23 February 2017

Since the beginning of 2017, 201 cases of meningitis were being reported by 19 health districts in Togo. However, the district of Akebou, which is part of the Plateau Region, issued an alert at week 2 with 4 cases of meningitis.  In week 4, the epidemic threshold was reached with nine cases and an attack rate of 12.4 per 100 000 inhabitants. From 2 January through 12 February, 48 suspected meningitis cases with three deaths have been reported with a case fatality rate (CFR) of 6.3%. Of these, 14 specimens were confirmed as serogroup W by PCR.

The Plateau Region, together with the other 3 regions in the country benefited from the mass vaccination campaign with MenAfriVac in December 2014.

Public Health Response:

1.     Additional doses of meningitis vaccines have been requested from the International Coordinating Group (ICG) for the vaccination campaign
2.     WHO Field Mission deployed in the field to strengthen outbreak management
3.     Efforts are underway to strengthen meningitis surveillance at the district level
4.     There is training of clinicians at the district level on case management
5.     Cross-border meetings with Ghana and Benin are taking place
6.     Sensitization of the population for early use of health centres

WHO Risk Assessment and Advice:

The largest burden of meningococcal disease occurs in the African meningitis belt. Although the successful roll-out of MenA conjugate vaccine has resulted to the decreasing trend of meningitis A, other meningococcal serogroups are shown to have caused epidemics. This report of the N. meningitidis W outbreak in Togo calls for a close monitoring of the changing epidemiology of meningococcal disease. There is a need to ensure that global stocks of vaccines are available, laboratory and epidemiologic surveillance systems are strengthened and outbreak response strategies in the countries are on hand.

Epidemic response consists of prompt and appropriate case management with reactive mass vaccination of populations.

·         N. meningitis serogroup W is responsible for large-scale epidemics and may pose a challenge to public health system due to high incidence, fatalities and sequelae.

·         Togo is part of the African meningitis belt and annually records cases and deaths due to meningitis. In 2016, the country recorded an epidemic in the northern part whose germ was the Neisseria meningitidis W. A total of 1975 cases and 127 deaths had been reported.

·         The disease can spread to neighbouring countries especially Benin and Ghana. Last year, the Togo outbreak was a spread of the meningitis outbreak in Ghana. 

·         WHO does not recommend any restriction on travel and trade to Togo based on the information available on the current outbreak.

Date: Sat, 27 Aug 2016 12:57:40 +0200

Lome, Aug 27, 2016 (AFP) - The Togo government said it is taking urgent measures to combat an outbreak of the avian flu virus, the country's state broadcaster said on Saturday.    The announcement came after the virus was detected at two poultry farms in the Togo capital, Lome.    Over 11,300 birds died in the outbreak, with the government incinerating the dead birds and culling others to prevent the spread of the virus. No human cases have been reported.

Agriculture minister Ouro-Koura Agadazi said the government would also destroy eggs and grain in homes, as well as inspect markets.    "In Lome, we have established a mobile team that travels the markets. We will also identify all poultry sellers that do not have the approval of the relevant authorities," Agadazi said.   Since its emergence in 2003, the H5N1 virus has spread around the world and resulted in millions of poultry infections, several hundred human cases and scores of human deaths, according to the World Health Organization.
Date: Tue 15 Mar 2016
Source: Star Africa, APA (African Press Agency) report [edited]

During the past week, 2 cases of Lassa fever have been detected in the Togolese district of Oti [Savanes region] over 500 km [310 miles] north of the capital Lome, the country's Health minister revealed in a statement on Tuesday [15 Mar 2016]. The minister was, however, quick to call for calm, advising the population not to give into panic but to instead strictly abide by measures being deployed against the disease, which is curable.

"The sooner a patient is admitted to a health facility, the more they stand a chance to be cured," his statement said, adding that a toll-free hotline has been put at the disposal of the general public.

The minister's statement described Lassa fever as an acute, viral disease, communicable to humans by rats whose urine or faeces contaminate food or household items.

"The virus can also be transmitted from human to human through direct contact with blood, urine, faeces, vomit or other body fluids of a sick person," the statement explained.

Symptoms of Lassa fever range from fever, headache, sore throat, coughing, nausea, vomiting and diarrhoea to muscle aches, chest pain and bleeding among others.
[A 14 Mar 2016 ProMED-mail post (archive no. http://promedmail.org/post/20160314.4090655) indicated that there were 2 suspected Lassa fever cases in Togo. It is not clear if those 2 cases reported above by the Health Minister are those or are new cases.

