WHO says undiagnosed illness in Liberia initially appeared to be undetermined poisoning after 31 cases, 13 deaths - April 26, 2017+ Neisseria meningitidis type C?

[alert]

The article also contains the statement:
It is common practice in Liberia to contribute food or drink for the wake and funeral and then bring it back to the home ? which is how Gasasira says the other case is believed to have been infected.

(The unusual rash reported above also suggests some kind of hemorrhagic process is going on. There are several anticoagulants used worldwide as rodenticides that might produce symptoms like this if ingested in high enough doses. - alert)

[Emily]

During the ebola crisis there were rumors about wells being poisoned in Liberia. Turns out chlorine and possibly other disinfectants were being added to wells out of fear of ebola and overdoses happened. The Observer has a follow-up on that and general drinking water problems in the country.

https://www.liberianobserver.com/columns/women/the-shocking-truth-about-our-drinking-water/

The Shocking Truth About Our Drinking Water

-I?m thirsty
By
Claudia Smith -

April 19, 2017

... Meanwhile, a family in Caldwell recalls that during the Ebola period many women and children became ill and lost their lives from drinking from contaminated or ?poisoned? wells. In reality, those poisoning the wells were those who thought an added quantity of chlorine could keep their wells safe from the Ebola virus.
?People would drink a cup and start vomiting; and before two or three days, die from stomach challenges,? the family added.
Presently, children (like the one pictured above) drink directly from wells whose waters are not intended for direct consumption; and in some instances, skin conditions, stomach cramps and loss of appetite occur after a cup of water from such wells.
When asked if the drinking water has any signs of chemicals, the children replied that ?the water is sweet.?
So what are the risks of using too much chlorine?...

[sharon sanders]

I have asked Kai for a link:

• Kai Kupferschmidt @kakape 25m25 minutes ago More
  
  
  
  Report by pathologist suggests that mystery disease in Liberia may be infectious after all: Neisseria meningitis. But many questions.
  
  
  
  
• Kai Kupferschmidt @kakape 2m2 minutes ago More
  
  
  
  That should be Neisseria meningitidis (thank you, autocorrect)
  
  
  
  
  FluTrackers.com @FluTrackers 2m2 minutes ago More
  
  
  
  Replying to @kakape
  Hi! Is this your reporting, or do you have a link? Thanks.
  
  

[alert]

Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

I'm looking, but I can't find any article confirming this fact, however.

[sharon sanders]

I have asked Kai for a link:

• Kai Kupferschmidt @kakape 25m25 minutes ago More
  
  
  
  Report by pathologist suggests that mystery disease in Liberia may be infectious after all: Neisseria meningitis. But many questions.
  
  
  
• Kai Kupferschmidt @kakape 2m2 minutes ago More
  
  
  
  That should be Neisseria meningitidis (thank you, autocorrect)
  
  
  
  
  FluTrackers.com @FluTrackers 2m2 minutes ago More
  
  
  
  Replying to @kakape
  Hi! Is this your reporting, or do you have a link? Thanks.
  

His response:



Kai Kupferschmidt @kakape 12m12 minutes ago More



Replying to @FluTrackers
This is what I was told by someone at the National Public Health Institute of Liberia. Apparently there was a press 1/2


Kai Kupferschmidt @kakape 12m12 minutes ago More



Replying to @FluTrackers
conference by Liberian MoH at 11 this morning where this was made public as well. but have not found a record so far. 2/2


Kai Kupferschmidt @kakape 2m2 minutes ago More



CDC tells me they have completed inf dis tests and are finalizing official statement @FluTrackers

[sharon sanders]

FluTrackers.com @FluTrackers 9m9 minutes ago More

Replying to @kakape
Thank you.



Kai Kupferschmidt @kakape 4m4 minutes ago More

Replying to @FluTrackers
Pleasure. FWIW, meningitis would seem consistent with symptoms and some other features. And meningitis belt is right next door.

[Pathfinder]

Liberia Early Warning Disease Surveillance Bulletin Week 17

BY MEATPIE ? MAY 7, 2017

Liberia IDSR Epidemiology Bulletin
2017 Epi Week 17 (April 24 ? 30)

Excerpt:
Meningitis
 One case of meningitis was reported from Montserrado County
 Cumulatively, since Epi week one, 7 suspected cases have been reported

http://moh.gov.lr/liberia-early-warning-disease-surveillance-bulletin-week-17/

[tetano]

Mystery illness in Liberia appears to be meningitis -minister

MONROVIA, May 8 (Reuters) - Medical samples from four of the victims of a disease in Liberia that initially baffled scientists have tested positive for a type of meningitis, the minister of health said on Monday.
So far a total of 31 cases of the so-called mystery illness have been reported, including 13 deaths in an outbreak linked to the attendance of a religious leader's funeral.
While the symptoms are different from Ebola, the sudden deaths nevertheless stirred anxiety about an outbreak of the tropical illness which was often spread through burial rituals in the West African epidemic that ended less than a year ago.
Seven specimens from the deceased tested positive for Neisseria meningitis, a particularly contagious type of bacteria, Dr. Bernice Dahn told reporters on Monday.
"Based on these initial results from the CDC Atlanta (U.S. Center for Disease Control), we believe that we are dealing with a probable outbreak of meningitis in Sinoe, which spread to Montserrado and Grand Bassa counties," she added, while calling for calm.
She said the government was investigating options for mass vaccinations against the illness, characterised by swelling of the membranes in the brain and spinal cord. Further laboratory analysis is under way. (Reporting by James Harding Giahuye; writing by Emma Farge; editing by Mark Heinrich)

http://www.dailymail.co.uk/wires/reuters/article-4485676/Mystery-illness-Liberia-appears-meningitis-minister.html

