Disease Updates - 1/12 to...

Peter Petrisko ptp at primenet.com
Sun Jan 18 09:43:00 EST 1998


17 Jan. 1998 UPDATE -

/Phx AZ US flu & general update /HongKong H5N1 /Paupa New Guinea leprosy /
Kenya (long report) Rift Valley fever /Somalia R.V.F. /Fiji dengue /
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Phoenix, Arizona (US) - An ususual number of cases with flu-like symptoms,
upper-respiratory infections, breathing difficulties, plus cases with dry
coughing symptoms lasting up to 4 weeks, have been reported, according to
local tv news reports.
   One hospital, Desert Samaritan, reports admissions up 30% due to these
cases.  
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   In general, influenza viruses (both A varieties & B) continue to spread
throughout most countries in the northern hemisphere (all parts, not just
US) with activity described as sporadic. (i.e. usual flu season).
   There is more widespread activity in several U.S. states, see CNN
report posted here a few days ago for that breakdown & other info.

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HONG KONG - A report that appeared Friday in the journal SCIENCE, stated
the 'bird flu' responsible for the deaths of six people here has so far
not altered into a more contagious virus that could start a global
epidemic.
   (For this avian virus to become transmittable from human to human, it
had to have mutated or combined with human flu genes. The researchers who
authored the aforementioned report said their study of genetic material
collected from people who contracted 'bird flu' showed this wasn't the
case with influenza A/H5N1.)
   Researchers are still baffled over how the 18 people infected with the
virus contracted 'bird flu', and the CDC continues work on a vaccine
because it is possible that 'bird flu' could still alter into a strain
easily transferred to humans.

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North Solomons province, PAPUA NEW GUINEA - (on reports of leprosy on
Bougainville Island & parts of North Solomons province) - A personal
correspondence. The author, Dr. Malau, is currently the manager of the
Community Health Programme, South Pacific Commission.
(to quote)- "For someone who had started the National Leprosy Elimination
Programme in Papua New Guinea... I should say leprosy control in the rest
of the country is a success story yet to be told to most disease control
people in the region...
   The problem of the (North Solomons) Province is the lack of multi-drug
therapy treatment availibility and case review and registration, as had
been done throughout the rest of the country.
   What is needed on the island of Bougainville and North Solomons
Province is re-establishment of a well-coordinated disease surveillance
and control system...
   I am afraid that following the long absence of government services
there is likely to be an increase in prevalence of most chronic infectious
diseases."  (end quote)
  
   So it would appear this outbreak, if it can even be described as that
severe, can be arrested rather quickly with a bit of diligence on the
government's part.

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KENYA -  The Kenya Ministry of Health has now confirmed more than 350
deaths from Rift Valley fever, but WHO epidemiologist Louise Martin
said, in an Associated Press article on Friday, that the count is
"possibly double that," adding, "we definitely have a Rift Valley fever
epidemic."
   Reliable statistics are impossible to compile because huge swaths of
both Kenya & Somalia are flooded by rainfall 500% above normal, making
travel from village to village - even when hitching rides on aid
helicopters - time consuming. As of late Thursday, WHO doctors had been
to only 20 out of 118 villages in Garissa district and had not even
reached two other districts, Mandera and Wajir, which are also infected by
the fever.
   WHO is also attempting to get the message out to residents to sleep
under bed nets and to use repellents, to ward off disease-carrying
mosquitos, but report finding people sleeping in the open or under trees
because their homes had been destroyed by floods. It is also warning
visitors to the country to protect themselves from the mosquitos that
ferry the fever-inducing virus from infected animals to humans.
   There is still concern that another disease is at work here, possibly 
in epidemic proportions. A Red Cross statement, carried by Agence France
Presse on Friday, said, "We are sure there is Rift Valley fever, but is
that all? We are seeing some strange phenomena and there may be something
else out there." The Red Cross also called for (more) helicopter lifts to
areas cut off by flood waters, livestock vaccinations, and masks, gloves &
disinfectants for corpse disposal.
   On a more personal note, a recent correspondence I read, from a medical
personnel in Kenya, said, "I saw the most unusual presentations in a
couple of camel herds... Complete ballooning of the head & upper neck
only, deaths by asphyxia, eyes very swollen, & huge mucoid membranous
sloughs in mouth covering some nasty ulcers. No foot involvement. From
what the DVO says, he & the vets who work w/ him have never seen anything
like this... It is a virus soup out there!" (endquote)
   Obviously, as a personal observation, it is unconfirmed.
   A Red Cross doctor, Dr. Saeed Abdalla, was quoted on Saturday by the
Associated Press, on the rate of infection, saying, "This is the first
time we have found cases so close to each other, and it is not a good
sign. I fear the outbreak is worse than we think." Dr. Abdalla then added
that so far there have been no confirmed cases of infection through human
to human contact.
   As stated earlier, some doctors, like Abdalla, aren't completely
convinced it is just Rift Valley fever. Her comments were, "In humans we
think it is Rift Valley fever complicated by something else, which we
don't know."
   There have been some reports, from WHO experts in this country, of
outbreaks in the North-eastern province now apparently spreading to areas
in the Eastern, Central, Rift Valley, and Coast provinces.
   They believe this is due, in part, to the movement of livestock to
market and increased market demand because of Ramadan-ending celebration
preparations. Festivities, set for Jan. 29, has WHO epidemiologist Martin
especially worried. The virus is concentrated in livestock blood, which
splatters widely when the animal's neck is slashed. Inhaled droplets, or
those that fall on an open wound or cut, can easily infect a human and,
Martin said, "That scares me." 

   Obviously, with miles of flooded land, overflowing river banks, mud
covered roads, and a lack of clean drinking water and medical services,
not to mention an oft malnourished population already ravaged by many
diseases - malaria & tuberculosis among them - agencies providing aid here
have their work cut out for them.

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SOMALIA - A Rift Valley fever outbreak is now being reported near the
towns of Belet Weyne and Johar, both on the Shabele River.
   Unlike previous RVF outbreak reports, on the Somalian side near the
Somalia/Kenya border, this comes out of central Somalia & a significant
distance from the border. (Belet Weyne is close to the Ethiopian border,
while Johar is around 100 miles from the Indian Ocean coastline.)
   A provisional plan by WHO officials, sending task forces into this
affected Somalia region very shortly, will include case-based hospital
surveillance throughout the country to detect new cases, and track its
spread, systematic sampling and testing of infected human and animal
specimens, and to work with other organizations to improve access to
regions cut off by floods. More anti-insect measures will be introduced. 
   Much of the same steps now being followed in Kenya by WHO.

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Suva, FIJI - A Ministry of Health report estimates 3,000 suspected cases
of dengue were seen at M of H Facilities in the last 5 weeks, as many as
of 1,500 of those in the past week alone. The current death toll is 6.
   Unless mosquito breeding grounds are destroyed soon, this epidemic may
soon pass the '90 -'91 dengue epidemic that infected 4,000 and killed 40. 
   Most of the cases overall are still in the Western Division (the
largest island, where the capitol Suva is located) & spreading in that
region, but some suspected cases have appeared in the Eastern Division,
and one confirmed case (imported from Suva by a traveller) has appeared in
the Northern Division.
   (Time to pull out your trusty map, boys & girls, to see what lies
where in each Division.)

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