Wincewicz 2002).

In Israel, 1 case of human rabies was caused by a bite from a small rodent -- possibly a rat or mouse (Gdalevich et al. 2000). In Thailand, out of 7000 human rabies cases reported each year, 1 percent is caused by rat bites (Kamoltham et al. 2002). The majority of rabies cases in Thailand are caused by dogs (86.3 percent) (Pancharoen et al. 2001). An outbreak of paralytic rabies in children in Surinam was attributed to rat bites (Verlinde et al 1975).

"Why is rabies so rare in rats?
--------------------------------------------------------------
The answer is unclear. Currently, it is presumed that rats are so small that they almost never survive the attack of a larger rabid animal, like a raccoon, skunk, or fox." The references are not included here. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/2877>.]
Date: Mon 24 Apr 2017
Source: Food Safety News [edited]

The Public Health Agency of Canada has confirmed 27 cases of _E. coli_ O121 infections across 5 Canadian provinces since November 2016 that have been linked to flour produced by Ardent Mills Canada. A 28th victim was a visitor to the country. A total of 7 of the outbreak victims were hospitalized, but are recovering. No deaths have been reported in relation to the outbreak.

_E. coli_ O121 is a Shiga toxin-producing strain of _E. coli_. In recent years, according to the CDC, it has been responsible for outbreaks associated with flour, frozen foods and raw clover sprouts.

Provinces reporting illnesses and the number of cases in each are:
British Columbia, 12;
Saskatchewan 4;
Alberta 5;
Ontario 1; and
Newfoundland and Labrador 5.

The country of origin of the affected visitor was not released. The 14 male and 14 female victims range in age from 8 years to 79 years, with an average of 24 years. On [Tue 28 Mar 2017], the Public Health Agency of Canada (PHAC), in concert with the Canadian Food Inspection Agency (CFIA), informed the public that "Original Robin Hood All Purpose Flour" was confirmed to be contaminated with the outbreak strain of _E. coli_ O121.

Smucker Foods of Canada Corp. recalled an undisclosed amount of the Robin Hood branded flour on [Tue 28 Mar 2017]. Robin Hood has been a member of the Smucker family of brands in Canada since 2004. Consumers and others can identify the recalled 10 kg [approx. 22 lb] bags of flour by looking for the following label information: UPC number 0 59000 01652 8; and Product code containing BB/MA 2018 AL 17 and 6 291 548.

Ardent Mills Canada is the manufacturer of Robin Hood Flour. In a statement released [Sun 16 Apr 2017], the company acknowledged that it was "... aware of one illness associated with the consumption of flour," but emphasized that no illnesses were linked to the additional products included in subsequent recall notices.

The additional recalls are a result either of the detection of _E. coli_ O121 in a sample of the production lot or a determination that the product was manufactured using the same source material as a product that tested positive for _E. coli_ O121, according to CFIA.

"One specific product has been directly linked to a case of illness," a CFIA spokesperson told Food Safety News. "Other products with specific production dates, while not linked to specific cases of illness, have been analyzed by our laboratory and found to contain the same type of _E. coli_ that is of concern in the outbreak."

So far, CFIA has not carried out environmental sampling in the production facility, but has focused of sampling flour products on the market. The genetic pattern of the Canadian outbreak strain is unrelated to the strain of _E. coli_ O121 that was responsible for an outbreak of more than 60 illnesses in the U.S. in 2016. That outbreak was traced to flour produced by a General Mills facility in Kansas City, MO.

All of the recalled Ardent Mills products were manufactured in 1 facility, during a 3 week period from [14 Oct to 3 Nov.2016]. Some of the products were distributed to retailers, including Costco Canada, while others were supplied to hotels, restaurants, and institutional customers. Additional brand names of the recalled flour include: Arrezzio, BakerSource, Brodie, Creative Baker, GFS, Golden Temple, Great Canadian Bagel, Kitchen Essentials, Robin Hood, and Sunspun.  [Byline: Phyllis Entis]
====================
[The enterohemorrhagic _E. coli_ (EHEC) serotype is identified as O121, one of the non-O157 EHEC serotypes. As a reminder, other non-O157 _E. coli_ serogroups that have been associated with EHEC disease include motile ones such as O26:H11 and O104:H21, and non-motile ones such as O111:NM (or H-). Such non-O157 isolates can be obtained from sheep and cattle, and although they cause as many as 30 per cent of outbreaks of EHEC (1), they appear to be somewhat less (or at least more variably) virulent in a variety of in vivo and in vitro assays (2-4).

