Yemen - A Report that Hanta Virus is Infecting Hundreds, 104 undiagnosed fatalities

[Ronan Kelly]

Unknown epidemic hits Hodeida
Hodeida is the poorest governorate in the country. Victims of a fever outbreak cannot afford medication.

Ali Saeed
Published:22-11-2010

HODEIDA, Nov. 21 — An unknown disease causing bouts of severe fever has spread across several districts of Hodeida, 200 km west of the capital Sana’a, a local doctor told the Yemen Times.

“It’s an epidemic which is now rampant, especially in the rural areas of Hodeida,” Dr. Mohamed Abdul Rahman Al-Qadi, a doctor in Al-Marawa’ district of Hodeida told the Yemen Times.

He explained that the disease, aided by falling temperatures at night, is seriously affecting Hodeida’s rural areas, which are more exposed and vulnerable to the cold. Adults, especially those over 30 are more susceptible to contracting the disease.

A similar disease hit the same area last year, but this year its prevalence has been much higher hitting around 40 percent of Hodeida’s population compared to the one percent of those infected in 2009, according to Al-Qadi.No deaths have yet been reported, but the disease can cause paralysis. The fever causes an acute inflammation of the joints as well as severe headaches, the doctor told the Yemen Times.

He added that those with already weak immune systems are particularly vulnerable.

Locals from Hodeida are reportedly alarmed by the disease, which has yet to be officially classified by doctors. However, officials from the Ministry of Health in Hodeida have told the Yemen Times that it is only a normal fever and that there is no need to panic.

“It is only a normal fever caused by the cold,” said Dr. Othman Al-Baidani, Director of the Ministry of Health Office in the governorate. “Not a single death has been recorded yet.”

The director said that the Ministry of Health has recently formed a medical team and sent them to some of the affected areas.

In addition, the Health Office in the governorate has formed an operation team in all of Hodeida’s districts to follow up on the strange epidemic, according to Al-Baidani.

Those suffering from the disease, which is known amongst locals as “Al-Kritis” fever, do not recover until given a strong dose of antibiotics and vitamin injections, Dr. Al-Qadi said.

But many of those living in the infected areas of Al-Marawa’, Al-Jarahi, Zabeed, Bait Al-Faqih, Al-Mansoorya and Hais are unable to afford the medication which costs more than YR 2,000 (USD 10). In addition to disease Hodeida, Yemen’s poorest governorate, suffers from rampant levels of poverty.

More than half of Hodeida’s two and half million people live in traditional houses built from wood, mud bricks, and straw. Their main source of income is derived from agriculture and livestock.

The director of the Health Office in Hodeida advised families to take care of hygiene in their houses and to cover water pools and swamps.

http://yementimes.com/defaultdet.aspx?SUB_ID=35093

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

This is the thread from the unknown epidemic in Hodeida last year:

http://www.flutrackers.com/forum/showthread.php?t=113114

The disease last year was diarrheal, and may have been cholera. That really isn't consistent with the above post on the current "outbreak" (if 40% of the people had cholera, there would be deaths).

The mention of vitamins in the above article (along with "paralysis") makes me wonder whether this report is the result of malnutrition and vitamin deficiencies as well. The mention of seasonal fever and headache above also might suggest an H1N1 outbreak, but the attack rate would be very high, and that many H1N1 cases in a malnourished population would surely cause some fatalities.

This is likely a report of a compound outbreak.

[Ronan Kelly]

Re: Yemen: Unknown epidemic hits Hodeida

Archive Number 20101125.4246
Published Date 25-NOV-2010
Subject PRO/EDR> Undiagnosed disease - Yemen: (HU) RFI


UNDIAGNOSED DISEASE - YEMEN: (AL HUDAYDAH), REQUEST FOR INFORMATION
************************************************** *****************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Mon 22 Nov 2010
Source: Yemeni Times [edited]
<http://www.yementimes.com/defaultdet.aspx?SUB_ID=35093>


An unknown disease causing bouts of severe fever has spread across several
districts of Hodeida [Al Hudaydah], 200 km west of the capital Sana'a, a
local doctor told the Yemen Times. "It's an epidemic which is now rampant,
especially in the rural areas of Hodeida," Dr Mohamed Abdul Rahman Al-Qadi,
a doctor in Al-Marawa' district of Hodeida told the Yemen Times.

