Kenya: Rift Valley Fever (600+ deaths)

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 68

Archive Number 20070106.0058
Published Date 06-JAN-2007
Subject PRO/AH/EDR> Rift Valley fever - Kenya (multi-province)



RIFT VALLEY FEVER - KENYA (MULTI-PROVINCE)
************************************************** ****
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: Fri 5 Jan 2007
From: Dr. S. K. Sharif <sksharif@africaonline.co.ke>


Update: Preliminary epidemiological data
----------------------------------------
The outbreak of Rift Valley Fever in humans was first confirmed from cases
presenting with fever, headache, myalgia and hemetemis in patients admitted
to Provincial General Hospital, Garissa on 23 Dec 2006. The diagnosis was
confirmed as Rift Valley fever virus (RVFV) infection by specific IgM
[assay] and PCR [amplification]. After the first cases were confirmed the
Ministry of Health (MOH), Centre for Disease Control (CDC) and the World
Health Organization sent a team to investigate and put in place control
measures to stop the spread of the disease.

Preliminary data show that 71 percent of all cases admitted with RVF were
males and 29 percent were females. Patients less then 20 years comprised less then 3 percent. The age of male patients was 28 years while the mean age of female patients was 33 years. The attack rate for Garissa district was 19 per 100 000 people and the highest attack rate was in Shanta Abak at 129 cases per 100 000. The first cases were reported from Shanta Abak.

The commonest presenting features were fever, headache, muscle pains and
joint pains. The patients with severe disease had a bleeding tendency such
as hemetemesis, bleeding from the nose and gums. A total of 86 percent of
the patients interviewed said that they drank raw milk and 71 percent said
that they had drunk milk from a sick animal 2 weeks before onset of
symptoms. Most patients lived near a swampy area. In all, 71 percent of
patients had sick animals in their herds and 60 percent had lost an animal
due to disease 2 weeks prior to onset of symptoms; 53 percent had
slaughtered a sick animal while 53 percent reported they had eaten meat
from either a sick or a dead animal. Fifty-one percent of patients were
using a [mosquito] net.

Cases have now been reported from other parts of North Eastern Province
such as Ijara, Garissa and also in 2 districts of Coast Province (Tana
River and Kilifi District). Cumulative figures as of 5 Jan 2007 are 188
cases with 68 deaths.

The Government has imposed a quarantine for animals in North Eastern
Province and also imposed a ban on slaughtering animals at home.

The Ministry of Health with CDC, WHO, UNICEF and the Red Cross have mounted an intensive health education program using electronic media, religious leaders and health workers to tell people to avoid contact with sick
animals, to stop drinking raw milk and to stop eating meat from sick or
dead animals. It has started distributing insecticide treated nets and
indoor residual spraying and larviciding stagnant pools of water.

--
Dr. S. K. Sharif
<sksharif@africaonline.co.ke>

******
[2]
Date: Sat 6 Jan 2007
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: Reuters Foundation AlertNet, ex MSF Belgium [edited]
<http://www.alertnet.org/thenews/fromthefield/msfbelgium/116801382768.htm>


On [Thu] 4 Jan 2007, 8 new suspected cases of Rift Valley fever were
discovered by Medecins Sans Frontieres (MSF) teams in the Ijara District in
the North-Eastern Province of Kenya. One of the patients died, taking the
death toll to at least 67 since the outbreak began on 7 Dec 2006. MSF
started battling the outbreak on 22 Dec 2006 when teams began work in the
town of Garissa, setting up facilities to care for patients in the hospital
in which 23 people had been treated for their Rift Valley fever infection.
Today, MSF teams are working in Garissa, Ijara and Tano River providing
information, trying to locate infected people and treating patients.

Rift Valley fever is a rare viral disease of which very little is known.
Transmitted primarily to humans through contact with infected animal
matter, such as blood or other fluids, or organs, it is also spread from
livestock via _Aedes_ mosquitoes. Consumption of raw milk, an important
element in the diet of many nomadic pastoralists of the area, is also
thought to lead to infection.

The epidemic has been triggered by extensive flooding in the region. [A map
of the flooded areas of Kenya, where conditions may be favorable for the
spread of Rift Valley fever, is available at:
<http://www.reliefweb.int/rw/fullMaps_Af.nsf/luFullMap/C1A04D85AE229930852572290055544F/$File/ocha_FL_hoa061116.pdf?OpenElement>.
- Mod.CP]

The infected mosquito eggs are often laid around river banks and can lay
dormant for years until they get submerged. Once covered with water, the
eggs become infected mosquitoes which spread the virus. The last large
outbreak in the same region was in 1997, also following heavy rains. During
that time in Garissa District, around 27 500 were infected and 170 died.
Only about one percent of people contracting Rift Valley fever develop the
disease in a severe form. But of those who do, around half will die.

"The great majority of people infected just suffer from headaches and
influenza-like symptoms reminiscent of malaria," explains MSF emergency
coordinator Dr Ian Vanenglegem, "but the severe form, like other
haemorrhagic diseases, attacks the liver and can cause the patient to bleed
from every orifice. There is no cure, so we are only able to treat the
symptoms."

