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Source: World Health Organization (WHO)This material has been condensed from information on the WHO Internet site. A link to this site can be found under 'Related sites' on the CDI homepage.
Sudan - updateThe outbreak of meningococcal meningitis that started in Northern Darfur State in early December 1998 has spread to 18 out of 26 states. From the beginning of the epidemic up to 22 April more than 16,000 cases, of which nearly 1,000 died, have been notified. The epidemic is expected to last until the end of June-July, depending on the geographical location of the states affected.
Since the start of the epidemic 7.6 million people have been vaccinated. The vaccination campaigns, as well as other epidemic control measures are being implemented through a national task force chaired by the Federal Ministry of Health. This task force includes the members of the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG), namely the IFRC, MSF, UNICEF and WHO.
Current work includes strengthening of the surveillance system and training for health care and laboratory workers in order to improve the detection and management of cases. Health education messages have also been widely distributed.
The task force estimated that a further 4.5 million people need to be vaccinated during the next three weeks and stressed the need for availability of medicines for treatment of the patients at peripheral health centres. The ICG is requesting an additional US$ 2.1 million from the international community with a view to meeting these needs immediately.
AngolaOn 23 March, the paediatric hospital in Luanda reported that a total of 21 cases of acute flaccid paralysis with 3 deaths had been registered. An investigation by the Ministry of Health demonstrated that by 3 April, 102 cases of AFP had been recorded in Luanda and neighbouring areas of Bengo province. Cases were primarily in children aged < 5 years and 90% of cases had received 2 doses or less of oral polio vaccine. Only 6% had received 4 doses.
On 8 April, the National Institute of Virology in South Africa reported that wild poliovirus type 3 had been isolated from 11 of 22 stool specimens taken from AFP cases in Angola. By 25 April, the number of polio cases was reported to be 661 with 41 deaths. Field investigation confirmed 6 cases of AFP in children aged < 5 years in Benguela, a city 500 km south of Luanda. Investigation of the outbreak is ongoing with the assistance of a WHO team. In response to the outbreak, 634 000 children were immunised with OPV in Luanda on 17 and 18 April. A national immunisation campaign is being planned to start in June.
Somalia - updateA total of 7860 cases with 233 deaths has been reported since the beginning of the current epidemic which started in December 1998. Areas where cases were still being registered at the end of March and first half of April are Mogadishu, Kismayo, and Baidoa. The disease is still appearing in new areas - Bay, Lower Shabelle, Upper and Lower Juba - which are difficult to access and figures are not available.
WHO is continuing to make supplies available and supporting the health authorities in strengthening cholera preparedness plans since more outbreaks are expected later in the year following the seasonal pattern
Acute haemorrhagic fever syndrome
Democratic Republic of CongoAn outbreak of suspected viral haemorrhagic fever has been reported in Durba, Watsa Zone, in the north-eastern Democratic Republic of Congo (DRC). Clinical features include fever, headache, lassitude, gastrointestinal bleeding, coughing up blood and agitation. The first cases are believed to have occurred in January 1999. Between January and 28 April, 50 cases, with 46 deaths have been recorded (CFR=92%). The earliest cases appear to have occurred in gold miners, but now cases are occurring among those living in the community. The WHO Office in DRC and the WHO Regional Office for Africa in Harare, Zimbabwe and MSF(Belgium and Holland) are preparing a team to investigate. The security situation in the area is poor and access to the affected area may be extremely difficult.
SudanThe outbreak of cholera which began in early March is continuing. The areas of Padak, Mading, Wanding, Lankien, Akobo and Burmat have reported a total of 892 cases with 24 death up to 27 April 1999.
These figures are cases admitted to hospital and are provisional. The epidemic mainly affects the Jonglei region in areas south of the river Sobat. As it is the beginning of the rainy season people have started moving with their animals from locations along the river to inland sites where other areas are likely to be affected.
A cholera response team coordinated by UNICEF is meeting twice weekly to review the situation, share information and plan the response strategy. UNICEF currently has ORS and tetracycline on standby for use as the need arises. WHO has sent an epidemiologist to assist local health authorities to assess the situation in the affected areas.
This article was published in Communicable Diseases Intelligence Volume 23, No 5, 13 May 1999.