Sudan: Undiagnosed outbreak in Deleig camp - government denies media report

[alert]

Published Date: 2014-02-14 21:03:03
Subject: PRO/AH/EDR> Undiagnosed outbreak - Sudan (04): (CD) children, donkeys
Archive Number: 20140214.2278865

UNDIAGNOSED OUTBREAK - SUDAN (04): (CENTRAL DARFUR), CHILDREN, DONKEYS
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Date: Wed 12 Feb 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/66603


A mysterious disease is afflicting children under 12 years of age as well as donkeys in Deleig camp for the displaced in Wadi Salih locality, Central Darfur.

One of the camp sheikhs told Radio Dabanga that about 75 percent of the children in the camp have been infected with the disease. The symptoms are coughing, vomiting, inflammation in the genitals, and sleeplessness.

The sheikh said that the disease has spread over the past 2 weeks. The camp's health centre has 9 rooms that can accommodate 20 children, but there are 100 or more cases. He said that there have been no fatalities thus far. The administration of the health centre has distributed white syrup and painkillers without explaining the reason for the disease's outbreak or how to prevent it.

The Sheikh called on the authorities and organisations working in the field of health care to urgently access the area to contain and identify the disease.

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[The description of the disease (coughing, vomiting, inflammation in the genitals, and sleeplessness) affecting mainly children under 12 years of age is too vague and non-specific to suggest a diagnosis. Is fever part of the illness? What is the sex distribution of the cases? What exactly is meant by "inflammation in the genitals," balanitis, orchitis, epididymitis in boys, vaginitis in girls? In what way are the donkeys involved? More information on the illness affecting the children and donkeys in the Deleig camp would be greatly appreciated from knowledgeable sources.

Sudan is an Arab state in the Nile Valley of North Africa. Sudan is divided into 18 states or wilayat (http://en.wikipedia.org/wiki/Sudan). Central Darfur is one of the states of Sudan, and one of 5 comprising the Darfur region. It was created in January 2012 as a result of the ongoing peace process for the wider Darfur region (http://en.wikipedia.org/wiki/Central_Darfur). The state was formed from land that was previously part of the states of West Darfur and South Darfur. For a map of Central Darfur showing the location of Wadi Salih and Deleig, see (http://reliefweb.int/sites/reliefweb.int/files/resources/map_2981.pdf). - Mod.ML

Yersinia pseudotuberculosis_ and _Y. enterocolitica_ can occur in equines, but humans get febrile diarrhea and/or abdominal pain, not vomiting and inflammation of the genitals (what ever that represents). - Mod.LL

West Nile virus infection seems unlikely because respiratory symptoms (coughing) are not part of the clinical WNV picture, nor is genital inflammation, nor is a high proportion (75 percent) of the population affected with clinical disease; 20 percent or less of WNV infected people have clinical signs. - Mod.TY

No donkey deaths were mentioned, so it is unlikely to be anthrax. - Mod.JW

 

[alert]

Re: Sudan: Undiagnosed outbreak in Deleig camp

Re: Sudan: Undiagnosed outbreak in Deleig camp

I don't think the human and donkey outbreaks are the same illness. While both illnesses cause coughing, the human one has vomitting, some kind of inflammation, and sleeplessness. The donkey one has loss of appetite and weight loss.

Might either of them be anthrax?

Published Date: 2014-02-24 18:43:24
Subject: PRO/AH/EDR> Undiagnosed outbreak - Sudan (05): (CD) fatal, children, donkeys, spread, RFI
Archive Number: 20140224.2297587

UNDIAGNOSED OUTBREAK - SUDAN (05): (CENTRAL DARFUR), FATAL, CHILDREN, DONKEYS, SPREAD, REQUEST FOR INFORMATION
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[1]
Date: Sun 23 Feb 2014
Source: All Africa [edited]
http://allafrica.com/stories/201402241308.html


The number of children who have died from a mysterious disease in Deleig camp for the displaced in Central Darfur has increased to 23. The number of fatalities among donkeys stands at 59.