He explained that the disease, aided by falling temperatures at night, is
seriously affecting Hodeida's rural areas, which are more exposed and
vulnerable to the cold. Adults, especially those over 30, are more
susceptible to contracting the disease.

A similar disease hit the same area last year [2009], but this year, its
prevalence has been much higher, hitting around 40 per cent of Hodeida's
population compared to the one per cent of those infected in 2009,
according to Al-Qadi.

No deaths have yet been reported, but the disease can cause paralysis. The
fever causes an acute inflammation of the joints as well as severe
headaches, the doctor told the Yemen Times. He added that those with
already weak immune systems are particularly vulnerable.

Locals from Hodeida are reportedly alarmed by the disease, which has yet to
be officially classified by doctors. However, officials from the Ministry
of Health in Hodeida have told the Yemen Times that it is only a normal
fever and that there is no need to panic.

"It is only a normal fever caused by the cold," said Dr Othman Al-Baidani,
director of the Ministry of Health Office in the governorate. "Not a single
death has been recorded yet." The director said that the Ministry of Health
has recently formed a medical team and sent them to some of the affected areas.

In addition, the Health Office in the governorate has formed an operation
team in all of Hodeida's districts to follow up on the strange epidemic,
according to Al-Baidani. Those suffering from the disease, which is known
amongst locals as Al-Kritis fever, do not recover until given a strong dose
of antibiotics and vitamin injections, Dr. Al-Qadi said.

But many of those living in the infected areas of Al-Marawa', Al-Jarahi,
Zabeed, Bait Al-Faqih, Al-Mansoorya and Hais are unable to afford the
medication which costs more than YR 2000 (USD 10). In addition to disease,
Hodeida, Yemen's poorest governorate, suffers from rampant levels of poverty.

More than half of Hodeida's 2.5 million people live in traditional houses
built from wood, mud bricks, and straw. Their main source of income is
derived from agriculture and livestock.

The director of the Health Office in Hodeida advised families to take care
of hygiene in their houses and to cover water pools and swamps.

--
communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: Sun, 21 Nov 2010
Source: <http://bit.ly/eGzAOv> (translated from Arabic by SB)


Strange epidemic ravaging western Yemen
---------------------------------------
A number of cities villages and districts of the province of Hodeidah,
western Yemen have been hit by strange outbreaks, the causes and sources of
which are unknown.

The outbreaks have so far resulted in the deaths of 5 people and infected
thousands of others from different age groups. Local sources say that the
epidemic started about a month ago and has now spread to the "Zabid -- Beit
al-Faqih --Nectarine".

The outbreak has so far killed 5 people in the Nectarine city and infected
thousands of others, many of whom are in a coma. There is a state of panic
and terror among the citizens because of the rapid spread of infection,
which has prompted a large numbers of students to leave school, especially
after the discovery of infections among students and teachers.

It is believed that there are deaths and infected people in many other
villages in remote and distant districts, where the inhabitants lack most
of the basic services and health infrastructure.

The sources confirmed that the epidemic, which is known to the inhabitants
of those areas as "Almkrvs". The disease begins with a very high
temperature, without without treatments leading to a sustained coma. In
addition to flulike symptoms [cough, fever, and muscle and joint pains],
headache, swelling of the face and joints, and trembling of the body have
been reported. Bleeding from the mouth and nose, and skin rash "bleeding
under the skin", diarrhea and vomiting, and inability to stand or walk have
also been described.

The sources said that the results of medical examinations conducted in the
patients affected by the epidemic, were all infections in the blood. The
treatment has been limited to giving the patient a dose of "glucose" with
some vitamins and painkillers.

A large number of the local population are being infected by the epidemic,
which appeared to infect in all the houses of the affected areas where the
number of patients in each family is between 4 and 5 people. It is a
serious threat to all county residents, who numbered over 2.1 million
according to the 2004 Census.

A large proportion of the population are experiencing difficult and
miserarable living conditions making them more susceptible to infection. It
is believed to be caused by bacteria transmitted by the wind resulting from
the bodies of dead animals.

A number of local residents have condemmed and rejected what they called
the "ignorance" shown by the concerned authorities and local councils in
the province. Citizens are demanding that the government, led by the
Ministry of Health and local authorities in the province to assume their
responsibilities and hasten to send medical teams to the areas where the
epidemic has spread and undertake the examination of infected cases to
identify the causes of the disease.