One of the biggest challenges of dealing with this outbreak is logistical.
"Much of Kenya's North-Eastern Province is not accessible by road because
of the floods, so the only way we can find patients is to travel by
helicopter," continues Dr Vanenglegem. [An interactive map is available at
<http://www.alertnet.org/map/index.htm?ct=2&style=2&ex_iso=ET,KE,SO,SD,TZ,UG&pc ode>
- Mod.CP]

"Just to reach the Masalani hospital in Ijara can take up to 3 days by
road. It is estimated that up to 500 000 people are at risk from infection
and this population is scattered over a vast area. We are sure that the
number of cases discovered is only the tip of the iceberg."

Another difficulty is the fear of the outbreak among the population. With
such a high death rate among those contracting the severe form of the
disease, many people will see no benefit in making the often long journey
to a health centre. To counter this, MSF teams are undertaking
awareness-raising activities to increase understanding of what Rift Valley
fever is and what measures people should take themselves. "This is an
important concern because it is likely that, with the flood waters being a
perfect breeding ground for mosquitoes, this outbreak will be followed to
by high numbers of malaria infections. The initial symptoms may be similar
to those of Rift Valley fever. If people are too scared to come to health
centres, or simply don't see the point, then there may be even more
unnecessary deaths," concludes Dr Vanenglegem.

--
Mary Marshall
<tropical.forestry@btinternet.com>

[ProMED-mail acknowledges contribution of the same report by Pablo Nart. -
Mod.CP]

[The outbreak of Rift Valley fever in the North Eastern Province of Kenya
continues to develop. The number of confirmed deaths has risen from the 54
reported on Wed 3 Jan 2007, to 67 reported by MSF on Thu 4 Jan 2007, and
now to the 68 reported by Dr. Sharif in the above report. Dr. Sharif also
reports that the outbreak is now affecting 2 districts of the Coast
Province of Kenya as well as the initial 3 districts of North Eastern
province

(see map at http://en.wikipedia.org/wiki/Image:K...-map-towns.jpg .)

Preliminary data suggest that unusually the disease is spreading in the
human population through the consumption of raw milk from sick animals and
that transmission by mosquitoes may not yet be a determining factor. This
circumstance may enable the local authorities to control the outbreak in
the human population by vector control measures. - Mod.CP]

http://www.promedmail.org/pls/promed/f?p=2400:1001:11861121735673823223::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35752

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 72

Kenya: Rift Valley Fever Kills Eight More

The Nation (Nairobi)

January 6, 2007
Posted to the web January 5, 2007

Mike Mwaniki And Ngumbao Kithi
Nairobi

An indoor fumigation campaign has been launched in areas affected by Rift Valley fever as the death toll rose to 72 from 62 in the past 24 hours.

Medical authorities said yesterday said the total number of infections in both North Eastern and Coast provinces stood at 196 from 183.

Senior deputy medical services director Shanaaz Shariff said the Government had banned the sale and consumption of raw milk in the affected areas to prevent further deaths and infections.

"At the same time, experts have identified herdsmen who are handling infected animals as another risk factor fuelling the spread of the disease," Dr Shariff said told the Nation by telephone.

Health officials are also providing insecticide-treated mosquito nets to people in the affected areas.

The viral disease is primarily spread by animals after being bitten by mosquitoes. Many types of animals, including cattle, sheep, camels and goats, may have been infected.

It can also be transmitted to humans through direct contact with infected animals or their products such as milk or meat.

People do not become sick immediately, but may take between two and six days before showing the symptoms, which include a sudden onset of high body temperature (fever), head and back aches, muscle pain, vomiting and in severe cases, bleeding from body orifices.

According to doctors, the viral fever can be prevented through sustained animal vaccination and control of the mosquito vector.

The disease has killed four people in Kilifi District. Two of them died on Thursday.

Residents have in the past returned 5,000 treated mosquito nets donated by the Government, complaining that they saw ghosts when sleeping under them.

District medical officer Davis Kimanga banned eating of meat and other animal products.

"We have launched an emergency vaccination of domestic animals and the spraying of all houses to kill mosquitoes, which are main transmitters of the disease," Dr Kimanga told the Nation after addressing a public meeting to educate villagers on the dangers of the disease and how to detect it.

A rapid response team from the Kenya Medical Research Institute and the Kenya Red Cross Society was assisting in the spraying.

Four more people have succumbed to the fever in Garissa District, according to North Eastern provincial medical officer of Health Ahmed Omar.

http://allafrica.com/stories/200701050838.html

[MHSC]

Re: Kenya: Rift Valley Fever Death Toll now at 57

http://www.who.int/csr/disease/riftvalleyfev/countrysupport/en/index.html

Country support
WHO Collaborating Centre Network


Many of the internationally important outbreaks involve the diverse group of arboviral diseases and viral haemorrhagic fevers. The WHO Collaborating Centres global network of centres for these diseases has collaborating centres in every WHO region and about one third of the centres are in developing countries. These centres work in close partnership with WHO and Member States to investigate, confirm and control outbreaks. Through the WHO Collaborating Centre searchable database, information about those centres and laboratories dealing with specifically with Rift Valley fever is available.

<table align="center" border="0" cellpadding="0" cellspacing="0" width="469"> <tbody><tr> </tr> </tbody></table> Remote sensing to help predict Rift Valley fever outbreaks
WHO has been working with remote sensing data provided by the National Space Agency of the United States to investigate environmental conditions, including vegetation and rainfall, which can help to provide early warning of possible outbreaks of Rift Valley fever in Africa.