[tetano]

Meningitis Suspected In Unexplained Cluster Of Deaths In Liberia

Senior Press Officer Sharon Hoskins wrote in a statement to HuffPost that the CDC is sending two meningitis laboratory scientists and one meningitis senior epidemiologist to Liberia this week to join the staff from the CDC Country Office in Liberia in the investigation.

On Saturday, Kateh stressed that this infection appears to be localized to those that attended the funeral and wake and one close contact. The CDC also reiterated that there is ?no direct threat to the United States.?

http://www.huffingtonpost.com/entry/meningitis-suspected-in-unexplained-cluster-of-deaths-in-liberia_us_59109a8ee4b0e7021e99b055

[alert]

Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

I'm looking, but I can't find any article confirming this fact, however.

Nope, not a new strain. Type C:

http://www.huffingtonpost.com/entry/meningitis-suspected-in-unexplained-cluster-of-deaths-in-liberia_us_59109a8ee4b0e7021e99b055

Meningitis Suspected In Unexplained Cluster Of Deaths In Liberia

Four of the 13 patients who died have tested positive for Neisseria meningitidis serogroup C.

By Lauren Weber








Four of the 13 patients who died of a mysterious illness in Liberia since April 23 have tested positive for Neisseria meningitidis serogroup C, a bacterial form of meningitis, according to the U.S. Centers for Disease Control and Prevention.

The news confirmed what Dr. Francis Kateh, Liberia?s deputy health minister and chief medical officer, told HuffPost Sunday.

Additional testing is ongoing to determine if the other deaths and 30 other illnesses in Sinoe County, Grand Bassa County and the capital city of Monrovia following the wake and funeral of a religious leader in Sinoe County are also due to this type of infection.

[tetano]

Health Minister Links Outbreak in Sinoe County to Meningitis

It remains unclear how the disease spread to several persons in the same location at the same time as most of the deceased were not closely related. According to healthline.com, ?most of the bacteria that cause this form of infection are spread through close personal contact, such as coughing, sneezing, and kissing. Throat secretions from an infected person (for example, phlegm or saliva) contain bacteria. When you cough or sneeze, the bacteria travel through the air.
But most of the germs that can lead to bacterial meningitis are relatively non-contagious. In fact, the bacteria that cause meningitis are less contagious than the viruses that cause the cold or flu.?
The symptoms are, however, similar to that which was observed prior to the death of victims in Sinoe County.
Dr. Dahn during Monday?s press conference said a total of 27 cases and 10 deaths have been reported from Sinoe County, while Montserrado County recorded two cases and two deaths, and Grand Bassa County reported two cases and one death.
?Liberia has never experienced Meningitis before,? Dahn said, noting that Meningitis normally affects countries that are hot and have a long dry season; such as Mauritania, Burkina Faso, Sudan, Ethiopia and other sub-Sahara countries which usually experience Meningitis every two years or sometimes annually.

http://africa.madepress.com/?p=10669

[sharon sanders]

hat tip @kakape Liberian mystery disease may be solved

By Kai KupferschmidtMay. 8, 2017 , 5:45 PM
When several people died suddenly late last month in Liberia after attending a funeral in the southern county of Sinoe, alarm bells sounded: Had Ebola returned to West Africa? In 2014 and 2015, the largest known outbreak of the deadly disease killed more than 11,000 people in Liberia and two neighboring countries. But instead of signaling the return of that virus, the outbreak?which so far has sickened 30 people and killed 13?may have highlighted its legacy: a disease-monitoring system put in place after Ebola. Although the public health response was far from flawless, it rapidly stilled Ebola fears and now points to a different disease: meningitis.
more...

http://www.sciencemag.org/news/2017/05/liberian-mystery-disease-may-be-solved

[Emily]

Meningococcal disease is symptomatically consistent, and would explain most of the reported symptoms (including the bizarre rash caused by broken blood vessels). It would also explain the rapid fatalities and the H2H spread, as well as the positive response to antibiotics.

As West Africa is in the middle of multiple meningitis outbreaks elsewhere, I'm a bit surprised it would have taken this long to identify if this indeed is the cause. There are multiple strains of the bacteria; I wonder if the testing took so long because it might be a novel or uncommon strain?

I'm looking, but I can't find any article confirming this fact, however.

Alert, did you read about cases responding to antibiotics, or are you thinking along the lines that the prophylactic antibiotics that were given may have terminated the H2H spread?

