Zimbabwe Cholera Epidemic Over - Not!

December 12, 2008

Robert Mugabe, fearing that the United States and the United Kingdom would use Zimbabwe's cholera epidemic as an excuse to topple his dysfunctional regime, has found an easy way out. He has simply declared that the epidemic has ended.

Sorry, Mr. President. It's not that simple.

One thing that world leaders and non-government organizations can agree on is that Zimbabwe's cholera epidemic is far from over, and that Mugabe and his government are not capable of reversing the total collapse of infrastructure that their policies precipitated. Kofi Annan, former Secretary-General of the United Nations, summarized that consensus, in a statement reported on December 8th. 

"This government," said Annan, "has not demonstrated the ability to lead the country out of its current crisis."

The World Health Organization reported on Wednesday that 775 people have died as a result of cholera in Zimbabwe since August. At least 16,141 suspected cases have been reported. WHO fears that the total number of cases could surpass 60,000 before the epidemic is contained.

Zimbabwe's problem also has become the problem of its neighbors, especially South Africa, Mozambique and Botswana. South Africa already has reported more than 600 cases of cholera in its norther border area near the Limpopo River. The South African government has declared one district – Vhembe – a disaster zone.

Zambia – Zimbabwe's northern neighbor – has set up a cholera screening process for people trying to cross the border into Zambia at Victoria Falls. Several people already have been turned back, and Zambian border officials have confiscated potentially contaminated food that individuals were trying to bring across the border with them. So far, the quasi-embargo appears to be working.

Regardless of what the world community thinks of Mugabe's regime, international aid agencies, governments and NGOs have been pitching in with supplies, money and trained workers to help the people of Zimbabwe. The International Committee of the Red Cross, and WHO have been on the job for weeks. The United States, through USAID, announced yesterday that it would contribute an additional US$6.2 million in aid, bringing its total contribution to Zimbabwe cholera relief to more than US$10.8 million. USAID also is sending a Disaster Assistance Response Team to Zimbabwe.

South Africa, too, is cooperating in relief efforts. And other African countries are making their own contributions. Tanzania, for example, has donated US$60,000 in medical supplies to Zimbabwe.

Doubtless, once this cholera epidemic has been contained, Robert Mugabe will claim the credit. But this is no time to play politics. Last March, when Cyclone Nargis struck Myanmar, the government put itself ahead of the population. This time, the health needs of the people must take priority over the political future of their President.

Zimbabwe Exports Cholera To Neighbors

The Zimbabwean economy is so bad that it has nothing to export – except its cholera victims. It has plenty of those.

According to the country's opposition leader, Morgan Tsvangirai, more than 500 Zimbabweans have died of cholera in an epidemic that has been simmering since August. The World Health Organization is somewhat more conservative, estimating a death toll of 412.

It's taken the better part of four months, but the government finally appears to have acknowledged that an epidemic is in full flower. One week ago, the deputy health minister blamed the epidemic on "illegal sanctions" and stated that the situation was under control. And Zimbabwe denied entry visas to a committee of "Elders" – former US President Jimmy Carter, former UN Secretary General Kofi Annan and Graca Machel, the wife of Nelson Mandela – who were hoping to help the country find a solution to its health crisis. 

The situation in Zimbabwe has been exacerbated by the total breakdown in the country's water and sewage infrastructure. On November 30, running water was cut off to the capital city of Harare. The water treatment department had run out of chemicals needed to treat the water. As a result, residents were forced to collect water from stagnant pools, or dig shallow wells – increasing the chances that cholera would continue to spread.

Earlier today, with the rainy season on its way and the epidemic still unchecked, Zimbabwe's President Robert Mugabe finally acknowledged the severity of the situation. He described the cholera situation as "disastrous" and called upon the population to exercise good hygiene practices. But it's not clear what the government can – or will – do to stem the cholera epidemic, beyond continuing to accept the assistance of international aid organizations, including the World Health Organization and the International Red Cross.

Meanwhile, Zimbabwe's neighbors are getting increasingly nervous. Cholera victims have crossed the border into South Africa, hoping to receive treatment that is unavailable at home. Between November 15th and November 24th, 168 cholera victims from Zimbabwe were treated in one South African border city alone. 

The United Nations has warned that the disease also is spreading into neighboring Botswana. And an editorial in the November 28th edition of The Daily Times (Malawi) urged that individuals crossing from Zimbabwe into Malawi should be required to take "preventive medication" to forestall further spread of the disease.

Zimbabwe's neighbors have reason to be afraid. Cholera is easily spread through contaminated water. The best defense against this disease is a safe drinking water supply and a sanitary means of human waste disposal – two items that are scarce in that part of the world. Even South Africa, the most developed of the countries in the region, has failed to maintain its water infrastructure.

In this last month of the International Year of Sanitation, the Zimbabwe cholera epidemic is a frustrating reminder of how much work is left to do.

Cholera in Zimbabwe and Beyond: The Perfect Storm

December 26, 2008

According to the latest report from the World Health Organization, the current cholera epidemic has killed 1,518 Zimbabwean victims. As of December 25th, 26,497 confirmed cases of cholera have been recorded, with more to come. And these numbers already are out of date.

