Mpox outbreak in Central Africa

 https://www.nytimes.com/card/2024/08/29/world/africa/mpox-outbreak-africa-congo

CDC discussion 

since january 1, 2024, the Democratic Republic of the Congo (DRC) has reported more than 31,000 suspect mpox cases and nearly 1,000 deaths. 

There have also been confirmed clade I cases in Central African Republic (CAR), which borders DRC to the north. Clade I mpox occurs regularly in ROC and CAR, but the new cases appear to be linked to spread from DRC. 

In late July 2024, the disease spread to countries that are not known to be endemic for the virus that causes mpox: Burundi, Rwanda, and Uganda, which sit on the eastern border of DRC, and Kenya, which has reported cases of travel-associated mpox only. Although contact tracing is ongoing, some cases have links to DRC. Person-to-person transmission has occurred during this outbreak, including through sexual contact, household contact, and within healthcare settings, when personal protective equipment was not available.

CDC is working with Ministries of Health and in-country partners across the region on disease surveillance, laboratory capacity including testing materials, strengthening workforce capacity, case investigation, case management, infection prevention and control, border health, and risk communication and community engagement.

In some provinces, patients have acquired infection through contact with infected dead or live wild animals, household spread, or patient care (transmitted when appropriate PPE wasn't used or available); a high proportion of cases have been reported in children younger than 15 years of age.

 

In other provinces, the cases are associated with sexual contact among men who have sex with men and female sex workers and their contacts. These are the first reported cases of sexual transmission with clade I mpox.

more here

The Republic of the Congo (ROC), which borders DRC to the west, declared a clade I mpox outbreak in April 2024. There have also been confirmed clade I cases in Central African Republic (CAR), which borders DRC to the north. Clade I mpox occurs regularly in ROC and CAR, but the new cases appear to be linked to spread from DRC. In late July 2024, the disease spread to countries that are not known to be endemic for the virus that causes mpox: Burundi, Rwanda, and Uganda, which sit on the eastern border of DRC, and Kenya, which has reported cases of travel-associated mpox only. Although contact tracing is ongoing, some cases have links to DRC. Person-to-person transmission has occurred during this outbreak, including through sexual contact, household contact, and within healthcare settings, when personal protective equipment was not available. CDC is working with Ministries of Health and in-country partners across the region on disease surveillance, laboratory capacity including testing materials, strengthening workforce capacity, case investigation, case management, infection prevention and control, border health, and risk communication and community engagement.

a readable Summary of epidemic in Legal Insurrection.

reports that after a year the vaccine doesn't give protection even after two doses.

Not mentioned: Is this in all cases or just in the MSM type who have HIV?

the reason for western countries to get worried about this disease is partly because it could morph into smallpox like epidemics, but also because mpox in the west is a sexually transmitted disease (unlike Africa, where touching lesions will spread it especially to children because of lack of lots of water and basic protective equipment such as gloves)....

the dirty little secret is that sex tourists have been bringing cases into Europe and the USA, and instead of stressing behavior modification or shutting down places in the west where the disease spreads, they will rely on vaccine. 

as for the deaths: remember: 

 

Malaria remains the leading cause of morbidity and mortality in DRC with 27.3 million malaria cases and 24,880 malaria deaths reported in 2022,

Africa covid

Troubles all over

The floods in Zimbabwe and Mozambique have affected many.

Mozambique also reports out break of cholera and malaria.

There is a drought in Kenya that could cause starvation there.

Ebola has spread to a new city in the DRC.

Sigh. No links, sorry.

But these are natural disasters.

the USNIblog refers to a new website about political violence/protests in all parts of Africa.

ACLED data website.

here is an example of their data:

Typhoid cases surge in Zimbabwe

from AlJezeerah

video

Zimbabwean health officials have called for an overhaul of the country's water and sanitation systems amid an outbreak of typhoid that has affected more than 1,500 people.

Henry Madzorera, Zimbabwe's health minister, said the country is reporting up to 50 cases of typhoid a day.

"By the end of December 2011, more than 1,500 cases had been seen and treated," Madzorera told a news conference in the capital, Harare, on Tuesday....

Madzorera appealed to his government for funds to "refurbish the water, sanitation and sewerage infrastructure as a matter of urgency", after years of neglect during the country's recent economic crisis.

Last week, Tendai Biti, Zimbabwe's foreign minister, announced the country would use $40m from the International Monetary Fund (IMF) to refurbish water and sanitation facilities.

Some suburbs go for weeks without running water, as Zimbabwean municipalities battle to keep up services.

