Date: Thu 23 Nov 2017
Source: Al-watwan [in French, machine trans., edited]
<https://alwatwan.net/sante/une-maladie-non-identifiée-sévit-dans-le-pays.html#.WhZoSDSfJ-U.twitter>

The health centres are packed with people, children and adults alike. The reception rooms and hospital rooms are packed. Children (mostly), women and men. Nobody is spared. The symptoms are the same for everyone: high fever, flu, cough, headache, vomiting, fatigue, pain in the joints. It has been almost 3 weeks since the citizens started living this situation, but nobody seems to know what it is.

Some call it an epidemic. While some doctors think it is seasonal flu, others refuse to give it a name and refute the idea that it would be an epidemic. As for the treatment, it is ... symptomatic. Yesterday [22 Nov 2017], at around 10 am, the reception room of the Caritas Comoros Sister Colette health centre, was crowded.

All the hospital rooms were full. Dr Habraji Mohamady says he and his colleagues have been working hard for 3 weeks. The cause? "The disease" that rages. But no one can give it a name. Is it "seasonal flu"?, he asks. However, according to him, the Caritas Comoros health centre in partnership with the health authorities have taken samples that are sent to the Pasteur Institute of Madagascar and the results of the assessment are still expected.

According to him, the symptoms are the same, fever of 40 deg C [104 deg F], influenza symptoms, cough, headache and pain in the joints." Also according to the doctor, the number of consultations has doubled in this period. "We do 50 to 60 consultations a day, apart from emergency consultations. And the capacity is less than 40 beds. Patients are hospitalized for 3 days." The doctor said the treatment is symptomatic while waiting for the results of the analyses.

The doctor advises to take hot drinks, to cover oneself against the dust and the wind, and to take vitamin C. For his part, the director of the Caritas health centre, Said Abdillah, said his service is "saturated" with 12 to 13 hospitalizations on average per day. "We have a capacity of 38 beds that are all occupied daily. Sometimes we send patients away for lack of space. To others, we prescribe treatment and ask them to go home and return the next day." He adds that the majority of patients are children from 7 months to 8 years old. "The treatment remains symptomatic and the patient is strengthened with vitamin C," he says.

[A patient] from Sidjuwu is on his 3rd day in hospital. He has pain, headache, and a sore hip. For his part, the national head of epidemiological surveillance, Dr Saindou Ben Ali Mbae, said that samples will be taken and sent to Madagascar next [Mon 27 Nov 2017] for analysis. According to him, the disease that plagues the region of the Indian Ocean and from communications he has had with colleagues from the sister island Mayotte, where it is also prevalent, is an influenza type A/H1N1. He calls on the population to strengthen hygiene measures.
===========================
[The news report above describes an undiagnosed outbreak in Comoros. The main symptoms are fever (40 deg C/104 deg F), headache, cough, vomiting, fatigue, and joint pains. Although all age groups are affected, the patients are mainly 7 months to 8 years of age. More information on this outbreak would be appreciated from knowledgeable sources.

The Union of Comoros, with a population of 795 601 residents, is a nation comprised of 3 islands in the Indian Ocean located at the northern end of the Mozambique Channel off the eastern coast of Africa between northeastern Mozambique and northwestern Madagascar; its capital is Moroni, on Grande Comoros (<https://en.wikipedia.org/wiki/Comoros>).

Caritas Comoros runs one health centre and 12 first aid posts on the 3 islands of the Union of Comoros (<https://www.caritas.org/where-caritas-work/africa/comoros/>). Maps of Comoros can be found at <https://en.wikipedia.org/wiki/Geography_of_the_Comoros#/media/File:Cn-map.png> and <http://healthmap.org/promed/p/175>. - ProMED Mod.ML]

[A diagnosis of influenza A is a likely diagnosis here, although the focus on joint pains makes one wonder about other possible explanations, such as chikungunya. Of note, there was a major outbreak of chikungunya in the Comoros Islands in 2005 -- approximately 12 years ago (see ProMED-mail Chikungunya - Comoros (Ngazidja) http://promedmail.org/post/20050405.0986 for details).

The mention that the most affected population in this current undiagnosed outbreak is the 7-months to 8-year-old population may well be a reflection of building up a susceptible population for another significant outbreak of chikungunya. It will be interesting to hear the results of the tests on the etiology of this outbreak. - ProMED Mod.MPP]

[The clinical presentation of high fever with respiratory symptoms is highly suggestive of a viral illness such as influenza, respiratory syncytial virus (RSV), or adenoviruses infections (<https://www.cdc.gov/adenovirus/about/symptoms.html>). However joint pain is not a common feature but it is reported in arboviral infections (such as chikungunya, as mentioned by ProMED Mod.MPP above), involving the small joints of the hands and feet, wrists, elbows, ankles, and knees.