While international aid agencies appeal – successfully – for money and supplies to fight the epidemic, Mugabe continues to resist the international community's attempts to assist victims. According to Zimbabwe's president, the cholera epidemic is a plot hatched by the United Kingdom to overthrow the government.

As we've reported previously, the Zimbabwe epidemic has spilled into neighboring countries, especially South Africa. Botswana and Zambia are on alert for cholera flare-ups, while Zimbabwe's remaining neighbor – Mozambique – is struggling to contain its own outbreak, which has claimed 31 lives (out of 1,585 confirmed cases) so far.

Africa's cholera problems, unfortunately, extend well beyond Zimbabwe and its immediate neighbors. Look for poverty, war, and natural disasters, and you will find cholera. In addition to Zimbabwe and Mozambique, WHO's cholera "hot spots" include Angola (10,186 cases and 232 deaths), Democratic Republic of Congo (357 new cases and 1 death in a two week period), Ethiopia (3,804 cases of "acute watery diarrhea", with 23 deaths) and Kenya (1,400+ cases and 13 deaths).

Other African countries that have been – or are still – battling cholera outbreaks include Guinea Bissau (14, 201 cases and 224 deaths), Namibia (29 cases and 3 deaths), Togo (100 cases and 1 death), Uganda (66 cases in a camp set up to house Congolese refugees), Nigeria (10 deaths) and Malawi (30+ victims and at least 8 deaths).

A seasonal disease, cholera's appearances often coincide with the rainy season. During dry periods, it lingers in the background, causing occasional illnesses in places such as the Philippines and India, where a young visitor from Hong Kong recently became infected.

Zimbabwe's rainy season extends from November to March. The UN estimates that more than 5 million of its residents are in need of food aid. 

No sanitation, no food, a dysfunctional government, and a cholera epidemic – all with the rainy season just beginning. A perfect recipe for a perfect storm.

Zimbabwe Cholera Update

December 3, 2008

The situation in Zimbabwe continues to deteriorate.

Two days ago, we reported that Zimbabwe's neighbors were getting worried that the Zimbabwe epidemic would spill over. South Africa, Botswana and Malawi already had reported cholera cases in people who had crossed their shared borders with Zimbabwe. Yesterday, the news got worse.

The health department of Limpopo Province (South Africa) reported that Vibrio cholerae – the causative agent of cholera – has been detected in the Limpopo River. This river forms part of the border between South Africa and Zimbabwe, as well as between South Africa and Botswana. Limpopo has treated 399 cholera patients since November 15th. An additional 101 patients were admitted to hospitals around the province between December 1st and 2nd. Six of the cholera patients – 2 South Africans and 4 Zimbabweans – have died.

In an update released yesterday, the World Health Organization reported that the cholera death toll in Zimbabwe had reached 484 as of December 1st; 11,735 cases of cholera have been reported in the country since August. But that tally already is out of date. According to the United Nations, the cholera epidemic has claimed 565 lives – 177 in Harare. The number of confirmed cases nationwide has risen to 12,546 victims, of which 6,448 live in Harare.

A Harare diarist's cry of desperation was published on-line by BBC yesterday. "People are dying in great numbers," Esther (not her real name) wrote, "because ... Harare's two main hospitals are closed."

"In some parts of town there is raw sewage running down streets."

Cholera Chronicle: May 20, 2009

Welcome to the eFoodAlert Cholera Chronicle. Periodically, we'll present a summary by region of cholera news from around the world.

Cholera is spread through human fecal contamination of food and water supplies. It is a frequent Disease of Disaster, accompanying famines, floods, wars, and other natural- or man-made disasters. Its victims typically are destitute, displaced or debilitated. And, all too often, dead.

Africa

• Zimbabwe: The United Nations reported on May 11th that the death toll for this 9-month outbreak has reached 4,271; at least 97,400 people have been infected with Vibrio cholerae since August 2008. The good news is that the number of new cases has dropped significantly – just 65 during April. Nevertheless, the conditions that allowed this outbreak to spin out of control are still in place. Zimbabwe suffers from inadequate medical facilities, inadequate sewage treatment, and and inadequate supply of fresh, safe drinking water. Mugabe inherited a system that worked. When he eventually steps down – or dies – he will bequeath to his successor a broken-down, dysfunctional national infrastructure.
  
• Kenya: The government is responding to limit the spread of an incipient outbreak of cholera in the capital city of Nairobi. Three cases have been reported so far. The city's water and sewage company also has responded, by moving to clean and repair the Nairobi sewer system, which typically suffers from an average of 600 sewage blockages and overflows per month.
  

Asia

• Vietnam: The country's annual tussle with cholera is well underway. Already, one person has died of cholera and 53 have been infected. At least 500 people have reported suffering from acute diarrhea. The outbreak has spread to 11 provinces so far. Some of the cases have been blamed on contaminated dog meat. As a result, the country has temporarily shut down a dozen or more dog slaughterhouses in an effort to contain the outbreak. 
  

Cholera can be treated successfully, if adequate medical facilities are available. More importantly, outbreaks can be prevented, by providing communities with safe drinking water, and with sanitary disposal facilities for human waste. 

2008 was the International Year of Sanitation. The World Health Organization partnered with other agencies to promote improvements in sanitation in underdeveloped areas of the world. But it will take many years before these efforts make a significant dent in the problem. 