In analyzing the genetic and phenotypic profiles of non-O157 groups, it has been found that they belong to their own lineages and have unique profiles of virulence traits different from O157 (5).

References
----------
1. Hussein HS and Omaye ST. Introduction to the food safety concerns of verotoxin-producing _Escherichia coli_. Exp Biol Med. 2003;228(4):331-2.
2. Blanco J, Blanco M, Blanco JE, et al. Verotoxin-producing _Escherichia coli_ in Spain: prevalence, serotypes, and virulence genes of O157:H7 and non-O157 VTEC in ruminants, raw beef products, and humans. Exp Biol Med. 2003 Apr;228(4):345-51.
3. Law D and Kelly J. Use of heme and hemoglobin by _Escherichia coli_ O157 and other Shiga-toxin-producing _E. coli_ serogroups. Infect Immun. 1995;63(2):700-2.
4. Tzipori S, Wachsmuth KI, Smithers J and Jackson C. Studies in gnotobiotic piglets on non-O157:H7 _Escherichia coli_ serotypes isolated from patients with hemorrhagic colitis. Gastroenterology 1988; 94(3): 590-7.
5. Schmidt H, Geitz C, Tarr PI, Frosch M and Karch H. Non-O157:H7 pathogenic Shiga-toxin producing _Escherichia coli_: phenotypic and genetic profiling of virulence traits and evidence for clonality. J Infect Dis 1999; 179(1): 115-23. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 12 Apr 2017
Source: The Japan Times News [edited]

Two pregnant women have died after they contracted a disease spread through a parrot's infected faeces, health ministry officials said, in what is likely to be the 1st such cases in Japan. According to a research team at the Japan Agency for Medical Research and Development, 2 maternal deaths related to the disease were found in a probe it conducted in fiscal year 2016. The ministry and the national research agency would not say when the 2 women died.

Animal-to-human transmission of the disease occurs if a person inhales a bacterium called _Chlamydophila psittaci_ that can be found in the faeces of pet birds such as parrots. Following an incubation period of 1 to 2 weeks, infected patients develop flu-like symptoms, such as high fever and a cough.

In Japan, a few dozen infections are reported annually, according to the ministry, and patients can die if symptoms become severe.

Pregnant women "should avoid unnecessary contact with pet birds, as their resistance (to diseases) is undermined during pregnancy," said Itaru Yanagihara, a department head at the research institute of Osaka Women's and Children's Hospital.
==================
[_Chlamydophila psittaci_ has been isolated from about 100 bird species, but most human _C. psittaci_ infections result from exposure to pet psittacine birds. Transmission has been documented from other birds, however, including doves, pigeons, birds of prey, and shore birds.

Psittacosis, also known as ornithosis or parrot fever, is a human disease caused by the bacterium _Chlamydophila psittaci_. Classically associated with psittacine birds such as parakeets, parrots, and cockatiels, it may affect other avian species such as turkeys, ducks, pigeons, and pheasants. Human infection in general is caused by inhalation of dust containing the bacterium, which is shed in large amounts in the feces and secretions of the infected birds. Illegally imported decorative birds that have not been screened and/or treated can be a significant source of the pathogen.

The respiratory infection, usually diagnosed serologically, can be fatal if untreated. Although most diagnosed cases have direct exposure to birds, the infection may be acquired indirectly through the aerosolization of infective material in the grass or ground such as when mowing a lawn. Because of such outbreaks, protective equipment may be recommended for individuals in areas frequented by free-ranging birds, if contact with birds and their droppings is likely when performing outdoor activities such as lawn mowing.