Speaking to Radio Dabanga, a sheikh of the Deleig camp in Wadi Salih locality reported that 23 children have died so far of a mysterious disease that affects children below the age of 12 and donkeys.

The sheikh complained that no official or medical team from the locality or Central Darfur state had come to examine and treat the young patients. "Also, no effort has been done to define and contain the causes of the disease, in spite of the high number of deaths, and the fear and horror experienced by the people in the region."

The Minister of Health of Central Darfur State, Dr Eisa Mohamed Musa, has acknowledged the "emergence of an unknown inflammation" among the children in Deleig. He stated in a press statement that 12 cases were recorded in Deleig. The disease, the minister noted, affects young children below the age of 5 years. The "mysterious disease" symptoms indicate a severe acute respiratory syndrome, according to Musa.

The minister also stated that a medical team was sent to Deleig to investigate the epidemic disease. "We are still waiting for the result of tests on samples collected in the area."

On 12 Feb [2014], Radio Dabanga reported that about 75 percent of the children in Deleig camp were infected with a mysterious disease affecting children below the age of 12 years and donkeys. The symptoms are coughing, vomiting, inflammation in the genitals, and sleeplessness. On 16 Feb [2014], a Deleig camp sheikh reported that 15 children and 47 donkeys had died.

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[2]
Date: Mon 24 Feb 2014
Source: All Africa [edited]
http://allafrica.com/stories/201402242068.html


People of the Southern Camp for the Displaced in Nierteti locality, Central Darfur have complained of the spread of an unknown disease among donkeys. 36 of the 146 infected donkeys have died within a week.

Speaking to Radio Dabanga, a camp resident reported on Sunday [23 Feb 2014] that the mysterious disease broke out among donkeys 15 days ago. The symptoms are severe coughing, weakness, [loss of] appetite and weight loss. Veterinary authorities have advised people to vaccinate the donkeys, but the camp resident said: "Most of us cannot afford the costs of a vaccination, which ranges between SDG 15 (USD 2.60) and SDG 20 (USD 3.50)."

The displaced appealed to the authorities and organisations working in the field of veterinary services to intervene as soon as possible to vaccinate the donkeys and contain the spread of the disease. "Donkeys are the most important means of livelihood for us."

On 12 Feb 2014 Radio Dabanga reported that about 75 percent of the children below the age of 12 years in the Deleig Camp for the Displaced in Central Darfur were infected with a mysterious disease. The disease affects children below the age of 12 years and donkeys. Four days later, 15 children and 47 donkeys had died.

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[The news reports above add little to the description of the disease in the Deleig refugee camp in Central Darfur given in the prior news reports (coughing, vomiting, inflammation in the genitals, and sleeplessness) (see ProMED-mail post Undiagnosed outbreak - Sudan (04): (CD) children, donkeys 20140214.2278865) that is affecting 75 percent of children under 12 years of age and donkeys. Now we learn that the disease (or perhaps another disease) is also affecting donkeys (severe coughing, weakness, appetite and weight loss) in another Central Darfur refugee camp in Nierteti (perhaps also spelled Nertiti). And we now also learn that the disease is rapidly fatal and has killed 23 children and 59 donkeys in Deleig and 36 of the 146 infected donkeys in Niertiti.

However, we are not given a better description of the illness to suggest a diagnosis. Is fever part of the illness? What is the sex distribution of the cases? What exactly is meant by "inflammation in the genitals?" What vaccine is being requested by the refugees for their donkeys in Niertiti? More information on the illness affecting the children in the Deleig camp and the donkeys in the Deleig and Niertiti camps would be greatly appreciated from knowledgeable sources.

