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Kenya

General Information:
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Kenya is situated on the east coast of Tropical Africa and is one of the most popular tourist resorts in the continent. The country is bounded by Ethiopia and Somalia in the north, Ugan
a on the west, Tanzania to the south and the Indian ocean to the east. The country has been regarded as one of the more stable in Africa but nevertheless recent events, as they head towards a multiparty democracy, have led to a spiralling devaluation in their currency and general unease and disturbances.
Climate:
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Nairobi is situated at approx. 6000' and has a mild climate throughout the year. Malaria prophylaxis is not usually recommended for those visiting Nairobi city alone. The main rains tend to fall in April and May or October and November. The annual rainfall tends to be about 39 inches but significant variations can occur. Mombasa, on the coast, has a much more tropical climate and travellers will need to take more care with regard to personal hygiene and also serious protection against mosquito bites.
Health Care Facilities:
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In general, travellers to Nairobi find that the level of health care facilities are good. All doctors in Kenya speak English and the level of care they provide is usually excellent for the holiday maker. As in many other countries in central Africa, the screening of blood against various viral agents cannot be assured and so travellers should avoid all but essential of blood transfusions. Sterile needles and syringes are in good supply in the major towns and so a syringe kit is not usually necessary. All of the larger hotels will have their own English speaking medical officer, though travellers are usually asked to pay cash. There are many hotels and restaurants providing excellent menu facilities and food borne disease can usually be traced to eating salads or undercooked bivalve shellfish.
Swimming in Kenya:
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In all the major tourist resorts throughout Kenya there are swimming pools and these are usually the best places to indulge. On the coast the sand is exceptionally fine and it feels as if you are walking on flour. Just be careful of local strong currents and don't swim out to the coral. Watch out for the sea urchins. Their spines are very uncomfortable and may need to be extracted by medical staff. Keep your children in view at all times and warn them to take care. If you are trekking around Kenya or on Safari don't go swimming in any fresh water rivers or lakes. There is a disease called Schistosomiasis (Bilharzia) which will penetrate through your skin and may cause serious problems in the future.
Rabies in Kenya:
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This viral disease occurs throughout Kenya and is a significant risk for travellers who are going away from the major tourist areas. Keep clear of all warm blooded animals and if you are bitten (even licked or scratched) wash out the area immediately, apply an antiseptic and get medical attention. Even though the risk of Rabies for the traveller is very small don't ever disregard a contact of this type. The beach hotels near Mombasa are favourite haunts for monkeys. Don’t feed them and stay clear. Report any bite (lick or scratch) immediately. Watch your children at all times.
Trekking through Kenya:
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Some travellers to Kenya will have no particular itinerary planned and so start their holiday from either Nairobi of Mombasa. Those planning to go off the beaten track should register with the Irish Counsel. Great care should always be exercised as each year too many tourists have significant problems while trekking off the usual routes. The major risks revolve around food and water borne disease, the risk of rabies, altitude sickness on Mount Kenya, being robbed or simply getting lost!

Tips for Trekkers
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Always plan your trip well in advance
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Make sure that you know about personal health and general food & water hygiene.
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Check in frequently
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Never travel alone
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Make sure you have plenty of clean water
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Stick to your itinerary
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If you are in trouble, admit it!
The Risk of Malaria:
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In Kenya, malaria poses a very real risk outside Nairobi. One of the highest risk areas is Mombasa which is where many travellers will find themselves at some time. Malaria is transmitted by the bite of an infected mosquito and so the first line of defence is to protect yourself against mosquito bites. (see leaflet on Protection against Insect Bites - Tropical Medical Bureau). Also it is essential to take your prescribed malaria tablets on a regular basis. Only stop your tablets under exceptional circumstances. Nevertheless, the traveller must remember that there is no perfect protection against malaria and the disease can still occur even after all the precautions have been taken. So be aware that any peculiar symptoms (especially 'flu) for at least a year after your trip will need to be checked out.
After your Journey:
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Just remember that some tropical diseases may not become evident for weeks or even months after your trip. If you are ill within a year of your journey always seek medical help.
Further Information:
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General travel health information may be obtained from the Tropical Medical Bureau at any of our centres. Please remember, every traveller will require a specialised consultation and this leaflet only contains general guideline information.

