Mysterious Angola outbreak: bromide poisoning

[Gert van der Hoek]

Health experts puzzled by mysterious Angola outbreak

Wed 7 Nov 2007, 10:11 GMT


LUANDA (Reuters) - International health officials are investigating the emergence of a mysterious disease in Angola that has killed at least four people and sickened more than 200.

The illness, which leads to weakness, muscular spasms, mental confusion and speech impairment, surfaced in Cacuaco, near Luanda, in early October, the World Health Organization (WHO) said in a press release sent to Reuters late on Tuesday.

It has since spread to seven neighbourhoods in the municipality, about 20 km (12.5 miles) north of the Angolan capital and home to some 200,000 people.

"As of 1st of November, more than 200 cases including four deaths have been reported," the WHO said in its statement.

Experts from the WHO, U.S. Centers for Disease Control and Prevention (CDC) and the Angolan government are investigating the outbreak.

"The Ministry of Health advised the population to observe the individual and collective measures, especially food hygiene, to avoid all risk factors related to solid wastes and to go to the nearest health facilities if suffering from any signs of sickness," the WHO added.

Angola suffered an extensive cholera outbreak last year that killed at least 1,800 people. Some 150 Angolans died in 2004-2005 after contracting Marburg virus, a close relative of the feared Ebola virus.

The oil-rich southwestern African nation is struggling to rebuild its health system, which was devastated during a 27-year civil war that ended in 2002. Millions were left vulnerable to malnutrition and other diseases due to the conflict.

An estimated one-quarter of babies and toddlers die before the age of 5.

Although former colonial power Portugal established a rudimentary health system while ruling Angola, services crumbled after independence in 1975.

http://africa.reuters.com/top/news/usnBAN736684.html

 

[Snowy Owl]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

Angola: Govt Investigates Causes of Strange Illness in Cacuaco

Angola Press Agency (Luanda)
7 November 2007
Posted to the web 7 November 2007


Luanda


A multi-sectorial team, led by the deputy minister of Health, Jose Van-Dunem, visited Monday Cacuaco District, in Luanda, to see the people affected by an unknown disease which has already killed four people, ANGOP has learnt.


According to a press note issued by the World Health Organisation (WHO), whose experts have been participating in the investigation, the first cases of the illnesses were reported on October 02 and until November 01 four deaths were recorded out of the about 200 cases.



At least an average of 20 cases have been recorded in Cacuaco hospital, a health source informed to the visiting team.
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Thus, the Health Ministry has created a health centre in Cacuaco to treat suspect cases.

http://allafrica.com/stories/200711070676.html

 

[Gert van der Hoek]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

Unknown illness in Angola

16 November 2007

An outbreak of a disease of unknown etiology is currently ongoing in Cacuaco municipality, Angola. The first cases were reported on 2 October. As of 15 November 2007, a total of 370 cases had presented for treatment at the Municipal Hospital in Cacuaco.

It is anticipated that additional unreported cases may be occurring within communities among patients preferring to remain at home or to receive treatment from traditional healers.

The clinical symptoms of the disease are extreme drowsiness, waking only to painful stimuli. Patients recover slowly, over a number of days, but remain ataxic with many unable to walk unaided. The symptoms are most extreme in children.

The neurological indication is of a cerebellar abnormality with no sign of peripheral neuropathy. Reflexes are normal. The case presentation suggests a toxicological cause, however, the etiological agent has not yet been identified.

Samples taken from patients have been tested for 300 organic solvents and a general drug screen covering 800 compounds has also been carried out.

These tests have so far proved negative. Tests for cadmium, lead, mercury and manganese have shown levels within the normal range.

Environmental samples, as well as food and drinking water, have also been taken and results of tests are awaited.

Epidemiological investigations so far have not revealed a common source or route of exposure, and these investigations are now being extended in scope.

http://www.who.int/csr/don/2007_11_16/en/

 

[hawkeye]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

Not to confuse the situation, however when I read the above posts...