In addition to the transfer of patients from villages and neighborhoods,
isolating them in special places outside the population centers and
providing treatment and other actions that would protect the population
against infection and limit the spread as they consider that the epidemic
is spread by the air and move with the wind.

The need is stressed to provide the necessary treatment for patients free
of charge as some families cannot pay the costs of treatment. Local press
sources confirmed by mid-August that a strange epidemic was killing
children in rural villages directorate "Alemrauap" Hodeidah province, which
has resulted in the deaths of five children and infecting dozens of cases
of diarrhea and vomiting.

The Office of Health, the Government and an anti-epidemiological
surveillance group in addition to a committee from the Ministry of Health
visited the region in an attempt to control the epidemic, but they did not
identify what the disease is. In late October, other press sources said
that the disease had alos been identified in the Directorate of "Beit al-
Faqih -- and the Nectarine.

--
communicated by:
ProMED-mail <promed@promedmail.org>

[The two reports differ in both detail and tone, which makes it hard to
assess what the cause is likely to be. Both agree that many cases of
something have occurred. Deaths appear to have been absent or relatively
rare. The following commentaries are based on the first and second reports,
respectively. Authoritative information from the region would be
appreciated. - Mod.SH

From the limited description of symptoms, it is difficult to make a
precise diagnosis. This seems to be a recurrent non-lethal disease
associated with poverty and lack of basic resources. In recent years, there
have been extensive outbreaks of malaria, dengue haemorrhagic fever, and
influenza in Yemen, any of which might be responsible for the current
outbreak. - Mod.CP

The newspaper message translated above says that thousands have been
infected but only 5 people have died. A picture of a patient published in
the newspaper article showed ecchymosis, a sign of subcutaneous bleeding.

Given that it seems to be large outbreak in a limited geographical area
within a short time span (few months?), vectorborne zoonoses like Crimean
Congo haemorrhagic fever, hantavirus, or Rift Valley fever seem unlikely.
Dengue haemorrhagic fever is another possibility and a large number of less
severe cases in a situation with an introduction of a new serotype could
explain the outbreak. Meningococcal infection would cause a clinical
picture of septicemia, disseminated intravascular coagulation, with
cutaneous bleeding, but a large community wide outbreak would be unusual
outside the meningitis belt in tropical Africa, and a higher case fatality
rate would be expected. Leptospira may cause DIC, but large outbreaks are
usually linked to exposure to surface water and a widespread outbreak like
this would have to be explained by contanmination of drinking water sources
in all of the affected areas.

Anthrax spread by airborne spores would probably more cause sporadic cases
and the zoonotic Alkhurma virus is rare and probably spread by direct
contact with infected animals, which cannot explain the large number of
cases including many children seen here. – Mod.EP

A map of the provinces and cities of Yemen can be accessed at
<http://www.citypopulation.de/Yemen.html#Land>. The HealthMap/ProMED-mail
interactive map of Yemen is available at <http://healthmap.org/r/01fw>. -
Mod.CP]

[see also:
Measles - Yemen: (SA) 20100503.1440
Unexplained deaths, bovine - Yemen (02) 20100105.0044
Unexplained deaths, bovine - Yemen: RFI 20100101.0010
2005
---
Yemen (Hodeidah): Aedes aegypti 20050310.0709
Dengue/DHF update 2005 (05) 20050306.0674
Dengue/DHF update 2005 (04) 20050209.0437]

..................sb/ep/cp/msp/sh

http://promedmail.org/pls/apex/f?p=2400:1001:556458378409345::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85980

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

The second article is as confusing as the first. The article beings by saying that the outbreak(s) have gone on for about a month, then later talks about deaths back in August. It seems that there are several things going on here, likely including diarrheal illness, dengue, and H1N1.

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

The following is the link for the second article. The article has apparently been edited heavily after machine translation, as the translation is barely readable.

Notably, the word "dengue" appears in the translation (but not in the ProMED post), which makes me suspect the Arabic word for dengue is in that article. The child fatalities also appear to be linked to the diarrhea and vomitting, not the "dengue". The article also mentions that many of the severe cases have been diabetic or had other pre-existing conditions, which isn't something you would see mentioned with some of the more severe etiologies suspected in the ProMED post.