People who are occupationally exposed to psittacosis include pet store workers, poultry farmers, poultry processing workers, and veterinarians

That severe infection due to _C. psittaci_ can occur during pregnancy and has been reported:

- Tiller CM: Chlamydia during pregnancy: Implications and impact on perinatal and neonatal outcomes. J Obstetr Gynecol Neonatal Nursing 2002; 31: 93-98

- Gherman RB, Leventis LL and Miller RC: Chlamydial psittacosis during pregnancy: A case report. Obstet Gynecol. 1995:86: 648-650, Volume 86, Issue 4, Part 2, October 1995, 648-650

A number of infections including influenza and coccidiodomycosis are well documented to be more severe during pregnancy presumably due to immunological and/or hormonal changes. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun 23 Apr 2017
Source: Geo TV [edited]

A new case of Congo virus [Crimean-Congo haemorrhagic fever virus] has been confirmed in Kohlu area of Balochistan, local hospital sources said on [Sun 23 Apr 2017].

A patient suspected of suffering from the Congo virus was admitted to Fatima Jinnah hospital 3 days ago. The patient remains under treatment at the hospital and has been declared to be out of danger, the sources said.

This is the 2nd case of the Congo virus reported in Balochistan during the ongoing month [April 2017]. At least 30 cases of the virus were detected in the province during 2016.

Health experts urge people to be wary of symptoms like headache, vomiting, red eyes, bleeding, and severe body pain. They advise that anybody suffering from these symptoms rush to a nearby hospital because early diagnosis can save lives.

Congo virus [is carried by several domestic and wild animals and transmitted by ticks to both animals and humans].
===================
["Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal tick-borne zoonosis characterized by hemorrhage, with a fatality rate of between 10 to 50 percent. The causative organism, Crimean-Congo hemorrhagic fever virus (CCHFV), belongs to the family Bunyaviridae, and genus _Nairovirus_ and is the world's most prevalent tick-borne virus. The tick which is the focal point for the transmission of CCHFV belongs to the genus Hyalomma. The environmental conditions in Pakistan are optimal for the replication of ticks, and this further increases the chances of spread of CCHFV infection.

"The CCHF virus is transmitted to humans through tick bites or by direct contact with infected animal blood often via farmers, slaughterhouse workers, veterinarians and so forth. In addition, person-to-person transmission can then occur due to direct or indirect contact with the skin, mucous membranes, or body fluids of infected patients.

"Tick bites serve as the major mode of transmission of disease; however, the blood, body fluids and tissues of susceptible animals might also pose a threat for humans. The disease is essentially asymptomatic in animals and poses a threat to people from across the population. For instance, healthcare professionals who deal with patients infected with CCHFV are at a high risk of infection due to inadequate biosafety policies and practices and a lack of proper management procedures as a result."  (<https://virologyj.biomedcentral.com/articles/10.1186/s12985-017-0726-4>)

The potential high risk groups of CCHF are recognized not only by their professional or work roles but also geographically. The prevalence of CCHF is highest in Balochistan, Khyber Pakhtunkhwa and cases have been reported from southern Punjab and Sindh.

Generally the case numbers of CCHF go up in the country from May onwards, due to a multitude of causes, including warmer climates, increased tick activity, increase in human and animal movements etc.

With these baseline conditions, sporadic cases have been already reported from Punjab and now Balochistan. There is need for coordinated action by both human and livestock/animal health sectors. The risk of CCHF transmission must be assessed and appropriate control measures instituted for slaughtering of animals, use of proper personal protective equipment/clothing, and providing public educational messages for the prevention and control of CCHF. - ProMED Mod.UBA]

[Maps of Pakistan can be seen at
and <http://healthmap.org/promed/p/59960>. ProMED Sr.Tech.Ed.MJ]
13th April 2017
http://www.who.int/emergencies/nigeria/meningitis-c/en/

13 April 2017 - A vaccination campaign is underway in Nigeria to contain an outbreak of meningitis C, a strain of meningitis which first emerged in the country in 2013. Since the beginning of this year, the country has reported 4637 suspected cases and 489 deaths across five states.

The International Coordinating Group (ICG) on Vaccine Provision, which coordinates the provision of emergency vaccine supplies during outbreak emergencies, has sent 500 000 doses of meningitis C-containing vaccine to Nigeria to combat the epidemic. The vaccines, funded by Gavi, the Vaccine Alliance, have been administered in Zamfara and Katsina states, which are the worst affected by the outbreak. An additional 820 000 doses of a meningitis C conjugate vaccine – a donation from the UK government to the World Health Organization (WHO) - is being sent to the country.

In the last week, the ICG, which is managed by the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins sans Frontières (MSF), the United Nations Children’s Fund (UNICEF), and WHO, has also sent 341 000 doses of the Gavi-supported meningitis C-containing vaccine to Niger, where there are over 1300 suspected cases of the disease in districts that border with Nigeria and in the Niamey region of the country.

Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord and can cause severe brain damage. Meningococcal meningitis is fatal in 50% of cases if untreated. Though cases of meningitis occur throughout the world, large, recurring epidemics affect an extensive region of sub-Saharan Africa known as the “meningitis belt” which includes 26 countries from Senegal in the west to Ethiopia in the east.

There are several different types of meningococcal meningitis (A, C, W, etc.) that can cause epidemics. Substantial progress has been made in recent years in protecting Africa from disease due to one of the main epidemic types, through the successful introduction of the Men A conjugate vaccine (MACV) against meningitis A. Since MACV was introduced in 2010, more than 260 million people have been vaccinated across 19 countries. This has resulted in a reduction of the number of meningitis cases by more than 57%. Much work, however, remains to be done to protect the region from meningitis C outbreaks and other types of the disease.

In addition to the use of vaccinations to prevent the transmission of meningitis, 20 000 vials of antibiotics have been sent by the ICG to treat people who have the disease in Nigeria. “Vaccination can drastically reduce the magnitude of the epidemic,” says Dr Sylvie Briand, Director of Infectious Hazard Management for WHO. “But in addition, it is essential to strengthen the care of all those affected by the infection and to ensure those people living in hard-to-reach areas can get treatment.”

The Nigeria Centre for Disease Control, with support from WHO, US CDC, UNICEF and other partners, is leading and coordinating the response to the ongoing outbreak, including intensified surveillance, capacity building for case management and risk communication. WHO’s Country Office in Nigeria, including a number of field offices, have been supporting the government since the outbreak began. An additional team of WHO of meningitis experts has arrived in Nigeria to provide additional epidemic response. “In addition to improving the care of the sick, we are focusing on ensuring accurate information about the spread of the outbreak is available as quickly as possible to help us make the most effective use of vaccines,” says Dr Wondimagegnehu Alemu, WHO Representative to Nigeria.

The emergence of meningitis C in Africa

Since 2013, there have been outbreaks of meningitis C in Nigeria, initially limited to a few areas in Kebbi and Sokoto states in 2013 and 2014. In 2015, however, there were more than 2500 cases of the disease across 3 states in Nigeria as well as 8500 cases in Niger.

Concerns about vaccine supply

Most vaccines currently being used for meningitis C outbreaks in Africa are polysaccharide vaccines, which are in short supply as they are being phased out in other parts of the world. The more effective and long-lasting conjugate vaccines, however, are not readily accessible for outbreak response in the region. The ICG global emergency stockpile currently has approximately 1.2 million doses of meningitis C-containing vaccines left.

“The very limited supply of vaccines to control outbreaks of meningitis C can affect our ability to control these epidemics,” says Dr Olivier Ronveaux, WHO meningitis expert. “In the long term, the accelerated development of affordable and effective conjugate vaccines to cover all epidemic types of meningitis is a high priority for WHO and partners.”

Nigeria and Meningitis A

In the past, Nigeria has suffered large-scale outbreaks of meningitis A. In 2009, such an outbreak in the country caused over 55 000 cases with close to 2500 deaths. Niger was also affected, with 13 000 cases and 550 deaths. However, preventive mass vaccination campaigns supported by Gavi and partners, using the safe and effective MACV in Niger (2010-11) and Nigeria (2011-14) have provided high and long-term protection against the bacteria. Since 2010, less than 20 cases of meningitis A have been reported from all vaccinated areas in the region. WHO recommends the continued roll-out of the Men A conjugate vaccine campaigns along with its introduction into routine immunization to prevent a major recurrence of devastating meningitis A epidemics.

Useful links:

International Coordinating Group (ICG) on vaccine provision for meningitis:
http://www.who.int/csr/disease/meningococcal/icg/en/

Map of meningitis belt:
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_MeningitisRisk_ITHRiskMap.png?ua=1&amp;amp;ua=1&amp;amp;ua=1

Meningococcal meningitis Fact Sheet:  
http://www.who.int/mediacentre/factsheets/fs141/en/

Media contact:
Tarik Jašarević
Mobile: +41 793 676 214
Tel: +41 22 791 5099
E-mail: jasarevict@who.int