Date: Thu 30 Aug 2018 2:31 PM
Source: Middle East Monitor [edited]
<https://www.middleeastmonitor.com/20180830-62-cases-of-cholera-in-algeria-hundreds-suspected/>

The Ministry of Health said yesterday [29 Aug 2018] that 2 people have died of cholera in Algeria as 62 cases of disease have been identified since the start of August 2018. According to a ministry statement, 62 cases had been confirmed as of [Tue 28 Aug 2018] with another 173 suspected cases.

"All preventive measures have been taken with a view to pre-empting the spread of the disease," the statement read. Since cases of the disease first appeared in mid-August [2018], the Algerian health authorities have been trying to determine its source. The Health Ministry had earlier attributed its appearance to contaminated water in Tipaza state, west of the capital. This was denied by local authorities. Cholera, which has not been seen in Algeria for more than 2 decades, is an infectious disease that causes severe diarrhoea. It is potentially fatal if the sufferer does not receive proper medical treatment.
========================
[The number of cases of cholera, likely waterborne, in Algeria continues to increase. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Algeria: <http://healthmap.org/promed/p/67>]
Date: Thu, 30 Aug 2018 05:43:06 +0200
By Abdelhafid Daamache

Boufarik, Algeria, Aug 30, 2018 (AFP) - Outside a hospital in Algeria, worried relatives arrive daily in a desperate bid to talk to those quarantined inside -- the victims of the country's first cholera outbreak in more than 20 years.   Cases began appearing in early August and two people have so far died, with scores hospitalised in Boufarik, about 20 kilometres (12 miles) south of Algiers.   Said, whose mother has been quarantined for 10 days, told AFP he is "tired and demoralised".   "I want to visit my mother. But they do not allow me access", he said.

Only suspected cholera admissions, confirmed cases and staff are allowed into Boufarik hospital's infectious diseases department, where 91 people have been quarantined.   For others, access is "formally forbidden", said manager Reda Daghbouche.   If they are fit enough to leave their beds, patients on the ground floor can talk to their loved ones through the windows.   Standing a metre (yard) or so in front of an open window with blue shutters, three women covered their mouths with veils or handkerchiefs, as they exchanged a few words with a relative.   And truck driver Fatah spoke through the bars of a locked door to his mother -- one of 59 confirmed cases.   "Thank God, she is now on her two feet -- when we brought her to the hospital she was in a serious condition, we thought we'd lose her", he said.   Fatah has visited his mother every day for 12 days and "hopes for her release very soon".

- Suspect watermelons -
Patients arriving at the hospital with acute watery diarrhoea and vomiting -- key cholera symptoms -- are immediately placed in isolation.   Samples are sent to the Pasteur Institute, the national body in charge of infectious diseases, to test for Vibrio cholerae bacteria.   Patients are rehydrated while they await results.   "Analysis takes from three to seven days", said Daghbouche.   Those who test negative are sent home, while confirmed cases are kept in hospital until tests show the Vibrio bug has disappeared.

In the hospital yard, a 35-year-old man kicked his heels, not quite sure what to do with himself.   He told AFP he has been cured of cholera, after eight days in hospital.   But around 10 of his relatives are still hospitalised, he added, declining to give his name.   Residents of Boufarik who live close to the hospital do not disguise their concern.

Many are poorly informed about cholera, which is transmitted through infected faecal matter, often via contaminated water or food.   A grocer told AFP he wears medical gloves in case "the banknotes are contaminated".   While the authorities insist tap water has not been compromised, the cost of mineral water has soared.   And anti-bacterial gel has sold out locally.

Meanwhile, watermelons -- allegedly the origin of the outbreak, since they absorb large quantities of untreated water -- won't sell for any price.   On Tuesday, 16 patients were allowed to go home from Boufarik hospital.   An elderly man jumped for joy, as he saw his daughter leave the isolation wing after 10 days inside.   He kissed the security guards who had stopped him from entering the wing.   The released patients ran to their relatives' cars, desperate to leave.   Those who remain in quarantine are like "prisoners waiting to be pardoned", said Fatah, disappointed that his mother remains inside.
Date: Thu 23 Aug 2018
Source: La Depeche de Kabylie [in French, trans. ProMED Mod.AB, edited]
<http://www.depechedekabylie.com/national/193366-neuf-nouveaux-cas-enregistres.html>

At least 9 new cases of food poisoning were recorded at the beginning of the week [week of 20 Aug 2018] by the medical teams at Ain-Bessem Hospital. According to a medical source, the subjects all suffered from vomiting, diarrhoea, and acute renal failure, just as the 7 previous cases transferred to the El-Kettar specialized hospital in Algiers. These new victims bring the number of people affected to 16, including 2 fatalities, since Tue 7 Aug 2018. The source stated that the last patients are aged between 42 and 56 years old and are all from the locality of Mrabhia, in the commune of Raouraoua, and the commune of Bir-Ghbalou.

