Sudan: Yellow fever outbreak - 171 fatalities; 849 total suspected cases

[Ronan Kelly]

Sudan: Unknown Fever Claims Several Victims
Tagged: East Africa, Health, Sudan
7 OCTOBER 2012
Comment
Zalingei ? A number of citizens passed away as a result of an unknown fever in Central Darfur during the past two days.

The reports on the exact number of victims are conflicting; eye witnesses say at least 10 people died, while a medical source from Zalingei confirmed the death of two people so far. One of the victims comes from the area of Doudou, west of Zalingei, and the second victim was working in Jebel 'Aamer, North Darfur in the gold mines.

He said the two victims died from injuries caused by the measles. The source disclosed they received several reports on the spread of the fever. The areas of Korley, Tur Kolmey and Doudou have all seen cases of the fever.
...

http://allafrica.com/stories/201210080007.html

[Shiloh]

Central Darfur: Seven dead from as yet unidentified fever in the Korley area

Source: http://www.radiodabanga.org/node/36914


Seven die from unknown fever
ZALINGEI

(11 Oct.) -

A number of residents from Central Darfur complained to Radio Dabanga about the increasing number of deaths and cases of an unknown fever in the region, in addition, to the increasing number of malaria and measles cases.

According to them, at least seven people died in the past two days in the area of Korley, south of Zalingei, as a result of the diseases and the shortage of medicines and poor health services.

In an interview with Radio Dabanga, the minister of health in Central Darfur, Issa Mohamed Musa Yusuf, confirmed that an unknown type of fever and malaria have been spreading in Nertety and Zalingei localities.

Yusuf added that so far three people have died and another 10 were diagnosed with the fever in these localities. Besides, he acknowledged to have received complaints from residents, especially from Romatas camp, about the spread of the unknown fever and the increase of malaria and measles cases...

[alert]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

I'm not sure I agree with the speculation about Ebola or Marburg here, especially with mention that the cases have come from "various areas in Sudan's South Darfur state". Those viruses tend to produce clusters of cases, not cases spread across an entire state.

Published Date: 2012-10-23 15:13:27
Subject: PRO/AH/EDR> Undiagnosed febrile illness, fatal - Sudan: (SF) RFI
Archive Number: 20121023.1360013

UNDIAGNOSED FEBRILE ILLNESS, FATAL - SUDAN: (SOUTH DARFUR) 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

Date: Tue 23 Oct 2012
Source: China Daily, Xinhua News Agency report [edited]

http://www.chinadaily.com.cn/xinhua/2012-10-23/content_7317475.html

Khartoum's Al-Sudani daily newspaper reported Tuesday [23 Oct 2012] that 6 people died of and 10 others are infected with unknown fever in various areas in Sudan's South Darfur state.

"Unknown fever appeared in various areas of the state and infected 16 people on Saturday and Sunday [20-21 Oct 2012], and 6 of them died," the paper quoted Hassan Mohamed Abul-Hassan, a local official in the state, as saying.

"As soon as we received reports on the cases, we have contacted the federal Ministry of Health," he said, noting that medical teams have been sent to these areas to investigate the cause of the fever and provide treatment for the infected people.

The local official further said that samples have been taken from the infected people and sent to Khartoum but that the test results have not come out yet.

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

[In the absence of additional information on the clinical presentation of the cases other than fatalities from a febrile illness it is hazardous to attempt to speculate a differential diagnosis at this time. The range of possible diagnoses includes diseases of viral, bacterial, and parasitic origin. With the current ongoing outbreaks of Marburg virus disease in Uganda and Ebola virus disease in the Democratic Republic of the Congo, it is tempting to consider a viral hemorrhagic fever as the etiology of a fatal febrile disease outbreak in Sudan, but not casting the diagnostic net further at this point seems potentially hazardous at best.

Earlier this month (October 2012), ProMED-mail carried a report of an undiagnosed fatal illness outbreak occurring in Zalingei, Central Darfur state. In that report, the description was "most of the victims of the unknown fever are Arab nomads and gold excavation workers. ...the patients suffer from headaches, vomiting, and fatigue". A similar report on that same outbreak carried a few days later on ReliefWeb mentioned there were 7 deaths, and attributed them to poor access to good health care and medications in the region. There was mention of specimens having been sent to Khartoum for testing as well. (http://reliefweb.int/report/sudan/se...-unknown-fever).

