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Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

nola_mnr

Well-known member
Hat-tip/ZCat

https://www.radiodabanga.org/node/82485

[...]
The director of El Fula hospital, close to Sudan's border with South Sudan, said that the hospital treats the two patients the same as patients with haemorrhagic fever. They show the same symptoms as the two civilians who died in Muglad this week: nosebleeds and high fever.
[...]

###

http://en.starafrica.com/news/ebola-fears-in-sudans-oilfields-spread.html

[...]
Sudanese authorities have repeatedly denied any cases of Ebola in the country despite many local media reports indicated that there are suspected cases in Darfur region.
[...]
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

More reports of illnesses from Sudan. This is the same source as the first link above. There is very little information coming out of Sudan.

https://www.radiodabanga.org/node/82609
[...]
He said that the first cases appeared on 20 October. ?Currently there is no home without a patient suffering from this fever.?
[...]
The medical assistant of the Um Shalaya refugee camp attributed the deaths to the spread of diseases such as malaria and respiratory infections.
[...]
A medical specialist at the Ministry of Environment has confirmed the emergence of hitherto unknown diseases in Darfur, South Kordofan and Blue Nile.
[...]
The director of the National Programme Against Tuberculosis, Dr Heba Kamal, recently announced that there are more than 20,000 cases of tuberculosis in Sudan. She warned that a number of patients have become immune to the treatment. ?This means?, she said, ?that the fatality rate will rise to 50 percent.?
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

If there is an ebola outbreak in Sudan (and we don't have enough information to know yet), it is possible that it is not directly related to the West Africa epidemic or the Central African Republic outbreak.

In 1976, the first known outbreaks of ebola occurred simultaneously in Zaire (now the Democratic Republic of Congo) and Sudan (now South Sudan).
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

More reports of illnesses from Sudan. This is the same source as the first link above. There is very little information coming out of Sudan.

https://www.radiodabanga.org/node/82609
[...]
He said that the first cases appeared on 20 October. ?Currently there is no home without a patient suffering from this fever.?
[...]

If someone in every home is ill, but only a handful of people have died, this isn't Ebola. This is also too many cases too fast to have had several generations of cases in a week.

That kind of distribution of cases suggests something vector-borne or food/water-borne, not a person-to-person illness.

Reports of undiagnosed illnesses in Sudan are unfortunately far too common:

http://www.flutrackers.com/forum/showthread.php?t=127563

http://www.flutrackers.com/forum/showthread.php?t=120915

http://www.flutrackers.com/forum/showthread.php?t=218035

http://www.flutrackers.com/forum/showthread.php?t=146906

http://www.flutrackers.com/forum/showthread.php?t=213719

http://www.flutrackers.com/forum/showthread.php?t=224492

http://www.flutrackers.com/forum/showthread.php?t=211926

http://www.flutrackers.com/forum/showthread.php?t=218817
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

More of the story, the phrase "no home without a patient" appears in the second paragraph.


Sudan: Six Refugees Die of Fever, Malnutrition in Central Darfur Camp

Azum Locality — The Chadian refugees of Um Shalaya camp, Azum locality in Central Darfur, complain about an increase of deaths, caused by "an unknown fever", accompanied by coughing, vomiting, and diarrhoea.

"Six people died so far, among them three children," Wardi Bahareldin, representative of the Chadian refugees in Darfur, told Radio Dabanga on Sunday. He said that the first cases appeared on 20 October. "Currently there is no home without a patient suffering from this fever."

He added that there is only one health centre in the camp, and appealed to the state's health authorities and aid organisations to provide more health care and medicines "as soon as possible".

Three patients in one bed

The medical assistant of the Um Shalaya refugee camp attributed the deaths to the spread of diseases such as malaria and respiratory infections. "Besides many people, and in particular children, are suffering from diarrhoea. Most of them are chronically malnourished," he explained to Radio Dabanga.

"These days, the general practitioner and two medical assistants at the health centre are receiving between 350 to 400 patients daily. We are currently accommodating between 120 to 175 people in the centre, which means that one bed is shared by three patients. Apart from an acute lack of beds, we are also short of medicines," he stressed.

Pollution, tuberculosis

A medical specialist at the Ministry of Environment has confirmed the emergence of hitherto unknown diseases in Darfur, South Kordofan and Blue Nile. "In particular these war-torn regions show an increase in pollution rates."

The director of the National Programme Against Tuberculosis, Dr Heba Kamal, recently announced that there are more than 20,000 cases of tuberculosis in Sudan. She warned that a number of patients have become immune to the treatment. "This means", she said, "that the fatality rate will rise to 50 percent."