"They are currently supported at El-Kettar's EPS, and their condition is stabilizing. The origin of these intoxications should be food, since no trace of water contamination was detected in the water-supply networks of the 2 regions. Although the epidemiological investigation has still not revealed the origin of this pathology, we have confirmation of acute gastroenteritis. Moreover, this disease, which is very similar to cholera, affects children and the elderly much more, as is the case with the 2 women who died last week," said Dr Henni, head of prevention at the health department of the province [Bouira].

The Ministry of Health and Population confirmed last Monday [20 Aug 2018] through a press release the thesis of food poisoning, while dismissing a link with waterborne poisoning. "A total of 35 cases of severe isolated gastroenteritis have been recorded in some areas in the provinces of Blida and Bouira. These are isolated cases registered in a supported family circle. The condition of the affected people is gradually improving, pending the results of bacteriological tests," the document from minister of health Professor Hasbellaoui stated, adding that bacteriological control has demonstrated the absence of pollution in the drinking-water supply network. "The control of water remains in force while strengthening the system of control and care at the different health structures. In order to prevent the emergence of other cases, we call for the respect of individual and collective basic hygiene measures through handwashing with soap several times a day," the minister recommended.  [Byline: Oussama K.]
=========================
[The health authorities in Bouira are working hard to unravel the underpinnings of this health crisis, which has been presented in the form of multiple cases of gastroenteritis of probable food origin, but with other symptoms such as acute renal failure noted in patients. The confirmation of the cholera outbreak in several Algerian provinces makes the situation even more complex. ProMED-MENA would appreciate more information on this "mysterious disease" as well as the results of the bacteriological analyses published as soon as possible. - ProMED Mod.AB]

[HealthMap/ProMED-mail map:
<Bouira, Algeria: http://healthmap.org/promed/p/12690>]

[It is noteworthy that Bouira province borders with Bilda province to its east, a province reporting cholera activity in the past week, raising one's suspicions that this "undiagnosed" illness might be cholera.

Bouira province is in the north central part of Algeria (see
<https://upload.wikimedia.org/wikipedia/commons/6/66/Algeria_provinces_english.png>. - ProMED Mod.MPP]
Date: Sat 25 Aug 2018
Source: Al Jazeera [edited]
<https://www.aljazeera.com/news/2018/08/algeria-person-dies-cholera-outbreak-180825173701802.html>

Algerian authorities have announced the death of a 2nd person in a recent cholera outbreak that has left dozens hospitalized. The latest fatality, like the 1st one, was a resident of Boufarik, a town in Blida province some 30 km [18.6 mi] south of the capital, Algiers, according to a health ministry statement carried by the official Algerie Press Service on Sat 26 Aug 2018. Another Boufarik resident was reported dead on 23 Aug 2018. Overall, 139 people have been hospitalised across the country since 7 Aug 2018, with at least 46 cases confirmed as cholera, the ministry said.

As of [Fri 24 Aug 2018], cases were reported in the provinces of Blida, Bouira, Tipaza, Medea, and Ain Defla, as well as the capital.

Reda Daghboush, the director of Boufarik hospital, confirmed in a statement that cholera was the cause for the death of the 2nd victim, an elderly woman who also suffered from "other chronic diseases".

In an interview with the Huffington Post, Mohamed Bekkat Berkani, president of the National Council of the Order of Doctors lamented the state of health in the country, saying that he regretted that the Pasteur Institute -- the body in charge of preventive healthcare and infectious diseases in Algeria -- was neither capable of controlling the "epidemic" nor identifying its origin.

A number of Algerians have also expressed anger on social media after Zoubir Harrath, director of Pasteur Institute, told a news conference earlier this week that "cholera outbreaks have occurred in Chad, Niger, Yemen ... not just in Algeria."
*******************************
Date: Fri 24 Aug 2018 19:06:12 CET
Source: Xinhua News Agency [edited]
<http://www.xinhuanet.com/english/2018-08/24/c_137415960.htm>

Health authorities in Algeria announced late on [Thu 23 Aug 2018], the outbreak of cholera, saying there have been 41 confirmed cases out of 88 suspected who are getting medical treatment at hospitals in northern Algeria. The ministry specified that the highest number of cholera affected cases was recorded in Blida province, 50 km [31 mi] south of Algiers, as 50 people have been admitted, including 22 confirmed cases.

In the capital Algiers, 14 people are suspected of being affected, including 5 confirmed cases. In Tipaza province, 50 km [31 mi] west of Algiers, 18 people are hospitalized, of which 11 confirmed cases. 6 other cases including 3 confirmed were identified in the province of Bouira, 100 km [62 mi] southeast of Algiers.

All of the suspected cholera cases are currently in isolation at different hospitals receiving medical treatment, noted the source.