<table align="center" border="0" cellpadding="0" cellspacing="0" width="425"> <tbody><tr> </tr> </tbody></table> Environmental impact and the East African outbreak, 1997-1998
Outbreaks of Rift Valley fever are associated with an increase in the mosquito vector population following increased water availability after heavy rains and floods, or due to man-made dams or irrigation systems and open water storage construction.
In December 1997 an outbreak of unidentified disease with a high number of deaths was reported from Kenya and Somalia, associated with heavy rains which had been occurring since October 1997. Initial investigations by a WHO national team found deaths occurring in humans and high rates of spontaneous abortions and deaths from haemorrhage among domestic food animals. Rift Valley fever virus was confirmed by the WHO Collaborating Centres in South Africa and the United States, part of the WHO Global Collaborating Centres Network for haemorrhagic fevers and arboviruses. A full-scale investigation and containment measures were carried out in 1998 by WHO and its partners. More details are available in An outbreak of Rift Valley Fever, Eastern Africa, 1997-1998.
Saudi Arabia and Yemen: First cases of Rift Valley fever reported outside Africa, 2000
The emergence of Rift Valley fever in Yemen and in the Kingdom of Saudi Arabia (KSA) in September 2000, led to 1 328 human cases including 166 human deaths and 20 000 abortions in livestock in Yemen and 882 human cases including 124 deaths in the KSA. The outbreak was located in the area of Wadi Mawr, on a coastal plain that extends from the southern tip of Yemen into the Jizan area of Saudi Arabia. The Ministry of Health of Saudi Arabia described a simultaneous outbreak of Rift Valley fever in the Jizan area. Both countries organized national efforts to limit the spread of disease, provide treatment to those affected and track the course of the outbreak. WHO provided support with experts in virology, epidemiology, laboratory diagnostics and entomology.
To control the outbreak, the governments carried out intensive vector-control measures, restricted animal movements, ran education campaigns to prevent exposure to infected animals and upgraded local hospitals to provide treatment to patients. Saudi Arabia and Yemen worked together to share information, including investigation protocols and coordinated logistics across the border.
The results of the investigation can be found in: Outbreak of Rift Valley fever, Yemen, August-October 2000

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[Niko]

Re: Kenya: Rift Valley Fever Death Toll now at 72+

At least 75 people die of Rift Valley Fever in Kenya


GARISSA, Kenya: About 75 people have died in Kenya of a hemorrhagic fever called Rift Valley Fever over the past three weeks and another 183 are infected with it, a senior health official said Sunday.

The death toll could be higher because the figures are only of adult victims as people in Northeastern Province rarely record the deaths of their children, said Dr. Ahmed Omar Ahmed, the province's chief medical officer.

This latest outbreak of Rift Valley Fever in Kenya saw its first victim die in mid-December.

The diseases' victims are residents of either the Northeastern or Coast Province, which received uncharacteristically heavy rain in December that caused flooding and created a large breading ground for mosquitoes, which spread the fever's virus from livestock to humans.

Infected mosquitoes may also lay eggs, which can survive for up to several years in dry conditions until it rains and they hatch to produce other infected mosquitoes and spread the disease years later, according to the World Health Organization.

The disease has also spread in Northeastern Province because people have defied a ban on meat and milk sales imposed in December to protect them, Ahmed said.
<!-- sidebar --><!-- today in links --> <!-- /170 x 60 ad -->
<!-- /sidebar --> People can also get Rift Valley Fever through contact with blood or bodily fluids of infected animals such as cattle or goats, according to the WHO. Drinking raw milk from infected animals can also spread the disease to humans, the organization says on its Web site.

Joseph Musaa, Kenya's director of veterinary services, arrived in Garissa Sunday with 400,000 vials of animal vaccines to be administered in the province.

He said that the vaccines, which the U.S. has donated, are only a quarter of what is needed to inoculate all animals in the region. Musaa, who was accompanied by a team of U.S. officials, said that about 1.6 million vials are needed to inoculate about 2 million animals in Northeastern Province.

Since 1930, when the virus was first isolated during an investigation into an epidemic among sheep on a farm in the Rift Valley of Kenya, there have been outbreaks in sub-Saharan and North Africa, according to the World Health Organization.

There is no vaccines for humans.

http://www.iht.com/articles/ap/2007/...lley-Fever.php

[hawkeye]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Outbreak of Rift Valley Fever prompts urgent research

Kennedy Abwao
8 January 2007
Source: SciDev.Net

Scientists are carrying out urgent research in order to predict the spread of Rift Valley Fever (RVF), following a fresh outbreak of the disease.

The latest outbreak of the haemorrhagic fever, which attacks herdsmen and their livestock, occurred in East Africa over December. Well-maintained rapid-response mechanisms have ensured a prompt response to cases, despite recent floods.

A biosafety laboratory from the Kenya Medical Research Institute in Nairobi has been transferred to the Garissa hospital, at the centre of the outbreak, to fast-track detection of the virus.

Researchers are trying to understand the factors fuelling the current spread, which government officials say has killed 61 people in the remote northeastern parts of Kenya.

Unlike previous outbreaks, recent occurrences have not been concealed or downplayed.

Kenyan public health officials confirmed for the first time that the last RVF outbreak, in 1997?1998, may have killed as many as 200 people. Advances in monitoring for infectious diseases and greater transparency have meant there was no attempt to conceal the gravity of the situation this time around.