...

http://allafrica.com/stories/201410272476.html
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

If someone in every home is ill, but only a handful of people have died, this isn't Ebola.

I agree with that but here appears to be a lot of disease in Sudan with multiple causes. A lot of the illnesses are known to be something else or have symptoms atypical of ebola (e.g. coughing). However, "nosebleeds and high fever" with two deaths could be.

Unfortunately, it is very hard to get accurate and timely information out of there.

The reports of drug-resistant tuberculosis are also concerning.
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Dengue fever kills 2 civilians and wounding 15 in El Fasher
26 أكتوبر 2014 | newspaper Sudan

mohammed-abdelhafeez announced that the Ministry of Health in North Darfur on Sunday, killing 15 people and wounding four others dengue neighborhoods of the city of El Fasher. She emphasized that diets are not Ebola, despite the similarity of symptoms, while revealed coordination with the mission "UNAMID" to prevent the entry of Ebola jurisdiction.

The Minister of Health mandate Mohamed Ahmed Abdel Hafiz about the existence of coordination with the United Nations Mission and the African Union to prevent the entry of Ebola to North Darfur, noting that his ministry will set up rooms for insulation in the border areas and the airport of El Fasher to deal with the arrivals of the country affected by Ebola.

Hafeez said, that after the emergence of cases of fevers They are similar in their symptoms of malaria accompanied by bleeding from the nose and mouth, the ministry was quick to investigate and take samples have been sent to the central laboratory, and found that 13 of them are for dengue mosquito-borne Azaaajh Egyptian.

He announced that Health has taken all precautions and measures to prevent the spread of the disease and the fight against cross-carrier spraying operations which began for all neighborhoods, next to the training of medical staff about ways of dealing with the disease, and to provide a stockpile of drugs and intravenous fluids.

Hafeez warned by a reporter, "Sunrise" Yasser Adam, to the presence of coordination with partners from national and foreign organizations to initiate a campaign to raise awareness of the health of the citizens

He assured citizens that the fever is contagious, and they fight against the carrier and sleep under mosquito nets. :tiphat:http://assudan.net/?p=28769
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

On Oct 19 an unofficial source in Khartoum Teaching Hospital confirmed that one patient was diagnosed with Ebola, One day after, workers at oil companies in West Kordofan State said that they have received alerts from their employers as there is a patient was identified with Ebola in Alfola hospital, however there is no official statement about the two cases yet.

On 21st, October, Altaghyeer an online newspaper cited a story from Almeghar Alsyasi, a daily newspaper in Sudan claims that WHO announced there are 19 identified cases in South Sudan, and Sudan government announced emergency situation on its boarders and ports. However nothing on WHO website on Ebola cases in South Sudan till the moment of writing this post. According to Sudan Tribune, the cabinet in South Sudan advised people not to shake hands in order to avoid catching the infection, yet this sounds not enough as there are more than 91% of the population lacking the improved sanitation facilities(world bank statistics of 2009-2013) beside the poor hygiene, lack of clean water resources in both Sudan and south Sudan.

http://kandakegranddaughter.blogspot.com/2014/10/the-government-of-sudan-must-act.html?spref=tw
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Source: http://news.sudanvisiondaily.com/details.html?rsnpid=241912


Issue #: 3377, Issue Date: 28th October, 2014
Khartoum Health Authorities Deny Ebola Cases

Khartoum – The Ministry of Health in Khartoum State denied the breakout of any Ebola cases in Sudan on Monday.

Spokesperson of health in Khartoum state Mutaz Hassan Bakhiet told reporters that there have been no Ebola cases registered in the country, accusing the media of spreading false information.

Bakhiet affirmed that Sudan has a good health system that meets international requirements, he added: “The health situation in Sudan has developed."

Minister of Health in North Darfur state, Mohamed Ahmed Abdalhafiz reiterated that his state is free from Ebola, revealing the high cooperation and coordination with UN African Mission in Darfur (UNAMID) and the Darfur Regional Authority to monitor entrances and check points at borders alongside El Fashir airport...

*************************

Source: http://www.shanghaidaily.com/article/article_xinhua.aspx?id=249163

» Latest News
Sudan health ministry affirms Sudan Ebola free
Oct 28,2014

KHARTOUM, Oct. 27 (Xinhua) -- Sudan's Ministry of Health on Monday reiterated that Sudan is free of Ebola disease, noting that no confirmed or suspected case has been registered.

