ProMED RFI: About 20 cases of undiagnosed illness in Kedougou, Senegal - Chikungunya confirmed

[alert]

Dengue? Influenza? Decreased platelets might be a sign of a hemorrhagic fever, but the lack of reported fatalities might argue against Ebola, Marburg, CCHF, etc.

Published Date: 2015-09-05 23:29:57
Subject: PRO/EDR> Undiagnosed illness - Senegal: RFI
Archive Number: 20150905.3626668
UNDIAGNOSED ILLNESS - SENEGAL: REQUEST FOR INFORMATION
************************************************** ****
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Date: Fri 4 Sep 2015
From: Dr Albie de Frey <a.defrey@inhemaco.com> [edited]


We have seen in the past week about 20 cases (one expat) with the following [symptoms] in the Kedougou region of Senegal:
fever, lower extremity joint pains, back pains, head ache, fatigue, negative Pf [_Plasmodium falciparum_] malaria tests. All Senegalese but the index case was an expat who also presented with a rash a few days into his illness. The expat was treated empirically for non-falciparum malaria as a precaution (normal/low white cell count and decreased platelets).

Is there any confirmation of chikungunya, dengue, other arboviruses or non-falciparum malaria in this region -- perhaps by the Institut Pasteur, Dakar? Do they have any information?

--
Dr Albie de Frey
International Health Management Consultants
Geneva
Johannesburg
<a.defrey@inhemaco.com>

[The symptoms are sufficiently non-specific that it is not possible to determine what the etiological agent(s) responsible for these cases might be. The possible etiologies questioned by Dr. de Frey are reasonable ones. Zika virus might be added to that list because it has been shown to be present in Senegal. In 2008, 2 American scientists were infected by this virus. Interestingly, one of these infected scientists apparently transmitted the virus to his wife, who had not traveled outside the USA, through sexual intercourse. ProMED would appreciate receiving any additional information about these cases as it becomes available. ProMED thanks Dr. de Frey for sending in this report.

- Mod.TY]

 

[Pathfinder]

Concerning malaria which appears to be ruled out:

Translation Google

Kedougou, the region where malaria kills the most in Senegal, according to a doctor

Dieyna SENE 3 days ago

According to the chief doctor of the district health K?dougou, Mamadou Diokhan?, "Kedougou leads regions where malaria kills the most, with 25 deaths recorded each year on 1000 inhabitants. He was speaking to the press ahead of the campaign chemopreventive against the disease.

Dr. Diokhan? took offense in the columns of the '' Obs '' the fact that "people use treated mosquito nets rather for their gardening activities or to cover vegetables in markets."

The doctor alleged inaccessibility of the area, the scattered settlement and the migratory flows, in particular in the gold-bearing zones which often change the target, thus calling for a multisectoral approach to fight against malaria, says the newspaper.

"I remain convinced that the fight for health is neither more nor less than the struggle for development," said the chief doctor who insisted on a synergy of forces to stop sickness .

The campaign chemopreventive against malaria will last five days, including 3 treatments targeting 24,988 children aged 3 months to 10 years, informs' 'L'Observateur'.

Dr. Diokhan? looked forward to the sense of responsibility of mothers to give children the last two doses.

http://www.lactuacho.com/kedougou-la...on-un-medecin/



The only news report that I found concerning dengue is in Mauritania, Senegal's neighbor to the north. This report is about 3 weeks old:

https://en.wikipedia.org/wiki/Geography_of_Senegal


Translation Google

12-08-2015 1:52 p.m. - "It is dengue which prevails in Nouakchott" (Doctor)

Alakhbar - The fever raging for nearly a month in the Mauritania capital is Dengue and not malaria, said Dr. Moktar Ould Weddih Tuesday on its Facebook page.

O. Weddih, working at hospitals in Nouakchott, said he reached this conclusion after consulting over 200 patients affected by fever. The doctor therefore urged his colleagues to avoid prescribing the aspegic to patients.

According to him, it could double the risk of blood vomiting. "Rather give Paracetamol to patients to reduce fever," said he advised.

Moreover, Ould Weddih criticized the attitude of the Mauritanian Department of Health which "denies" the existence of the fever, according to the doctor.