Response mechanisms set up during the previous outbreaks have aided the recent response, said Dr Shahnaaz Sharif of the Kenyan Health Ministry. "We were already collecting blood samples and as soon as the first human case was detected, we knew it was Rift Valley Fever," he told SciDev.Net.

The team of Kenyan and American scientists are trying to determine why at least 80 per cent of people who contract RVF do not get sick, whilst 10 per cent die from the virus. Sharif said their research would help determine the risk factors in terms of where the virus is likely to spread.

According to the World Health Organisation, RVF is spread primarily among animals through the bite of an infected female mosquito, although humans can develop the disease after eating contaminated meat. Female mosquitos also pass the virus through their eggs, making it difficult to fight the virus out of the rainy season.

[hawkeye]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Somalia: Fighting Halts Effort to Verify Deadly Fever

January 9, 2007
Posted to the web January 9, 2007

Nairobi

Fighting in southern Somalia has hampered efforts to confirm a possible spread of Rift Valley Fever (RVF) from neighbouring Kenya to the Lower Juba Region where seven people have died after showing symptoms of the rare, contagious haemorrhagic disease, Somali health officials said.

The deaths were reported in Dobley, 18 km north of the Kenyan border, in the last five days. "The dead are mainly nomadic herders," said Hassan Mursal, a clinical officer in nearby Afmadow hospital. "The number could be higher but because of the current insecurity in the area there is no way of getting the full picture."

Mahamud Haji Hassan Jabra, an epidemiologist with the European Union-funded Somali Animal Health Service Project, said numerous reports of animal abortions - a key indicator of the disease - had been received from the area. But plans to send two teams to verify the outbreak would only go ahead once the security situation allowed.

"Our focal point in the area has reported the clinical signs of the disease but we need to confirm this by testing the samples collected," he said. "If it turns out to be RVF it will have a devastating impact on the livelihoods of the pastoralists, who have suffered two years of drought followed by heavy flooding."

Dobley is close to the Kenyan border where fighting continues between Union of Islamic Courts (UIC) remnants and Ethiopian-backed Somali government soldiers, who have been chasing them since the UIC were forced out of Mogadishu and much of southern Somalia.

A humanitarian source in the area told IRIN on Tuesday that casualties had been reported when planes carried out air strikes in villages close to Dobley. "We have reports of 22 people killed by the bombing," he said. International media reported that the planes were American, targeting suspected ******** operatives.

"Most of those killed were in a convoy of donkeys carrying sugar to the outlying villages," which have been rendered inaccessible due to recent heavy rains, said the source, who requested anonymity. Another source told IRIN there were reports of a number of armed militia in the area. "We don't know whether they belonged to the Islamic courts or not but some people are saying that they were there."

The bombardment took place in an area known as Jiiro, a "very good pastureland, with the highest concentration of cattle in the Juba valley", said the humanitarian source, adding that whether there were militants in the area or not, "civilians had been hit".

The fighting, he added, was making "it impossible to access the area and help the pastoralists".

Addressing the outbreak

An epidemic of RVF is first manifested in unexplained abortions among livestock. However, Jabra cautioned that "some of the symptoms of RVF, such as fever, headache and muscle pain are also common in flu and malaria".

According to the United Nations World Health Organization, the disease is endemic in Africa, naturally occurring in livestock but occasionally affecting humans. Animals are infected with the RVF virus by the Aedes mosquito. Characterised by bleeding from all orifices, it is spread to humans via infected mosquitoes; through contact with blood or other body fluids; or from the organs of infected animals.

The disease mainly occurs after heavy rainfall - southern Somalia has been experiencing El Ni-o-type rains, which flooded many parts of the country. "The conditions in Lower Juba region are conducive to an outbreak," said Jabra.

At least 60 people in Kenya's Northeastern Province have died from the disease and last week, health experts warned it may have begun to spread. "All evidence suggests that the disease is still spreading," said Kariuki Njenga, a virologist and laboratory director for the United States Centers for Disease Control (CDC) in Kenya.

The worst affected districts are Garissa, where 100 cases, including 40 deaths, have been reported; and Ijara, where 20 out of 42 people infected with RVF have died. The CDC has set up a field laboratory to test suspected cases and is helping the Kenyan government to develop a vaccination strategy.

A team from the UN Food and Agriculture Organisation is also working with Kenya, Somalia and Ethiopia to address the outbreak. "Together with officials from the WHO and various international aid agencies present in the area, the FAO team is helping to draw up preparedness, communication, surveillance and response activities," according to a FAO statement.

The last outbreak of RVF in Somalia was in 1997 and led to a ban on livestock from Somalia by the Arab Gulf States. Livestock exports had been the backbone of the Somali economy.

[Theresa42]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Deadly fever is spreading across Kenya - WHO
January 10 2007 at 12:47AM

Geneva - Heavy flooding has provoked the spread of Rift Valley Fever from north-east Kenya to Garissa in the north-west of the country, the World Health Organisation warned on Tuesday.

There have been 197 cases of the disease reported in the past two weeks, 70 of which have proved fatal, as flood waters have led to the displacement of people and animals.

Rift Valley Fever occurs mainly in sub-Saharan Africa. The signs are flu-like symptoms which can lead to inflammation of the brain.

There have been significant outbreaks since the disease was diagnosed in the 1930s, including in 1997 in the same region in Kenya when 170 people died.

