WHO says undiagnosed illness in Liberia initially appeared to be undetermined poisoning after 31 cases, 13 deaths - April 26, 2017+ Neisseria meningi

[Ronan Kelly]

Liberia to Send Blood Samples Abroad in Latest Disease Outbreak

Dr. Francis Kateh, Chief Medical Officer, says the Health Ministry is considering sending blood samples broad for further testing.

Monrovia ? Liberia does not have the capacity to diagnose the latest disease outbreak which has already killed at least 11 persons in Sinoe County.

Lennart Dodoo | ldodoo@frontpageafricaonline.com
...
According to reports, seven of the deaths were linked to the death of an 11-year-old who died on Sunday, April 23, 2017.

She died after showing symptoms of diarrhea, vomiting and mental confusion.

She was immediately taken to F.J. Grante Hospital where she reportedly died within one hour after she was admitted into the emergency room.

She reportedly attended the funeral ceremony of a religious leader on Saturday, April 23, (sic - Saturday was April 22 - Ro) in Greenville.

The religious leader is said to have died at John F. Kennedy Medical Center in Monrovia, Liberia?s capital. He was diagnosed of high blood pressure.

On Monday, April 24, another patient from Down Town Community who also attended the funeral of the religious leader presented symptoms of head ache, skin itching and body pain. He was admitted the same night at the F.J. Grant Hospital died by 2:00 A.M. Monday morning.

Another lady from Red Hill community who also attended the same funeral presented symptoms of vomiting and diarrhea. She died upon arrival at the Grant Hospital.
...
http://www.frontpageafricaonline.co...ood-samples-abroad-in-latest-disease-outbreak

 

[alert]

What makes them think this case is the same illness? Are there any epidemiological links to the cases in Sinoe?

http://gnnliberia.com/2017/04/29/29618/

‘Strange Disease’ Hits Monrovia, Health Authorities Say 1 Pronounced Dead April 29, 2017


The outbreak of what medical authorities considered as ‘Strange Disease’ in Greenville, southeastern Liberia, Sinoe County, has reportedly taken the lives of eleven person and several being placed on critical list has reportedly crept in the populated City of Monrovia with one been pronounced dead by health authorities in Monrovia on Friday evening, and several quarantined in an undisclosed location.
According to health authorities in Monrovia those infected with the “strange” disease showed symptoms of severe stomach pain, vomiting, diarrhoea, fever and headaches, Liberia’s chief medical officer, Francis Kateh, said on national radio.

​[snip]

 

[Gert van der Hoek]

SITUATIONAL REPORT

Unexplained Cluster of Health Event: Sinoe County, 29 April 2017

New update

On Tuesday, 25th April 2017 at 10:30 GMT, Sinoe County Health Team (SCHT) notified the National Public Health institute of Liberia (NPHIL) and the Ministry of Health (MoH) of a cluster of unexplained health event involving 14 cases with 8 deaths in Greenville Citye.

From the 25th to 27 th April, the number of cases increased to 20 with 11 deaths reported (Case fatality rate is 55%). Most of the cases presented with headache, diarrhea, vomiting and mental confusion.

Over the past 48 hours, no news cases were reported from Sinoe and Montserrado Counties.

SITUATIONAL REPORT 5 th Edition

 As of the 29th April 2017, twenty (20) cases have been reported from eight (8) communities

o Nineteen (19) cases reported from Sinoe and one (1) from Montserrado Counties
o Eleven (11) deaths recorded (Sinoe -10, Montserrado- 1)
o Five (5) currently admitted in F.J. Grant hospital have stabilized.

 One new case identified during active case search within the Down town community, Greenville, Sinoe County, who presented with similar symptoms recovered two days ago.

 21 specimens collected so far: 7 oral swabs, 7 whole blood, 3 urine, 2 cardiac fluid, 1 rectal swab.
o 7 oral swabs, 6 whole blood and 2 cardiac fluid tested negative for EVD.
o Chemistry analysis of 3 urine specimens has yielded no common pattern and inconclusive.
o Laboratory tests to exclude cholera and shigellosis is on-going.
o Aliquots 11 specimens shipped to CDC-Atlanta for toxicological testing.

 Fifty-two (52) contacts have been listed (age range of contacts: 6 ? 15 years (8), 23 ? 65 years (40) and 4 adults.

Thirty-two (32) are females while twenty (20) are males.

Situational Overview

Saturday, 29 April 2017, no new admission reported from Sinoe County.

Cumulatively, there are 20 cases and 11 deaths (10 deaths in Sinoe County and one (1) death in Montserrado County).

Five (5) patients being managed at the FJ Grante hospital have stabilized and none is critical.

All samples collected were confirmed negative of Ebola Virus Disease (EVD). The Ministry of Health with support of WHO is accelerating the process of deploying a pathologist to conduct autopsy.

Probable Risk Factors

The event is driven by possible predisposing risk factors such as:

 Attending and participating in Funeral events ? Wake keeping, Funeral, Burial and Re-pass within the community of the deceased (Teah town).

 The risk of consuming the same food or drink that is probably contaminated.

