Date: Fri 28 Jun 2019
Source: Standard Media [abridged, edited]
<https://www.standardmedia.co.ke/article/2001331800/kisumu-county-on-alert-as-two-die-of-rabies>

The Kisumu County Government has declared an outbreak of rabies after 2 children died of dog bites with several other cases being reported in Seme Sub County.

County Director of Health Services Dr Dickens Onyango has confirmed the outbreak but said health officials were working to stop the spread through timely treatment and sensitisation.

In a letter dated 27 Jun 2019 and addressed to medical superintendents manning all public hospitals, Dr Onyango ordered all hospitals to stock anti-rabies vaccines and ensure that those bitten by dogs are treated immediately.

"This is to notify you that there is a confirmed rabies outbreak in Kisumu County," Dr Onyango said in a letter signed on his behalf by Dr A. Ng'ong'a.

The confirmation came as a family on Thursday [27 Jun 2019] buried one of their children bitten by a stray dog. As [the father] buried his 10-year-old daughter in Seme, his other son was fighting for his life at a local hospital. The 2 children were bitten by stray dogs within 2 weeks.

In the 1st incident, [the daughter] was taking a nap when a stray dog attacked her at their home. When she woke up to scare it away, the dog jumped on her, biting her on the right side of her cheeks. She was rushed to Kombewa Sub County Hospital, but the family could not raise money to buy the anti-rabies drug.

"We were not able to raise the money and opted to take my child to an herbalist," said [the father]. The herbalist administered some drugs and gave her some to drink, but her health deteriorated. After 3 days, the father rushed the child to a neighbouring dispensary, which referred them to the Kisumu County Referral hospital.

"It was too late when we arrived at the facility, it did not take long before the doctors confirmed that my daughter had passed," said the emotional [father].

In the 2nd incident, his son was attacked by a stray dog while in the garden. Medical superintendent at Kombewa hospital David Okeyo, however, said that by the time the son was taken to the hospital, the facility was out of stock of the anti-rabies drugs. Dr Okeyo said the medics advised the parents to buy the vaccine at a nearby chemist at Sh 1500 [USD 14.57] per dose, but they never returned.

In same week, another case was brought at the facility and was advised to buy the vaccine, adding that the 2 succumbed. "They did not buy the drugs as advised; neither did they bring back the patients; there was nothing we could do without the vaccine," said Okeyo.

Okeyo confirmed that there was a high prevalence of dog bites in the area, saying that over the weekend, 6 cases were reported and administered with the vaccine. "As per now, we have a stock of the vaccine, but due to high demand, the stock runs out fast," noted Okeyo.

The county director of veterinary services, Dr. Evans Odhiambo, confirmed the recent deaths related to dog bites in the sub-county.
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[HealthMap, Kenya: <http://healthmap.org/promed/p/174>]
Date: Fri 21 Jun 2019
Source: The Star, Kenya [edited]
<https://www.the-star.co.ke/counties/coast/2019-06-21-amoebic-dysentery-outbreak-100-lamu-cases-reported/>

The Lamu Public Health Office on Thursday [20 Jun 2019] reported an outbreak of amoebic dysentery, infecting more than 100 people. It is spread through drinking or eating uncooked food, such as fruit that may have been washed in contaminated water, or drinking contaminated water.

Officials denied rumours of a cholera outbreak in Lamu. "It's not cholera but amoebic dysentery. Both have similar symptoms," Public Health director Athman Dumila said.

Amoebic dysentery is a parasitic infection of the colon and is most common in tropical areas with untreated water. Symptoms include diarrhoea, cramping, bloody stools, vomiting, fever and, in the worst cases, liver infections. Dumila said many cases were reported in May and June [2019]. Speaking in his office, he said they suspect the outbreak is caused by consumption of dirty water during this rainy period. He said they also believe the outbreak is worsened by the many flies in the region since the rains began.

