Chen Qi-The World of Micro-Organism

Kenia | Cholera Risk Spreading

March 20th 2010

Nairobi — As of 15 March, 15 districts nationwide were affected with cholera, with 663 cases confirmed since January, according to a Ministry of Public Health and Sanitation update. At least 15 deaths have been recorded.

Worst affected are parts of Coast, Eastern and Rift Valley provinces. Kajiado District, in Rift Valley, has 177 cases.

In 2009, at least 781 cholera cases were laboratory confirmed with 274 deaths, in an outbreak attributed to widespread water shortages because of drought, contaminated dry river beds and poor hygiene.

At present, more cholera deaths and cases are being reported in remote areas. Suspected cholera deaths have been reported in the northwestern Turkana Central District, the medical officer, Kilkrist Lokoyer, told IRIN.

"We have sent a medical team from Lodwar [the main town] to Mugur area where five people have reportedly died after vomiting and diarrhoea. We will conduct an audit to ascertain if it is indeed cholera that killed them," said Lokoyer.

Mugur is an island in the crocodile-infested Lake Turkana making it difficult to access, he said.

Major disease risk factors in Mugur include contaminated lake water and a lack of medical facilities. The nearest health centre is about 50km away.

Temporary medical camp

Some 127 cases of cholera have been recorded in the eastern district of Tharaka since 7 March, Justus Kitili, Tharaka medical officer, told IRIN.

A temporary outpatient treatment camp has been set up at the worst-hit Makutano Police Post, with medical personnel from surrounding areas mobilized to assist the sick. Other areas affected include the villages of Ura Gate, Mauthuni, Gakauni and Gatithini.

"We do not wish to raise the risk of more infection by transporting the sick to the referral district hospital; that is why we set up the temporary camp [close to] the most affected areas," he added.

"We urgently need help... we are running out of antibiotics and intravenous fluids," Kitili said, adding that contaminated water from the local River Ura is suspected of being the source of the outbreak.

Education campaigns

The government is conducting health education campaigns and has sent teams comprising epidemiologists, public health officers and nutritionists to assist in cholera investigation and control, said the senior assistant director of medical services, Philip Muthoka.

Humanitarian organizations are also on high alert due to ongoing short March to May rains, which fuel cholera risk.

The Kenya Red Cross Society is distributing water purification drugs in flood-hit areas where water systems have been damaged, with UN agencies assisting in hygiene education and drug provision.

According to Muthoka, seepage from burst sewer lines running parallel to drinking water pipes often contaminates otherwise clean water in slum areas such as Korogocho in Nairobi. Poor food handling and unhygienic human waste disposal are also to blame.

"Our problem is that during the ongoing slum upgrading process, many of the water pipes were broken and there are only a few [clean] water points now. Our drainage is clogged and waste disposal is not always standard," Joseph Gathu, a Korogocho community leader, told IRIN.

Gathu is part of a team teaching residents to boil drinking water and observe other hygiene measures.

The Nairobi Water and Sewerage Company has also distributed water tanks in the slum to enable it to truck clean water to 153,000 residents.

Yellow fever outbreak in howler monkeys

March 19th 2010

Tuberculosis cases up by 5% in year

March 18th 2010

The Health Protection Agency has warned people to be vigilant after latest figures revealed the number of cases of tuberculosis rose by more than 5% last year.

Figures from the HPA showed there were 9,153 cases across the UK last year, compared with 8,679 in 2008.

This represents an increase of 5.5%.

London accounted for more than a third of all cases (3,476), while in the Midlands there were a further 1,035 cases.

Both regions saw little change from 2008 figures. But the number of cases in Wales rose by 31.7% from 167 in 2008 to 220 last year.

The South West also saw cases increase from 268 to 337, which represents a rise of more than a quarter (25.8%).

There were also rises of just over 10% in the East Midlands (to 596 cases), the North West (to 841 cases) and the South East (to 765 cases).

There was a slight fall (down 2.3% to 168 cases) in the North East and a fall of 28.8% in Northern Ireland from 59 infections in 2008 to 42 in 2009.