Travel News Headlines WORLD NEWS

Date: Fri, 13 Mar 2020 11:41:16 +0100 (MET)

Nairobi, March 13, 2020 (AFP) - Kenya announced Friday the first confirmed case of coronavirus in East Africa, as the region so far unscathed by the global pandemic scaled up emergency measures to contain its spread.   A 27-year-old Kenyan woman tested positive for the virus on March 12 in Nairobi, a week after returning from the United States via London.   She was in a stable condition and recovering, Health Minister Mutahi Kagwe told reporters.   "We wish to assure all Kenyans that the government will use all the resources available to fight coronavirus," he said, as the government rolled out a raft of new containment measures.

The government had traced all the contacts of the patient since she arrived back in Kenya on March 5, he added.   "At the moment, there is absolutely no need for panic and worry," he said.   There are now 14 countries in Africa with confirmed cases of the virus that has swept the globe, infecting more than 130,000 people and killing nearly 5,000.   But to date the continent has been spared the worst of the pandemic.    Only five people have succumbed to coronavirus so far -- all in north Africa -- with the sub-Saharan region recording no deaths and very low numbers
of confirmed cases.

But countries in East Africa -- which until the positive case in Kenya, had only recorded negative test results -- have been taking precautions.   Some flights have been restricted, with Kenya Airways suspending its route to Rome, and charter flights from Italy to the Kenyan coast on hold.   It has also suspended international conferences, a top earner in Nairobi, a hub for such events in the region, and non-essential travel abroad for politicians.   The government announced more expansive restrictions on Friday, including a temporary ban on major public gatherings, prison visits and activities between schools.

- Soap and sanitiser -
Other countries in the region have been rolling out their own measures.   In Rwanda, which shares a border with the Democratic Republic of Congo, which has confirmed cases, washing basins with soap and sanitiser have been placed on streets for commuters to use before boarding buses.   Authorities in Kigali, the capital, have also banned concerts, rallies and trade fairs -- although like in Kenya and Uganda, church services have been proceeding and bars, restaurants and entertainment precincts remain open.   Neighbouring Burundi, meanwhile, has quarantined 34 people in a hotel in Bujumbura as a precaution.

Uganda has ordered that visitors from a number of affected countries self quarantine for 14 days, or consider simply not visiting at all.   South Sudan's health ministry said meanwhile that it was "temporarily suspending direct flights between South Sudan and all affected countries"   Kagwe, the Kenyan health minister, also addressed a rumour circulating on social media that people with black skin cannot contract the virus.   "I would like to disabuse that notion. The lady (confirmed with coronavirus in Kenya) is an African, like you and I," he said.
Date: Thu 20 Feb 2020
Source: Daily Nation (Kenya) [edited]

A malaria outbreak has left over 130 people seeking treatment in Bomet County in the past 4 days, according to local health officials.

Bomet County Executive for Health Joseph Sitonik confirmed the outbreak at a press conference Thursday morning [20 Feb 2020]. He said the number of affected residents was rising by the day. "Public health officers have mounted a surveillance in the affected regions with a view to containing further spread of infections," Dr. Sitonik said.

In January [2020], 4 patients were treated, but in the recent past the number of patients has increased sharply.

A majority of the cases have been reported in Sotik. Some 60 patients have been treated at various hospitals in the sub-county, Dr. Sitonik said. "So far, 39 cases have been recorded at Longisa Hospital and 25 cases at Tenwek Hospital," he said.  [Byline: Vitalis Kimutai]
=======================
[Bomet County is part of the former Rift Valley Province. It is located at an altitude of 1960 meters (6430 ft), which usually excludes malaria transmission because the temperature is too low. Thus, sustained transmission at this altitude probably signals an increasing temperature, which allows development of _Plasmodium falciparum_ malaria (we assume it is _P. falciparum_) in the local _Anopheles_ mosquito population. _P. falciparum_ requires a 24-hour temperature of not below 20 deg C (68 deg F) to develop in the mosquitoes. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Bomet, Rift Valley, Kenya: <http://healthmap.org/promed/p/17486>]
Date: Mon 3 Feb 2020
Source: The Star [edited]