The ministry denied the reports that the cholera outbreak is due to water contamination. Experts of the ministry said the outbreak is probably due to contaminated fruits and vegetables, urging populations to take prevention measures.
=======================
[Cholera is not commonly reported in the Saharan areas of Africa. - ProMED Mod.LL]

[Maps of Algeria: <http://healthmap.org/promed/p/67> and
<http://healthmap.org/promed/p/67>]
Date: Wed 15 Aug 2018
Source: Le Soir D'Algerie [machine trans., edited]
<https://www.lesoirdalgerie.com/actualites/une-etrange-maladie-cree-la-panique-a-ain-bessem-9739>

It all began on [Wed 8 Aug 2018], when the emergency department of AH Bessem, 26 km [about 16 mi] southwest of Bouira, received a patient from the commune bordering Raouraoua who was showing signs of food poisoning, namely, vomiting and diarrhea.

According to testimony of the patient's relatives, during the 4 days while the patient was still hospitalized, other family members who visited him fell ill one by one and were hospitalized in the same location, EPH of Ain Bessem. On [Sun 12 Aug 2018], one of the 5 admitted and hospitalized patients died without anyone being able to explain to the family the causes of death.

Yesterday, the panic was at its height, and the members of this family, who all reside in Raouraoua, had to alert the media so that the officials of the DSP would deign to send a commission of inquiry and a prevention team immediately.

The same day, an elderly woman, who had fallen ill less than 2 days earlier, also died, bringing the number of deaths due to this strange disease that no one has been able to identify to 2 deaths. According to one family member, all hospitalized patients had the same symptoms, namely kidney blockage, which requires dialysis sessions.

However, on the spot, the prevention team, seeing the seriousness of the situation of the other 3 patients from the same family who were admitted to the emergency room, decided to evacuate them to the El Kettar specialized hospital in Algiers.

Contacted yesterday afternoon by telephone, the head of prevention service at the Bouira DSP, Dr. Henni, who was on site at the EPH of Ain Bessem, said that "medical teams are in the process of investigating to determine the true causes of these deaths and the origin of this contagion."

"Another team moved to the home of this family in Raouraoua to take samples and try to understand what really happened and how they were infected," he added. Asked about the nature of the disease that killed 2 people, while 3 others were in serious condition, Dr Henni said that "he preferred to wait for the results of the investigation and analyses to formally comment on the disease and causes of these deaths." Meanwhile, a real panic has seized the citizens of Raouraoua and even Ain Bessem, especially since there are rumors of contamination of anyone who has been in contact with members of this family.
***********************************
Date: Wed 15 Aug 2018
Source: Algerie Monde infos [edited]
<http://www.algeriemondeinfos.com/2018/08/15/ain-bessem-bouira-mysterieuse-maladie-tue-quatre-personnes/>

Four people, including 3 from the same family, died after having contracted an unidentified illness in Ain Bessem, Bouira wilaya. According to various sources, the people died at the hospital Mohamed Bachir of Ain Bessem. The last one was a 40-year-old woman. Two others were in their 70s, while the 3rd was 60 years old.

According to the head of the department in charge of prevention at the health department of the wilaya of Bouira, an investigation was opened to learn the precise causes of these deaths.

The symptoms of this mysterious disease are characterized by high fever, diarrhea, and liver damage.

The families of the deceased observed a sit-in, demanding the sending of a commission of inquiry to elucidate this mystery.
=====================
[From the above description, it appears as though there is a cluster of cases of an as yet undiagnosed illness associated with fever, vomiting and diarrhea, and renal failure (although there is also mention of liver failure). The description of "intoxication" (used to describe foodborne illness) is helpful, but the differential diagnosis can be fairly extensive. By the timing of the presentations, one suspects there may have been a common source exposure with possible varying infective doses, or the possibility of human-to-human transmission (although less likely as there haven't been reports of healthcare workers with the same symptoms).

Running the symptom complex through Gideon, the high-probability diagnoses consistent with the symptoms include the following: Leptospirosis, 53 percent probability; Legionellosis, 20 percent probability (I question this); typhoid and enteric fever, 10 percent probability; relapsing fever, 8 percent probability; Crimean-Congo hemorrhagic fever, 7 percent probability; septicemia (bacterial), 1 percent probability (I question this, as this is a cluster of cases); and Q-fever, 1 percent probability.

A possible diagnosis may be hemolytic uremic syndrome associated with an _E. coli_ O157 (or related organism) infection. Interestingly, running the ProMED-mail archives for posts on events in Algeria, a common event involving human cases in the past few years has been brucellosis outbreaks, although checking posts on our MENA network (MidEast North Africa), there have been a number of foodborne illness outbreaks reports in recent times.

Rather than continue to speculate, it seems most prudent at this point in time to request more information from knowledgeable sources in the area. Information that would be helpful includes results of an epidemiologic investigation, including history of common exposures and ages, and a more in-depth clinical presentation.

Ain Bessem is located in Bouira province in the north central part of Algeria (see
<https://upload.wikimedia.org/wikipedia/commons/6/66/Algeria_provinces_english.png>.)

HealthMap/ProMED-mail map:
Algeria: <http://healthmap.org/promed/p/67>. - ProMED Mod.MPP]
More ...