Several neighborhoods in the Mauritania capital were hit by the high fever accompanied by vomiting. No deaths were recorded.

http://cridem.org/C_Info.php?article=674168



Mali prefecture in Guinea, which is close to Kedougou region, reported cases of Anthrax in March this year:

https://flutrackers.com/forum/forum...ts-le-charbon-bactéridien-a-déjà-fait-un-mort


Kedougou also had an Hepatitis E outbreak last year:

https://flutrackers.com/forum/forum/...ak-in-kedougou



​Concerning Ebola, WHO seems to be in the area as there was a simulation exercise on September 4th:

Special K?dougou Prevention against Ebola, IOM facilitates a simulation exercise

Xibaaru

September 5, 2015 By Xibaaru in News flash

This Friday, September 4, 2015, with support from IOM and WHO and under the supervision of the Centre for Health Emergencies Operations (COUS), medical K?dougou region held a simulation exercise involving the taking responsible for possible cases of Ebola Virus Disease (MVE).

Alongside this exercise held at Dalaba health post, actors (Police, Fire Brigade, Health Department, C2K, the doctors nurses, and representatives of the partners (IOM, WHO) met to assess.

A mastery of procedures but errors in practice.

During this evaluation, a number of errors were noted in this simulation exercise. It is the failure to comply with directives, the lack of filings, the waste disposal problem. The relaxation and difficulties in wearing protective equipment at the time of dressing and undressing.

"In the management of suspected cases of Ebola, one must be careful and avoid contact as much as possible. We made their remarks and are sure they will improve. We must get back on the guards, applying the national directives "advised Dr. Mamadou Sarr Chief Medical Officer of the Region.

A quasi-operational mechanism for the response

In K?dougou, different services in the provisions to support safely any potential suspect cases or at risk.

"We achieved our goals as it was for us to see if we are ready to face a possible case. This exercise has allowed us to detect problems. There is always a gap between theory and practice. The PKI had protective equipment, they were trained. I can assure you that the device is in the position to manage any suspect cases, we do not want, can occur at any time, "added Dr. Sarr.

M Omar Sow, the deputy prefect of K?dougou thanked the International Organization for Migration (IOM) for its support to the realization of this simulation He also urged journalists to clarify to people that this exercise is only simple simulation. In no case should they panic.

Diaby Adama in K?dougou to xibaaru.com

http://xibaaru.com/societe/preventio...de-simulation/

 

[alert]

ProMED replies with a long list of possible diagnoses:

Published Date: 2015-09-07 19:40:13
Subject: PRO/AH/EDR> Undiagnosed illness - Senegal (02): comment
Archive Number: 20150907.3628503
UNDIAGNOSED ILLNESS - SENEGAL (02): COMMENT
*******************************************
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: Sun 6 Sep 2015
From: Steve Berger <steve@gideononline.com> [edited]


[Re: ProMED-mail posting Undiagnosed illness - Senegal: RFI 20150905.3626668]
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A recent outbreak of suspected viral infection in Kedougou Region highlights the complexity of establishing a specific etiological agent in West Africa. At least 20 arthropod-borne viruses are associated with known or suspected human infection in Senegal. The following alphabetical list is abstracted from Gideon http://www.GideonOnline.com and the Gideon e-book series [1] (Primary references are available from Dr Berger on request)

Bagaza: Bagaza virus has been recovered from mosquitoes in Senegal (_Aedes fowleri_, _Culex neavei_, _Cx. poicilipes_ and _Mansonia_, _Mimomyia hispida_, _Mi. lacustris_, _Mi. splendens_, and _Aedeomyia africana_.

Bangui: Bangui virus was identified in mosquitoes in the Senegal River basin in 1988.

Bunyamwera: Bunyamwera virus has been identified in mosquitoes in the Barkedji region.

Chandipura: Chandipura virus has been identified in mosquitoes in the Barkedji region, and in phlebotomines in the Kedougou district.

Chikungunya: outbreaks of chikungunya were reported in Senegal in 1966, 1977, 1982, 1988, 1992, 1996, and 1997. In 2006, a cluster of 6 cases in France was reported among travelers returning from Senegal. The virus has been found in a variety of local mosquito species, notably _Aedes furcifer-taylori_, _Ae. luteocephalus_, _Ae. dalzieli_ and _Stegomyia (Aedes) aegypti_. Additional vectors may include _Ae. vittatus_, _Anopheles rufipes_ and _An. coustani_.

Dengue: an outbreak of dengue was reported in Senegal during 1927 to 1928; and circulation of the virus was subsequently confirmed in 1974 and during 1999 to 2000. An epizootic among monkeys was reported in 1981; and the 1st human case was reported in 1983 (from Casamance). Several human and monkey infections were reported in 1990. In 2009, a dengue outbreak (196 cases, 1 fatal) was reported -- the 1st report of human dengue in Senegal for 2 decades. Italy reported a case of dengue hemorrhagic fever, imported from Senegal, and cases of dengue fever have been confirmed among French military personnel serving in this country.