Six more people on Monday morning [3 Feb 2020] were treated and discharged following a suspected anthrax outbreak in Emityot village in Sotik, Bomet. Health executive member Joseph Sitonik said all the individuals exhibited cutaneous signs where watery wounds appeared on parts of their bodies. Sitonik said they were out of danger.

Those referred on Sunday [2 Feb 2020], he added, were also attended to and discharged. No patient is admitted to any health facility as a result of anthrax, Sitonik said. "We treated and released them after they tested positive for the disease, but we would also like to state that there are no patients admitted to hospitals since their conditions are not severe," Sitonik told journalists in his office.

The number of those who came in contact with the carcasses of the animals was 29: 4 [children] under 5 years old, 17 male adults, and 8 women. Sitonik said the number of animals that died were 7.

While calling on residents from the area to visit the nearest health facilities for a check-up, the CEC said the disease had adverse effects on humans, saying it can cause severe pneumonia.  [byline: Felix Kipkemoi]
====================
[The previous report had 18 villagers affected and treated. With these additional 6 over the weekend, the total is now 24 people with cutaneous lesions. Whether these 24 were all included in the 29 carcass handlers is unclear, though not impossible. How the 4 children under 5 years of age came to be exposed is not described, but it could well have been through playing and coming in contact with a butchered carcass. There would have been ample spilt blood. And we now have 7 dead cattle in this village. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Bomet, Rift Valley, Kenya:
Date: Thu 30 Jan 2020
Source: Daily Nation [edited]

A shortage of yellow fever vaccine at City Hall since October [2019] has disrupted plans of many Kenyans seeking to travel abroad.

A spot check by the Business Daily since [Mon 27 Jan 2020] showed that dozens of Kenyans were being turned away and forced to pay more to get the jab at airports.

A nurse at the Nairobi County's inoculation centre, who sought anonymity, said the last time City Hall had supplies for the vaccine was in late October [2019], adding that they had not received any fresh stocks despite making requisitions to health authorities.

City Hall charges Sh 3000 [USD 29.85], up from the previous Sh 2500 [USD 24.88], for the vaccine that is mandatory for all people seeking to travel to countries that are considered to be vulnerable to yellow fever. The same dose goes for USD 50 or about Sh 5043 at the airports.

Kenya is one of the eastern, central, western and southern African countries the World Health Organisation considers to be prone to the disease, making the yellow fever vaccine a must-have for any traveller to or from these nations.  [Byline: Kevin Rotich and John Mutua]
========================
[It is not clear why the yellow fever (YF) vaccine shortage exists. The shortage and higher than previous prices run the risk of driving vaccination efforts underground, administration of fake vaccine, sale of fake vaccination certificates or issuance of the certificates without vaccination. These practices have been a problem in the past.

Not only would these illegal practices pose a risk to the individuals who might be exposed to YF virus and be unprotected, there is a risk to the general public should a viraemic individual introduce the virus into an area where the vector mosquitoes are abundant enough to permit ongoing transmission of the virus. This also damages public confidence in health officials in general. Fortunately, the governor has been aware of these practices, has taken steps to inform the public, and instructing the police to investigate and prosecute the offenders. Close monitoring of the current vaccine situation by Kenya health authorities would be prudent. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Mon 16 Dec 2019
Source: Outbreak News Today [abridged, edited]

Health officials continue to report cases of the parasitic disease, leishmaniasis, in Kenya. During the week ending [8 Dec 2019], officials saw 34 additional cases.

This brings the leishmaniasis outbreak tally this year [2019] to 2822, including 34 deaths.

Most cases of leishmaniasis have been reported from Mandera, Marsabit, Wajir, and Garissa counties.