Ibrahim Abubakar, a TB expert at the HPA’s centre for infections, said the increase is the biggest rise since 2005, when confirmed UK cases rose 9.4% to 8,394.

“This increase shows that we must remain vigilant in our fight against TB,” he said.

“This is an entirely preventable and curable infection, but it can be fatal if prompt diagnosis and treatment are not given.”

The ticking TB time bomb

March 20th 2010

TUBERCULOSIS began to shape Suren Arakelyan's life from the moment he was born, and it will almost certainly decide when he dies. The disease took his father when Arakelyan was a baby. Growing up fatherless, he says, goes a good way to explaining the unrulier moments in his colourful 42 years.

While working in St Petersburg in 1997, Arakelyan got into a brawl one night and earned himself six months' jail. Russia's prisons are rife with tuberculosis and Arakelyan was diagnosed with it after his release. Patchy treatment with antibiotics beat the disease back, but in 2008 it returned, tougher than ever, in the form of XDR - extensively drug resistant - tuberculosis.

Today, he lies in a bed in the Abovyan hospital on the outskirts of Yerevan, the capital of his native Armenia, the victim of a long-neglected scourge that kills at least 1.8 million people a year, almost as many as HIV/AIDS.

Widespread misuse of the antibiotics created to combat tuberculosis - particularly in the former Soviet Union and China - has led to drug resistant strains that now infect at least half a million people globally each year, less than 3 per cent of whom receive proper treatment.

Big cities with high immigration rates such as London and Paris have also had increases in tuberculosis rates. And the United States last year uncovered its first case of XXDR - extremely, extensively drug resistant tuberculosis, a new and virtually untreatable category - in a 19-year-old Peruvian man studying in Florida.

''Rich countries thought TB was a disease of the past,'' says Mario Raviglione, head of the World Health Organisation's Stop TB Department. ''It's always a problem of 'the others' - a problem of the poorest. But it kills twice as many people as malaria and almost as many as AIDS. If you think this doesn't affect you, you are dead wrong.''

Emaciated and emotionally fragile, Arakelyan has lost half his lung tissue to the disease and most of his hearing to the powerful but toxic medications. He is lonely without his wife and young children, who live far away in Belarus.

''I've had TB for 13 years. I've seen a lot of patients die and it's usually because they are isolated and alone and it's very hard for them to keep going,'' he says. ''How do you keep going when you're afraid to hug and kiss your own children because you could infect them?''

For a while after he entered a treatment program run by the aid organisation Medecins Sans Frontieres, Arakelyan's illness appeared to be in retreat, but three months ago, tests showed that the mycobacterium tuberculosis was there again in his sputum samples, a clear indication the drugs were not working.

Demoralised, he began skipping part of his medication - taking some of the pills but refusing others. It is the worst thing he could do. Without the strict multi-pronged attack from several antibiotics, the bacteria can regroup, with even more resistance.

''I'm trying to take them,'' Arakelyan says. ''But sometimes it's impossible; the drugs are so terrible on your body.''

It is patients such as Arakelyan that World Health Organisation chief Margaret Chan had in mind when at a conference in Beijing last year she called drug resistant tuberculosis a time bomb.

Next week, WHO will release a global survey of drug resistant tuberculosis to coincide with World TB Day on Wednesday. The report contains good and bad news, but ''some of the bad news is really bad'', Raviglione says. Just as disturbing, he says, is what we don't know.

''Most developing countries don't survey drug resistance. In Indonesia, we think there are nearly half a million new cases [of tuberculosis] a year and we have no clue whatsoever how many of them are MDR [strains resistant to the main first-line drugs] and XDR.''

Worryingly for Australia, a study published in 2008 in the Medical Journal of Australia found drug resistant tuberculosis was a looming problem in Papua New Guinea and could spread via Torres Strait to northern Queensland, sparking ''a major public health crisis''.

''The failure to contain an epidemic of MDR-TB now may have significant long-term financial and social implications for both PNG and Australia,'' the authors wrote.

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Let's Kick Typhoid Out of Country

March 19th 2010

Harare — THE rise of Typhoid cases in Mabvuku from an initial four at the beginning of the month to 160 as of yesterday is worrisome particularly as memories of the cholera outbreak that killed an estimated 4 000 people in 2008/09 are still fresh in the minds of many.