"The ministry (of health) reiterates that the country is free of Ebola disease and that no confirmed or suspected cases were registered", the ministry said in a press release.

"Also, nothing was received from the World Health Organization (WHO) indicating existence of any infection cases in the neighboring countries, which confirms that Chad and South Sudan are free from any Ebola cases", it added.

The ministry further announced that it has worked to increase sensitivity of disease monitoring at the crossings of the border states and new monitoring centers have been established in five states of Darfur besides West and South Kordofan, White Nile and the Red Sea States, stressing that cadres who operating disease monitoring and personnel of the forces have been trained on disease detection, means of prevention, the necessary medical interventions and infection control.

In the meantime, the ministry admitted a great increase in malaria infection rates in Khartoum, Gezira, West Kordofan and North Darfur States, saying that "malaria has become an epidemic threat where some cases of severe malaria have been registered in Gezira and West Kordofan States"...
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported

Another version of Treyfish's post from earlier;

Death and injuring of (17) citizens of dengue fever in Sudan?s El Fasher

Khartoum-SudaneseOnline -Sudanese North Darfur?s Ministry of Health announced on Wednesday death of two citizens and wounding (15) others of the dengue fever in four neighborhoods in El Fasher city.
The minsitery confirmed that the fevers are not Ebola despite similarity in symptoms, revealing the coordination with the African Union ? United Nations Hybrid Operation in Darfur (UNAMID) to prevent entry of Ebola for the state
In press statements on Sunday, North Darfur?s Health Minister Mohammed Ahmed Abdel Hafiz said that there is coordination with UNAMID mission to prevent entry of Ebola to his state, pointing out that his Ministry will set up special rooms in border areas and at El-Fasher airport to deal with the arrivals of the country affected by Ebola.
Abdel Hafiz said after occurrence of viruses similar to the malaria symptoms accompanied by bleeding from nose and mouth, the Ministry has investigated into the fever and taken samples which sent to the central laboratory and showed that (13) of the cases is mosquito-borne dengue fever which transmitted by Aedes mosquitoes.
The minster announced his state has taken all precautions and procedures to prevent the spread of the disease and fight the carrier through the spraying of all neighborhoods which have already begun, besides training of medical staff about ways to deal with the disease and to provide drugs for affected persons, adding that there is coordination with partners from the national and foreign organizations to initiate a campaign to raise awareness among citizens and assured citizens that the viruses are not infectious.
http://www.sudaneseonline.com/board...gue-fever-in-Sudan’s-El-Fasher-1414443398.htm
 
Sudan: Seven Children Die in North Darfur Camp, Dengue Fever Cases in El Fasher

Sudan: Seven Children Die in North Darfur Camp, Dengue Fever Cases in El Fasher

Source: http://allafrica.com/stories/201410281325.html


Radio Dabanga (Hilversum)
28 October 2014
Sudan: Seven Children Die in North Darfur Camp, Dengue Fever Cases in El Fasher

North Darfur ? Seven children died in Shangil Tobaya camp in North Darfur within the last ten days. In El Fasher, capital of North Darfur, two people died of Dengue fever on Sunday. 15 others are infected.

Speaking to Radio Dabanga, the coordinator of the Shangil Tobaya camp said that an unknown disease hit the camp, "in particular the children".

"Seven children died the past ten days, among them two siblings who both died on Monday. They were vomiting blood, and complaining of severe headaches."...
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Sudan has banned reporting on Ebola.
http://en.starafrica.com/news/sudan-bans-reporting-on-ebola.html

And the health ministry reports Sudan is Ebola free
http://news.xinhuanet.com/english/a...al&utm_source=twitter.com&utm_campaign=buffer

Reports persist
http://kandakegranddaughter.blogspot.co.uk/2014/10/the-government-of-sudan-must-act.html

As I mentioned earlier in the post Ebola in Sudan? unofficial sources prefers to remain anonymous testified that there was a case identified in Khartoum hospital. Oil companies in West Kordofan warned its' employees as another case identified in Alfola hospital. All the government efforts since then was meeting with Ethiopian authorities, attending a meeting in Tunisia, creating a kind of mechanism with DRC & CAR ...