Searching maps for locations, the 1st report above refers to deaths occurring "in various areas of the state [South Darfur]." The earlier report refers to the deaths occurring in the "area of Korley, south of Zalingei." Looking at a March 2012 map of Sudan available on Relief Web (http://www.un.org/Depts/Cartographic...file/sudan.pdf) and looking at a map showing the location of Zalingei, the capital of Central Darfur state http://www.myweather2.com/City-Town/...arfur/map.aspx, one sees the proximity of the states, it is tempting to wonder whether the 2 outbreak reports might be related events, as the descriptions on both news reports seem similar. Again, this may well be a hazardous speculation as transportation is significantly challenged in these areas.

We await more information from knowledgeable sources in the region. - Mod.MPP]

[Ronan Kelly]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

Unknown fever claims six lives
MERSHING
(25 Oct.) -

An unknown fever has led to the death of six people and infected 10 others in Mershing locality, South Darfur, Radio Dabanga has learned.

Hassan Adam Mohamed Abu al-Hassan, member of the Legislative Council of Al-Malam and Mershing in South Darfur constituency, disclosed in a press statement issued in Nyala on Tuesday October 23, that an unknown fever is spreading in areas north of Nyala and East Jebel Marra and added that six new cases were found in Gadirki area in Mershing locality.

The statement read that a medical team has taken blood samples to investigate the cause of the disease. Hassan added that all cases appeared among cattle owners and herders.

...

http://www.radiodabanga.org/node/37450

[Emily]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

Hassan added that all cases appeared among cattle owners and herders.

That could be a good clue. Q fever?

[Ronan Kelly]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

Could be anthrax with that apparently high cfr. Brucellosis is also a possibility. Or it might not be cattle related at all. Zoonotic diseases of cattle details some of the diseases shared by humans and cattle.

[alert]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

We don't have any symptomatic description. With 6 fatalities in 16 cases (37.5&#37; CFR) a viral hemorrhagic fever such as Ebola, CCHF, or Marburg should also be considered.

Rift Valley Fever might also explain both the high CFR and the contact with animals, and has previously been reported in Sudan.

Q fever, with a CFR of perhaps 1-2%, seems less likely to be responsible for this outbreak, unless large numbers of milder cases have been missed. Measles also seems unlikely now, given the CFR and the fact that most/all of the cases seem to be adults.

[Ronan Kelly]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

'Mysterious disease' leads to death of five
ZALINGEI
(26 Oct.) -

The emergence of a 'mysterious disease', causing diarrhea and vomiting, has led to the death of five people in the region of Jebel al-Ahmar, east of Zalingei and close to Beida in Central Darfur, Radio Dabanga has learned on Friday October 26.

Residents informed Radio Dabanga that 15 patients are in critical condition after they were infected with the disease. It is feared that these patients will die due to the lack of treatment and hospitals in the area. The residents described the disease, causing death within 24 hours after infection, as an epidemic. The cause of the disease remains unknown.

They added that the state Ministry of Health in Zalingei was informed about the 'mysterious disease', but has not acted yet and refuses to recognize the epidemic. It was said that the disease spread to nomads in the areas of Tello and east Mornei, the residents told Radio Dabanga.
...

http://www.radiodabanga.org/node/37552

[Emily]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

Zoonotic diseases of cattle details some of the diseases shared by humans and cattle.

Thanks, Ronan. That's a great reference!

Q fever, with a CFR of perhaps 1-2%, seems less likely to be responsible for this outbreak, unless large numbers of milder cases have been missed.

You're right, Alert. I don't see any reports of Q fever being this acute, even in stressed people without ready access to treatment. In fact, it's hard to imagine any of the zoonotic diseases in Ronan's list causing death in 24 hours, except possibly listeria.

http://www.ncbi.nlm.nih.gov/pubmed/4062448

[alert]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

Actually, diarrhea and vomitting leading to death within 24 hours, especially without mention of hemorrhage, might suggest cholera, and the animal exposures would be a red herring.

I'm starting to lean more toward RVF here, though, as some of the more recent RVF outbreaks elsewhere in Africa have involved some very rapid fatalities.

There also appears to be several undiagnosed fatalities in one family in a nearby district:

http://www.radiodabanga.org/node/37063

[Ronan Kelly]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

There may well be more than one disease involved in this thread - measles, food poisoning/ gastroenteritis, cholera ...

Measles infections on the rise
SARAF OMRA
(25 Oct.) -

Dr. Munir Mohamed Matar, general director of the state?s ministry of health, disclosed that two people died and another 50 got infected by measles in al-Sref Beni Hussein, Saraf Omra and Al-Waha localities in North Darfur, Radio Dabanga has learned on Tuesday October 23.

The general director told Radio Dabanga that two people died from measles in Jebel ?Aamer, al-Sref Beni Hussein locality. According to Dr. Munir?s statement there are at least 34 other cases in Saraf Omra, Mistreihah and Al-Waha localities.