Still No Cause Found for Mysterious Twitching Illness Plaguing Va. School

Tuesday, November 13, 2007

ROANOKE, Va. ? Tests at William Byrd High School in Roanoke County have ruled out several possible causes for strange, seizurelike symptoms in roughly 10 people at the school.

The school system hired environmental consultant ECS Mid-Atlantic to perform the tests. Company official Derek Cooper said tests on surfaces at the school found no evidence of anything abnormal inside the building.

He said they ruled out mold, carbon dioxide and carbon monoxide. While there's no evidence of mercury, pesticides or herbicides, final results are not in.

The surface tests follow earlier tests on the school's air and water supply, which turned up nothing unusual.

The Virginia Department of Health is performing its own epidemiological investigation.

 

[FrenchieGirl]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

UN Regular Press Briefing - dated 16 November 2007 - http://www.unog.ch/80256EDD006B9C2E/(httpNewsByYear_en)/9995A80B7EA35E78C1257395005093D4?OpenDocument

Mystery Outbreak in Angola

Ms. Chaib announced that reports had been received of an outbreak of illness in Angola. Over the course of a few weeks now, over 100 persons had fallen ill, but WHO did not know yet know the cause of the illnesses. All the cases reported were from one town in the north of the country ? Cacuaco. The first case was diagnosed on 2 October, but since 14 November the number of cases had been growing. Symptoms included pain, loss of sensation, lack of motor control, sleepiness and fever. Researchers in WHO's Geneva and Africa headquarters were currently trying to work that out. Hypotheses included exposure to a toxic substance and environmental contamination that was transmitted via the food chain, but the possibility of an infectious disease had not been ruled out. Updates would be available on WHO's website (www.who.int).

 

[FrenchieGirl]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

WHO Update - dated 16 November 20007 - http://www.who.int/csr/don/2007_11_16/en/index.html

Unknown illness in Angola
16 November 2007

An outbreak of a disease of unknown etiology is currently ongoing in Cacuaco municipality, Angola. The first cases were reported on 2 October. As of 15 November 2007, a total of 370 cases had presented for treatment at the Municipal Hospital in Cacuaco.

It is anticipated that additional unreported cases may be occurring within communities among patients preferring to remain at home or to receive treatment from traditional healers. The clinical symptoms of the disease are extreme drowsiness, waking only to painful stimuli. Patients recover slowly, over a number of days, but remain ataxic with many unable to walk unaided. The symptoms are most extreme in children.

The neurological indication is of a cerebellar abnormality with no sign of peripheral neuropathy. Reflexes are normal. The case presentation suggests a toxicological cause, however, the etiological agent has not yet been identified. Samples taken from patients have been tested for 300 organic solvents and a general drug screen covering 800 compounds has also been carried out.

These tests have so far proved negative. Tests for cadmium, lead, mercury and manganese have shown levels within the normal range. Environmental samples, as well as food and drinking water, have also been taken and results of tests are awaited.

Epidemiological investigations so far have not revealed a common source or route of exposure, and these investigations are now being extended in scope.

 

[Gert van der Hoek]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

WHO

Unknown illness in Angola - Update

21 November 2007

The investigation of an outbreak of unknown origin in Angola has revealed extremely high levels of bromide in plasma sampled from several affected patients.

As of 19 November 2007, over 390 cases had been identified and treated at the Municipal Hospital in Cacuaco. About 64% of those affected are children below 15 years old.

Toxicological tests carried out in Munich, Germany, detected very high levels of bromide in 5 out of 6 plasma samples taken from affected patients. Bromide intoxication has been one of the working hypotheses being explored by WHO and partners as a cause of the outbreak.

The laboratory results provide an important focus for testing on human, environmental and food samples to confirm these bromide levels. Additional samples are currently on the way to a laboratory in the UK for testing for bromides.

On Wednesday 21 November WHO deployed further technical and operational support to assist Angolan health authorities, including a field coordinator, clinician, two epidemiologists, food safety expert, laboratory specialist, and a logistician.