Gabek Forest: Gabek Forest virus, a Phlebovirus, has been identified in sandflies (_Phlebotomus_ species) in Senegal (1990 to 1995).

Koutango: Koutango virus (similar to Spondweni virus) has been identified in mosquitoes (_Culex neavei_) in the Barkedji region.

LeDantec: LeDantec virus is a rhabdovirus which is distinct from the vesicular stomatitis group 1. A single case of infection was reported in Senegal in 1965.

Ngari: Ngari virus has been identified in mosquitoes in the Barkedji region. 2 cases of Ngari virus infection were reported from Dakar.

O'nyong nyong: although specific data are lacking for Senegal, circulation of O'nyong nyong virus is reported in this region of West Africa.

Rift Valley fever (RVF): RVF virus was first isolated in West Africa in 1974, from _Aedes (Aedimorphus) dalzieli_ in Senegal. Highest seroprevalence rates are found in the northwest and north central regions. Serological studies suggest that the disease was active in Diawara and Bakel (Eastern region) in 1998. Outbreaks were reported among goats, sheep and / or cattle in 2002, 2003, 2013, and 2014. Carriage by mosquitoes and seroprevalence among sheep in the northern region increased during the 1990's. Rift Valley virus was identified in mosquitoes in Barkedji in 1993, and re-emerged in 2002. A single isolated case of human Rift Valley fever was confirmed in a school teacher in Kedougou in 2012.
Rift Valley fever virus seroprevalence surveys (as percent):
- 22.3 of Peul people of the North-central region
- 15.3 of the population in the Senegal River basin (1995 to 1996)
5 of children born after 1987, vs. 25.3 of the older population in Podor District (1999 publication)
- 5.2 of individuals in Diawara (1999)
- 2.9 of small ruminants tested in the Ferlo region (2003)
- 24.4 of sheep and goats in the Senegal River basin in 1988, 19.3 percent in 1989
- 17.2 of ungulates in the Senegal River Basin (1990)
- 3.8 of wild rodents, notably _Rattus rattus_, _Mastomys huberti_, _Arvicanthis niloticus_ and _M. erythroleucus_ (2000 publication)

Semliki Forest: Semliki Forest virus has been recovered from mosquitoes (_Ae. vittatus_) and ticks (_Rhipicephalus guilhoni_) in Senegal.

Tataguine: antibody toward Tataguine virus is found in 57 percent of the population.

Usutu: zoonotic infection by Usutu virus has been identified in Senegal.

Wesselsbron: seropositive humans were documented in Senegal during 1972 to 1975; and the virus itself has been identified in mosquitoes (_Ae. vexans_) in the Barkedji region.

West Nile: seroprevalence rates for West Nile virus of 78.3-92 percent have been reported among horses. Infection of wild birds and dogs has also been identified. Vector mosquito species in this country are thought to include _Culex neavei_, _Cx. tritaeniorhynchus_, _Cx. modestus_, _Cx. perfuscus_ group, _Cx. poicilipes_, _Ae. vexans_, _Mi. hispida_, _Mi. lacustris_, _Mi. splendens_, _Aedeomyia ,_ and _Mansonia uniformis_.

Yellow fever: epidemics of yellow fever were reported in Senegal in 1768, 1769, 1778 to 1779 (50 deaths among Caucasians), 1814, 1816, 1828, 1830, 1837, 1840 to 1841, 1844, 1852, 1858, 1863, 1866, 1872, 1900 to 1901 (225 fatal cases) and 1923 to 1927. _Ae. furcifer_, _A. metallicus_, and _A. luteocephalus_ are involved in the wild vertebrate transmission cycle in this country. Yellow-fever activity among mosquitoes in Senegal has been used to monitor potential human disease in West Africa. Infected mosquitoes were identified during 1976 to 1979, 1983, 1987, 1989, 1990, 1992, 1993 and 2010.
Chronology of recent yellow fever outbreaks in Senegal:
- 1965: 243 cases were reported in Diourbel.
- 1965 to 1966: 2000-20 000 cases and 200-2000 deaths were estimated.
- 1979: 2 French tourists contracted fatal yellow fever in Senegal.
1995: cases reported in Ribo-Escale and Guente-Pate Districts (vicinity of Koungheul).
- 1996: highest number of cases for any country (30.2 percent of the world's total), including an epidemic centered at Kaffine town. {p 9855398}
- 2001: 3 cases were reported in Kedougou District (Health Ministry report not included in WHO data).
- 2002: An outbreak (78 cases, 11 fatal) was reported with 18 cases in Diourbel and Ziguinchor regions, and 60 cases in Touba, Mbacke, and Bambey districts, Diourbel region; Gossas and Fatick districts, Fatick region; Tambacounda district in Tambacounda region; Louga, Koulda, and Dakar regions.
- 2005: activity was reported in Tambacounda region (Goudiri, Kadira)
- 2010: 2 Senegalese fishermen acquired yellow fever in Gambia.
- 2011: 3 cases were reported in Kedougou and Saraya Health districts, near the borders with Mali and Guinea Conakry.