Sudan is an Arab state in the Nile Valley of North Africa. Sudan is divided into 18 states or wilayat (http://en.wikipedia.org/wiki/Sudan). Central Darfur is one of the states of Sudan, and one of 5 comprising the Darfur region. It was created in January 2012 as a result of the ongoing peace process for the wider Darfur region (http://en.wikipedia.org/wiki/Central_Darfur). The state was formed from land that was previously part of the states of West Darfur and South Darfur. For a map of Central Darfur showing the location of Wadi Salih and Deleig south of the state capital Zalingei, and Nertiti, east of the state capital, see http://reliefweb.int/sites/reliefweb.int/files/resources/map_2981.pdf. - Mod.ML

 

[alert]

Re: Sudan: Undiagnosed outbreak in Deleig camp

Re: Sudan: Undiagnosed outbreak in Deleig camp

Published Date: 2014-02-26 21:53:46
Subject: PRO/AH/EDR> Undiagnosed outbreak - Sudan (06): (CD) donkeys, RFI
Archive Number: 20140226.2302682

UNDIAGNOSED OUTBREAK - SUDAN (06): (CENTRAL DARFUR), DONKEYS, REQUEST FOR INFORMATION
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Date: Mon 24 Feb 2014
From: Arnon Shimshony ProMED-mail Animal Disease and Zoonoses Moderator <promed@promedmail.org>


The following information related to the donkey disease in the Nierteti locality, Central Darfur, Sudan is derived from the All Africa newswire dated Mon 24 Feb 2014 and posted by ProMED in "Undiagnosed outbreak - Sudan (05): (CD) fatal, children, donkeys, spread, RFI 20140224.2297587:"

1. The disease started around 8 Feb 2014 (15 days prior to the report).
2. The clinical signs were severe coughing, weakness, loss of appetite and weight loss.
3. Out of 146 sick animals, 36 have died up to 24 Feb 2014 (case fatality rate of 24.7 percent).
4. A vaccine against the disease is apparently available in Sudan (price given).

Though the said disease is mentioned as coinciding and synchronic with a fatal disease in children, there is no evidence (yet?) that there is a common etiology for both human and animal diseases in Darfur.

Several OIE-listed diseases reported in the past from Sudan may be considered as candidates for differential diagnosis, producing some of the clinical signs described in donkeys. They include African horse sickness, surra (_Trypanosoma evansi_) and equine piroplasmosis. The list of zoonotic diseases of equines includes about 30 entities, some being equine-specific while others being multi-species. Selectively, _Streptococcus equi subsp zooepidemicus_ and _Rhodococcus (corynebcterium) equi_ may be candidates for consideration.

Since vaccination has been mentioned, it would be interesting to note whether African horse sickness should be included in the suspect list. This disease is said to be mild in African donkeys.

Further information on the described health event in donkeys will be appreciated, in particular, identification of the vaccine which has been reportedly considered to address the syndrome. - Mod.AS

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[ProMED Veterinary Moderator TG suggests _Rhodococcus equi_.

Human infection
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"_Rhodococcus equi_, mainly known from veterinary medicine as a pathogen in domestic animals, can also cause infections in immunocompromised humans, especially in those with defects in cellular immunity...

"R. equi infection is predominantly airborne, acquired through the respiratory tract. Exposure to domestic animals, such as horses and pigs, may play a role in acquisition of this organism...

"[A]fter the latest chemotherapy treatment... the patient experienced flu-like symptoms and had a fever of 38.9?C... Outpatient evaluation showed 2 lung abscesses. From 3 consecutive blood cultures and from the bronchoalveolar lavage fluid, a gram-positive bacillus with mucoid growth was isolated and identifi ed as _R. equi_."

Meeuse JJ, Sprenger HG, et al. 2007. Rhodococcus equi Infection after Alemtuzumab Therapy for T-cell Prolymphocytic Leukemia. Emerging Infectious Diseases Vol. 13, No. 12, December 2007. [ 7 refs.] http://wwwnc.cdc.gov/eid/article/13/12/pdfs/06-1559.pdf. Accessed on 26 Feb. 2014.