Residents have been advised to practice good hygiene in their environments and to wash their hands and food in clean water. They have been urged not to buy ready-made food on the streets, as it may be infected. A lot of street food is not covered and may be infected by flies. Anyone with major symptoms of diarrhoea and vomiting should go to a hospital. "There is that outbreak but we can do something to stop it," Dumila said. "Cook in your house and eat there. Use insecticide where possible. Cover [food] and keep flies away and don't use dirty rainwater," he said.

Free insecticide is being distributed to all homes, markets and public places to kill flies. Public sessions will be held on personal and environmental hygiene.  [Byline: Cheti Praxides]
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[Outbreaks of amoebic dysentery, i.e., bloody diarrhoea caused by the protozoan parasite _Entamoeba histolytica_ are rare. The parasites are transmitted by cysts contaminating water and food, and there are as far as we know no animal reservoirs. Diagnosis relies on microscopy or detection of specific nucleic acid by polymerase chain reaction. Microscopy is difficult, as the _E. histolytica_ cysts can easily be confused with the slightly larger cysts of _Entamoeba coli_, which is not a pathogen. Thus, it is important to exclude other sources of dysentery, especially infections with _Shigella_. The fact that a large proportion of the patients seems to report bloody diarrhoea almost certainly excludes cholera. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Kenya: <http://healthmap.org/promed/p/174>
Lamu, Kenya: <http://healthmap.org/promed/p/46024>]
Date: Sat 25 May 2019
Source: Xinhua News Agency/CGTN [edited]
<https://newsaf.cgtn.com/news/3d3d514f32677a6333566d54/index.html>

An anthrax outbreak that affected Kenya's Lake Nakuru National Park is over, and the last buffalo death was recorded on 10 May [2019], the country's wildlife conservation agency said on Saturday [25 May 2019]. John Waweru, director general of Kenya Wildlife Service (KWS), said in a statement that the total mortalities to date are 145 buffaloes representing 3.54% of the estimated population of 4100 buffaloes in Lake Nakuru National Park.

"Our partnership with the local administration and department of Public Health as well as directorate of Veterinary Services to educate the local communities about anthrax and our surveillance and monitoring efforts have paid off," Waweru said.

Lake Nakuru National Park which is about 160 km [99 mi] northwest of Kenya's capital city, Nairobi, covers an area of 188 sq km [73 sq mi] and is an important ecosystem supporting high diversity of waterfowl, large mammal, and floral species. "It was set up as the 1st rhino sanctuary in Kenya and has been a successful breeding habitat. The park hosts a number of threatened mammal species, including lion, leopard, and the Rothschild giraffe. Five globally threatened bird species are also found in the park," he added.

He noted that the park management would continue with the monitoring and will report any suspicious deaths for urgent action by veterinary authorities.

The KWS official said that management would also undertake other long-term measures to mitigate such disease outbreaks, noting that prolonged drought is a risk factor in anthrax outbreaks. "This results in depletion of pasture, forcing animals to graze closer to the soil that is potentially infested with anthrax spores. The park has a previous history of anthrax outbreak in July 2015."

Waweru revealed that the long-term measures include translocation of buffaloes from the park to avoid depletion of pastures during prolonged dry spells, which are becoming more frequent.
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[Overall, a very professional response. Wildlife outbreaks can frequently involve large numbers of animals. This happens when biting flies (Tabanids) get involved and widen the target both in space and in numbers. This is not to ignore the occasional dead animal, but these are frequently missed against the background of normal sporadic mortality and the efficiency of vultures and buzzards in rapidly identifying and disposing of carcasses, though it is a messy business. These singular carcasses should be burnt where found. - ProMED Mod MHJ]

[HealthMap/ProMED-mail maps:
Kenya: <http://healthmap.org/promed/p/174>
Nakuru County, Kenya: <http://healthmap.org/promed/p/47100>]
Date: Wed 15 May 2019
Source: The Conversation [abridged, edited]
<http://theconversation.com/insights-from-kenya-why-anthrax-outbreaks-recur-in-the-same-areas-116615>

There's been an anthrax outbreak in Kenya's Nakuru county. But it's not the 1st time. Nakuru seems to be a hotspot for these outbreaks. The Conversation Africa's Moina Spooner asked Bernard Bett and John Gachohi to shed light on the reasons for this.

