Date: Sat 9 Dec 2017
Source: NewsHub [edited]
<http://www.newshub.co.nz/home/health/2017/12/nats-hit-health-minister-over-tongan-mumps-outbreak.html>

A mumps outbreak in Tonga could have started in Auckland and the Government should take responsibility, 2 Opposition MPs say.  Shane Reti and Alfred Ngaro believe Tongan and other Pacific Island rugby league players at the recent World Cup could have been exposed to mumps while they were in Auckland. They're upset because when Health Minister David Clark was asked about it, he said individual countries were responsible for their own immunisation regimes.  "There are currently 1600 recorded cases in Tonga," Mr Reti and Mr Ngaro said in a joint statement. "Is the minister saying that the complications of this disease such as deafness, sterility and meningitis don't matter in Pacific Island people?"

The MPs thinks the Government should offer advice to Tonga and help with its vaccination programme. "The minister is displaying an appalling lack of responsibility," they said. Dr Clark told Newshub mumps outbreaks in the Pacific are not uncommon. "The latest outbreak in Tonga began in March and peaked in June [2017] - before the Rugby League World Cup. The suggestion from the 2 National MPs that Tongan Rugby league players that contracted mumps in New Zealand have somehow caused the outbreak in Tonga does not make sense and is irresponsible at best."

He said the Ministry of Health isn't aware of any requests for assistance from Tonga, which would actually come through the Ministry of Foreign Affairs and Trade.  "Anyone who needs treatment while in New Zealand will receive it, but individual countries are responsible for their own vaccination programmes."
========================
[Before sports teams travel to countries where mumps outbreaks are occurring, MMR vaccination status of each player should be checked. The coaches should advise unvaccinated players to immediately go to clinics that conduct immunizatons. Because measles and mumps are highly infectious, sports teams should take extra precautions to protect their players from disease even in country. They can become infected at home and when travelling, and can spread infection to other non-immunized individuals.

A Healthmap/ProMED of Tonga can be seen at
<http://healthmap.org/promed/p/3>. - ProMED Mod.LK]
Date: Sat, 4 Nov 2017 11:54:53 +0100

Sydney, Nov 4, 2017 (AFP) - A 6.8-magnitude earthquake struck off the coast of Tonga Saturday in the tectonically active Pacific region, but there was no tsunami threat, seismologists said.   The tremor hit at a depth of 10 kilometres (six miles) some 90 kilometres off the Tonga island of Niuatoputapu, and 230 kilometres southwest of the Samoan capital Apia, the US Geological Survey reported.

The Pacific Tsunami Warning Center said there was no current tsunami threat.   The quake lasted for almost one minute, and caused residents to leave their homes for open spaces across Samoa, according to reports cited by the Samoa Observer news website.   Tonga and Samoa are part of the "Ring of Fire", a zone of tectonic activity around the Pacific that is subject to frequent earthquakes and volcanic
eruptions.
Date: Sun, 8 Oct 2017 17:24:57 +0200

Sydney, Oct 8, 2017 (AFP) - A strong 6.1-magnitude earthquake struck off the Pacific nation of Tonga Monday, US seismologists said, but no tsunami warning was issued.   The US Geological Survey (USGS) said the quake was shallow, striking 154 kilometres (95 miles) northwest of the village of Pangai, the administrative capital of the Ha'apai group of islands in central Tonga.    The region's homes are vulnerable to earthquake shaking, according to USGS, but it said there was a low likelihood of casualties and damage.   The Pacific Tsunami Warning Center did not immediately issue any warnings.   Tonga sits on the so-called Pacific Ring of Fire, a region of frequent seismic activity due to collisions between continental plates.
Date: Thu 3 Aug 2017
Source: WHO Western Pacific Region [edited]
<http://www.wpro.who.int/mediacentre/releases/2017/20170731/en/>

The Kingdom of Tonga in the Pacific Ocean may be small in population, but it is kicking big goals in public health. The World Health Organization (WHO) has validated that the country has eliminated lymphatic filariasis -- also known as elephantiasis -- as a public health problem.

Lymphatic filariasis is a mosquitoborne disease that damages the lymphatic system, leading to severe disfigurement, pain and disability. For people affected by this disease, the impacts of disfigurement and the associated stigma are profound: people often lose their livelihoods and suffer from psychological impacts such as depression and anxiety.

"Lymphatic filariasis is a dreadful disease; it causes terrible pain and suffering for those who are affected," said Dr Shin Young-soo, WHO regional director for the Western Pacific. "The World Health Organization sincerely congratulates the Kingdom of Tonga for eliminating this disease as a public health problem. From today, the children of Tonga can grow up knowing that they are safe from this very nasty disease; what a wonderful achievement for the health of your people," Dr Shin said.

This achievement in Tonga comes after decades of dedicated efforts to stop transmission of this disease, known in the local language as "kulokula fua".

Tonga joins 7 other countries in WHO's Western Pacific Region that have been validated as having achieved elimination of lymphatic filariasis as a public health problem since WHO launched the Global Programme to Eliminate Lymphatic Filariasis in 2000: Cambodia, China, Cook Islands, Niue, the Marshall Islands, the Republic of Korea and Vanuatu.