"The federal Food and Drug Administration recalled all products produced by Specialty Compounding of Cedar Park [Texas] after reports of bacterial infections affecting 17 patients. 2 patients died... _Rhodococcus equi_ [was] found in the blood of 17 people who fell ill at Corpus Christi Medical Center hospitals, Doctors Regional and Bay Area, said David Ball, a spokesman hired by the pharmacy. "There are literally hundreds of potential sources of contamination" ... The bacterium commonly is found in dry and dusty soil..." See ProMED 2013 archive below.

Equine infection
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"_Rhodococcus equi _ is responsible for high mortality rates and large economic losses related to severe pneumonia in foals under 6 months of age. This review includes the etiology, epidemiology and pathogenesis with special attention to the surface protein Vapa, its main determinant of virulence. The main [equine] clinical manifestations are presented...

"The disease in its severe form is characterized by massive lung abscesses, the presence of hyperthermia, tachypnea, and depression which may or may not be associated with coughing and nasal discharge. With the progression of clinical symptoms, the animals tend to have anorexia, recumbency, abdominal breathing and cyanosis, which if not immediately controlled culminate in death."

Rusca ACCP, Fernandes WR, Barrier MCR 2011. Rhodococcus equi Part 1 - epidemiology, clinical manifestations, diagnosis and treatment. (in Portuguese, machine trans., edited). Cienc. Rural vol.41 no.12 Dec. 2011 http://www.scielo.br/scielo.php?pid=S0103-84782011001200017&script=sci_arttext. Accessed on 26 Feb. 2014

Photo of donkey in Nertiti camp, Sudan
http://thewe.cc/thewei/_/images_1/sudan/abu_shouk_camp_darfur.jpe - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1A1E.]

 

[alert]

Re: Sudan: Undiagnosed outbreak in Deleig camp

Re: Sudan: Undiagnosed outbreak in Deleig camp

Whooping cough is consistent with the human outbreak, especially if the fatality count is incorrect:

Published Date: 2014-02-27 23:01:26
Subject: PRO> Undiagnosed outbreak - Sudan (07): (CD) child & donkey deaths denied
Archive Number: 20140227.2304709

UNDIAGNOSED OUTBREAK - SUDAN (07): (CENTRAL DARFUR) CHILD & DONKEY DEATHS DENIED
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Date: Wed 26 Feb 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/67631


The Minister of Health of Central Darfur State has denied that there have been fatalities among children and donkeys suffering from a "mysterious disease" in El Salam camp for the displaced in Deleig.

In an interview with Radio Dabanga on Tuesday [25 Feb 2014], Eisa Mohamed Musa, Central Darfur State's Health Minister, strongly denied the deaths. He responded to a claim by one of El Salam camp sheikhs that 23 children and 59 donkeys did not survive the disease.

The Minister said that the cases were suspected to be whooping cough. He affirmed that samples were sent last week [week of 17 Feb 2014] to a referral laboratory in Khartoum for diagnosis. "We have not received the results so far." He stated that the ministry had received reports from the Deleig rural hospital about 12 cases of pneumonia among children. In total 15 pneumonia cases were recorded in February [2014]; 55 percent of these cases have not received vaccination, 33 percent have not completed their vaccinations, and 11 percent have not had vaccination because they have no vaccination cards. "The age of the children infected with pneumonia ranges between 1-5 years old. No one has died."

According to the Minister, the cases are limited to the area of El Salam camp, emphasising the absence of similar cases in other areas in Central Darfur. "The situation is now stable." He demanded from "those who claim there were deaths among children to report the details to the director of Deleig hospital." He advised the parents to ensure the vaccination of their children after they are born, telling them that "vaccines are available in the hospital of Deleig."

The Health Minister told Radio Dabanga that "the ministry is facing many challenges."