The disease strikes livestock mainly but can be passed to humans by mosquito bites or as a result of contact with blood or other body fluids. Livestock workers and vets are most at risk from the disease.

A team of health experts has been sent to the region.

http://www.iol.co.za/index.php?from=rss_Africa&set_id=1&click_id=68&art_id=iol1168375175152B251

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

comment ProMedmail:

It is almost inevitable that Rift Valley fever will spread into the
regions of Somalia adjacent to the North East Province of Kenya if
the outbreak around Garissa in Kenya is not rapidly contained.

The combination of extensive flooding in Kenya and the upsurge of
military operations in the adjacent regions of Somalia in the past
few days is not propitious. Further information from the region is requested.

A map of Somalia showing the location of the Juba region and the
North East province of Kenya can be viewed at
http://www.lib.utexas.edu/maps/africa/somalia.jpg.

- Mod.CP

http://www.promedmail.org/pls/askus/f?p=2400:1001:78987::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35792

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Kenya: Vaccination to End Deadly Rift Valley Fever Starts

The Nation (Nairobi)

January 10, 2007
Posted to the web January 9, 2007

Nairobi

A livestock vaccination campaign was launched yesterday in renewed efforts to fight Rift Valley Fever.

But even as the Government went full throttle to confront the viral infection in Garissa, the death toll continued to rise, with the fever claiming four more people in just 24 hours. This brings the number of victims to 74.


Dr Shanaaz Shariff, a senior deputy director of medical services, said infection could be prevented through sustained animal vaccination and control of mosquitoes.

Veterinary officials started vaccinating livestock in Garissa's Modika area and are expected to cover Ijara, Wajir and Kilifi districts soon.

Speaking in his Afya House office in Nairobi, Dr Shariff said the total number of infections in both North Eastern and Coast provinces now stood at 219.

"I would like to reassure Kenyans that the situation is under control since no human-to-human infection has been reported. Experts have identified herdsmen handling infected animals as being primarily responsible for fuelling the spread of the disease," he said.

The Government, the medic said, had banned the sale and consumption of raw milk in the affected areas.

"As a preventive measure, health officials are providing insecticide-treated mosquito nets, while also carrying out indoor spraying," he added.

A quarantine has also been imposed.

The viral disease is primarily spread by animals that have been bitten by mosquitoes. It can be transmitted to humans through direct contact with infected animals or their products.

It takes two to six days for infected people to start showing symptoms, which include a sudden onset of high fever, head and back aches, muscle pain, vomiting and, in severe cases, bleeding from body openings.

Dr Shariff said the disease had killed 48 people in Garissa, 10 in Ijara, nine in Wajir, three in Tana River and three in Kilifi.

"Most of those infected are herdsmen aged 20 to 30 years who were either slaughtering or skinning infected animals and came into contact with their products," the medic said.

He added that unlike in 1997 when the disease outbreak killed 300 people and decimated livestock in parts of the vast and arid North Eastern Province, the Health ministry had anticipated the current outbreak.

"Even before the first case was reported in Garissa District, the ministry, in collaboration with the Kenya Medical Research Institute, was testing samples from patients admitted to the provincial hospital with symptoms of the disease," Dr Shariff said.

He urged Kenyans to ensure meat they ate was inspected and well cooked.

In Laikipia District, the Veterinary Department has instituted measures to ensure the fever does not affect the district. According to the district veterinary officer, Dr Kiguru Mwaura, all staff on leave have been recalled.

"We have reactivated disease control committees," he said. He added that although no cases have been reported in Laikipia, veterinary officers were investigating a case reported in Isiolo and that meat inspectors were on the lookout for animals whose origins were unknown.

http://allafrica.com/stories/200701090934.html

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Archive Number 20070111.0112
Published Date 11-JAN-2007
Subject PRO/AH> Rift Valley fever - Kenya: early warning system


RIFT VALLEY FEVER - KENYA: EARLY WARNING SYSTEM
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 8 Jan 2007
From: ProMED-mail <promed@promedmail.org>
Source: All Africa [edited]
<http://allafrica.com/stories/200701080142.html>


Kenya: NASA Gave Warning Over Deadly Fever
-----------------------------------------------
The deaths from Rift Valley fever (RVF) could have been avoided if
Kenya had heeded a warning by an American body that changing climatic
conditions posed a risk.

The UN Food and Agricultural Organization (FAO) says the US-based
National Aeronautics and Space Administration (NASA) Goddard Space
Flight center sounded the alarm way back in September [2006], 2
months before the 1st case was reported in Garissa.

However, it is not clear whether the country received the warning or
simply ignored it.

Since November [2006], more than 47 human deaths have been reported
in North Eastern Province.

The center had warned that rising temperatures accompanied by heavy
rains in the Central and Eastern Pacific Ocean and Western Indian
Ocean could spark an outbreak of the disease.

The warning was contained in FAO's September [2006] edition of the
Emergency Prevention Systems Magazine, Empress Watch. The center had
been monitoring climate in East Africa for several years.

"The heavy rains being experienced were similar to what was observed
in 1997/1998, when a major outbreak occurred in Tanzania, Somalia and
Kenya," read the warning.

"The outbreak of Rift Valley Fever is another example that requires a
quick and coordinated response," said FAO's New Crisis Management
Centre manager, Karin Schwabenbauer.