I believe the mention of "paralysis" in the first article is a wrong word - the second article's translation indicates that some of the sick are too weak to walk, which might produce that report.

http://www.elaosboa.com/elosboaonline/news/show.asp?fesal_hussien=add&id=17423&vnum=fesal&page=elom

[Gert van der Hoek]

Yemen - Undiagnosed disease kills 14, infects thousands

Chikungunya? Dengue?

machinetranslated

26/12/2010

Mysterious disease kills coasts of Yemen


Increased mortality and B unknown sweep the directorates of the province of Hodeidah Coastal (226 km west of the capital Sanaa, Yemen) since last August to 14 people and injured tens of thousands of people, and attacked among medical and parliamentary Ministry of Health because of its role as "feeble" in the detection of the epidemic and find a vaccine suitable to eliminate it.

According to the assurances given with the patient dose nutritious "glucose" mixed with some vitamins and analgesics only and does not recover from the pain.

The Mohammed Hussein Abdo in a telephone interview with the AP that he was wounded and three of his sons at the same time, pointing out that the disease did not leave a single family in the city inhabited only by Zaidi and lethality of the majority of its members.

According to the Director of Health Center Directorate of the current Abdul Hakim Hazza center receives daily about 90 cases, and explained that the disease virus and is transmitted through the air and no mosquitoes, and feel a patient developed fever and chill and quaver in the bones with pains in the joints and legs may hinder the natural movement completely.

For his part, criticized the decision of the Commission of Health and Population House Samir Khairi Reda authorities and ignored in the fight against the disease and reduce its spread.

He said the island revealed that the efforts of the Ministry of Health remains very limited in the fight against epidemics which kill citizens, and called on officials to assume their responsibilities and to send teams to assess the extent of the disease and provide the necessary support for patients.

The member of parliament that would require the House of Representatives and Minister of Public Health next week to look closely at the Alamaaga V taken by his ministry about the disease.

Responsibility
An official source in the Health Office in Hodeidah Governorate - on condition of anonymity - denied control of the disease, viral fever disease, popularly known as "Almkrvs."

And move the location of sympathy and net news source as saying "The official efforts were limited to sending teams to spray the affected areas, while did not provide any treatments for those infected and most of them landless, who can not afford to buy medicine."

The source accused the local authority and the Office of Health, the government of shirking their duties and take responsibility for exchange between them in the cause of providing medical aid to patients.

And prevail in the current state of panic among the inhabitants of cities Zabid and surgical and Zaidi and hays and Beit al-Faqih and Nectarine Aldirihmi and after the spread of the disease among students in schools without the intervention of the authorities to stop it.

The city of hays last week's march was attended by people who had gathered in front of the General Hospital, expressing their anger to ignore the Ministry of Health and disregard for their suffering, and called for pumping more medicines and emergency campaigns to contain the epidemic.

In turn, denied the Director-General of the Office of Public Health in Hodeidah Governorate Osman Baidhani outbreak of the disease in those areas, and confirmed that he was brought under control and the situation is very reassuring.

The Baidhani daily political official said the ministry sent a medical team of epidemiological surveillance to contain the disease along with a materials and medical treatments and drugs to various regions affected by the disease.

AlJazeera

[Gert van der Hoek]

Re: Yemen - Undiagnosed disease kills 14, infects thousands

From Health Map

23 NOVEMBER, 2010

Undiagnosed Disease in Yemen

Mysterious outbreak in Hodaida Province (Yemen): Affecting Thousands, Five Dead

While originally reported as a dengue fever in our earlier blog post on the subject, an epidemic of what appears to be an unknown disease continues to spread in western Yemen.

Unconfirmed newspaper reports state the epidemic emerged approximately one month ago, reportedly disproportionately affecting women and children. Schools have been adversely affected in a number of towns due to both student and teacher absentees, as the illness and fear of it spread in the region.

Attempts by the government to calm the situation do not appear to be working.

Known in Yemen as ?Al Mukrifas? (المكرفس), most of its spread has been south of the province?s capital in rural areas in and around Zabid, Beit al Faqih, Jebel Ras, Al Jurrasi (Translates incorrectly as ?Surgical? in Google Translate) and Al Khawkhah (which translates incorrectly as ?nectarine in Google Translate). Reports vary, but up to 4 have died in Al Khawkhah and up to 5 in Jebel Ras.

Symptoms include those similar to Dengue fever and an unspecfied ?German fever?, including caugh, headache, swelling of the face and joints, myalgias and, occasionally, bleeding under the skin. Medical treatment has so far been supportive.