Khalid Abdel Ati, a Sudanese pathologist told Sudanese Dream "The danger in Ebola outbreak extends beyond the high mortality rates to the destruction of the whole health system. Whenever there is case of Ebola discovered in a certain hospital; people would ban that hospital and hence might die as a result of complications of other health conditions. The health workers would be reluctant to provide medical care to any patients with hemorrhage of unknown cause. Never mentioning that the reagents to test the Ebola are not available in Sudan as well as the laboratory safety for handling suspected specimen is Level 4. Upon this circumstances, any case of hemorrhage should be handled as Ebola until proofed to be another condition"

The fact that Ebola cannot be tested in Sudan was confirmed by Dr. Hayat Salah, the head of Epidemiology department in the ministry of health in an interview with Alsaiha, a Sudanese daily newspaper on 27th, Oct 2014 issue.
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Health: malaria epidemic in the country and not Ebola


<dl class="article-info" style=";text-align:left;direction:ltr"><dt class="article-info-term"> Details </dt><dd class="published"> Published on Thursday, October 28 1 / Okrudolf 2014 09:31 </dd></dl>
hjhggfd.jpg

Khartoum: Emotions Qadir
Federal Ministry of Health has confirmed the absence of the country from the epidemic of Ebola and non-registration of any confirmed or suspected Sudan's case, while the ministry recognized the extreme rise in Hlat incidence of malaria both Khartoum and the island and West Kordofan and North Darfur, described the current status of malaria as a threatened epidemic. The ministry revealed in a statement about the recording of cases of severe malaria on the island and West Darfur. The ministry announced that an agreement has been reached with the United Nations spends not to change the UNAMID forces during the next three months, the ministry stressed that the WHO did not respond as stating the existence of any cases of neighboring countries, which confirms the absence of both Chad and South Sudan of any cases of Ebola.
Pointing out that the Nigerian government's ability to control the epidemic. The ministry said it has worked to increase the proportion of surveillance sensitivity crossings and the US border and the establishment of new centers to monitor the states of Darfur in five western and southern Kordofan, White Nile and the Red Sea and the airport in Khartoum, as well as the establishment of centers to isolate each of the Suakin and Port Sudan, Khartoum and Kosti and Alfolh and Kadugli and Darfur States, have been trained cadres in the field of surveillance of patients on how to detect cases, prevention and therapeutic interventions and the provision of personal aids infection control and prevention, in addition to training the regular forces and the joint forces and the forces of the United Nations and the African Union.:tiphat:https://translate.google.com/transl...UTF-8&u=http://www.alintibaha.net/&edit-text=
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

ProMED looking for info...

Published Date: 2014-10-28 09:09:05
Subject: PRO/AH/EDR> Undiagnosed hemorrhagic fever - Sudan (02): (WK) RFI
Archive Number: 20141028.2907268
UNDIAGNOSED HEMORRHAGIC FEVER - SUDAN (02): (WEST KORDOFAN) 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: Fri 24 Oct 2014
Source: Radio Dabanga [edited]
https://www.radiodabanga.org/node/82485


A listener told Radio Dabanga that 2 civilians died from an infection, and 2 other infected [individuals] remain in the hospital of El Fula [Al-Fulah], West Kordofan. They all showed symptoms that may qualify for the deadly Ebola [virus] disease.

The director of El Fula hospital, close to Sudan's border with South Sudan, said that the hospital treats the 2 patients the same as patients with haemorrhagic fever. They show the same symptoms as the 2 civilians who died in Muglad this week: nosebleeds and high fever.

Speaking to Radio Dabanga, the production manager of the petrol company Energy for Petrol, working in oil fields near El Fula, said that he called El Fula hospital for information about the patients and the [possible] Ebola virus [infections]. The director told him that the infected patients showed symptoms of bleeding and fever.

The production manager asked his employees via Radio Dabanga to take caution and attend to their personal hygiene.

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

[Not enough detail is provided for these 4 cases to make a definite diagnosis. Interestingly, no mention is made of diarrhea, a common symptom of Ebola virus disease in the current outbreak in West Africa. Yellow fever (YF) virus infection is an obvious possibility, given that it has occurred in the region in the not-too-distant past. Between 3 Oct and 24 Nov 2013, a total of 44 confirmed cases of YF were reported, including 14 deaths. A total of 12 localities in West and South Kordofan were affected by that outbreak.

A thorough laboratory study is needed for the cases above. ProMED-mail would appreciate receiving information about additional cases or results of any laboratory test rests that become available.

Maps of Sudan can be seen at http://www.emapsworld.com/images/sud...itical-map.gif

http://www.promedmail.org/direct.php?id=2907268
 
Last edited by a moderator:
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Hemorrhagic fever cases reported in Sudan?s Kordofan

KADUGLI (5 Nov.)