Harare city authorities say they cannot supply water to all the city's residents.

measles epidemic in Zim

from NPR (USA):

The epidemic, which began in September 2009, has been abetted by Christian religious sects that shun vaccination and a badly degraded health system that has fallen down on once-exemplary immunization efforts.

Measles has spread to all 10 Zimbabwean provinces, with 90 percent of districts affected. The official count is 2,000 cases and about 200 deaths, "but this is likely to represent a gross underestimate," says Dr. Peter Salama, chief of the UNICEF mission in Zimbabwe....

He said an exodus of doctors and nurses has crippled immunization programs. Last year Zimbabwe, a nation of about 12 million, had a raging cholera epidemic, with 100,000 cases and thousands of deaths. A decade of political strife and astronomical inflation rates have eroded all government programs.

Zimbabwe's immunization programs were once among the best in Africa, but now, he says, "estimated coverage for measles is well below 70 percent, so there's no herd immunity...

measles in Zimbabwe

from Fides News agency


Harare (Agenzia Fides) – An outbreak of measles has hit 28 of the 62 districts of Zimbabwe and is still spreading. Efforts to vaccinate people are hampered by local religious beliefs. According to the latest Epidemiological Bulletin of the World Health Organization (WHO), since the beginning of the epidemic in October 2009, there have been about 1,200 suspected cases, 221 confirmed and 50 resulting in death. UNICEF, together with other organizations involved in the health sector, has undertaken an intensive vaccination program. The campaign aims at all children ages 6 months to 14 years. In the eastern part of Zimbabwe, in the District of Buhera in the Manicaland Province alone, more than 25,000 children are already vaccinated. Now the organization is engaged in a door to door campaign, to highlight the importance of vaccination of children, although the strategy also finds resistance among those who refuse the vaccine because of religious beliefs.
The epidemic of measles has also struck a group of families belonging to the "Johanne Marange Apostolic Church" in the area of Nzvimbe, about 70 km from the city of Mutare, on the border with Mozambique. The elders of the church do not allow the vaccination nor allow their followers to receive medical treatment, and prefer to sprinkle holy water on the patients as a remedy. The report says that 30 people belonging to religious groups, mostly children, died from measles, although the number could be higher, due to the practice of Vapostori, “quick burials.”

Pushing Circumcision against HIV

From the BBC:

.

In the next eight years the government aims to carry out the operation on 80% of all young men in the country - three million people in all.

Circumcision is not widely practised among Zimbabwe's cultural and religious groups, but the centuries-old procedure is now regarded as a key weapon in the country's fight against the spread of HIV and Aids .

Trials in Kenya, Uganda and South Africa have shown that the operation, in which the foreskin is removed from the penis, reduces by 60% the risk of a man contracting HIV - the virus that causes Aids....

thirty children of cult died from measles

from the VOA:

At least 30 children have died in eastern Zimbabwe where members of the Johanne Marange Apostolic Faith church have refused to allow their children to be vaccinated against the deadly communicable disease.

World Health Organization Country Representative Custodia Mandhlate said it is tragic that children are dying of a preventable disease. The outbreak is also affecting other provinces with 340 cases of measles reported.

Health Minister Henry Madzorera told VOA Studio 7 reporter Sandra Nyaira his ministry has been frustrated by the denial of access to children for vaccination by members of the Apostolic Faith Church and other religious sects.

thirty children of cult died from measles

from the VOA:

At least 30 children have died in eastern Zimbabwe where members of the Johanne Marange Apostolic Faith church have refused to allow their children to be vaccinated against the deadly communicable disease.

World Health Organization Country Representative Custodia Mandhlate said it is tragic that children are dying of a preventable disease. The outbreak is also affecting other provinces with 340 cases of measles reported.

Health Minister Henry Madzorera told VOA Studio 7 reporter Sandra Nyaira his ministry has been frustrated by the denial of access to children for vaccination by members of the Apostolic Faith Church and other religious sects.

Cholera breaks out again

from the UKTimes

Summary...Some new cases...worries as the summer rainy season starts.

The sewers are not yet fixed, and with government squabbling, few foreign governments want to invest in the infrastructure.

The Zimbabwe Mail has more information on the outbreak

"...A senior Health Ministry official, Gerald Gwinji, told the state-controlled Herald that the five deaths had been recorded from 117 cases in the Manicaland, Mashonaland West and Midlands provinces.

"Most of the cases were recorded ... among religious objectors, who for a long time have been reluctant to seek medical attention," Gwinji said...."

There are some African/Christian cults in Zimbabwe (as there are in other areas of Africa) that rely on faith healing and don't use western medicine.

But of course, even if the deaths are from non treatment, the infection is spread via contaminated water.