Health Map

[alert]

Re: Yemen - Undiagnosed disease kills 14, infects thousands

This is the thread from last year; apparently this has been going on for over a year.

http://www.flutrackers.com/forum/showthread.php?t=113114

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

An earlier report (October 31) suspecting this as dengue fever, but also mentioning several other diseases, possibly suspecting a compound outbreak. I'm also not sure that this isn't all just H1N1.

http://translate.google.com/translate?u=http://news.google.com/news/url&#37;3Fsa%3Dt%26fd%3DR%26usg%3DAFQjCNF3ate2jdgEN63-WnVXGtR12_L9Lg%26url%3Dhttp://www.almotamar.net/news/85315.htm&tl=en&sl=ar

Health Office in Hodeidah denies the existence and mortality due to dengue fever
الأحد, 31-أكتوبر-2010 Sunday, 31 - Oct -2010
المؤتمرنت- الحديدة- وليدغالب - LONDON - Hodeidah - and Idgalb -

Health Office in Hodeidah denies the existence and mortality due to dengue fever

Denied the director of the Office of Health and Population in Hodeidah Governorate (west of Yemen) and no cases of deaths from the disease of dengue fever in any of the directorates of the Directorate of the province.

Dr. Osman Hussain Baidhani The deaths reported by some media is not the official was due to chronic diseases of the heart or kidney coincided with the spread of fever cases have not yet determined its kind which is already deployed in the districts (Zabid _ Beit Faqih _ Surgical _ Nectarine) by the variables of weather and climate and has not been confirmed to us what If dengue fever or other.

Adding: We have been going down a ministerial committee to areas suspected of where the epidemic at the direction of the Minister of Health and the Governor of the province, has been taking samples from the patients and sent to central laboratories in the capital Sana'a to ensure the quality of the disease, and is currently awaiting the results.

Zkralwhitani and that the leadership of the local authority had directed the Bureau to take the necessary measures. Where the distribution of medicines and drugs to patients and download epidemiological surveillance teams to the departments that spread the fever, and forming operations room to follow up and monitoring of communication and information first hand.


He was astonished that the Director General of Health Hodeidah media hype and inaccurate reporting of news about the existence and mortality and to identify the disease by non-specialists as dengue fever before the laboratory results, causing the creation of a state of panic and fear among ordinary citizens.

Assured everyone that he does not need all this hype and exaggeration of the spread of the epidemic seriously, whether dengue fever or other, and calling at the same time, citizens and the competent authorities to maintain cleanliness and fill wetlands and action handlers for the conduct of health random in front of houses especially in rural areas is the main factor in the spread of diseases and epidemics.

With regard to disease (conjunctivitis), which affects the eyes, Dr. Baidhani that a viral disease that lasts from 3 to 5 days to treat and prevent the sugar syrup and hot packs, and wash hands frequently while taking the patient rest for 3 days to avoid sunlight, dust and wind and to prevent transmission. And that there is any danger of it.

The leadership of the Office of Health and Population in Hodeidah Governorate met with mosque preachers and scholars to educate people and reassure them of the Friday sermons and lectures after the panic that has acquired a lot of citizens as a result of Altnaullac media Holt and the reality of the health situation in Hodeidah _ according to Baidhani.

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

http://www.yobserver.com/front-page/10020468.html

Mysterious epidemic expands in al-Hodeidah districts
Posted in: Front Page
Written By: Fares Anam
Article Date: Dec 28, 2010 - 11:28:38 PM

Digg this story! Leave Your Comments! Email This Article Printer Friendly Page

Currently 3.00/5
12345Rating: 3.0/5 (2 votes cast)
More than 8 death cases of a new mysteries disease in al-Hodeidah governorate are currently being investigated. The Ministry of Health of Saudi Arabia called all its citizen in Jazan, Asir, and Najran to take precaution for the disease in returning from Yemen and to be wary of those entering illegally into Saudi Arabia

Abdul-Karim Ras?e, Minister of Public Health and Population suggested the implementation of the coordination between the relevant sectors to provide outreach and education to cope with infectious diseases and prevention.

SEYAJ for Childhood Protection emphasized that this mysteries epidemic is classified by unidentified fever that is sweeping the al-Zahra region in the province of Hodeidah.

SEYAJ appealed to authorities in the Ministry of Public Health and Population, National Population Council and the local council in Hodeidah Governorate and the Directorate of al-Zahra to quickly identify the epidemic and the majority of the disease victims are children, and to provide urgent assistance for the affected people.