Meanwhile, cholera will continue to follow in the wake of world disasters.

Cholera and Diarrhea by the Numbers – Iraq and Elsewhere

Everyone seems to agree that there is – or was – an outbreak of cholera in Iraq. But that's where the agreement ends.

The International Society for Infectious Diseases, in an unusual move, incorporated five different reports on Iraq's cholera outbreak into its September 15th "Cholera, Diarrhea and Dysentery Update." The official, government-provided data reported 5 deaths and 68 confirmed cases of cholera. But the Chairman of Iraq's Parliamentary Health Commission claimed that more than 1,000 people had died, and unnamed members of parliament have said that more than 10,000 people have been hospitalized with the disease.

To add to the confusion at the national level, a member of the Governorate Council of the province of Babil has accused Iraq's leaders of hiding the magnitude of the outbreak and has demanded that the province's Health Director be dismissed for mishandling the crisis. According to the report in the Al-Zaman newspaper (available on RedOrbit), Babil has suffered more than 15 deaths from cholera, and there are 50 victims hospitalized in two hospitals, alone.

Political considerations aside, it's understandable that officials at various levels can't agree on the scope of the outbreak. We saw reporting lags and misunderstandings in the United States during the Salmonella Saintpaul outbreak, and in Canada's recent Listeria monocytogenes outbreak, even though both countries maintain sophisticated reporting systems. Some of the reporting discrepancies in Iraq are probably due to logistic and bureaucratic delays; others may be due to confusion between "confirmed" and "suspect" cases of the disease. It will take some time before the true impact of this year's Iraqi cholera epidemic is known.

Iran, Bahrain and Kuwait are watching the situation in Iraq with unease. Iran has warned its citizens who are making pilgrimages to Iraq for Ramadan to take special precautions to guard against infection. So far, no Iranians who traveled to Iraq have developed cholera. Bahrain is monitoring food products and travelers entering the country from Iraq. And Kuwait has banned the import of foodstuffs from Iraq.

Meanwhile, cholera is carrying on its usual activities in other parts of the developing world.

Zimbabwe

A recent cholera outbreak in the Harare region (Chitungwiza) claimed 11 lives and sickened 80 more. That outbreak has been contained, in part thanks to the efforts of UNICEF. 

But the risk of new outbreaks is ever-present, due to the deteriorated water and sewage infrastructure in and around the country's capital city. According to the chairman of the Harare residents association, the population is "... sitting on a time bomb that can explode anytime as a result of the unavailability of a reliable source of water, the flow of raw sewage in residential areas and piling of uncollected garbage around Harare and surrounding areas." The Zimbabwe Health Minister, however, said that the situation was under control.

Guinea-Bissau

UNICEF representatives have been working with the local government in Guinea-Bissau to control and especially stubborn cholera outbreak. But the outbreak has resisted all efforts at containment and has spread to all 11 regions of the former Portuguese colony.

At least 6,461 people have contracted cholera since the outbreak began in May of this year. As of September 16th, the death toll stood at 122 – more than double the 59 deaths that had been reported as of August 21st. 

Health officials blame the difficulty in controlling the epidemic on "... rains, the lack of basic sanitation and the population's stubbornness in not following the authorities' instructions..." 

Nepal

Flooding has triggered an outbreak of infectious diarrhea in the southeastern part Nepal, claiming 3 lives and sickening at least 22 people in the Susari district. The Saptari district, in southern Nepal has been hit even harder; cholera, pneumonia and fever have claimed 11 lives and sickened more than 13,000 victims living in a temporary camp.

Kenya

The Kenya Broadcasting Corporation reported on September 12th that cholera was responsible for 23 deaths in the Bungoma and Homabay districts. As is so often the case, the outbreak was blamed on contaminated river water that is used by local residents for drinking, washing and cooking.

Separately, about 50 cases of infectious diarrhea – not confirmed as either cholera or dysentery – were reported in the Tana Delta District. The Tana river apparently changed its course, drying up the reliable water supply for approximately 40,000 people. 

Tanzania

Cholera has reappeared in northern Tanzania; 180 cases have been reported in two districts. Four people in the Tarima district, which borders Kenya, have died. The government has responded by sending medical personnel and medicines to the area and by arresting some individuals who violated health regulations.

Bangladesh

Dhaka has been experiencing an increase in cases of diarrhea, now that flood waters are receding. During the rainy season, the rate of admission to the "cholera hospital" of patients with diarrhea was 400-450 per day. That number has risen to as high as 600 in a single day. The hospital has erected tents in the parking lot to increase its capacity to treat diarrhea patients.

Indonesia

An unchecked outbreak of cholera has killed at least 291 members of a Papuan tribe since April. Human rights organizations are expressing concern that, if left unattended, the outbreak may spread beyond the confines of Papua and trigger an international epidemic – as happened in 1961.

Philippines

The Dagupan City Health Office is taking steps to prevent future outbreaks of cholera and other forms of infectious diarrhea in that northern Philippines city. Health officials are conducting education campaigns, and sanitation teams are sampling raw and treated water. The new campaign was triggered by reports of three new cases of cholera in the area.