According to the latest WHO influenza update, "In Eastern, Middle and Western Africa, influenza detections continued to be reported, with all seasonal influenza subtypes present in the regions" (<http://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/>). Laboratory diagnostic results can help confirm whether influenza is indeed the underlying cause or if further investigation is required. - ProMED Mod.UBA ]
Date: Thu, 29 Dec 2016 12:44:03 +0100

Mamoutzou, Dec 29, 2016 (AFP) - The Indian Ocean island of Mayotte has been forced to impose severe water restrictions on tens of thousands of people due to the late arrival of seasonal rains.   Around a third of the 200,000 residents on the island, which is administered by France, have seen their access to piped water at home cut to one day in three.    Hotels, an important part of the local economy, have been told not to fill up their swimming pools and many are having to hand out bottled water to customers.

Local officials met on Wednesday and decided to extend the measures until the end of January when rains are forecast to arrive and replenish the island's two dwindling reservoirs.   "This is a crisis situation," local official Florence Ghilbert-Bezard told AFP, adding that the restrictions were necessary "to maintain our resources at any cost until the start of the rainy season."

The drought has exacerbated Mayotte's water problems. The island's resources were already under pressure from a rising local population which saw water consumption jump by 9.7 percent in 2016.   Low-lying island nations have lobbied hard for global efforts to combat climate change, arguing that they are the most vulnerable to extreme weather events such as drought, as well as rising sea levels.
Date: Tue, 22 Nov 2016 04:06:05 +0100
By Aboubacar MCHANGAMA

Moroni, Comoros, Nov 22, 2016 (Agence France-Presse) - Though victory is yet to be officially declared, Comoros health authorities believe the three islands of the Indian Ocean archipelago are on the cusp of being malaria-free.   "With eight cases in 2015 in Anjouan and three in Moheli, we can say we have reached the phase of total elimination of the epidemic, although sporadic cases are still recorded on the Grande Comore," said Mbae Toyb, a doctor with the Comorian Association for Family Welfare.

After a 10-year anti-malaria campaign, health workers in the capital Moroni say the parasite is no more than a bad memory.    "We can go for one or two months now without a single case," said a caregiver at El-Maarouf hospital.    This has changed life for businessman Hassane Assoumane, who suffered recurrent attacks of the mosquito-borne disease that can be fatal if not diagnosed and treated early.   "I was (like) a malaria subscriber," said Assoumane. "For me it was (like) my monthly period."   "But for the last four years, nothing."

The eradication of malaria from the impoverished islands off the coast of Mozambique is a huge accomplishment for their 800,000 inhabitants.   It means fewer maternal and infant deaths, less absenteeism from work and school, and substantial financial savings.   "Treatment for a child with malaria costs 15,000 francs ($33)," Assoumane says, and "if you add a brother, father, mother ..."

Some 214 million cases of malaria were reported worldwide last year, killing 438,000 people, mainly in Africa, according to the World Health Organization.    There is currently no vaccine against malaria, which is caused by parasites transmitted to people bitten by infected female mosquitoes.     "Until 2004, the Comoros was ranked among countries with intense and perennial malaria transmission," affecting 40 percent of the population, especially children, said Toyb.

- Awaiting certification -
But in less than five years the number of deaths from malaria has fallen drastically to almost zero, he said.   The Comoros launched its first five-year anti-malaria drive in 2005 with initial funding of $2.4 million from the Global Fund against malaria, tuberculosis and AIDS. 

The targets of the drive were early treatment, prevention among pregnant women and the wide use of treated mosquito nets.   But the key to its success was probably more attributable to a treatment blitz of Artequick, a combination drug therapy derived from a Chinese plant, artemisinin, and an antimalarial called piperaquine.

Artemisinin, a derivative of a plant called sweet wormwood, has in recent years become the frontline anti-malarial drug, after chloroquine and sulphadoxine-pyrimethanine lost their parasite-killing powers.   Its use has reduced the numbers of death to one in 10 in severe cases, according to experts.

The therapy was first rolled out in Moheli, the smallest of the three islands which has a population of 40,000 people.    In 2012, government extended the treatment to Anjouan island before taking it to the Grand Comore in 2013.   The second five-year campaign valued at $11 million started in 2010.   "The number of cases went from 54,078 in 2004 to 1,052 in 2015, a drop of more than 98 percent," said Toyb.