About five cases of hemorrhagic fever have been reported in Kadulgli town in Sudan?s South Kordofan, according to medical sources.

A source told Radio Tamazuj that about five children were taken to Kadugli Hospital, amid a media blackout due to a visit by the First Vice President Bakri Hassan Selah to the town today.

The visiting vice-president was expected to inaugurate health facilities in the area. Meanwhile, security agents allegedly refused a transfer of one of the suffering children to El Obeid Hospital for treatment.

This comes after similar reports in October of patients suffering from high grade fever and epistaxis (bleeding from the nose) in an oil-producing area of neighboring West Kordofan State.
...
https://radiotamazuj.org/en/article/hemorrhagic-fever-cases-reported-sudan’s-kordofan
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

There is also a thread on similar cases in Darfur, Sudan
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Source: https://www.radiodabanga.org/node/83626


Health Ministry registers hemorrhagic fever in North Darfur
EL FASHER
(14 Nov.) -

The North Darfur Ministry of Health and the World Health Organization (WHO) have reported that 81 cases of hemorrhagic fever were registered between 28 August and 5 November in El Fasher, Dar El Salam, Kuma, and Tina localities. This includes three fatal cases.

An overwhelming 95 percent of the potentially fatal hemorrhagic cases is from El Fasher locality, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported in its news bulletin this week. The most cases, a total number of 35, in the four localities were reported two weeks ago.

15 out of 22 blood samples tested positive for dengue fever. The results of re-confirmation tests by the WHO are expected to be released soon, the humanitarian office writes...
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Humanitarian Bulletin
Sudan
Issue 46 | 10 ? 16 November 2014
http://reliefweb.int/sites/reliefwe...n_Bulletin_Issue_46_(10-16_November_2014).pdf

...
Dengue fever outbreak in North and West Darfur
The State Ministries of Health (SMoH) in North Darfur and West Darfur and the World
Health Organization (WHO) report that since late August 101 cases of Haemorrhagic
Viral Fever/ Dengue Fever have been registered. All but three of the registered cases
occurred in North Darfur.

In North Darfur, SMoH said that between 28 August and 12 November 2014 the total
cumulative number of cases reached 98, including three deaths. This is an increase of 17
cases compared to the last week. The cases were reported from the localities of El
Fasher, Dar El Salam, Kuma, Klaimendo, Tawila, and Tina, with the majority detected in
El Fasher locality. This includes five suspected cases from three IDP camps - three
cases in Abu Shouk camp, Zamzam and Salam camps had one case each, SMoH said.
SMoH, WHO and partner organisations continue to implement measures aimed at
containing the outbreak. This includes indoor spraying campaigns in El Fasher town,
awareness raising activities targeting affected areas, health promotion activities as well
as information campaigns in the local media.
In West Darfur, three cases of dengue fever have been reported by WHO after 21 blood
sampes were sent for testing at the national public health laboratory in Khartoum. The
SMoH and WHO have formed a task force to prepare a contingency plan, monitor
interventions and support other prevention activities.
According to WHO, dengue is transmitted by mosquitos infected with one of the four
dengue virus serotypes. There is no vaccine or any specific medicine to treat dengue.
Severe dengue (also known as dengue haemorrhagic fever) is characterised by fever,
abdominal pain, persistent vomiting, bleeding and breathing difficulty and is a potentially
lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical
management by trained physicians and nurses increase survival of patients.
...
 
Re: Sudan - West Kordofan: Reports of patients with haemorrhagic fever-like illness; Two deaths reported - dengue

Source: https://radiotamazuj.org/en/article/more-reports-hemorrhagic-fever-sudans-south-kordofan

More reports of hemorrhagic fever in Sudan's South Kordofan
KADUGLI (22 Nov.)

People in Kadugli, Abu Jubaiha, and Habila localities in South Kordofan have complained about the outbreak of an unknown fever. The outbreak has also been acknowledged by the state?s health minister.

A number of residents revealed that the symptoms of this disease are high fever, vomiting, and headaches. It has led to ?a high mortality rate?, they told Radio Dabanga. The residents pointed to the shortage of medicines and health care.

?The state authorities ignored us despite the repeated complaints,? said one source. South Kordofan?s Minister of Health said that the government has sent medical teams to the affected areas.

In a press release, Minister Abdallah Imam El Tom previously acknowledged the spread of hemorrhagic fever, as well as leishmaniasis. He revealed that 25 people were infected and have been isolated in hospitals...
 
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