Leishmaniasis is not a single disease, but a group of syndrome due to a variety of species of this parasite. They affect different populations and are related to a characteristic vector, the sandfly.

The disease can range from asymptomatic infections to those causing significant illness and death. Disease can appear on a spectrum from a single skin ulcer to destructive lesions of the face to terminal organ disease.

The vector for this parasite is a phlebotomine sandfly. There are a few different species implicated depending on the part of the world. Sandflies are very small (about 1/3 the size of a mosquito) and make no noise when flying. Their bites can sometimes be painless; because of these reasons, many people have no idea they were bitten. Even one bite of a sandfly can transmit disease, so travellers on short trips can still get infected.

There are several species of _Leishmania_ that cause disease in humans. The most common are _L. donovani_ (kala-azar), _L. tropica_ (Baghdad boil), and _L. braziliensis_ (espundia, [affects mucous membranes]). After getting bitten by a sandfly, the disease may manifest itself from a week to many months later.

It starts out as a papule that enlarges to an ulcer. The ulcer can give the appearance of a volcano crater. Lesions may appear singly or multiple; many heal spontaneously within weeks to months to years.

Certain species (_L. braziliensis_) can disseminate to the mucosal areas of the face and mouth and cause very destructive and disfiguring disease (espundia [affects the mucous membranes]) that appears similar to leprosy.

Kala-azar, an Indian name given to systemic type of the disease due to the greyish appearance of the body, can result in enlarged spleen and liver, diarrhoea, emaciation, weakness, and death.
=======================
[Leishmaniasis, both cutaneous and visceral, are endemic in Kenya. Please see our review of the situation in Kenya in archive no.

[An image of the phlebotomine sandfly vector can be seen at

[Maps of Kenya: <https://goo.gl/pcUuf4> and
More ...

World Travel News Headlines

Date: Wed, 1 Apr 2020 14:43:58 +0200 (METDST)

Paris, April 1, 2020 (AFP) - A man has been jailed in France for repeatedly violating strict anti-coronavirus lockdown rules, which have seen 359,000 fines issued countrywide as the outbreak death toll continues to mount, authorities said Wednesday.    Police Minister Christophe Castaner warned residents to write off any travel plans for school holidays starting this weekend, promising to punish any unwarranted movement as the country continues to evacuate dozens of critically ill patients from hospitals in overstretched areas of the country.

The Ile-de-France region, with Paris at its core, saw its first evacuations Wednesday as the outbreak which started in the east of France takes an ever-heavier toll on the capital.   Twenty-four patients were sent from Paris to Brittany in northern France in the morning on a high-speed train, fully equipped as a hospital on tracks, with 12 others to follow on a second train later.

A third of the 499 deaths registered in France in the previous 24 hours had been from Ile-de-France, the government said, with the countrywide death toll now at 3,523.   Only deaths in hospital are counted towards the official tally, which excludes people who passed away in old age facilities or at home.   To date, the government has evacuated nearly 300 patients from hospitals in hard-hit areas of the country to lesser burdened ones, and some to Germany, Switzerland and Luxembourg. Austria said Wednesday it would take three patients from eastern France.

- 'We must stand strong' -
As the medical crisis escalates, a court in Calais in the country's north sentenced a 20-year-old man to two months in prison after he was caught eight times without the self-certified document all residents are required to show if they leave the house for critical business.   This can include essential shopping, going to the doctor, walking the dog, a quick jog, and going to work for those in critical fields.     In Paris on Tuesday, a court sentenced a 22-year-old man to 105 hours of community service, also for repeatedly violating the lockdown.