--
ProMED-mail
<promed@promedmail.org>

[The above newswire was circulated internally at ProMED-mail with the
following question posed by Mod.MPP: "What would/could they have done
to prevent the outbreak?" The response of our moderators definitely
warrants sharing with the general ProMED-mail community. - Mod.MPP]

[What, indeed could they have done? There is no commercial human RVF
vaccine available. The virus is in _Aedes_ eggs deposited in "dambos"
(periodically flooded wet areas), and when they hatch and adults
emerge, they come equipped with virus ready for transmission. _Aedes_
vector control in this large an area seems impractical and expensive.
Moving people and their small ruminant animal RFV hosts out of areas
of potential or active transmission also seems impractical,
especially along the Kenya-Somalia border given what has been going
on there over the past several days.

The only feasible alternatives that occur to me are:

(1) vaccinating livestock as WHO proposes,
(2) educating people not to handle or butcher infected animals, to
minimize animal-to-human (non-vector) transmission, and even that
would be daunting with people spread over a large area of difficult
access, and
(3) giving health care providers time to get ready to
attend the human cases that would result from an outbreak. - Mod.TY]

[A comment on some aspects of RVF in Kenya as posted in ProMED
archive 20070106.0058 and our internal discussions:

As regards vector transmission, at least 30 species of mosquitoes
have been found naturally infected with the virus of RVF. Although it
is stated that _Aedes_ species are the main vectors, considerable
transmission can be due to _Culex_ and _Mansonia_ species. In Kenya,
species found naturally infected include _Aedes dalzei_, _Ae.
durbanensis_, _Ae. lineatopennis_, _Culex antennatus_, _Cx.
simpsoni_, _Cx. vansomereni_, _Cx. zombaensis_, _Cx rubinotus_ and
_Anopheles christyi_ and _An. pharoensis_. Note the large numbers of
_Culex_ species.

In addition, the tick _Rhipicephalus appendiculatus_ was reported as
a vector in Kenya in 1933. In Nigeria (1967) _Culicoides_ species
were reported positive for the virus as were _Simulium_ species in
South Africa in 1953. However, whether these non-mosquito vectors are
important epidemiologically is questionable. I would guess not.

Whereas the eggs of _Aedes_ mosquitoes can tolerate desiccation for
months and even years, species of _Culex_ and other genera cannot.

Transovarial transmission was shown in _Ae. lineatopennis_ in Kenya
and in _Ae. vexans_ in Senegal, but most likely occurs in other
aedine species. It has been suggested that such transmission
maintains the virus in nature during inter-epidemic periods.

Recent epidemics in Kenya have shown the importance not only of
rainfall but also of crop irrigation practices.

If logistics and finances allow, then ultra-low-volume (ULV) aerial
applications of insecticides are the most appropriate method for
curtailing epidemics; or on a smaller scale, ground-based spraying
can be used. Commonly used insecticides include organophosphates,
such as malathion and pirimiphos-methyl, or pyrethroids, like
permethrin and deltamethrin, to kill the adults.

Insecticide-impregnated nets, which can remain effective for many
months or even years depending on the method of treating the nets
with pyrethroid insecticides, will only be effective at night, when
people are sleeping under them. Many of the potential RVF vectors
(e.g. most _Aedes_ species) bite during the daytime, not at night,
although in general, _Culex_, _Mansonia_ and _Anopheles_ species bite at night.

Indoor residual spraying, whether in human or animal quarters, will
only be effective if the vectors enter such quarters to feed and or
rest, and most potential vectors do not. By the way, one hopes that
Kenya will soon reintroduce DDT spraying of houses for malaria
control, as have at least 8 other African countries.

What is meant by larviciding stagnant pools? Many, if not most, RVF
vectors will not breed in stagnant waters but in relatively clean
aquatic habitats. Moreover, larviciding needs precise identification
of the aquatic habitats colonized by vector mosquitoes, which,
combined with the often extensive nature of such habitats, means that
larviciding is not likely to be very effective. Moreover, when
desiccated eggs are flooded, not all will hatch; it may take several
repeated flooding and drying periods to stimulate hatching.
Larviciding will kill only the larvae, not any un-hatched eggs. - Mod.MS]

[A live vaccine prepared from Smithburn's attenuated strain of RVF
virus has been used for the control of RVF in non-pregnant cattle and
sheep in endemic areas and during outbreaks, while inactivated
vaccines for use in pregnant animals and in RVF-free countries are
prepared from virulent field strains. RVF vaccines have been
extensively applied in RVF-infected countries, such as South Africa
(where both live and inactivated vaccines are commercially produced),
Zimbabwe, Kenya, Egypt and Saudi Arabia. For example, Egypt's annual
mass vaccination during 2004 included more than 7 million
vaccinations, of which 1 986 825 were in cattle, 1 259 195 in
buffaloes, 3 170 183 in sheep, 935 128 in goats and 95 308 in camels.
Both attenuated and killed vaccines are applied. Egypt's last RVF
outbreak was reported in July 2003.

Israel, an RVF-free country, carried out preventive vaccination
against RVF during the years 1979 -1981 in the face of the RVF
panzootic in neighboring Egypt. The entire country's ruminant
population and camels were vaccinated with a commercial inactivated
vaccine and earmarked; the country remained free of disease. No
vaccinations have been carried out since.