 Environmental exposure

READ THE FULL REPORT

 

[Ronan Kelly]

Greenville Calm But Confused over Strange Deaths
By Ishmael F. Menkor - May 1, 2017
...
Rev. Robinson Dweh of Greenville told the Daily Observer that, ?Up to today, I don?t actually know what killed my wife; I am still confused about it.?

He said his wife had complained about her foot ?and pain in her body,? for which she was repeatedly taken to the hospital, where she was initially diagnosed with hypertension (pressure), and was treated and discharged on the same night.
Then, on Monday, April 24, Mrs. Dweh came down with a strong fever, vomiting and crying from pain in her foot and headache. Rev. Dweh said she was taken to the hospital at 11p.m., and again her pressure was high, until she met her demise on Tuesday, April 25.

?My son also came down with a strong fever while we catered to his mother, but he survived. My wife did not tell me of eating anything anywhere as it has been speculated; all she could say was pain in her foot.

?My wife?s body was not in a bad condition like the other bodies where their tongues and eyes came out of them, with some in very bad condition,? he added.

Some of the healthcare officers, who did not want to be named because they are not clothed with the authority to speak to the press, described the condition of some of the bodies as ?very terrible, decomposing, with swollen stomachs.?
...
Local authorities on April 30 called a town-hall meeting to clear the air on what was happening in the county. Liberty Radio station manager David Dee Kpangbala quoted the County Health Officer as telling the residents that the victims died from food poisoning. He added that the government is investigating to establish the type of poison.
...
https://www.liberianobserver.com/news/greenville-calm-but-confused-over-strange-deaths/

 

[Shiloh]

Source: http://www.cnn.com/2017/05/01/health/liberia-mystery-illness-who/

Mystery illness claims 12 lives in Liberia
By Susan Scutti and Bijan Hosseini, CNN
Updated 12:07 PM ET, Mon May 1, 2017
Mystery illness claims 12 lives in Liberia
By Susan Scutti and Bijan Hosseini, CNN

Story highlights

21 people have become sick since attending a funeral in Sinoe County, Liberia
Symptoms include headache, diarrhea, vomiting and confusion...

 

[Pathfinder]

Outbreaks and other emergencies updates
http://www.afro.who.int/en/clusters-a-programmes/whe/outbreaks-and-other-emergencies-updates.html

Source: Week 17: 22 ? 28 April 2017


WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
REGIONAL OFFICE FOR Africa
WHO Health Emergencies Programme
Week 17: 22 ? 28 April 2017
Data as reported by 17:00 28 April 2017

Excerpt:

Cluster of undiagnosed illness and deaths Liberia
Event description
20
Cases
11
Deaths
55.0%
CFR


On 25 April 2017, the Liberia Ministry of Health notified WHO of
a cluster of acute illness and sudden deaths due to an unknown
aetiology in Sinoe county located in the southern region. The event,
linked to a funeral function, started on 23 April 2017 when the index
case, an 11 year old girl from Teah town, Greenville district developed
an acute onset illness. She presented to FJ Grante hospital
with diarrhoea, vomiting and mental confusion; and died within one
hour of admission. The following day (24 April 2017), the second
case-patient, a 51 year old woman from Teah town, Greenville
developed sudden onset of vomiting, abdominal pain and confusion.
She was admitted to FJ Grante hospital on 25 April 2017 and
died the same day. On 25 April 2017 (the third day), a cluster of 13
case-patients from 5 communities in Greenville [Teah town - 6 cases,
Congo town ? 3 cases, Red hill - 2, Down town - 1, and Johnstone
street - 1] developed similar acute onset illness. Seven out of
the 13 case-patients died the same day on 25 April 2017.

Between 23 and 27 April 2017, 20 case-patients presenting with similar illness were line-listed, 11 of those died, giving a case fatality rate of 55%. Over 80% (9/11) of the deaths occurred within the first 3 days (between 23 and 25 April 2017). Forty-two percent of the cases manifested with headache, 37% had vomiting, 27% had confusion, and 26% had abdominal pain and body weakness. Ninety five percent (19/20) of the cases came from Sinoe county. The first case outside Sinoe county (but linked to the funeral) occurred on 27 April 2017 in Montserrado county. Ten of the deaths took place in Sinoe and one in Montserrado. By 28 April 2017, 5 case-patients were admitted in F.J. Grant hospital in stable clinical condition. Fifty two close contacts have been listed and are being followed up on a daily basis for signs and symptoms of the illness.

A total of 20 biological specimens were collected: 7 oral swabs, 7 whole blood, 3 urine, 2 cardiac fluid, and 1 rectal swab. Of these, the 7 oral swabs, 6 whole blood and 2 cardiac fluid tested negative for Ebola virus. One whole blood sample is still being tested for Ebola virus. Chemistry analysis on 3 urine specimens has not yielded any significant results. Further laboratory investigations for the pathogens including toxicological testing are ongoing. The first set of 11 samples have been shipped to Atlanta, United States. Another set of samples is being shipped to the WHO Reference Laboratory in South Africa.

Over 95% of the line-listed cases participated in at least one aspect of the funeral rites of the religious leader who reportedly died of a known cause. The aspects of the funeral activities include burial, ?repass? and ?wake keeping?.