"We are short of medical staff, and of transportation means, in order to cover vast distances to remote areas in Central Darfur. In addition, we are in urgent need of a referral laboratory to be located in one of the states of Darfur to diagnose suspected diseases, instead of having to send samples to Khartoum."

Musa also pointed to "the problem of transmission of diseases from neighbouring Chad and the Central African Republic. But above all, the transmission of diseases in Darfur is associated with the seasons. Climatic conditions play an important role in the spread of diseases.

"Apart from this, many women have complicated child births. And many of them are suffering from urinary fistula."

The Minister stressed the need for citizens to pay attention to primary health care. "The people are not well informed about health issues. They do not understand the messages broadcasted via the local radio stations about timely vaccinations."

He called on "the citizens of Deleig in particular and of Darfur in general, to regularly visit the nearest health facility, medical centre, or hospital, whenever there is an outbreak of a disease. They should actively search for information, reports, and follow-ups about the symptoms, spread, and treatment of the disease."

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[The Minister's denial of fatalities among children and donkeys in the El Salam camp adds confusion about the true nature of the situation there. The earliest report of 24 deaths among children came from North Darfur on 27 Dec 2013. On 12 Feb 2014, Radio Dabanga reported that about 75 percent of the children in Deleig camp, Central Darfur, were infected with a mysterious disease affecting children below the age of 12 years and donkeys. On 16 Feb 2014, a Deleig camp sheikh reported that 15 children and 47 donkeys had died. A 23 Feb 2014 report stated that the number of children who had died had increased to 23 and the number of fatalities among donkeys was 59. Perhaps a visit to the affected camps by medical NGOs would help to determine if these fatalities have occurred or not.

A HealthMap/ProMED-mail map showing the location of Central Darfur in Sudan can be accessed at: http://healthmap.org/r/4Iun. - Mod.TY

The Minister seems to be talking about illness in a different camp. Deleig is quite a long way south of Jebel Marra where the cases were reported in Nertiti camp, see map at http://wber.oxfordjournals.org/content/early/2011/01/28/wber.lhq019/F2.large.jpg showing Garsela-Deleige in the NE corner of Wadi Salih province in the centre of the map and Nertiti in the top right of the map in Jebel Marra province (unfortunately there is no map scale provided). Recently, Zallingi & Wadi Saleh were incorporated into the new province of Central Darfur.
- Mod.JW]

 

[Emily]

Re: Sudan: Undiagnosed outbreak in Deleig camp - government denies media report

http://reliefweb.int/report/sudan/five-children-die-mysterious-disease-central-darfur-camp-head

Published on 04 Mar 2014
?Five children die of mysterious disease in Central Darfur?: camp head
DELEIG (4 Mar) - Five children died on Saturday in the Deleig camp for the displaced, Central Darfur, of the ?mysterious disease? that appeared in the region more than a month ago.

The head of the Deleig camp in Wadi Salih locality reported to Radio Dabanga that that there are currently 73 infected children in the camp. ?They are in critical condition. On Saturday Mawadda Ahmed Adam (1 month), Abdallah Eisa Eisa (15 months), Najla Mohamed Doka (5), and two other young children died.?

He added that a large number of donkeys are infected too, and expressed his discontent at the lack of action by the authorities and humanitarian organisations to combat and contain the disease...

The medical director of the Deleig Rural Hospital strongly denies this is whooping cough. Laboratory tests are in progress in Khartoum.

 

[Ronan Kelly]

Re: Sudan: Undiagnosed outbreak in Deleig camp - government denies media report

Unknown disease hits El Salam camp in South Darfur
EL SALAM CAMP
(15 Jun.) -

On Thursday a girl died of a hitherto unknown disease at El Salam camp for the displaced in Nyala locality, South Darfur.

Sheikh Mahjoub Adam Tabaldiya of El Salam camp told Radio Dabanga that Kaltouma Adam Omda (12) died of an unidentified disease on Thursday.