Swine flu hits eastern Mutare

from Nehanda Radio

Zimbabwean Health Minister Henry Madzorera confirmed Thursday that the H1N1 influenza virus responsible for the so-called swine flu pandemic has reached the country, telling a news conference in Harare that five cases have been confirmed at a private primary school in Mutare, capital of eastern Manicaland Province.Meanwhile, Zimbabweans are reliving the health care crisis of late 2008 though thankfully this time around there is no surging cholera epidemic claiming lives as hospital wards close.

Yet there is no end in sight to the latest strike by resident doctors in the main state hospitals in Harare and Bulawayo, who were joined this week by some nurses while other nurses are in go-slow mode. Many sick people are being turned away without medical assistance.

88,000 affected by Cholera

from Xinhua:

but it's getting better


At the start of the year, as many as 8,000 new cases were being reported per week at the national level, but over the past few weeks, that number has been slashed by half.

According to a joint update by the WHO and the Zimbabwean government, 395 new cases and 18 deaths were reported Thursday.

Nearly 4,000 people have died from the disease, which is caused by contaminated food or water, the agency said.

Tenuous agreement and cholera

from PBS Newshour:

	Tenuous Zimbabwe Government Deal Approved as Cholera Crisis Worsens
	In the midst of an escalating cholera outbreak in Zimbabwe, a summit on a power-sharing deal decided Tuesday that opposition leader Morgan Tsvangirai should be sworn in as prime minister by Feb. 11.
	Tsvangirai's Movement for Democratic Change party voiced skepticism about the agreement on Tuesday, but he told South African newspaper The Star "Everyone agrees that, subject to the clearing of all the issues that are outstanding, a coalition government can be formed." Tsvangirai said negotiators would meet in Harare on Thursday to try to resolve those issues, including distribution of cabinet posts and the control of security agencies. Tsvangirai's comments contradicted more negative assessments from other members of his party, feeding reports of a rift in the MDC. "There seem to be internal struggles in the MDC which presents Tsvangirai with a challenge, though it's likely he will prevail over the hawks in his party," Eldred Masunungure, a politics professor at the University of Zimbabwe, said in a telephone interview with Bloomberg News.... The political crisis has contributed to the breakdown of water, sanitation and health systems, allowing conditions for the bacterial illness cholera, which spreads through contaminated water. The World Health Organization announced Wednesday that the death toll for the cholera outbreak that began in August has now passed 3,000. actually, complaints about the Harare water system goes back about three years, so you can't blame it on the political problems...if you don't fix leaking pipes, and don't stop holes in sewers, you do tend to get disease...

Anthrax outbreak

From Baraza (world wildlife direct team).

I write this blog post with tears in my eyes, tears for the millions who are suffering in Zimbabwe. It was bad enough when these wonderful people had to accept a megalomaniac for president, rampant poverty, famine, hyper inflation, starvation and cholera – now there is an anthrax outbreak.

The outbreak has reported already killed three people in the Zambezi Valley though as usual this figure may be under reported, this site suggests the human mortality is already 6, and that over 200 cattle have already died in Bulawayo. The disease threatens to wipe out livestock in northern Zimbabwe....

30,000 cholera patients in Zim

from Psyorg:

More than 30,000 people in Zimbabwe have been diagnosed with cholera, the World Health Organisation said Thursday, as the number of those contracting the deadly disease continues to mount.

As many as 31,656 suspected cases were diagnosed to date with one third of them in the capital of Harare, the WHO said.

The organisation last reported some 29,131 suspected cases on Monday and 1,564 deaths from the water-borne disease.

Cholera also continues to plague neighbouring South Africa, where it has killed 13 people, mainly in the Limpopo border region where nine people have died from a total of 1,334 suspected cases, the WHO said citing South African sources.

United Nations aid agencies fear Zimbabwe may be hit with up to 60,000 cases, with the upcoming rainy season likely to spread the disease more easily.,,,

Rains worse cholera risk

AP via the IHT:

GENEVA: The onset of seasonal rains in Zimbabwe has increased fears that the cholera epidemic could turn into a catastrophe with tens of thousands more sickened and further spread into neighboring countries, the Red Cross federation said Tuesday.

"We've already got a very serious situation and rain will only make it much, much worse," said Matthew Cochrane, a spokesman for the International Federation of Red Cross and Red Crescent Societies.

The rainfall, which usually brings floods to the southern African country, has started in the northern provinces, he said.

Aid agencies have been warning the rains could spread cholera further in a population already weakened by disease and hunger...

on the other hand, my friend wrote me she was worried because the rains were late, and people were starving...so it is good news that the rains have finally arrived.
Rain, by spreading sewage, makes cholera more widespread into the water supply.