Hong Kong

The Centre for Health Protection (CHP) has confirmed an isolated case of cholera. The victim is a 25-year old man from Tuen Mun. He is in hospital in stable condition. There is no obvious explanation for the man's illness. He has not traveled recently, and has not been in contact with anyone who was suffering from the disease. This is only the second confirmed case of cholera in Hong Kong in 2008.

Also this week, CHP issued a reminder to Hong Kong residents to pay attention to personal hygiene and hand washing, after receiving 19 reports of dysentery – 18 locally-acquired and one imported – so far this month. Five of the victims had eaten at a local fast-food restaurant. Shigella, the microbe that causes dysentery, has no known animal reservoir. It is spread human-to-human through fecal contamination of food, water or utensils. Dysentery is best controlled by scrupulous attention to sanitation and personal hygiene.

Cholera Chronicle: May 10, 2009

Welcome to the eFoodAlert Cholera Chronicle. Every Sunday, we'll present a summary by region of cholera news from around the world.

Cholera is spread through human fecal contamination of food and water supplies. It is a frequent Disease of Disaster, accompanying famines, floods, wars, and other natural- or man-made disasters. Its victims typically are destitute, displaced or debilitated. And, all too often, dead.

One troubling side-effect of the current influenza near-pandemic is the diversion of international attention and resources from the fight against cholera and other diseases that afflict the world's underdeveloped countries.

The World Health Organization, which had been providing regular updates on the status of Zimbabwe's cholera outbreak, issued its last report on March 23rd. At that time, the number of new cases reported weekly had decreased from a peak of approximately 8,000 to just 2,076.

Asia, Including Russia

• India, May 9 – Contaminated water in Hyderabad's district of Bholakpur has led to an outbreak of cholera in the state capital. An initial report of 10 confirmed cases has now grown to at least 16 victims. A two-member team has been dispatched from Kolkata to assist local health authorities in dealing with the outbreak.
  
• India, May 10 – Officials in Vijayawada have expressed concern that their city, too, might experience an outbreak of cholera similar to the one that has struck Hydrabad. Vijayawada, which has a slum population of 350,000 people and a 20-year old water supply system, is crisscrossed by a canal system that is susceptible to sewage contamination.
  

Africa

• Zimbabwe, May 7 – The United Nations warned that the country's cholera epidemic – finally is on the wane – will reignite if attention is not paid to renewing the countries water and sewage systems, which have collapsed from neglect under the Mugabe regime.
  
• Congo, May 8 – Health authorities in the southern region of Pool have reported 130 new cases of cholera since early April.
  

Cholera can be treated successfully, if adequate medical facilities are available. More importantly, outbreaks can be prevented, by providing communities with safe drinking water, and with sanitary disposal facilities for human waste.

2008 was the International Year of Sanitation. The World Health Organization partnered with other agencies to promote improvements in sanitation in underdeveloped areas of the world. But it will take many years before these efforts make a significant dent in the problem.

Meanwhile, cholera will continue to follow in the wake of world disasters.

The China Syndrome: Looking Back (Again)

What's worse? A cholera epidemic that got out of hand due to government neglect, denial and incompetence, or the systematic adulteration of food and feed that was winked at by all levels of government? It depends on your point of view.

Zimbabwe's government, let by Robert Mugabe, has a lot to answer for. After decades of neglect, the country's water and sewage infrastructure – once fully modern – has collapsed. The resulting cholera epidemic has claimed more than 500 lives and infected in excess of 12,000 Zimbabweans. And it has spilled into the neighboring countries of South Africa and Botswana.

China's melamine adulteration scandal, in contrast, cost 6 lives and sickened 294,000 infants – nearly 52,000 of them were hospitalized – as a result of the presence of high levels of melamine in Chinese dry infant formulas. 

While the cholera epidemic is tragic, the disease is endemic in Africa and Asia. Periodic outbreaks happen – usually as a result of a natural or man-made disaster. The Zimbabwe epidemic might be the straw that topples Mugabe's government, but it won't have a lasting impact on the world economy. 

Melamine, on the other hand, has changed the way in which China's trading partners view the safety and reliability of the country's food and feed exports. All over the world, countries large and small, rich and poor, developed and emerging, reacted to the melamine scare by closing their borders to Chinese dairy imports, removing those products from store shelves, and testing them for the presence of melamine. 

As soon as the Chinese government – after initial denials – began to get a handle on the dairy problem, other shoes started falling. Melamine was reported in egg powder, animal feed, shell eggs, and even a chemical leavening agent. More borders were closed. More products were embargoed.

China now is faced with a serious credibility problem. The European Union, which already prohibited the import of milk and other animal products from China, now requires that all products from China that contain milk as an ingredient must be tested for melamine. And – after a French company reported finding melamine in a sample of soy meal – the EU also has banned soy-based foods from China that are meant to be consumed by infants and young children. All other soy-containing foods from China must be tested for melamine at the time of import.

Canada, a long-standing trading partner, hasn't quite closed its border to protein-based foods from China. But it now requires importers to sample and test:

• infant formula or baby food with milk ingredients sourced from China;
  
• Chinese food products derived from milk or containing milk-derived ingredients as one of the first three ingredients; and
  
• dairy ingredients and soybean meal from China destined for use in animal feed.
  