According to OIE's manual of Diagnostic Tests and Vaccines for
Terrestrial Animals, an inactivated experimental RVF vaccine has been
used for 25 years in humans with considerable success to protect
persons at risk. This vaccine is currently produced on diploid cells.
However, the limited availability of the vaccine precludes its use in
the general population.

Two new vaccine candidates produced from human RVF virus isolates are
undergoing extensive testing with a view to replacing existing animal
vaccines. The 1st, MV P12, is a mutagen-derived strain of virus found
protective in young lambs and in cattle, but its safety for pregnant
animals is still under investigation. The 2nd candidate is Clone 13,
a small plaque variant that did not react with 2 specific monoclonal
antibodies and which has undergone testing in lambs, sheep and young
and adult goats with promising results.

Further information, including description of live and inactivated
vaccine production and testing and data on the above mentioned
experimental vaccines, is available in chapter 2.1.8 of OIE's Manual
of Diagnostic Tests and Vaccines for Terrestrial Animals (available on-line at
http://oie.int/eng/normes/mmanual/A_00031.htm ).

OIE's reference laboratory contact is: Dr. G.H. Gerdes, Onderstepoort
Veterinary Institute, Onderstepoort, South Africa. - Mod.AS]

http://www.promedmail.org/pls/askus/f?p=2400:1001:78987::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35812

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Kenya: Area Zoned Off to Contain Killer Fever

The Nation (Nairobi)

January 12, 2007
Posted to the web January 11, 2007

Nairobi

The Government yesterday established a disease control buffer zone as the death toll from Rift Valley Fever reached 81.

The buffer zone follows reports that the disease might have extended into some Eastern Province districts.


The buffer zone covers parts of North Eastern, Eastern and Coast provinces.

Ministry of Health chief medical officer Shahnaaz Sharif said yesterday the zone included districts neighbouring Garissa, which so far has the mosst deaths from the disease.

Dr Sharif said: "Reports that the disease has spread to Meru are yet to be confirmed.

"However, we have ring-fenced some districts to prevent the disease from spreading further."

Surveillance teams

The report about the spread was also denied by Livestock and Fisheries Development permanent secretary Jacob ole Miaron.

"We have surveillance teams on the ground that are keeping us informed about the fever. The vaccination is going on well and the Government will not rest until the threats to human and animal life have been eradicated," Dr Miaron said.

The official said cases had reached 221 since the outbreak hit North Eastern Province.

Meanwhile, nine of the 157 specimen samples collected in various districts in Eastern and North Eastern provinces proved positive of the fever, the Department of Veterinary Services said.

The director of Veterinary Services, Dr Joseph Musaa, said the positive samples were drawn from cattle, camels, sheep and goats.

http://allafrica.com/stories/200701110923.html

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Kenya: Schools Disrupted As Deadly Fever Hits Incomes

UN Integrated Regional Information Networks

January 11, 2007

Posted to the web January 11, 2007

Garissa

The closure of livestock markets in Kenya's Northeastern Province after an outbreak of Rift Valley Fever (RVF) has hit livelihoods and the economy, which is almost entirely dependent on livestock, local residents said.

Most affected, they added, were secondary schools because many parents had found it hard to raise fees for their children to resume classes this week.

Mohamed Sheikh Dahir, a herder and father of two secondary school students in the neighbouring Ijara district, said only one had been able to return to school with the help of a relative and a local trader.

"One of my children is still at home. If the market is not opened he will not go back to school," he said.

The head teacher of Modogashe Secondary School in the provincial capital of Garissa, Abdullahi Ibrahim, said more than 100 parents had asked him to allow their children to remain in school until they were able to raise the fees.

"We sympathise with them and acknowledge that there is a problem, but it is not possible to help them all," said Ibrahim.

Garissa District Commissioner, Joseph Imbwaga, said the issue had been brought to the attention of the district disaster management committee, but could not immediately say what was being done about it.

"The situation is very serious. I am embarrassed that I cannot even provide food for my family. The closure of the slaughterhouse has affected many people," said Ahmed Omar, who previously worked at the abattoir in Garissa.

"The government should intervene, give us food and help us pay school fees for our children," he added.

The Kenyan government introduced free primary-school education in 2003, but parents still have to bear the financial burden of secondary school.

"We need relief food just like the drought and flood victims. We are desperate," said Halima Ahmed, a single mother of five, who used to eke out a living selling tea at the local livestock market.

The government imposed a ban on the sale and slaughter of livestock when RVF broke out in the province early in December. Last week, reports indicated the disease may have spread to neighbouring Somalia.

A vaccination campaign intended to innoculate more than two million cattle, goats, sheep and camels in the affected areas over the next three weeks began on Tuesday.

The director of veterinary services, Joseph Musaa, said it would take more than a month to determine the safety of animal products in the area even when the disease is brought under control.

The vaccination exercise involves 400 personnel, led by 37 veterinary surgeons. Religious and community leaders were helping to raise awareness among the nomadic communities to ensure the vaccination exercise was successful.

RVF has claimed the lives of an estimated 80 people in the region since it was first reported, according to local health officials. Nearly 500 livestock had also died from the disease.

The RVF virus is spread to humans from livestock via the aedes mosquito, which breeds rapidly during floods. The Northeastern Province, inhabited by nomadic pastoralists, was hit by devastating floods over the last three months of 2006.