Castaner said some 5.8 million checks have been carried out and 359,000 fines issued since the lockdown started on March 17, and stressed that leaving on holiday was not allowed under the lockdown rules that have confined millions of children at home with schools closed.   Even with train and plane traffic slashed to a minimum, authorities fear a holiday exodus and the minister said controls will be stepped up on the roads and at train stations and airports.   "Confinement is a strain for families, I know, but we must stand strong," he said.   More than 22,700 people are hospitalised for COVID-19 in France, with 5,565 in intensive care.
Date: Wed, 1 Apr 2020 12:33:43 +0200 (METDST)

Tehran, April 1, 2020 (AFP) - Flooding in Iran caused by heavy rainfall has left 21 people dead and one missing, an emergency services spokesman said Wednesday, even as the country battles the coronavirus pandemic.   Mojtaba Khaledi told Iran's ISNA news agency that 22 people had also been injured, with most of the casualties in southern or central provinces.   He said 11 people had died in Fars province, three each in Hormozgan and Qom, two in Sistan and Baluchistan province, and one each in Bushehr and Khuzestan.   Khaledi said one person was still missing in Hormozgan on the Gulf coast.

Flooding last week killed 12 people, and Khaledi warned of more heavy rain to come.   Iran is battling one of the world's deadliest coronavirus outbreaks with 3,036 deaths and 47,593 infections.   In March and April last year, heavy rainfall and flooding killed at least 76 people in Iran.   At the time, the International Federation of Red Cross and Red Crescent Societies estimated 10 million people were affected, describing the floods as "the largest disaster to hit Iran in more than 15 years".
Date: Wed, 1 Apr 2020 10:00:47 +0200 (METDST)

Sydney, April 1, 2020 (AFP) - Australian health officials set up a coronavirus testing clinic on Sydney's Bondi Beach Wednesday, as concern grew that COVID-19 was spreading among backpackers in the popular tourist destination.   More than 100 cases of coronavirus have reportedly been identified in the area -- many linked to two massive club parties held in mid-March before the country shut down bars, pubs and other non-essential services.   Photos shared online last week also showed mostly young beachgoers packed together on the sand after outdoor gatherings were curtailed, drawing howls of protest.

That led to sunbathers, surfers and tourists being banned from the beach, with police enforcing the prohibition.   New South Wales Health said the Waverley Council area, which encompasses Bondi, had the highest number of confirmed cases in Sydney.   "A plausible explanation is they have come in contact with an infected backpacker before that backpacker was aware they had COVID-19," said chief health officer Kerry Chant.   Australia has recorded almost 5,000 coronavirus infections and 20 deaths, with almost half of those in New South Wales.
Date: Wed, 1 Apr 2020 00:15:13 +0200 (METDST)

London, March 31, 2020 (AFP) - A 13-year-old British boy has died days after testing positive for COVID-19, hospital officials and his family said on Tuesday, with relatives saying he had no underlying illnesses.   The boy, who died Monday at King's College Hospital in London, is believed to be Britain's youngest confirmed death in the coronavirus pandemic.

A 12-year-old girl, whose death was confirmed earlier on Tuesday in Belgium, is thought to be Europe's youngest victim.    The boy's family said Ismail Mohamed Abdulwahab "started showing symptoms and had difficulties breathing" before he was admitted to hospital.   "He was put on a ventilator and then put into an induced coma but sadly died yesterday morning," the family said through a family friend, Mark Stephenson, adding: "We are beyond devastated."

Nathalie MacDermott, a lecturer at King's College, said: "While we know it is much less likely for children to suffer severe COVID-19 infection than older adults, this case highlights the importance of us all taking the precautions we can to reduce the spread of infection in the UK and worldwide."   She urged research into deaths outside the groups expected to succumb to infection as it "may indicate an underlying genetic susceptibility."

On Tuesday, Britain announced 381 deaths from COVID-19 in the past 24 hours, the highest figure in the country since the start of the pandemic, bringing the death toll to 1,789.
Date: Tue 31 Mar 2020 4:36 PM PDT
Source: San Francisco Chronicle [abridged, edited]

The captain of a nuclear aircraft carrier with more than 100 sailors infected with the coronavirus pleaded Monday [30 Mar 2020] with US Navy officials for resources to allow isolation of his entire crew and avoid possible deaths in a situation he described as quickly deteriorating.