Last month, the United States issued an Import Alert advising border agents to detain without examination "... all milk products, milk derived ingredients and finished food products containing milk from China..." This de facto embargo puts the onus on importers to document the safety of each individual shipment. The US Food and Drug Administration also has opened an office in Beijing to work with Chinese officials on ensuring the safety and quality of food and drug ingredients and products destined for shipment to the United States.

From the Chinese perspective, a cholera epidemic might have been preferable to the melamine adulteration. At least cholera is easily treated, if one can deliver medications, clean drinking water and some basic health care to the afflicted population. 

And cholera wouldn't have triggered the international after-effects that have resulted from the melamine scandal.

Cholera Oozes Across Africa

March 23, 2009

In the three months since we last visited Africa, cholera has continued its usual seasonal spread across the continent – helped, as always, by lack of access to safe drinking water, limited availability of health care, and an inadequate supply of toilets.

As of March 16th, the death toll in Zimbabwe's long-running cholera epidemic had reached 4,035 and the number of recorded cases surpassed 91,000. But there are signs that the epidemic is starting to abate. The number of new cases has fallen from a peak of nearly 8,000 per week to only 4,000-4,500 per week.

But, while the epidemic is showing early signs of running down in Zimbabwe, outbreaks of cholera have emerged elsewhere in Africa.

Angola reported three cholera cases last Friday, after flooding induced by heavy rains left 33,000 people homeless in the southern part of the country. 

Botswana has confirmed 15 cases of cholera, with an additional 40 cases under investigation, according to a report released last week.

Kenya has been hard-hit recently. The national government issued a cholera alert last Tuesday, while revealing that the disease recently had killed 25 people, and infected 551 in various parts of the country. This is in addition to the 369 cases and 16 deaths reported in February.

Malawi has suffered its worst cholera outbreak in six years, with 4,697 cases and 104 deaths since the start of this year's rainy season in January.

Mozambique reported 30 new cases since the end of February. At least seven victims died.

South Africa has gained control over its cholera outbreak, reporting only 8 new cases per day – down from 200 per day in January. Many of the cases reported in the northern province of South Africa were Zimbabweans who crossed the border into South Africa to gain treatment that was unavailable in their own country.

Zambia reported six new cholera victims, one of whom has died. The outbreak was blamed on unsanitary conditions and unsafe drinking water drawn from Lake Kariba.

The rainy season in southern Africa usually runs from October to April. Once it has passed, the worst of the cholera season will be over for another year.

Outbreaks and Alerts: November 8, 2010

A daily digest of international outbreaks, alerts and food safety news

If you would like to receive automatic email alerts for all new articles posted on eFoodAlert, please click here or submit your request using the sidebar link. Please include "subscribe eFoodAlert" in the subject line.

United States

• Baltimore, MD. November 4th: The Maryland Department of Health and Mental Hygiene (DHMH) and local health departments are investigating a cluster of seven E. coli O157 infections. There have been no deaths, although three of the seven cases have been hospitalized. A potential association exists with the consumption of unpasteurized Baugher's apple cider. In response, Baugher's Orchard & Farm of Westminster, MD has issued a voluntary recall of all its apple cider.
• Fort Lauderdale, FL. November 7th: The Nieuw Amsterdam cruise ship (Holland America Line) arrived in Fort Lauderdale at the end of a transatlantic voyage and was boarded by CDC officials on arrival in port. While still at sea, the ship reported having 123 ill passengers (out of 2,027) and four sick crew members. All 127 reportedly were suffering from diarrhea and vomiting. Stool samples have been collected for analysis by the CDC lab and the crew has undertaken cleaning and disinfection. The cause of the outbreak is not yet known.

Asia, Africa and the Pacific Islands

• Harare, Zimbabwe. November 8th: The Zimbabwe Broadcasting Corporation is reporting that a fresh cholera outbreak in the eastern Marange district in Zimbawe has killed at least 16 people. A total of 753 cholera cases have been reported, although only 68 have been lab-confirmed.
• Mt. Hagen, Papua New Guinea. November 8th: Wardens in Papua New Guinea have killed five prisoners who tried to escape from a jail in the highlands after a dysentery outbreak killed four of their fellow inmates. Another five are being treated in hospital for gunshot wounds.

Latin America and the Caribbean

• Port-au-Prince, Haiti. November 7th: According to the World Health Organization, the cholera outbreak has killed more than 500 people and has infected in excess of 7,000.

Outbreaks and Alerts: September 15, 2010

A daily digest of international outbreaks, alerts and food safety news

If you would like to receive automatic email alerts for all new articles posted on eFoodAlert, please click here or submit your request using the sidebar link. Please include "subscribe eFoodAlert" in the subject line.

For information on the US Salmonella Enteritidis outbreak and egg recalls, please click here.

United States

• Norton, KS. September 11th: The Kansas Department of Health and Environment rescinded the boil water advisory for the City of Norton, after lab testing on samples collected indicated no evidence of contamination.
• San Diego County, CA. September 14th: The County of San Diego, Department of Environmental Health has issued a Boil Water Order and Public Notification for the Wynola Water District (Julian), because the drinking water system has tested positive for the presence of total coliform bacteria (and absent for E. coli). The Boil Water Order will remain in effect until the distribution system has been disinfected and additional samples confirm the absence of bacteria in the water supply.