The disease can be transmitted by mosquitoes or through contact with infected animal material such as blood or other body fluids or organs. Consumption of milk, a staple for many pastoralists, is also a possible risk. Symptoms in humans include bleeding through the nose and mouth, and liver failure.

Northeastern Province was previously hit by an outbreak of RVF in 1997 following heavy flooding caused by the El Ni-o weather pattern.

The disease was first identified in Kenya in 1931. A first sign of it is spontaneous abortions in sheep, goats and cattle.

[ This report does not necessarily reflect the views of the United Nations ]

http://allafrica.com/stories/200701110662.html

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever Death Toll now at 75+

Viral fever spreads from Kenya to Somalia -officials

12 Jan 2007 15:26:00 GMT

GARISSA, Kenya, Jan 12 (Reuters) - The Rift Valley Fever, a virus that has killed nearly 80 people in Kenya, has spread to the Somali border town of Doble, where thousands of refugees fleeing conflict are assembled, officials said on Friday.

The disease was largely confined to remote parts of Kenya's northeastern and coast provinces. However, the disease which is spread through the movement of infected livestock, has crossed over to neighbouring Somalia.

"In Doble, there were reports of people falling sick and animals dying," Kariuki Njenga, a virologist with the Centre for Disease Control, told Reuters. "There are also reports of animals aborting for the last two weeks. These are some of the symptoms of the Rift Valley Fever."

Although transmission from animals to humans is rare, the disease develops into a much more severe illness once it crosses over causing victims to abort, vomit blood or bleed to death.

The disease is transmitted to humans through mosquito bites or frequent contact with contaminated animals.

"Four more people have died of Rift Valley Fever in the region today. This brings the total death toll to 78. There are now 214 confirmed cases since Dec. 14," said Ahmed Omar, medical officer for North Eastern province.

The World Health Organisation (WHO) has said its teams were having difficulties getting help to affected people as heavy rains over Kenya had made roads impassable, meaning the disease could spread to other areas.

The WHO, Medecins Sans Frontieres and other agencies have deployed teams of experts to reinforce local hospitals and clinics and stop the epidemic spreading any further.

http://www.alertnet.org/thenews/newsdesk/L12869448.htm

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever (78 deaths/214 cases)

Kenya: Five Die As Fever Spreads to Somalia


The East African Standard (Nairobi)

January 12, 2007
Posted to the web January 12, 2007

Standard Team
Nairobi

Five more people have succumbed to Rift Valley fever (RVF) as reports indicated that the disease had spread to Somalia.

Of the five, four are herdsmen from North Eastern Province while the other one is a resident of Taita Taveta.

The latest fatalities push the death toll to 88 since the contagious viral disease broke out last month.

North Eastern Provincial Medical Officer of Health, Dr Omar Ahmed, confirmed the three deaths, but Bura District Officer, Mr Wilberforce Baraza, said a fourth victim died of a disease with symptoms similar to RVF's.

The toll rises as the Centre for Disease Control (CDC), which is vaccinating animals in northern Kenya, announced that the disease had spread to Somalia.

Medical officers also confirmed that the disease had spread to Turkana and Marsabit where deaths of animals were reported over the last one-week.

Ahmed said the death toll in three districts in North Eastern Province had reached 78. At least 214 people tested positive.

"The death toll in Wajir, Garissa and Ijara districts now stands at 78 although more deaths have been reported in neighbouring Coast Province where the disease was detected a fortnight ago," he said.

Chairman of the Taita Taveta County Council Mr James Mboga has protested against the influx of livestock from other districts without permits.


Machakos DC, Mr Osman Warfa, said disease control measures had been put in place.

He urged the public not to eat meat from sick animals.

Warfa urged butchers to ensure that health officers inspect meat before selling it.

http://allafrica.com/stories/200701120829.html

[Gert van der Hoek]

Re: Kenya: Rift Valley Fever (78 deaths/214 cases)

88 dead in Rift Valley outbreak

13/01/2007 12:27 - (SA)

Nairobi - The death toll from an outbreak of Rift Valley fever in Kenya has hit 88, said officials on Saturday, as health authorities fanned out across affected regions in a bid to contain the disease.

The viral disease has infected about 250 people since it was first reported in mid-December and has continued to spread across several, mostly arid, districts in the country.

"In northeastern regions, so far we have recorded 82 deaths," said Omar Ahmed, the medical services chief in the country's worst-hit Northeastern Province.

Health authorities have also reported the death of at least six people in the coastal province, bringing the overall toll to 88.

"We are moving across the affected region to ensure that we contain the disease, which is spread by either mosquitoes or by direct contact with infected animals," Ahmed told AFP by telephone.

Slaughter of animals banned

Officials said vaccinations targeting two million animals, which began on Monday, have intensified in the region, most of which was recently hit by flooding triggered by unusually heavy rains.

The exact number of people infected is unknown but experts believe it is much higher than officially recorded because most of those affected come from communities of nomadic farmers in remote areas.

The government has banned the slaughter of animals in affected regions, advised farmers to reduce contact between humans and livestock, boil milk before drinking it and sleep under mosquito nets.

Patients have fever, general weakness, back pain, dizziness, vomit blood and lose weight at the onset of the illness.

The Untied States Centres for Disease Control and aid agencies Medecins Sans Frontieres, the World Health Organisation and the United Nations children's fund are assisting the government in containing the outbreak.

http://www.news24.com/News24/Africa/News/0,,2-11-1447_2054459,00.html