The symptoms of this epidemic are accompanied by a high fever with severe pain and headache
for several days and moves quickly said Ahmed Al-Qurashi, Chairman of SEYAJ.

SEYAJ confirmed that a statistics of al-Zahra government hospital pointed of the arrival of forty cases on Saturday, while the statistics of al-Shifa recovery clinic reached to 35 cases.

According to the tests that were made on a number of people from different villages of al-Zahra area are suffering from the same symptoms. The tests were examined in the laboratories of al-Hodeidah governorate by a committee formed by the Office of Health. The results showed that six out of ten have been testing them are infected with al-Dhanak fever and four of them condition is unknown, said Doctor Hassan Gaish, Manager of Health Office in al-Zahra district.

Al-Zahra district is one of the poorest districts in al-Hodeidah governorate that suffer from a severe shortage of health services which makes such disease a real disaster where there are no laboratories able to diagnose such disease and test strips. There are not also laboratories highly qualified persons to respond such exotic diseases.

Al-Mukrfess is the popular name of this epidemic and appeared more than a month in the city of Zabid, al-Garrahi, Bet al-Faqeeh and al-Khokha.

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

I don't know what "Al-Dhanak fever" is, but it is apparently a well-known diagnosis in Saudi Arabia. Could it be dengue? Perhaps ProMED will jump on this article and clarify it.

The only other reference to it I can find is:

http://www.alltalaba.com/board/index...owtopic=120677, which also associates it with H1N1.

The word "dhanak" is interpreted by Google as ظنك , which translates as "think", so perhaps "Al-Dhanak fever" is meningitis or encephalitis?

The mention of bleeding below the skin in earlier articles (absent in this last one) makes me think of meningococcal meningitis, although the indications of tens of thousands ill with a handful of deaths is not consistent with that (although compound outbreak is possible, even strongly probable). The new article indicates 75 cases (of something) in just two hospitals in one day.

[alert]

Re: Yemen: Unknown epidemic hits Hodeida - Probable dengue

Al-dhanak fever is likely dengue, based on my comparison of the following Arabic dengue article with the word above:

http://www.saudiwave.com/index.php?option=com_content&view=article&id=1036:q-q-&catid=50:2008-12-02-08-52-24&Itemid=115

[Shiloh]

Re: Yemen: Unknown epidemic hits Hodeida

Source: http://www.yobserver.com/local-news/10020547.html

*

Disease claims lives in al-Hodeida
Posted in: Local News
Written By: Iscander al-Mamari
Article Date: Jan 8, 2011 - 10:19:35 PM

Mohammed Husaini, a man in his forties, died only a few days due to symptoms of a disease known as al-Mukarfes in al-Hodeida province which has begun sweeping the city as of two months ago.

Husaini is one of dozens infected by this disease that is spreading through many districts, according to local sources.

Local sources also confirmed that the symptoms of al-Mukarfes are similar dengue fever which starts with a high temperature that cannot be easily reduced by treatment and finally put the patient in a sustained comma.

In addition to the flu, chronic cough and headache, swelling of the face and joints, trembling body and the occurrence of bleeding from the mouth and nose as well.

?The illness devastates the lives of children of the Tihama, where the number of dead exceeds the number which the authorities announced,? said the source...

[alert]

Re: Yemen: Unknown epidemic hits Hodeida

Please see this thread as well (from 2006). Apparently, large dengue epidemics have been hitting Hodeidah annually for several years.

http://www.flutrackers.com/forum/showthread.php?t=12631

[alert]

Re: Yemen: Unknown epidemic hits Hodeida - dengue

And this is why we love ProMED. Dengue essentially confirmed, and even an explantion of what "Almkrvs" means.

Actually, dengue was sometimes referred to as "breakbone fever" in English, for the same reason.

http://www.promedmail.org/pls/apex/f?p=2400:1001:2922440385667421::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86691

******
[1] Yemen (dengue suspected; request for information)
Date: Fri 14 Jan 2011
Source: Sabanews.net [in Arabic, trans. Corr.SB, edited & summ.]
<http://www.sabanews.net/ar/news233216.htm>


Since October of last year (2010) a number of directorates in
Hodeidah province [have expressed] great concern due to the spread of
the epidemic known popularly as "Almkrvs" [translated from the Arabic
as "the crunching" - Corr.SB] in relation to symptoms associated with
joint pain and inability to walk, high fever and severe cases of
diarrhea and vomiting in some infections and others with slight [light] rashes.