Zika: there is evidence for the occurrence of yearly epizootics of Zika virus infection in Senegal. In 2008, 2 American scientists contracted Zika in the country. Natural infection has been identified in 2 local primate species, _Cercopithecus aethiops_ and _Erythrocebus patas_; and in 1.82 percent of mosquito pools (2011).

Zinga: Zinga virus, a variant of RVF virus, has been identified in humans and mosquitoes in Senegal.

Reference
---------
Berger SA: Infectious Diseases of Senegal, 2015. 449 pages, 55 graphs, 1864 references. Gideon e-books, http://www.gideononline.com/ebooks/c...es-of-senegal/

--
Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<steve@gideononline.com>

[ProMED-mail thanks Steve for submitting this extensive list of viruses that should be considered as possible etiological agents for the undiagnosed febrile cases mentioned in the 4 Sep 2015 post (Undiagnosed illness - Senegal: RFI 20150905.3626668). One hopes that appropriate samples have been sent to a reference laboratory, perhaps the Pasteur Institute in Dakar or Paris for testing. If so, results are awaited with interest.

 

[alert]

Chikungunya confirmed:

http://www.who.int/csr/don/14-septem...hikungunya/en/

Chikungunya &#150; Senegal

Disease outbreak news
14 September 2015

On 9 September 2015, the Ministry of Health and Social Affairs (MOHSA) of Senegal notified WHO of active circulation of chikungunya virus in the region of K?dougou. The circulation began on 27 August 2015. Samples were collected from 14 suspected cases for laboratory-confirmation at the Institut Pasteur of Dakar. Ten (10) samples tested positive for chikungunya virus. As of 8 September 2015, ten (10) chikungunya confirmed cases were reported. The latest active circulation in the affected area was reported between 2009 and 2010.
Public Health Response

On 7 September 2015, the MOHSA discussed the situation during the routine weekly meeting. The meeting provided technical directives to the different teams and departments involved in the response. The overall coordination of the response will be led by the MOHSA&#146;s Preventive department with the support of WHO and partners.
Official declaration of this public health event was made by the MOHSA through press release. Control actions that are being implemented include case management, distribution of technical documents on the disease to all health centres in the country and reinforcement of the epidemiological surveillance. Social mobilization is ongoing in the affected region and in all the other regions. The deployment of a multidisciplinary team of experts is under preparation. The team will conduct a sero-entomo-epidemiological investigation and provide technical support for surveillance and vector control activities.
WHO recommendations

WHO recommends protective measures against mosquito bites, vector control activities targeting major breeding sites of mosquitoes, community-based surveillance and social mobilization to avoid misconceptions and false rumours.
WHO does not recommend any trade or travel restriction to Senegal based on the information available on the current active circulation of the chikungunya virus.
Background

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. Joint pain is often debilitating and can vary in duration. The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya. The disease occurs in Africa, Asia, Latin America and the Indian subcontinent. Senegal was affected by the disease in 2009.

 

[Pathfinder]

Translation Google

31 cases of chikungunya diagnosed and cured in Senegal (Official)

by APA published: 30/09/2015 09:51 UTC 46 views In: Africa

The health authorities of Senegal K?dougou region (Southeast) diagnosed and cured 31 cases of chikungunya, an infectious viral disease that is transmitted to humans by a mosquito raging for several years in Africa, Asia and America, revealed the Ministry of Health and Social Action (MSAS) in a statement received on Tuesday at APA.

The text explains that this disease, whose last appearance in Senegal dates back to 2009, is characterized by high fever, with intense joint pain that can be associated with muscle pain, headache, nausea, fatigue or rash.

'Serious complications are exceptional and can be noted in the elderly and children, "adds MSAS, noting sending a multidisciplinary team in K?dougou to' conduct a case investigation and the vector".

http://fr.starafrica.com/actualites...gnostiques-et-gueris-au-senegal-officiel.html