Europe

• United Kingdom. September 15th: Research by the Health Protection Agency (HPA) has revealed that over half the cleaning cloths used in restaurant and take-away kitchens were found to contain unsatisfactory levels of bacteria which are a sign of poor hygiene and cross contamination. The research team sampled 133 cloths, from 120 establishments in the North east of England, and found that 56 per cent contained unacceptable levels of bacteria. The most common of which were Enterobacteriaceae (found on 86 cloths), E. coli (21 cloths), Staphylococcus aureus (six cloths) and Listeria (five cloths).
• Ulyanovsk, Russia. September 15th: Thirteen children (age 4 to 6 years) who attend a nursery in the village of October Cherdaklinskogo fell ill recently with vomiting and fever. They were taken to hospital, where they were diagnosed with an intestinal infection. Two remain hospitalized. Based on preliminary investigation, the source of the infection is suspected to be either kefir or watermelon, both of which were on the kindergarten menu that day.

Asia, Africa and the Pacific Islands

• Mascara, Algeria. September 11th: Six members of one family were admitted to hospital on September 7th complaining of vomiting and acute diarrhea. One of the victims – a 30-year old woman – died at home after leaving the hospital in the company of another family member on September 10th. An autopsy has been ordered. Three people, including two children, remain under medical observation.
• Sidi Brahim, Algeria. September 14th: A flock of 8,500 broiler chickens was ordered slaughtered after lab analysis determined that the flock was infected with Salmonella Enteritidis. Steps have been taken to disinfect the equipment and transport vehicles which came into contact with the infected chickens.
• Taiwan. September 14th (update): Taiwan Centers for Disease Control reports an imported outbreak of shigellosis. A life insurance company invited 140 members of the company to Siem Reap, Cambodia, during 3-7 Sep 2010. Upon the group's return through Taoyuan International Airport, Taiwan, on 7 Sep 2010, quarantine officers found 7 members with fever and diarrhea. The earliest onset of symptoms was on 6 Sep 2010. Rectal swabs were taken from 7 persons. On 10 Sep 2010, 4 were confirmed to be infected with Shigella flexneri. Contact tracing of all members of the tour group found an additional 51 persons with symptoms.
• Taiwan. September 15th: In April, 113 agricultural products were randomly sampled and tested in the first testing, of which 102 were found in compliance with relevant regulations (qualified rate 90.3%). The agricultural products that failed the tests included: water spinach (2), cucumber (1), egg plant (2), bell pepper (1), tomato (1), snap bean (2), kidney bean (1), and cucumis sativus (1).
• Harare, Zimbabwe. September 15th: A fresh outbreak of cholera has killed one person and infected four others in Chiredzi town, some 300 kilometers north of Zimbabwe's border with South Africa.

Australia and New Zealand

• Canterbury, NZ. September 15th: The New Zealand Food Safety Authority is warning cafés, restaurants and whitebaiters that food taken from sewage-contaminated rivers and estuaries could cause serious illness. The Heathcote, Avon, Halswell and Stxy Rivers are probably contaminated with sewage, according to the warning.

Cholera Chronicle: October 28, 2009

October 28, 2009

Cholera is spread through human fecal contamination of food and water supplies. It is a frequent Disease of Disaster, accompanying famines, floods, wars, and other natural- or man-made disasters. Its victims – as many as several million each year(1) – typically are destitute, displaced or debilitated. And, all too often, dead.

Although its incidence waxes and wanes with the seasons, cholera never sleeps. So far this month, the disease has made its usual rounds in Africa and Asia. It has left death and diarrhea in its wake in Angola, Cameroon, Guinea-Bissau, India, Kenya, Nigeria, Papua New Guinea, Russia, Tajikistan, Tanzania, Uganda and Zimbabwe.

Since early in September, cholera has killed 149 people in Nigeria, 59 in Tanzania, and 51 in Cameroon. Recent storms and flooding in the Philippines and Afghanistan have triggered outbreaks of cholera and other waterborne diseases in both countries.

Cholera can be treated successfully, if adequate medical facilities are available. More importantly, outbreaks can be prevented, by providing communities with safe drinking water, and with sanitary disposal facilities for human waste.

2008 was the International Year of Sanitation. The World Health Organization partnered with other agencies to promote improvements in sanitation in underdeveloped areas of the world. But it will take many years before these efforts make a significant dent in the problem.

Until then, cholera will continue to thrive.

(1) Nelson, E.J., et al. 2009. Cholera transmission: the host, pathogen and bacteriophage dynamic. Nature Reviews/Microbiology, vol. 7: 693-702.

Water Woes: Asia, Africa and Cholera

It's a rare day that goes by without a story somewhere in the news about a cholera outbreak in Asia or Africa. In 2007, the World Health Organization received reports of 177,963 cases of cholera – including 4,031 deaths – from 53 countries. These data are not all-inclusive. No cases were reported from Central or South America, and no information was available from the Western Pacific or Central Asia.

The culprit is Vibrio cholerae, a rod-shaped bacterium that is spread through contaminated water – including shellfish harvested from contaminated sea beds, produce grown using contaminated irrigation water, or produce washed in contaminated water.