"Al Siyasiat" [a local Arabic language newspaper - Corr.SB] has
explored the views of academics and specialists on this epidemic.
Specialists affirm that there is no disease [officially] called
"Almkrvs," but there are cases with clinical signs of dengue fever
and a professor of physiology and nutrition at the University of
Hodeidah, Dr. Hazza El Jebel, says that the dengue virus is spread by
a female mosquito "_Aedes aegypti_," which transmits the virus from
an infected persons to healthy ones. The incubation period lasts for
a period of 5 days and [mosquitos] multiply in sewage, garbage and
breed in the winter period. [_Ae. aegypti_ breeds in fresh water in
water catchments in and around buildings, but not in sewage or
garbage. - Mod.TY]

He confirms that the virus, when its attacks a person, leads to a
significant decrease in white blood cells and platelets, and if not
addressed at the beginning of the disease progresses to bleeding and
may cause the patient to bleed to death.There is no disease called
"Almkrvs," but it is a name derived from the symptoms of the disease
in a patient, one of vulnerability and malnutrition, hygiene, housing
and others due to poverty and ignorance, and causes [conditions for]
dengue fever.

The symptoms associated with the disease are muscle weakness, joint
pain, high fever, headache, and eye pain, in addition to a rash. In
addition to the lack of awareness by the patient, [there is]
ignorance about disease states that have been transferred to us from
the affected countries such as South and East Africa. He also refers
to the lack of awareness by media and the competent authorities on
the reasons for the transfer of the virus from infected individuals
to non-infected persons.

He points out that a committee of the University of Hodeidah and the
Office of Health will visit the affected districts and will be taking
samples and a study on the causes of infection.

Dr. Bandar, of the al-Faqih military hospital in Hodeidah, said that
the disease is a viral infection and [based on] the epidemiology [of
the disease], the most important symptoms associated with the
disease are very high temperature and runny nose and pain of the
joints. The disease is confirmed as dengue fever after conducting
tests such as general blood [complete blood count?] giving the
percentage of platelets. The results provide [data on] the proportion
of white blood cells and platelets in particular.

It is confirmed that the clinical situation is evolving with the
progress to bleeding from the nose, which indicates that a critical
situation [exists] due to lack of blood platelets that may lead to
the death of the patient from to internal bleeding if the disease is
not treated in its early stages. Antibiotics are given if the disease
progresses in the patient and when there is inflammation due to
secondary bacterial infections as a result of HIV [the virus? - alert] in the patient
infected with dengue fever.

He says that the symptoms of "Almkrvs" are similar to the symptoms of
dengue fever, with the same and pain associated with this disease,
and can be confirmed by the presence of dengue virus when tested.
Many cases have reached the hospital and have been processed and
given the necessary treatment. If a case has reached the bleeding
stage, it may may cause complications for the patient.

In advanced cases, transfusions may be given to the bleeding patient,
which saves the patient from internal bleeding that causes the
patient's death. Dr Abdullah Al-Hariri, head of laboratory at the
military hospital in Hodeidah, said that complete blood counts are
done on samples that come to the laboratory for diagnosis.

Dr. Abdu-Zeid, head of nursing at the military hospital, says that of
the number of patients examined in December, more than 400 cases have
been tested [by what means?] and were serious.

--
Communicated by:
HealthMap Alerts vis ProMED-mail
<promed@promedmail.org>

[This outbreak is a continuation of the undiagnosed "Almkrvs" disease
reported from western Yemen in November 2010 (see ProMED-mail archive
number 20101125.4246). Although the above report indicates that the
cases are dengue and DHF, it is difficult to conclude that these are
indeed cases of dengue fever or DHF from this report.

Medical authorities indicate that these are dengue virus infections,
with reduction in platelet counts as the diagnostic criterion. No
mention is made of virus detection or serological diagnosis of dengue
virus infections.

The term "crunching" makes one wonder if chikungunya virus infections
might be involved as well. The dengue and chikungunya virus vector
mosquito, _Aedes aegypti_, is present in this area in Yemen (see
ProMED-mail archive no. 20050308.0685). Dengue has been reported in
other parts of Yemen in August 2010, with 309 out of 2200 suspected
dengue cases confirmed positive and many Yemeni governorates
reporting the spread of this epidemic, according to a June 2010
report issued by the Ministry of Health (see ProMED-mail archive
number 20100826.3010). Additional information about this current
outbreak and laboratory testing that has been done would be appreciated.