He added that most victims are between 20 and 45 years old and that many of them work in the gold mines.
...

http://www.radiodabanga.org/node/37446

[Ronan Kelly]

Re: Sudan: Unknown Fever (possibly measles) Claims Several Victims

37 die and 125 infected with unknown fever
ZALINGEI
(28 Oct.) -

As a result of the spread of an unknown fever, 37 people have died and more than 125 others have been infected over the past three weeks in the areas of Jebel Ahmar, Hillat Beida, Abta, Nertete and the area of Tololo in Central Darfur, Radio Dabanga has learned on Sunday October 28.

A resident from Zalingei, Saad Ahmed Aseel, told Radio Dabanga that the fever has claimed dozens of lives in the area around Zalingei, in particular among nomads.

Aseel added that 17 citizens from Jebel Ahmar area have died recently as a result of the unknown fever, as well as nine in Tololo locality and one in Abta. In addition, the resident added that in the area of Nertete two people passed away and 17 others are in critical condition.

The resident pointed out that people infected with the fever suffer from bleeding in the mouth and nose. He explained that local authorities did not take the necessary action to contain the disease and, until now, did not acknowledge the fever is evolving to an epidemic.
...

http://www.radiodabanga.org/node/37642

[Ronan Kelly]

Re: Sudan: Unknown Fever up to 37 fatalities - report of haemorrhagic symptoms

Unknown Fever May Be Spreading Across Sudan

Oct 29, 2012
Comments 0
By Katharina Schwan


Radio Dabanga, a news source from central Darfur, reports that a new, unknown fever has killed 37 individuals over the past three weeks in western Sudan, with an additional 125 infected. Residents have appealed to health authorities, such as the Ministry of Health and the World Health Organization (WHO), to help manage the epidemic and impede its spread.
Case reports of this mysterious illness began to surface in early October. According to witnesses, Arab nomads and gold excavation workers have been most affected by the outbreak. However, Radio Dabanga also reported on the deaths of three young brothers, likely from the same illness. Additional cases were reported from refugees living at the Romatas camp within several days. A medical source of unknown reliability confirmed that at least two of the victims died from complications caused by measles.
Residents report that symptoms of the illness include vomiting, diarrhea, and bleeding in the mouth and nose. Death usually occurs within 24 hours of infection. Additionally, it is believed that the disease was spread to nomads passing through the area, which may escalate the extent of the outbreak. Radio Dabanga reports that the Ministry of Health in Zalingei, one of the affected towns, refuses to acknowledge the epidemic, and thus has not yet intervened.
Earlier articles, however, say that Issa Mohamed Musa Yusuf, the Minister of Health in central Darfur, has in fact confirmed the cases of unknown fever and is working towards determining the source by sending patient samples to Khartoum for analysis.
A substantial shortage in essential medicines is at the forefront of worry among both residents and health authorities. There simply are not enough doctors or supplies to dedicate towards diagnosing the mysterious illness, and treating it accordingly.

http://www.healthmap.org/news/unknown-fever-may-be-spreading-across-sudan-102912?utm_medium=twitter&utm_source=twitterfeed

[alert]

Re: Sudan: Unknown Fever up to 37 fatalities - report of haemorrhagic symptoms

I can't tell if this is related or not, but it is nearby:

http://www.radiodabanga.org/node/37693

Foro Baranga residents complain about diseases
FORO BARANGA (29 Oct .) -
Residents from Foro Baranga locality in West Darfur have complained to Radio Dabanga about the increased spread of diseases such as malaria, diarrhea, typhoid and dry cough in the region on Monday October 29. In addition, the citizens complained about the lack of medicine and health care facilities.

The residents noted that the majority of patients resorted to traditional treatment and others to treatment in private clinics, due to the lack of medication and health care facilities in the area.

Suleiman Khater Zayyed, commissioner of For Baranga locality, acknowledged in an interview with Radio Dabanga the lack of medicine in the locality, but denied the existence of an epidemic or an increased spread of diseases.

[snip]

[Shiloh]

Re: Sudan: Unknown Fever up to 37 fatalities - report of haemorrhagic symptoms- Yellow Fever

Source: http://www.minews26.com/content/?p=20693

Yellow fever outbreak in Darfur kills at least 32

POSTED October 30, 2012 BY BNO News
KHARTOUM, SUDAN (BNO NEWS) -- A previously unknown disease which has claimed more than 30 lives in Sudan's troubled Darfur region this month has been identified as yellow fever, the World Health Organization (WHO) said on Tuesday. Preparations for a mass vaccination campaign are now underway.

The outbreak was first detected early this month when a number of people in the central and southern regions of Darfur became ill and eventually died. Sudanese media said the victims suffered from a number of symptoms, including diarrhea, vomiting, and bleeding from both the mouth and nose...