The unusual plea from Captain Brett Crozier, a Santa Rosa native, came in a letter obtained exclusively by The Chronicle and confirmed by a senior officer on board the aircraft carrier Theodore Roosevelt, which has been docked in Guam following a COVID-19 outbreak among the crew of more than 4000 less than a week ago. "This will require a political solution but it is the right thing to do," Crozier wrote. "We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset -- our sailors." In the 4-page letter to senior military officials, Crozier said only a small contingent of infected sailors have been off-boarded. Most of the crew remain aboard the ship, where following official guidelines for 14-day quarantines and social distancing is impossible. "Due to a warship's inherent limitations of space, we are not doing this," Crozier wrote. "The spread of the disease is ongoing and accelerating." He asked for "compliant quarantine rooms" on shore in Guam for his entire crew "as soon as possible."

"Removing the majority of personnel from a deployed US nuclear aircraft carrier and isolating them for 2 weeks may seem like an extraordinary measure. ... This is a necessary risk," Crozier wrote. "Keeping over 4000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care."

Acting Navy Secretary Thomas Modly spoke to CNN. "I heard about the letter from Capt Crozier (Tuesday) morning [31 Mar 2020], I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn't have enough beds right now and we're having to talk to the government there to see if we can get some hotel space, create tent-type facilities," Modly said.

"We don't disagree with the (captain) on that ship and we're doing it in a very methodical way because it's not the same as a cruise ship, that ship has armaments on it, it has aircraft on it, we have to be able to fight fires if there are fires on board the ship, we have to run a nuclear power plant, so there's a lot of things that we have to do on that ship that make it a little bit different and unique but we're managing it and we're working through it," he said.

So far, none of the infected sailors has shown serious symptoms, but the number of those who have tested positive has jumped exponentially since the Navy reported infections in 3 crew members on [24 Mar 2020], the 1st time COVID-19 infections had been detected on a naval vessel at sea.

Retired Admiral James Stavridis, former NATO Supreme Allied Commander Europe, told The Chronicle Tuesday [31 Mar 2020] in an email that "we should expect more such incidents because warships are a perfect breeding ground for coronavirus." "Unfortunately, naval vessels are ideal breeding grounds for the spread of viruses because it is impossible to do social distancing on one" because of the tight quarters on board, Stavridis said. The ship's problems will "compound", Stavridis said, because you can't tie the vessel up "and send everyone ashore. It is full of weapons, billions of dollars of equipment, fire hazards, and nuclear reactors".

Scrubbing the Theodore Roosevelt of the virus will not be complicated, but "time-consuming", he said. He estimated cleaning would take 5 to 10 days with a crew of 350 people. Senior military officials said last week that the entire crew of more than 4000 will be tested. The carrier's home port is San Diego.

At the time, Modly expressed confidence that they identified all the sailors who had been in contact with the trio of infected sailors and they had been quarantined. "This is an example of how we are able to keep our ships deployed at seas and underway, even with active COVID-19 cases," Modly said. But by the time the ship reached port in Guam on Friday [27 Mar 2020], the number of cases had grown to 25, and soon after to 36, according to reports.

But by Monday [30 Mar 2020], a senior officer on board the massive aircraft carrier, who wished to remain anonymous because they are not authorized to speak to the media, said between 150 and 200 sailors had tested positive. None had been hospitalized -- yet, the source said. The Chronicle agreed to withhold the officer's name based on its anonymous sources policy.

Gilday told reporters last week [week of 23 Mar 2020] it was unclear if sailors became infected following the ship's previous port of call in early March [2020] to Da Nang, Vietnam. Gilday said they debated whether to go on with the Viet Nam visit, but at the time there were only 16 coronavirus cases in northern Viet Nam and the port was in the central part of the country. Sailors were screened prior to returning on board. The 1st 3 sailors tested positive 15 days after leaving Vietnam, officials said.

The virus has been hard to contain on board ever since. Federal and military guidelines recommend individual quarantine, including no use of common areas. "Due to the close quarters required on a warship and the current number of positive cases, every single sailor, regardless of rank, on board the TR [Theodore Roosevelt] must be considered 'close contact,'" Crozier wrote. The tight quarters on the carrier are "most conducive to spread", he wrote, including large amounts of sailors in a confined space, shared sleeping quarters, restrooms, workspaces and computers, a common mess hall, meals cooked by exposed personnel, and movement constraints requiring communal contact with ladders and hatches.