SADC to discuss cholera

from the Zimbabwean

JOHANNESBURG – According to sources, ministers from the Southern African Development Council (SADC) are due to meet on December 11 to discuss the recent outbreak of cholera in Zimbabwe that has claimed almost 600 lives and infected 12,000 people nationwide. The outbreak has been deemed a national disaster and concerns are growing over the spread of the disease into neighbouring countries as people continue to flee hunger and persecution in Zimbabwe.

According to a spokesperson from the South African health department, the ministers are health and water representatives from the SADC troika from South Africa, The Democratic Republic of Congo and Zambia. The spokesperson gave no further details on the meeting but South African broadcasters have referred to it as ‘an emergency meeting.’

South Africa has sent a team of experts into Zimbabwe to determine the need for humanitarian assistance and it is hoped that the visit will push political leaders into action.....

Cholera outbreak in Zimbabwe

from my essay at bloggernews

The bad news coming from Zimbabwe constantly getting worse. Now the problem is cholera.

Cholera is one of the few diseases that can literally kill a healthy person in 24 hours. You start vomiting, get terrible diarrhea to the point that your bowels empty and you end up passing clearish fluid. You literally dehydrate to death: You lose so much fluid you go into shock (low blood pressure from loss of the fluid in blood) and die.

The discovery of Oral Rehydration fluid is one of the miracles of modern medicine, but the idea is so simple that it gets little press. Someone discovered if you replace the fluid with water with just a certain amount of sugar and a small amount of salt, the fluid is absorbed much more efficiently by the sick person’s intestines.

A 1-liter preparation of ORT solution^[9] contains:

• sodium chloride (NaCl) - 2.6g
• trisodium citrate dehydrate - 2.9g
• potassium chloride (KCl) - 1.5g
• anhydrous glucose - 13.5g

Usually hospitals buy pre measured packets of the stuff (one packet for one liter of boiled water), but when I worked in Africa, our hospital pharmacist used to mix up our own, and made up packets to give out to our “village health workers” to keep in the villages. The dirty little secret is that diarrhea is common, and families might not have the time, money or transportation resources to go to the big clinic and sit all day waiting for treatment for common diarrhea; as a result, some kids die. But having trained workers in villages nearby who are trained to use this simple fluid saves many of these lives.

The rehydration fluid is especially important to save the lives of small children with diarrhea of all sorts. But for adults, it has made the difference in saving the lives of adults with cholera or more severe types of diarrhea.

Most of the time, these diarrhea type illnesses are “sporadic”: they break out, make a lot of people sick, a few end up in the hospital, but usually the disease is mild.

But cholera, even the less severe strain that is common in Africa, is different.

In epidemics, hospitals may be overwhelmed with cases. The danger of spreading the disease to other patients is high, so usually you place the patient in an isolation ward. The treatment is simple: You place a relative on a stool next to the patient, and instruct the relative to give the patient lot and lots of rehydration fluid. In areas where cholera was common, my friends told me that they used special beds with holes, so the diarrhea just drips through the cot into a bucket to make cleanup easier.

The nurses and doctors keep an eye on the patients, and if they can’t get enough fluid by mouth, might start fluid in a vein (IV therapy). But in third world hospitals, this is expensive, and in an epidemic you might run out of supplies. For rural epidemics, there may not be a nearby hospital, just a small clinic. Transporting a lot of very sick patients is impossible, so usually one sets up a cholera clinic at a local school or similar building, and the patients use (disposable straw) mats instead of beds.

This is, of course, a recipe for massive outbreak of the disease, but emphasizing strict hygiene and hand-washing prevents it from spreading.

Cholera can be treated with antibiotics (but they are not usually necessary), and there is a vaccine that gives some protection, but the real answer is hygiene and prevention.

In Zimbabwe, the problems with the Harare water supply has been known and complained about by residents for over a year. In January 2007, there were reports of sewage contaminating the water supply, then a few months ago, reports that those administering the water supply were not able to afford chemicals to keep the water clean. So it is not as if the epidemic could not have been foreseen.

Now, the water supply is almost absent in Harare: It has been shut down…

Since the Zimbabwe National Water Authority (Zinwa) had failed to find chemicals to treat the water supply, the state-run utility on Sunday stopped pumping water in the capital, the government mouthpiece Herald newspaper said….

Residents in Harare’s populous sister city of Chitungwiza said that their taps had also run dry. People throughout the city were carrying containers searching for water, while others have resorted to digging shallow wells in their yards in the hope of finding water.

Shallow wells, however, are often contaminated by sewage, or from latrines, and only make the problem worse.