Vibrio cholerae infections result in a watery diarrhea, which can vary from mild to severe – sometimes bloody. Severe cases can result in life-threatening dehydration, especially in the very young and the elderly.

Following are recent examples of the impact of cholera on the health and lives of people living in parts of Africa and Asia.

Kenya (July 29th): Government officials blamed contaminated water for recurring outbreaks of cholera in the western province of Nyanza. A high water table, wells located too close to latrines, and poor sanitation practices were cited as contributing to the outbreaks.

Guinea-Bissau (August 1st): Cholera has caused 25 deaths and 1,077 illnesses so far in an outbreak that has spread through the country. Three-quarters of the victims live in the capital city, Bissau. As in Kenya, heavy rains and contaminated wells have contributed to the problem. Only 20% of the residents of Bissau have access to municipal "piped" water.

Zimbabwe (August 4th): Harare has been hit with an outbreak of diarrhea, which may or may not be due to Vibrio cholerae. As in Bissau, a severe lack of municipal water has forced residents to use water from nearby – often polluted – streams, and unprotected wells.

Indonesia (August 4th): Social workers have accused government officials of neglecting a cholera outbreak that has killed 173 people since April. The Health Ministry disputed the claimed death toll, saying that "only" 87 people have died. The Ministry blamed the on-going outbreak on a traditional custom of hugging dead bodies.

The Indonesian situation is just one example of how political and cultural issues can complicate the fight against cholera and other similar diseases. A recent news article in The New Vision quoted the Ugandan water minister as blaming cultural beliefs for a recent cholera outbreak that killed between 30 and 40 people.

According to the article, Minister Jennifer Namuyangu said, "They say the water from unprotected sources is thick and tastes sweet yet some of the sources that I visited were untidy and surrounded by faeces." Residents in the eastern part of the country – especially the older generation – apparent prefer to drink unprotected water from rivers, streams and unprotected wells.

Until government inertia and local customs can be overcome, the World Health Organization will be hard-pressed to make a serious dent in the frequency and size of cholera outbreaks in Asia and Africa.

Cholera Chronicle: May 31, 2009

Welcome to the eFoodAlert Cholera Chronicle. Periodically, we'll present a summary by region of cholera news from around the world.

Cholera is spread through human fecal contamination of food and water supplies. It is a frequent Disease of Disaster, accompanying famines, floods, wars, and other natural- or man-made disasters. Its victims typically are destitute, displaced or debilitated. And, all too often, dead.

Africa

• Kenya, May 27 – A cholera outbreak on the outskirts of Nairobi has prompted government officials to close 20 food outlets in an effort to prevent the spread of the disease. Fourteen cases have been reported so far in this most recent episode.
• Swaziland, May 30 – Two 9-year old girls in the Lubombo region of Swaziland have been diagnosed with cholera and are undergoing treatment. Officials expressed themselves as surprised by the mini-outbreak, since the rainy season – when cholera is most likely to show its face – has passed.
• Zimbabwe, May 26 – The Red Cross reports that the country's cholera epidemic has slowed, but not yet stopped. Infection rates, which have fallen from their February peak, remain at a shockingly high 4.5% of the population. Red Cross officials predict that the number of confirmed cases soon will surpass 100,000; already this year, 4,283 people have died as a result of the disease.

Asia

• India, May 28 – A broken pipeline resulted in an outbreak of cholera and other diarrheal diseases in Kerala. Eight victims are thought to have contracted cholera. Four people have died in the district, but officials deny that their deaths are linked to the cholera outbreak.
• Vietnam, May 24 – The cholera outbreak, which began in mid-April, has infected 56 Vietnamese people so far. Despite the government's efforts at containment, cholera cases have been reported in 16 cities and provinces. Vietnam's northern neighbor, China, has strengthened its border surveillance in an effort to prevent the disease from spreading into Yunnan Province.

Cholera can be treated successfully, if adequate medical facilities are available. More importantly, outbreaks can be prevented, by providing communities with safe drinking water, and with sanitary disposal facilities for human waste.

2008 was the International Year of Sanitation. The World Health Organization partnered with other agencies to promote improvements in sanitation in underdeveloped areas of the world. But it will take many years before these efforts make a significant dent in the problem.

Meanwhile, cholera will continue to follow in the wake of world disasters.

Diseases of Disaster - Another Installment

War and famine aren't the only triggers for outbreaks of diseases such as cholera and dysentery. The People's Daily On-Line reported this morning that 20 Bhutanese refugees in a camp in eastern Nepal are suffering from pneumonia and dysentery. The refugees were forced to leave their homes 320 km east of Kathmandu after a fire destroyed the entire village.

Earlier this week, the International Society for Infectious Diseases posted its regular weekly update of cholera, dysentery and diarrhea outbreaks – five cholera outbreaks (4 in Africa and one in Asia) and one outbreak of watery diarrhea.