This team will support further epidemiological studies, case management, social mobilization and risk communication, environmental investigations and laboratory testing to confirm the cause of the outbreak, and to support response and control measures.

http://www.who.int/csr/don/2007_11_21/en/index.html

 

[Gert van der Hoek]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

Possibly the bromide intoxication comes from traditional African medicin:

Impila (Callilepis laureola)


Detection of poisoning by Impila (Callilepis laureola) in a mother and child

Poisoning with impila (Callilepis laureola) is a recurring phenomenon in South Africa.

Cases of poisoning with other plants which contain atractyloside also occur in Europe and the Americas. Since poisoning leads to rapid death from renal and/or hepatic failure, it is suspected that many cases are undiagnosed; this is especially so in South Africa, where patients may die without reaching hospital and do not often admit to ingestion ofa traditional remedy.

We have developed a thin layer chromatographic method for the detection of impila constituents in urine. We describe the clinical symptoms and the application of the screening method to diagnosis in the case of a mother and child, who both showed symptoms of impila poisoning; the mother died but the child survived. This method is rapid and may be used for the definitive diagnosis in cases of poisoning with atractyloside-containing plants.

http://cat.inist.fr/?aModele=afficheN&cpsidt=1212369



More on Bromide intoxication:

http://www.gulflink.osd.mil/library/randrep/pb_paper/mr1018.2.chap10.html

 

[Gert van der Hoek]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

Last Updated: Friday, 23 November 2007,


WHO links Angola illness to salt

By Peter Greste
BBC News, Johannesburg



The World Health Organization (WHO) believes that contaminated salt may be behind the world's largest outbreak of bromide poisoning, in Angola.

More than 400 victims have been identified, and the numbers are rising.

The WHO has a team in place to identify how the victims came to ingest the substance, and try to get the outbreak under control.

Initial reports that the contamination could come from the oil industry or a rubbish dump have been dismissed.

Doctors from the community of Cacuaco, just north of the capital Luanda, began to realise something was wrong late last month.

People started complaining of dizziness, of muscle spasms and of having difficulty speaking and walking.

The numbers rapidly started to rise and some of the victims slipped into a kind of stupor. Doctors raised the alarm.

Mystery illness

According to the WHO there are now at least 414 victims, all showing symptoms of what they now believe to be bromide poisoning.

The vast majority of them are under the age of 15.

According to a spokesman for the WHO it is the biggest ever outbreak of bromide poisoning.

So far, four people have died, though the WHO says it is still too early to say whether they passed away because of bromide or some other unrelated problem.

At first it seemed that the region's oil industry may be to blame or a nearby rubbish dump.

But now the WHO's team of investigators believes the most likely culprit is contaminated salt.

They found traces of bromide in food and in salt but they still have not found the direct source.

http://news.bbc.co.uk/2/hi/africa/7110405.stm

 

[Gert van der Hoek]

Re: Health experts puzzled by mysterious Angola outbreak

Re: Health experts puzzled by mysterious Angola outbreak

WHO

Mass Bromide poisoning in Angola - update 2

30 November 2007

As of 29 November 2007, 468 confirmed cases of bromide poisoning have been identified in the ongoing outbreak of a neurological disease in the Cacuaco municipality, Luanda Province, Angola. The cases have been treated at the Municipal Hospital in Cacuaco.

Toxicology laboratories in Munich (Germany) and Birmingham (UK) have detected very high levels of bromide in blood samples of patients.

In addition, laboratories in Geneva (Switzerland) and Munich have detected very high levels of sodium bromide (>80%) in table salt samples collected in the households of patients.

These findings provide a clear indication that this outbreak is very likely due to bromide poisoning which occurred through use of table salt highly contaminated with sodium bromide.

It is still unknown how the salt samples were contaminated. Additional food samples are currently being analysed to identify any potential secondary source of exposure.

WHO continues to provide support to the Angolan Health Authorities for further epidemiological studies, environmental investigations, laboratory analysis, case management, risk communication, and social mobilization actions, including a salt replacement campaign.

http://www.who.int/csr/don/2007_11_30/en/index.html