Since 2014, the numbers of deaths from malaria have dropped to nearly zero at hospitals, said Toyb.   What remains now is to ensure the gains achieved are sustained and to await WHO certification.   "This is the most delicate phase," warns Toyb, adding that while some people still suffer from the disease, there have been no new infections.   A new anti-malaria campaign to run until 2018 has already been launched with the backing of a team of Chinese practitioners.
Date: Fri, 6 Mar 2015 15:38:29 +0100 (MET)

Moroni, Comoros, March 6, 2015 (AFP) - The main hospital of the Indian Ocean archipelago of the Comoros has stopped admitting patients over the last five days due to water and electricity shortages, doctors said Friday.   "There is no water, no electricity, toilets are not working," Thayatti Hamidou, an anaesthetist at the El-Maarouf Hospital of Moroni, told AFP.   "We cannot keep patients in wards, carry out (laboratory) tests, deliver babies or carry out surgeries in the dark," said the head of the dermatology department Tadjiri Hamada. "It's a defacto closure of the establishment."

In an economy that has been weakened by political instability, the Comoros' cash-strapped state utility firms are failing to maintain existing infrastructure.   The impoverished archipelago, situated just off the coast of Mozambique, experiences daily power cuts.   The hospital's overworked back-up generators also packed up earlier this week, plunging the health care facility into total darkness, the doctors said.   Since gaining independence from France in 1975, the archipelago of three islands with a combined population of less than 800,000 people, has witnessed more than 20 attempted coups, four of which were successful.
Date: 27 Dec 2012
Source: LINFO.re [in French, trans. ProMed L. Mialot, edited]
<http://www.linfo.re/-Societe,402-/Comores-3-morts-suite-a-une-intoxication-alimentaire>

Several cases of turtle meat food poisoning were reported in Ndrondroni in the south of Comoros since last Saturday [22 Dec 2012]. The local authorities announced 3 deaths and over 30 hospitalizations.

The turtle meat began to cause serious problems on Sat 22 Dec 2012. These cases of food poisoning are due to the consumption of turtle meat, which is very popular in Mwali.

According to a source related by the newspaper Al Watwan, the cause of the food poisoning was a male turtle that "is not edible." For many years, the Comorian authorities have declared a ban on the consumption of turtle meat and eggs. Three deaths were reported following consumption of this prohibited meat. The 1st victim was an unborn child. The mother ate some turtle meat and was hospitalized.

Al Watwan reports that "the doctors did all they could to deliver the baby and save the mother after they realized the baby could not be saved. Two boys also died after they ate turtle meat."

Over 30 people suffered acute stomach pain, and also vomiting for some of them, and were admitted to a healthcare center in the district of Nyumashiwa and to the hospital on the island of Fomboni, where they received intensive care.
--------------------------------------------
[Chelonitoxism is a form of poisoning from the flesh of turtles, generally from marine turtles. There is no antidote for it, and treatment is symptomatic. Generally, 80-90 percent of consumers are affected, and death is not an uncommon side effect. The causative toxins are currently unidentified. Children appear to be more sensitive to the toxin than adults.

Turtles are reasonably high on the food chain and may consume a number of toxins or potential toxins as they feed and migrate. These toxins are likely to bioaccumulate in the turtle.

Turtles, in their long migratory lives, accumulate in their bodies elevated levels of contaminants present in the marine environment: mercury, cadmium, POPs (persistent organic pollutants), and a cocktail of different pesticides. Inorganic mercury, in contact with water organisms, becomes methyl-mercury, a highly toxic form of mercury. Small fish feed on tiny contaminated organisms; larger fish feed on small fish, accumulating mercury in their bodies, and, unable to expel these heavy metals through digestion, these remain in the organic system, poisoning it. Being high up in the marine food-chain, migratory species such as the largest fish (tuna, swordfish, marlin, sharks, king mackerel, etc.), dolphins, whales, and turtles end up carrying very high concentrations of methyl-mercury in their flesh, blood, organs and eggs.

Ongoing studies show that sea turtles and eggs carry bacteria: mycobacteria (which may cause TB), salmonella, vibrio (which may cause cholera), _E. coli_, chlamydia (causing a pneumonia-like disease), leptospira, as well as arsenic, and potentially lethal  toxins from ingesting algal blooms (red tides).

Data from 2003-2004 showed that 80 percent of samples from green turtles in Baja California exhibited high antibody levels to leptospira. People with leptospirosis often show no symptoms, but left untreated, it can cause kidney damage, meningitis, liver failure, respiratory distress, or death.

Cooking may kill bacteria and fungi, but cooking does not eliminate the harmful toxins, which once ingested, remain in our bodies. It is important to underline that cooking turtle meat or eggs cannot get rid of heavy metals.

The article does not give us much specific data, such as the type of turtle consumed and the length of time between consumption and onset of signs. We do know that it caused acute vomiting, but that is also present with a number of toxins.

Portions of this comment were extracted from:
<http://www.caribbeancompass.com/seaturtles_2010.html>. - ProMed Mod.TG]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/2rq7>.]
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