• Katanga, Congo: There were 5483 cases of cholera and 120 deaths in the first seven weeks of 2008. The outbreak is continuing, but the epicenter appears to be shifting.
• Harare, Zimbabwe: Fourteen cases of cholera have been diagnosed in the last two weeks in and around Harare. Another nine cases, and one death, were reported in the area of Mashonaland Central during February.
• Mandera Province, Kenya: This area has seen 392 suspected cases of cholera, and has reported 7 deaths from the disease.
• Belet Hawo, Somalia: The people living in and around this town in southwestern Somalia have experienced 263 cases of "acute watery diarrhea" since the end of January 2008. The outbreak, which has caused 11 deaths so far, may have been triggered by the cholera outbreak just across the border in Mandera Province, Kenya. The spread of the disease is believed to be due to a severe water shortage, which has forced people to drink unsafe water. The district government has responded by chlorinating all of the wells and is warning residents to avoid drinking unchlorinated water.
• Cunene Province, Angola: Flooding has forced people from their homes in this region, and a cholera outbreak is in progress amongst the displaced population. Five to seven new cases are being reported each day; 82 people have died so far.
• Mon State, Myanmar: 61 people in eastern Myanmar are suffering from cholera; 2 victims have died so far. The affected village is near the Thai border, and is in an area controlled by the New Mon State Party under a cease-fire agreement with the Myanmar government. Local authorities are asking a Thai government hospital in nearby Sangkhlaburi to provide emergency assistance.

Cholera and dysentery spread rapidly in the absence of safe water for drinking, washing and cooking. Recently, a Swiss company introduced the LifeStraw which, according to the device's developer, can be used to decontaminate water "on the spot". I'll review LifeStraw and other approaches to achieving safe drinking water soon.

Outbreaks and Alerts: July 9, 2010

A daily digest of international outbreaks, alerts and food safety news

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United States

• Rhode Island. July 8: Health Department lifts precautionary boil water advisory for United, Narragansett Point Judith, Narragansett North End, South Kingstown South Shore, and South Kingstown Middlebridge customers.
• Maine. July 8: With high levels of Paralytic Shellfish Poisoning toxin detected recently in the Downeast area of the state, the Maine Department of Health and Human Services and the Maine Department of Marine Resources are reminding Mainers and tourists of recommendations for the safe consumption of shellfish.
• Boulder County, CO. July 8: A second child has been hospitalized with severe illness after becoming ill from drinking unpasteurized goat milk in June that came from Billy Goat Dairy in Longmont. The first child was hospitalized on June 27 and remains hospitalized. Lab tests have confirmed that the non-pasteurized milk product from the Billy Goat Dairy farm is associated with illness in 30 people. Both Campylobacter and E. coli O157 were detected in samples taken at the farm.
• Nebraska. July 9: Nebraska has issued a health alert for toxic blue-green algae at Red Willow Reservoir in Frontier County, and an alert continues at Johnson Lake in Gosper County, which was first placed on alert last week. A health alert has ended at Swan Creek Lake 5A near Tobias in Saline County.
• Silver Spring, MD. July 9: FDA's new Egg Safety Final Rule has now become effective for egg producers having 50,000 or more laying hens -- about 80 percent of production. Among other things, it requires producers to adopt preventive measures and to use refrigeration during egg storage and transportation.

Canada

• Ottawa, ON. July 8: The Canadian Food Inspection Agency is warning the public against consuming personally harvested bivalve shellfish from and around closed harvest areas. These bivalve shellfish could contain paralytic shellfish toxins that can cause serious and potentially fatal illness if consumed.

  The levels of paralytic shellfish poisoning (PSP or red tide) are currently high and several areas are now closed to harvesting bivalve shellfish due to unacceptable PSP levels.

Europe

• United Kingdom. July 6: The Ministry of Justice has admitted breach of duty following an outbreak of salmonella poisoning at HMP Wandsworth in September 2009. Over 300 people fell ill after eating egg cress rolls prepared in the prison kitchens. A Health Protection Agency report on the incident found that hundreds of raw eggs were pooled together and then cooked at an inadequate temperature and for an insufficient time.
• Inverness, Scotland. July 8: A young Inverness woman contracted E. coli O157 while on holiday at Club Julian in the Turkish resort of Marmaris with her partner and three-year-old daughter. The woman fell ill shortly after returning home.
• London, England. July 9: The Health Protection Agency has been fined £25,000 for a spillage of E. coli 0157 at its centre in Colindale, north London.

Asia, Africa and the Pacific Islands

• Mumbai, India. July 9: Maharashtra's Food and Drug Administration (FDA) has filed a chargesheet in the Mazgaon metropolitan magistrate's court against health drink Complan's advertising claim that it can add two inches to children's height. The FDA's chargesheet names seven officials of Heinz India Pvt Ltd in its petition dated May 3, 2010.
• Chiadzwa, Zimbabwe. July 9: Four cholera cases have been confirmed in Chiadzwa this week, with the victims reported to be panners who had sneaked into the diamond fields.
• Vietnam. July 9: The Pasteur Institute has confirmed that three more patients in Ho Chi Minh City had tested positive for the cholera virus.

Australia and New Zealand

• Australia. July 8: Heinz Australia has announced that it plans to phase out use of bisphenol A (BPA) in all its baby food packaging in response to mounting consumer fears over the substance.

Latin America and the Caribbean

• Del Dios, Peru. July 9: Some six thousand residents of the city of Del Dios are at risk of an epidemic of typhoid. The residents have gone for two months without safe drinking water, because the pump for the well that supplies water to the population broke down and has not yet been repaired.