Typhoid, just like cholera, is a water-borne disease that is transmitted by the ingestion of food or water contaminated with waste from an infected person.

Again, just like cholera it can be easily prevented by better sanitation and cleaner food handling.

And also as with cholera, there need not be any fatalities from typhoid infection since the infected can be saved by oral rehydration till they access antibiotics with the disease prevented by improved sanitation and hygiene.

Another plus is that typhoid does not affect animals and therefore transmission is only from man to man which makes it easier to contain once we all know what is required of us.

Since all that is required is ensuring that urine and/or faecal matter do not come into contact with food, all food must of necessity be carefully prepared with hands washed before food is handed.

These are very basic preventive measures that do not cost anything but whose import is invaluable.

This is why the increasing number of typhoid cases in Mabvuku is worrisome as it implies that people are not aware of how easy it is to contain typhoid or they are simply not practising good hygiene and sanitation.

Regrettably, five lives have already been lost to the disease, but then that was before it was known that there was an outbreak of typhoid, and now that it's known, there need not be anymore fatalities let alone new infections.

To this end, we hail the Harare City Council's decision to afford free medical treatment to all those infected and their order that all food handlers, from vendors to those in the hospitality industry undergo medical tests to ascertain whether they are free from Salmonella typhi, the typhoid pathogen.

The good thing about the typhoid outbreak is that it has been confined to Mabvuku, as there have been no reported cases in other parts of the city.

This development, in a way, makes the City fathers work easier as they have to focus efforts on only one area to ensure that their order is enforced.

All vendors and those dealing in food in Mabvuku should be compulsorily tested for typhoid, after which a provisional ban on vending, at least till the disease is eradicated, should be enforced.

More so at this critical juncture, it is vital that Mabvuku's water and sewer problems be attended to as a matter of urgency to reduce the likelihood of having sewer effluent come into contact with food.

Let us all, in our various spheres of activity, play our part to ensure that typhoid is kicked not only out of Mabvuku, but Zimbabwe as a whole.

Swine flu threat to children 'not taken seriously'

March 18th 2010

Medical leaders have been accused of not taking the threat to young children from swine flu seriously enough, as time runs out for parents to have their under-fives vaccinated.

Professor Lindsay Davies, director of public health at NHS London, said she was ‘very worried’ that millions of children had been left exposed to future waves of the outbreak, with only a small proportion having had the vaccine so far.

She revealed in London, one of the worst hotspots for swine flu, only 13.5% of under fives have been vaccinated, with the vaccination campaign due to wind up at the end of March.

‘I’m very worried about the under-fives,’ said Professor Davies told a special session of the London Assembly health committee.

‘I’ve been really disappointed that there are some medical leaders within their own trusts who haven’t taken it more seriously.’

Pulse revealed last month that the Department of Health had decided to take the under-fives out of the at-risk groups for swine flu when flu vaccinations are carried out later in the year.

A vaccine against swine flu will be incorporated within seasonal flu jabs for other groups, although pregnant women will also be excluded from those routinely targeted.

Professor Davies said there were ‘really quite high hospital admission rates’ for children and said she feared a lack of urgency would come back to haunt the medical profession.

Take-up of the swine flu vaccine in England has been far lower than in other countries, especially for children. But GP leaders have claimed it would have been much higher if a national deal had been agreed with the DH, instead of cash-strapped trusts being left to negotiate with practices over vaccine delivery.

This led to many SHAs, including London, clamping down hard on any plans to provide extra flexibility over GP workload to enable better take-up.

Pulse revealed how NHS London stamped on agreements with PCTs in Richmond, Kingston and Croydon, which Sussex and Surrey LMCs claimed had agreed to concessions over extended hours.

Professor Davies said fears over the safety of the vaccine among the public and also frontline medical staff had contributed towards a lower-than-hoped-for uptake.

Asked if it would be made clear to patients that the new vaccine included a vaccine against swine flu, she said: ‘I don’t want to put people off, but I don’t want to be dishonest.’