The Sciencemag article Sharon just posted has possible explanations as to why if this outbreak was caused by MenC, it wasn't recognized sooner.

"But the evidence for meningitis is mounting. A Kenyan pathologist who did autopsies this weekend on two of the bodies noted signs consistent with meningitis, Nagbe says. Although few patients had fever, a common sign of meningitis, other symptoms and the short time between onset of disease and death are typical. ?The clinical presentation was very unusual, that is why meningitis was not at the top of our list,? Gasasira says. Samples from the other patients will be tested for N. meningitidis as well, Gasasira says. ?Then we?ll be much more confident.? A big question is why N. meningitidis should suddenly appear in Liberia. Since a new vaccine was introduced in 2010, the number of meningitis cases in Africa has dropped dramatically. But that vaccine protects only against serotype A. The number of infections with serotype C has gone up; Nigeria and Niger are now battling a large outbreak. ?Meningitis C is filling the vacuum created where meningitis A was a problem,? Gasasira says. ?But we never had Type A.? Another possibility is that the disease was present in Liberia but just wasn?t picked up in the past. "

I'm still skeptical that this was a MenC outbreak due to the lack of fever, etc. I'd like to know how the positive test results can differentiate between benign carriage of the bacteria vs disease. Also, if this is a MenC outbreak and the current vaccine used in Africa only protects against serotype A, why are they considering a mass campaign with an A vaccine for a C outbreak?

[alert]

Alert, did you read about cases responding to antibiotics, or are you thinking along the lines that the prophylactic antibiotics that were given may have terminated the H2H spread?

The Sciencemag article Sharon just posted has possible explanations as to why if this outbreak was caused by MenC, it wasn't recognized sooner.

"But the evidence for meningitis is mounting. A Kenyan pathologist who did autopsies this weekend on two of the bodies noted signs consistent with meningitis, Nagbe says. Although few patients had fever, a common sign of meningitis, other symptoms and the short time between onset of disease and death are typical. “The clinical presentation was very unusual, that is why meningitis was not at the top of our list,” Gasasira says. Samples from the other patients will be tested for N. meningitidis as well, Gasasira says. “Then we’ll be much more confident.” A big question is why N. meningitidis should suddenly appear in Liberia. Since a new vaccine was introduced in 2010, the number of meningitis cases in Africa has dropped dramatically. But that vaccine protects only against serotype A. The number of infections with serotype C has gone up; Nigeria and Niger are now battling a large outbreak. “Meningitis C is filling the vacuum created where meningitis A was a problem,” Gasasira says. “But we never had Type A.” Another possibility is that the disease was present in Liberia but just wasn’t picked up in the past. "

I'm still skeptical that this was a MenC outbreak due to the lack of fever, etc. I'd like to know how the positive test results can differentiate between benign carriage of the bacteria vs disease. Also, if this is a MenC outbreak and the current vaccine used in Africa only protects against serotype A, why are they considering a mass campaign with an A vaccine for a C outbreak?

I don't know if antibiotics were prophylactically used (to terminate H2H spread), but I do know that most of the cases that survived long enough to reach treatment survived. The articles said that treatment consisted of rehydration and antibiotics, so once we had ruled out things like cholera and dysentery (which the rash alone likely would do), it had to be the antibiotics that were helping.

Also, we have a report here of a case that attended the funeral and was found alive and unconscious on May 1, that has apparently since recovered. That would be incredibly unlikely for a mass poisoning on April 22.

[Ronan Kelly]

Update on unexplained cluster of deaths ? Liberia


10 May 2017

On 25 April 2017, the Ministry of Health of Liberia notified WHO and partners of a cluster of sudden deaths of unknown aetiology in Sinoe County. The event began on 23 April 2017 when an 11-year-old child was admitted to hospital presenting with diarrhoea, vomiting and mental confusion after attending a funeral on 22 April 2017.

As of 9 May 2017, a total of 31 cases including 13 deaths have been reported.

The Ministry of Health of Liberia (MOH) responded quickly to the cluster using the emergency management and laboratory infrastructure it developed during the Ebola outbreak alongside WHO, and other public health partners. The Liberian MOH sent blood, urine, and plasma samples to the US Centers for Disease Control and Prevention (CDC) for testing of infectious diseases and environmental toxins.

On 8 May, WHO was informed by Liberia?s MOH that samples from four of the deceased patients had tested positive for meningitis C (Neisseria menigitidis). Although these most recent reports point to meningitis as the probable cause of illness and death in these patients, the investigation is still ongoing to determine if this bacteria is responsible for other reported illnesses in this cluster.

While awaiting full toxicology reports, the Liberian MOH is exploring whether vaccination against meningitis is an appropriate course of action. WHO supports the ongoing epidemiological and laboratory investigations to identify the aetiological agent of this cluster of cases to guide additional control measures.

Since it was notified of the cluster of sudden deaths, WHO has worked closely with Liberian Ministry of Health and other partners in areas of overall coordination, surveillance, contact tracing, case management, social mobilization, community engagement, laboratory investigation, and infection prevention and control.

http://www.who.int/hac/crises/lbr/update-deaths-liberia/en/