?More than 1,000 camp residents have been infected within four days. The symptoms are high fever, diarrhea, vomiting, and coughing?, the sheikh explained.
...
https://www.radiodabanga.org/node/74972

Unknown disease kills 18 in Kalma camp, South Darfur
KALMA CAMP
(24 Jun.) -

An unknown disease that broke out in South Darfur?s Kalma camp a month ago has claimed the lives of 18 displaced.

The Association of Displaced People and Refugees of Darfur called on the UN, health organisations operating in Darfur, and the Sudanese Ministry of Health to immediately intervene, and stop the spread of the hitherto unknown disease, ?before it turns into a disaster?.

?The mysterious disease that started spreading in the camp a month ago, has killed 18 people so far?, Hussein Abu Sharati, chairman of the Association told Radio Dabanga on Monday. ?The symptoms are a loss of appetite, headache, pain in the chest, diarrhoea, vomiting, and a high fever.?
...
https://www.radiodabanga.org/node/75549

 

[alert]

Re: Sudan: Undiagnosed outbreak in Deleig camp - government denies media report

The story refuses to go away...

Published Date: 2014-07-06 19:58:10
Subject: PRO/AH/EDR> Undiagnosed outbreak - Sudan (09): (CD) children, donkeys, spread, RFI
Archive Number: 20140706.2591218

UNDIAGNOSED OUTBREAK - SUDAN (09): (CENTRAL DARFUR), CHILDREN, DONKEYS, SPREAD, REQUEST FOR INFORMATION
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Date: Sun 6 Jul 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/76237


A donkey owner reported to Radio Dabanga from Nierteti that last week a mysterious disease broke out in the locality.

"More than 40 donkeys died, 32 around Nierteti town, and 10 at Khor Ramla. Suddenly, the donkeys could not eat or drink anymore and started shivering. After a day or 2, they fell dead," the donkey owner explained.

Veterinary authorities in the locality have confirmed that so far the causes of the disease are unknown. "They said that they would take samples of the infected donkeys to send for tests in Central Darfur's capital of Zalingei."

On 24 Feb [2014], Radio Dabanga reported that an unknown disease had spread among donkeys in the Nierteti South camp for the displaced. Of the then 146 animals infected, 36 died within a week. The symptoms were coughing, weakness, [lack of] appetite, and weight loss. Veterinary authorities advised vaccinating the donkeys, but the displaced could not afford the vaccination costs.

Radio Dabanga reported on 12 Feb [2014] that about 75 percent of the children living in Deleig camp, Central Darfur were infected with a mysterious disease. The disease affected children below the age of 12 years and donkeys. Four days later, 15 children and 47 donkeys had died.

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[The apparent synchronic occurrence of a health problem in children and donkeys could be coincidental; otherwise, a common cause (biological or otherwise) should be sought. One of the etiologies which deserve to be taken into consideration in relation to the signs described in donkeys is botulism.

In any event, in view of the stubborn repetition of such information, investigation by a science-based international body (e.g. representatives in Darfur of FAO? WHO? Doctors/Veterinarians Without Borders?) is certainly clearly needed. - Mod.AS

 

[Ronan Kelly]

Re: Sudan: Undiagnosed outbreak in Deleig camp - government denies media report

Fever of unknown origin hits South Darfur camp
EL SALAM CAMP
(9 Jul.) -

A sudden high fever has caused the death of three displaced in El Salam camp, near South Darfur?s capital of Nyala. The causes are unknown.

Speaking to Radio Dabanga, camp sheikh Mahjoub Adam Tabaldiya reported that a baby girl and her mother died of the fever on Monday, a few hours after the mother had given birth. Another woman died last week.

Tabaldiya said that the two hospitals at the camp daily receive more than 600 people suffering from the fever, including many children.
...
https://www.radiodabanga.org/node/76425