Why does Nakuru county have recurring outbreaks?
Last month [April 2019] an anthrax outbreak killed more than 10 buffaloes in Lake Nakuru National Park, which is in Kenya's Rift Valley. This area is no stranger to outbreaks. In our research, we identify 3 outbreaks that occurred in 2014, 2015 and 2017 in the park and surrounding areas. In 2015, 766 wild animals -- 745 of them buffaloes -- died from the disease. Preliminary results from the same project show a high-risk belt that experiences repeated outbreaks, especially in the dry season. This stretches from Narok in southwestern Kenya, through Nakuru, to Muranga and Meru in central Kenya. Outbreaks often affect the same areas because, once released, the bacteria continue to live as spores in the soil. Environmental factors that support these spores include high humidity, pH and calcium levels. Endemic areas are also often located in low-lying areas or in dry river beds. It's believed that these areas concentrate spores, carried by water, during wet seasons. Lake Nakuru National Park and its surrounding areas fit the anthrax profile.

How are these outbreaks dealt with?
When there's an outbreak, the Kenya Wildlife Services usually works with the Department of Veterinary Services to vaccinate certain endangered animals -- like rhinos -- dispose of carcasses and disinfect the areas to limit the disease spread. But the immunity that vaccinations provide to wildlife doesn't last very long; maintaining it would require regular booster vaccines. Another issue with the vaccine for wildlife is that its effectiveness across different species isn't known because it was developed mainly for use in livestock. The Department of Veterinary Services has recommended that livestock in the area be routinely vaccinated and the community given information about how the disease is transmitted.

What else can be done to prevent these outbreaks?
Anthrax outbreaks could be minimised if susceptible areas were properly managed. For instance, there are concerns that the population of herbivores in Lake Nakuru National Park -- especially buffaloes -- is so high that it's causing overgrazing, especially during the dry season. Overgrazing increases the risk of exposure to anthrax spores in the soil. Communities should also be made aware of how to dispose of livestock carcasses. For example, carcasses should always be disinfected using the right disinfectants and either burnt to ash or buried in pits that are at least 6 feet deep. The increasing human and livestock population in the countryside has also exerted a lot of pressure on grasslands. This has led to certain ecosystems being overstretched and unable to contain disease outbreaks and other natural disasters. In Lake Nakuru National Park, endangered wildlife species, like rhinos and Rothschild giraffes, should be targeted in vaccination campaigns. At the same time, much more needs to be done to determine the efficacy and levels of coverage of anthrax vaccines in wildlife.
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[Valuable insights by informed folk on the ground. This predicts well for the future of possible control of anthrax in Kenya. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail maps:
Kenya: <http://healthmap.org/promed/p/174>
Nakuru County, Kenya: <http://healthmap.org/promed/p/47100>]
Date: Sat 4 May 2019
Source: Daily Nation [edited]
<https://mobile.nation.co.ke/counties/Fear-of-cholera-outbreak-in-Embu/1950480-5099034-a8pb13/index.html>

Public health officials in Embu county are on high alert following the outbreak of a disease suspected to be cholera which has left 3 people hospitalized. The victims, 2 men and a 7-year-old girl, are undergoing treatment at Embu County Referral Hospital where they were rushed immediately they fell sick.

County Public Health Officer Rosaline Kaugi confirmed that the 3 have been admitted to the isolation ward. She added that the men are from Nairobi while the girl is from Embu Blue Valley Estate. The victims were taken to the hospital after they started vomiting and complaining of stomach pains.  [Byline: George Munene]
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