In rural Zimbabwe, people traditionally go “in the woods”, away from the village; one shudders to think of what has entered into the water of “shallow wells” in city slums that lack sewers and septic tanks. Only those who have deep wells will be safe.

In the absence of a working government, the UN is trying to do these things to keep people from dying:

The United Nations Children’s Fund… has secured sufficient chemicals to treat Harare’s mains water for two or three weeks, with another four months’ worth of supplies on their way. Unicef is also distributing millions of water purification tablets and taking 360,000 litres of clean water to Harare’s poorest suburbs every day.

But Roeland Monasch, its acting representative in the country, said that many households could not manage the simplest preventative measure - boiling their drinking water - because they cannot afford the fuel.

The poor state of nutrition in a Zimbabwe where many are out of work or lack enough food means means that more of them will die. My friend has written that those in her area are starving; December and January are traditionally the “hunger season” before the crops are harvested, but this year there is little rain.

My friend, a teacher, was laid off last year because the government couldn’t pay more experienced teachers the higher salary; this year, however, many teachers are not paid at all, and most of the schools are closed….and despite the epidemic, many hospitals are closed because they can’t pay the salaries of the doctors and nurses (many of whom are leaving to work in other countries) and the hospitals that are still open lack medicines…

Obviously, one can see where this is going. With the economy collapsing, even more people will join the Zimbabwe diaspora, and some will take cholera with them.

As a result, already there are reports of Cholera outbreaks in nearby Botswana, Zambia and South Africa.

But the possibility of tens of thousands of deaths in Zimbabwe still hasn’t made Mugabe change his heart.

The European Union, President Bush, the presidents of Botswana, Zambia, and Kenya, Archbishop Tutu and others have said that Mugabe needs to leave, and proposed international peacekeepers to stabilize the collapsing country. What is preventing this is that, with only a few exceptions, the African Union continues to oppose his removal by force. I understand why pride makes some oppose outside intervention, but what good is pride when thousands will die?

The dirty little secret is that South African forces could remove Mr. Mugabe with little or no problem, yet that country has so far refused to do so.

Zim cholera march broken up

from the BBC


Police in Zimbabwe
This is the second time in a month a health protest has been broken up

Police in Zimbabwe have broken up a march by nurses and doctors in the capital, Harare, angered at the worsening cholera outbreak.

Witnesses say officers used batons to disperse and beat up the crowd of health workers.

Correspondents say there was no sign of trade union protest called over the deepening banking crisis.

The defence minister has said soldiers who rioted earlier this week over cash shortages will be arrested.

On Monday, dozens of troops ran amok in Harare after losing their temper while queuing up to withdraw cash. ...
The cholera outbreak has killed at least 565 people since August and more than 12,545 cases of cholera have been recorded over the same period, the latest statement from the UN Office for the Co-ordination of Humanitarian Affairs.

Most of Zimbabwe's capital has been without water since Sunday. ...

More people succumb to cholera

from SWRadioAfrica

A reports from the north east border town of Nyamapanda says that bodies are being buried in very shallow (1 meter) graves, in council land adjacent to the mortuary in the town.

An eye witness who had just travelled from Nyamapanda said: “Flea market operators who go and set up stalls from Harare are sharing accommodation with unburied corpses.” A commentator added that it seems as if ‘Robert Mugabe is quite content to turn the country into a giant death camp.’

The former chairperson of the Combined Harare Residents Association (CHRA) Mike Davies, speaking in his private capacity, said people would not be dying from cholera if there were adequate resources, but the continuing deaths are a symptom of the failure of the regime to address the basic social needs of the citizens.

Prevention of the disease is relatively easy with adequate water supplies and proper sanitation practices, but Zimbabwe has now become a breeding ground for this infectious disease. There is no clean water in most parts of the country, resulting in many desperate people scrounging for water from unprotected wells and streams, in spite of the cholera outbreak.

With the collapse of the health industry and most hospitals now being shut, many people are just dying at home, making it very difficult to come up with statistics. The government has also been downplaying the extent of the crisis. Furthermore the fact that there is still no government in place in Zimbabwe makes the situation even more abnormal.

On Wednesday the Herald newspaper could not hide the extent of the crisis. The paper wrote: “The Harare City Council yesterday remained mum as cholera continued to take its toll. Yesterday afternoon The Herald witnessed two trucks ferrying bodies of cholera victims from Budiriro Polyclinic to Beatrice Road Infectious Diseases Hospital mortuary.”

A number of areas in the capital have been without water for several weeks and yet residents are still being forced to pay their rates. Some areas like Mabvuku and Tafara have gone for half a year without water....