Virus transmission can occur in houses, in hospital environments, or laboratories in the absence of adequate infection-control measures. Nosocomial infections can occur in health care centres if barrier nursing practices and use of personal protective equipment are not implemented. Public education is an important measure to prevent infections in the home. Preventing entry of rodents into the home and keeping food materials tightly covered are helpful measures to prevent infection. Prevention and control of Lassa fever depend on control of the rodent reservoir, the multimammate mouse (_Mastomys_ spp.), which occurs across Nigeria and beyond. Reduction of populations of this rodent will require active participation at the village level.

Images of _Mastomys_ mice can be seen at

Maps of Togo can be accessed at
<http://www.mapsofworld.com/togo/maps/togo-political-map.jpg> and
<http://healthmap.org/promed/p/64>. - ProMED Mod.TY]
Date: Thu 10 Mar 2016
Source: Overseas Security Advisory Council (OSAC), United States Department of State, Bureau of Diplomatic Security [edited]

The US Embassy wishes to inform US citizens about one confirmed and one suspected case of Lassa fever in northern Togo.
This message is for informational purposes only.

Lassa fever is a rare but potentially life-threatening viral haemorrhagic disease. The risk of contamination is low, but can occur if someone comes into contact with an infected person's blood or bodily fluids. Lassa fever cannot be spread through casual contact, including skin to skin contact, without exchange of bodily fluids. Those at highest-risk would be health care workers treating patients in facilities known to have Lassa fever and family members caring for infected patients.

Early diagnosis and supportive care are essential. You should consult a medical professional if you have been in direct contact with an infected person within the past 3 weeks and have symptoms of Lassa fever, which include: fever, chest, stomach or back pain, cough, vomiting, diarrhea, or mucosal bleeding. For more information on Lassa haemorrhagic fever, please visit the CDC website at <http://www.cdc.gov/vhf/lassa/>.
Communicated by:
Dr Irene Lai MB, BS (Syd), FFTM RCPS (Glasg)
Medical Director, Medical Information & Analysis
Level 3, 45 Clarence St, Sydney NSW 2000

[Maps of Togo can be seen at
<http://www.mapsofworld.com/togo/maps/togo-political-map.jpg> and
<http://healthmap.org/promed/p/64>. - ProMed Sr.Tech.Ed.MJ]
USA (Georgia) ex Togo: suspected
Date: Fri 11 Mar 2016
Source: Medical Daily, Reuters report [edited]

An American doctor [physician assistant] who was working with missionaries in West Africa is being moved to an isolation ward at an Atlanta hospital on [Fri 11 Mar 2016] with a suspected case of Lassa fever, a deadly haemorrhagic disease similar to Ebola, officials said.

The patient, who has not been identified publicly, was being flown in a specially equipped aircraft from Togo and was expected to arrive at Emory University Hospital sometime [Fri 11 Mar 2016] or this weekend [12-13 Mar 2016], officials said.

The isolation ward is where Emory successfully treated 4 Ebola patients in 2014, said Dr Bruce Ribner, director of Emory's Serious Communicable Disease Unit.

"The take-away from this for the public, is that there is absolutely no risk to anyone," he said. "We've shown that we can handle Ebola and this [Lassa fever] is a lot less communicable."

Lassa fever has been endemic in Africa for many years, with up to 300,000 infections annually. Only about 3 percent presenting symptoms severe enough need hospitalization, Ribner said.

Of those hospitalized, about 20 percent of the cases are fatal, compared with a 70 percent rate for all patients who catch Ebola [virus disease], which is transmitted through blood and bodily fluids.

"With Lassa [fever], most of the people who get it never even know it," Ribner said.

The worst Ebola [virus disease] outbreak in recorded history began in West Africa in December 2013, spreading to at least 11 countries on the continent before petering out. In all, more than 11 300 people died, almost all in the 3 worst-affected countries. At its height, the Ebola outbreak sparked fear around the world, prompting governments and businesses to take emergency precautions.

An outbreak of Lassa fever is now underway in Nigeria, according to the World Health Organization, and it is starting to spread to nearby countries, including Togo.

According to a WHO statement, 159 suspected cases of Lassa fever and 82 deaths were reported between August 2015 and January 2016. Some media reports have said as many as 101 people have died as of February [2016].