The captain compared the situation to the Diamond Princess cruise ship, citing a study that focused on what could have happened to that cruise ship had no isolation been done. A total of 712 passengers eventually tested positive for COVID-19 from that cruise departing from Japan; however, the study found if there had been no early isolation close to 80% of passengers and crew would have been infected. And had the cruise line immediately evacuated the ship after the 1st positive tests, the study found only 76 people would have tested positive.

Of the 1st 33 Roosevelt sailors testing positive, 7, or 21%, originally tested negative. After testing negative, those 7 sailors presented symptoms within 1 to 3 days after their initial negative test, Crozier said. The testing should be utilized, the captain wrote, after a proper 14-day quarantine to ensure no infected sailors return on board a clean ship. As part of his plan, 10% of the crew would stay on board to run the reactor plant, sanitize the ship, ensure security and provide contingency response for emergencies.  [byline: Matthias Gafni Joe Garofoli]
==================
[It does seem as though ships in general are ideal incubators for this virus (the SARS-CoV-2). Cruise ships with cabins for 2-4 passengers have proven to be excellent captive audiences for the virus to spread (see prior post: COVID-19 update (60): global, cruise ships, lessons learned, WHO http://promedmail.org/post/20200329.7156949 for a recent summary of cruise ship related outbreaks as well as a series of posts from mid-February 2020 through the present
http://promedmail.org/post/20200215.6993525,
http://promedmail.org/post/20200328.7153651).

In addition to having people in close quarters even in "luxury liners" where maintaining a minimum of 6 feet (2 m) separation is virtually impossible, meals are often buffet style, with serving instruments shared by all. Imagine naval ships with more dormitory style quarters, perfect locations for rapid viral transmission. One can't help but wonder how many other naval vessels from multiple countries around the world are also experiencing similar outbreaks on their ships. - ProMed Mod.MPP]
Date: Thu 26 Mar 2020
Source: The News [edited]

At a time when health authorities are dealing with the threat of coronavirus in the country, cases of Crimean-Congo haemorrhagic fever (CCHF), which is a lethal viral disease, have started surfacing in Sindh, and 2 people have been diagnosed with the tickborne viral ailment within a week.

"Today, we had a 37 year old female patient from Tharparkar, who was bleeding from her nose and mouth. We sent her sample to the lab and the lab test confirmed that she is infected with Crimean-Congo haemorrhagic fever (CCHF)," said Dr Seemin Jamali, the executive director of the JPMC [Jinnah Postgraduate Medical Centre], while talking to The News on Wednesday [25 Mar 2020].

It is the 2nd case of the Congo fever in the current year [2020], she said, adding that earlier a 40 year old person from the Pak Colony of the city had been referred to the JPMC from the Civil Hospital Karachi, who tested positive for the CCHF. Dr Jamali maintained that the previous patient, who was a butcher by trade, had recovered and been discharged from the hospital, but the new patient, a woman from the Tharparkar district of Sindh, was under treatment and in a precarious condition.

Experts say Crimean-Congo haemorrhagic fever is a tickborne viral disease whose mortality rate is over 40 per cent, and it is mostly people who deal with livestock, including butchers and shepherds, who contract the disease after coming into contact with infected animals.
======================
[This is the 2nd case of CCHF from Karachi in 2020. The 1st case has already been reported in an earlier post. The CCHF cases in Pakistan show biannual peaks, between the months of March-May and August-October. Many factors, including poor sanitation, unhygienic transportation, and numerous animal slaughter sites, inefficient tick-control programs, post-slaughter piles of animal remains, nomadic lifestyle, and lack of general awareness contribute to the spread of CCHF.