Lymphatic filariasis is classified by WHO as a neglected tropical disease (NTD). This means it is one of a diverse group of communicable diseases that thrive mainly among the poorest populations in tropical and subtropical areas. NTDs cause serious illness and in some cases death, but they are preventable. Through a series of public health strategies including preventive treatment of communities, intensive case management, vector control, control of animal diseases that can spread to humans, and provision of safe water, sanitation and hygiene, many NTDs can be controlled and eventually eliminated.

The fight against lymphatic filariasis in the 17 countries and areas where it remains endemic in the Western Pacific Region is an important priority for WHO's work in this region.

The disease has a long history in Tonga: the common occurrence of swelling of the leg, arm and scrotum among people in Tonga was observed in the 1770s by Captain Cook. In the 1950s, the prevalence rate of this disfiguring and debilitating disease was close to 50 per cent. Mass drug administration in the 1970s and 1980s reduced the prevalence significantly, but a series of further efforts were required over the last few decades to reach the elimination goal.

"Lymphatic filariasis' long history in Tonga makes today's victory over the disease all the sweeter. This could not have been achieved without the unwavering support and leadership of the Ministry of Health, as well as strong financial and other support from donors and partners, and most importantly, the commitment of the communities of Tonga affected by the disease," Dr Shin said. "Tonga has shown us that despite significant challenges, elimination of neglected tropical diseases such as lymphatic filariasis is possible. WHO is 100 per cent committed to supporting our member states to rid our region of the scourge of this disease, so no one needs to suffer from this awful disease any longer," concluded Dr Shin.

[For further information, please contact:
Mr Ruel E Serrano
Communications Unit
telephone: +632 528 9993
email: serranor@who.int]
=====================
[The Pacific Programme to Eliminate Lymphatic Filariasis was launched by the WHO in 1999 and relies on mass drug administration (MDA). The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate lymphatic filariasis as a public health problem by the year 2020. The program has recently been reviewed (Ramaiah KD, Ottesen EA. Progress and impact of 13 years of the Global Programme to Eliminate Lymphatic Filariasis on reducing the burden of filarial disease. PLoS Negl Trop Dis. 2014; 8(11): e3319 <https://doi.org/10.1371/journal.pntd.0003319>), and it concluded: "The MDA programme has resulted in significant reduction of the LF burden. Extension of MDA to all at-risk countries and to all regions within those countries where MDA has not yet reached 100 per cent geographic coverage is imperative to further reduce the number of microfilaraemia and chronic disease cases and to reach the global target of interrupting transmission of LF by 2020."

The latest progress report (2015) from the Global Programme can be found here:
<http://www.who.int/lymphatic_filariasis/resources/who_wer9139/en/>. - ProMED Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/3>.]
Date: Wed 12 Apr 2017
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/tonga-reports-11-typhoid-cases-since-january-11200/>

The Tonga Ministry of Health has reported 11 typhoid cases since January 2017, including 5 cases from the village of Veitongo, according to a Radio New Zealand report today [Wed 12 Apr 2017]. This has prompted health officials to temporarily ban kava drinking in public halls in an effort to get the outbreak under control. In addition, the health ministry also imposed a month long ban on making food for public gatherings such as funerals.

The news comes as Auckland, New Zealand battles a typhoid outbreak that as of today [Wed 12 Apr 2017] has sickened 20 and killed one.

Typhoid fever, caused by the bacterium _Salmonella_ Typhi, is a life-threatening bacterial infection. Typhoid fever is still common in the developing world, where it affects about 21 million people annually. _S._ Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacterium. Both ill persons and carriers shed the bacterium in their faeces.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding _S._ Typhi or if sewage contaminated with _S._ Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is commoner in areas of the world where hands are washed less frequently and water is likely to be contaminated with sewage.

Typhoid fever can be successfully treated with appropriate antimicrobials, and persons given such therapy usually begin to feel better within 2 to 3 days. Dr Sinclair says good basic hand washing is one of the best means of protecting yourself.
====================
[Typhoid fever, so-called enteric fever caused by _Salmonella enterica_ serotype Typhi, has a totally different presentation from that of the commoner kinds of salmonellosis. Epidemiologically, usually spread by contaminated food or water, typhoid is not a zoonosis like the more commonly seen types of salmonellosis. Clinically, vomiting and diarrhoea are typically absent; indeed, constipation is frequently reported. As it is a systemic illness, blood cultures are at least as likely to be positive as stool in enteric fever, particularly early in the course of the infection, and bone marrow cultures may be the most sensitive.

The symptoms of classical typhoid fever typically include fever, anorexia, lethargy, malaise, dull continuous headache, non-productive cough, vague abdominal pain, and constipation. Despite the often high fever, the pulse is often only slightly elevated. During the 2nd week of the illness, there is protracted fever and mental dullness, classically called coma vigil.

Diarrhoea may develop but usually does not. Many patients develop hepatosplenomegaly [both liver and spleen enlarged]. After the 1st week or so, many cases develop a maculopapular rash on the upper abdomen. These lesions ("rose spots") are about 2 cm [0.78 inches] in diameter and blanch on pressure. They persist for 2-4 days and may come and go. Mild and atypical infections are common.

The word typhoid (as in typhus-like) reflects the similarity of the louse borne rickettsial disease epidemic typhus and that of typhoid fever; in fact, in some areas, typhoid fever is still referred to as abdominal typhus. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/3>.]
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