Like Ebola, Lassa causes a severe fever with bleeding, Ribner said. It is most commonly transmitted to people from rodent excrement, and it can be transmitted from person to person by contact with blood or bodily fluids, Ribner said.

He said the hospital will take every precaution and that the public should not be alarmed.

"You can't catch it like you get the common cold," he said. "We can handle this."

The disease [virus] is carried by the _Mastomys natalensis_ rodent [African soft-furred rat or Natal multimammate rat or mouse], found across sub-Saharan Africa, and often eaten as a source of protein. Lassa fever virus infects an estimated 300,000-500,000 people each year, and kills about 5000.  [Byline: Rich McKay, Editing By Frank McGurty, Bernard Orr]
Date: Thu 10 Mar 2016
Source: Outbreak News Today [edited]

An individual who was referred to the University Hospital of Cologne for malaria treatment has died from suspected Lassa fever, according to German media. The patient was apparently in West Africa, admitted to the Cologne hospital for malaria, later died and on [Wed 9 Mar 2016] the Bernhard Nocht Institute for Tropical Medicine's post-mortem examination revealed the suspected diagnosis of Lassa fever. "We then immediately informed the competent authorities, with whom we are now in close coordination" spokesman Timo Mügge said. Lassa occurs in several countries in West Africa. In Germany, the disease occurs only rarely and manifests when it is introduced by travellers from Africa.

According to the Robert Koch Institute (RKI), since October 2011, Germany has reported only 5 cases of the disease. Both Nigeria and Benin are experiencing current Lassa fever outbreaks. According to the US Centers for Disease Control and Prevention (CDC), Lassa fever is an acute viral illness that occurs in West Africa. The virus, a member of the family _Arenaviridae_, is a single-stranded RNA virus and is zoonotic, or animal-borne. Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease.

The animal host of Lassa virus is a rodent known as the "multimammate rat" of the genus _Mastomys_. Humans get infected with Lassa through aerosol or direct contact with excreta from the rodent. Laboratory infections do occur primarily through contaminated food materials. The symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. The Lassa virus and was first described in 1969 in the town of Lassa, in Borno State, Nigeria. [Byline: Robert Herriman]
Communicated by: Sabine Zentis Castleview English Longhorns Gut Laach D-52385 Nideggen Germany sabinezentis@gmail.com
[This is not the 1st instance of Lassa fever cases being imported into Germany. There were 2 cases imported from Nigeria in 2000. In a 27 May 2015 comment (ProMED-mail archive no. http://promedmail.org/post/20150529.3392905), Dr Nicholas Beeching of the Liverpool School of Tropical Medicine, Royal Liverpool University Hospital and NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK said in regard to a case in New Jersey, USA, "The reports of a patient presenting with Lassa fever in New Jersey serves as a reminder that Lassa fever has historically been the most common viral haemorrhagic fever to be exported from West Africa, until the current Ebola virus outbreak.

Including the 5 previous cases imported to the USA up to 2004, we identified 28 cases in the 4 decades 1969-2009. The majority of these came from Sierra Leone (14 cases) followed by Nigeria (11 cases), both countries known to have large numbers of cases on a regular basis. Some of these cases were evacuated from West Africa for further medical treatment and the overall mortality was 36 per cent (9/28). "None of the cases were associated with onward transmission to other patients or to fellow travellers, although delays in recognition and isolation of patients continue to occur for a variety of reasons, including failure of patients to report their travel history risks.

Other causes of fever in travellers returning from West Africa are much more common, such as malaria, diarrhoeal disease and respiratory infections. However, the recent case of Lassa fever in New Jersey emphasizes the need to consider other viral haemorrhagic fevers in travellers returning from endemic areas of the world and not to focus on Ebola virus disease alone." His comments underscore the importance of good travel histories. They are essential in order to initiate treatment as early in the course of disease as possible. Unfortunately, not all patients are forthcoming in providing that history, as in the fatal case in the USA (New Jersey)  (see ProMED-mail archive no. http://promedmail.org/post/20150526.3386913).

ProMED-mail thanks Sabine Zentis for sending in the report of this case in Germany. ProMED would be interested in learning if the case is laboratory confirmed as Lassa fever. A map of Germany is included in the report at the URL above. A HealthMap/ProMED-mail map can be accessed at <http://healthmap.org/promed/p/7446> - ProMED Mod.TY]
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