Pakistan has confirmed cases of CCHF in almost every province: Sindh (Karachi), Punjab (Faisalabad, Multan, and Rawalpindi), Balochistan (Quetta) and Khyber Pakhtunkhwa (Peshawar). There is a need to educate the general public, farmers, and healthcare workers about the causes, transmission, and risks of CCHF and advise on practical preventive measures. - ProMed Mod.UBA]

[Maps of Pakistan:
Date: Mon 30 Mar 2020

There were 3 newly confirmed cases reported by Botswana with travel histories to the UK and Thailand. - ProMed Mod.MPP

HealthMap/ProMED-mail of Botswana:
Date: Mon 30 Mar 2020
Source: Zee News [edited]

A child died due to acute encephalitis syndrome (AES) in Bihar on Sunday (29 Mar 2020). "A child has lost his life due to acute encephalitis syndrome at Sri Krishna Medical College & Hospital (SKMCH) in Muzaffarpur," Dr SK Shahi, SKMCH superintendent said.

This is the 1st AES related death in the district this year [2020]. Last year [2019], over 140 children died due to AES in the district. As per official data, 121 deaths were reported at the government-run SKMCH, which handled the largest number of patients in the district, while 21 deaths were confirmed at the Kejriwal Hospital.

AES is a viral disease that causes flu-like symptoms such as high fever, vomiting, and, in extreme cases, brain dysfunction, seizure, and inflammation of the heart and kidney.
====================
[AES is a common ailment in children in north-eastern India, especially in Bihar state.

The issue of the aetiology of AES has been under discussion for a long time. AES has continued to be attributed to various aetiologies, including Reye syndrome-like disease, possible Japanese encephalitis, enterovirus infection from polluted water, heatstroke, intoxication from lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_).

A recent publication states that dengue virus is one of the 3 commonest agents identified in AES, but existing surveillance for AES does not include routine testing for dengue.

The above report does not indicate whether any of the above aetiologies have been ruled out or confirmed. Until the aetiology (or aetiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible. The season in which AES cases occur is just beginning, and additional cases can be expected over the coming 6-7 months. - ProMed Mod.TY]

[HealthMap/ProMED map available at:
Bihar State, India: <http://healthmap.org/promed/p/364>]
Date: Sat 28 Mar 2020
Source: CGTN Africa [edited]

The number of reported hepatitis E cases in Namibia are on the decrease, statistics released by the Ministry of Health on Saturday [28 Mar 2020] show. A total of 74 hepatitis E (HEV) cases were reported countrywide between 24 Feb and 8 Mar 2020, compared with 102 cases reported during the previous 2 weeks.

The Ministry of Health declared an outbreak of hepatitis E on 14 Dec 2017 in the capital, Windhoek. The outbreak then spread to other regions around April 2018, eventually involving a total of 10 regions. Cases have been reported mainly from informal settlements such as Havana and Goreangab in Windhoek, DRC [Democratic Resettlement Community] in Swakopmund and similar settings in other regions where access to potable water, sanitation, and hygiene is limited.

A total of 7457 hepatitis E cases have been reported since the outbreak began with 65 deaths reported nationally, representing a case fatality rate of 0.9 per cent.

"There is a decrease in the number of HEV cases during the reporting period. (However) the outbreak continues to be protracted and cases are still being detected in areas where water and toilet facilities are limited, particularly in Khomas and in Erongo regions," a report from the health ministry said.
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[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMed Mod.LL]

[Maps of Namibia:
Date: Tue, 31 Mar 2020 22:17:01 +0200 (METDST)

Beirut, March 31, 2020 (AFP) - Lebanese authorities said Tuesday they would allow expatriates to return despite a lockdown in response to the coronavirus pandemic, a move that could affect up to 20,000 people.   The cabinet gave its initial approval for the proposal, which could be put in motion "in principle" from Sunday, a government statement said, without giving details of how it would be implemented.

An estimated 20,000 people "want to return to Lebanon", Foreign Minister Nassif Hitti told local television.  Beirut's international airport has been closed for nearly two weeks, along with schools, universities, restaurants and bars, and Lebanese have been urged to stay at home to stem the spread of COVID-19.   Lebanon has reported 463 official cases of the virus and 12 deaths.