Public health actions
? The national and county epidemic preparedness and response committees have been reactivated to coordinate response to the event.
? A multi-disciplinary national rapid response team has been deployed to Sinoe to conduct detailed outbreak investigation and support
lower level outbreak response.
? Active case search has been initiated in the affected and surrounding communities. Outbreak case definition has been developed to
facilitate active case search among those who attended the funeral functions and others. Investigation and compilation of line list of all
cases including systematic identification of contacts are ongoing.
? Case management of patients currently admitted at the F.J. Grante Hospital is ongoing
? County level advocacy meetings and community engagement have been conducted. The county health team has also embarked on
mass public awareness.
? Infection prevention and control interventions have been re-enforced including hand hygiene practices, water points testing and safe
burials.

Situation interpretation

An alarming and a rapidly evolving situation unfolded in Liberia, understandably so, coming in the aftermath of the Ebola virus disease outbreak.

While the dreaded Ebola virus disease has been ruled out in this event, there is still an urgent need to establish the ultimate aetiology of this cluster of acute illness and sudden deaths. The dramatic evolution of the event with very short course of illness and sudden death, and the clustering of the cases is indicative of a common source exposure to the pathogenic agent. All indications are pointing at the funeral functions of the religious leader. The likelihood of foods, drinks or water poisoning is high and the ongoing toxicology testing will be very critical to provide some answers. The overall risk of spread of the event is lowering with the sharp decline in the number of cases and deaths reported. No new cases and/or death have been reported since 28 April 2017.

The Ministry of Health has requested WHO and CDC to expedite the process of toxicological testing outside the country. WHO is currently supporting the deployment of an experienced pathologist to do autopsy on one dead body that is preserved.

The Government of Liberia and the Ministry of Health is being commended for the swift and effective response to this event, including the early detection and rapid deployment of response teams. The strong collaboration between WHO, CDC and the other partners in dealing with this event should set precedence for future response.

 

[alert]

Source: http://www.cnn.com/2017/05/01/health/liberia-mystery-illness-who/

Mystery illness claims 12 lives in Liberia
By Susan Scutti and Bijan Hosseini, CNN
Updated 12:07 PM ET, Mon May 1, 2017
Mystery illness claims 12 lives in Liberia
By Susan Scutti and Bijan Hosseini, CNN

Story highlights

21 people have become sick since attending a funeral in Sinoe County, Liberia
Symptoms include headache, diarrhea, vomiting and confusion...

​This article later says:

Several cases have tested positive for malaria and have been treated accordingly, Skinner said. He added that a CDC team is in Liberia and working closely with the government to provide additional support.

​While malaria alone does not explain this outbreak, it might explain why such a wide range of symptoms have been reported; some of the patients apparently have both malaria and the unexplained illness. - alert

 

[alert]

They weren't consistent from a timing point either, but Lassa and yellow fever have also both been ruled out:

http://www.ebony.com/news-views/liberia-unexplained-illness#axzz4fs3iUuEu

 

[Ronan Kelly]

Mystery Liberia disease claims 12th victim

A mysterious disease has claimed its 12th victim in Liberia and authorities are searching for people who attended a funeral who might be infected.
Source: AAP
2 MAY 2017 - 1:38 PM UPDATED 6 HOURS AGO

Another person has died from a mysterious disease in Liberia, raising the death toll to 12, the health ministry says.

The latest victim was the fiancee of a man who had died after returning to the capital, Monrovia, from Greenville in the southeast, where he had attended a funeral.

...

Out of nine other people who were infected, three have been discharged from hospital.
...
http://www.sbs.com.au/news/article/2017/05/02/mystery-liberia-disease-claims-12th-victim

Did the fiancee attend the funeral? If not, is this a case of transmission? - Ro

 

[Ronan Kelly]

It Is Scaring! As Two Contacts Of Greenville Victims Confirmed Dead In Monrovia
May 1, 2017 Cholo Brooks Liberia 0

Liberia Health Minister Bernice Dahn
Health authorities have reported two deaths in Monrovia from the strange disease that hit Greenville in Sinoe County last week.

The Communication Director of the Ministry of Health, Mr. Sorbor George, told a local radio Monday that one of the dead was among 60 persons who went to Greenville, Sinoe County from Monrovia to attend a funeral where the victims of the strange disease are said to have contracted it.

According to George, the second victim to die from the disease in Monrovia is the fianc?e of the man who died from the disease following his return from Greenville.

He said the deaths of the two bring the toll from the disease to 12, and the total number of persons who have contracted the illness to 21.
...
http://gnnliberia.com/

 

[Ronan Kelly]

Sinoe Health ?Crisis? Enters Monrovia
?Dr. Kateh confirms 2 more deaths

By Cewhy Kwanue - May 2, 2017130
Share on Facebook Tweet on Twitter
Dr. Kateh: ?While two persons are confirmed dead in Monrovia?we have sent blood samples abroad for investigation?

Dr. Francis Nah Kateh, Chief Medical Officer (CMO) and Deputy Minister of Health, yesterday confirmed a second death in Monrovia from the ?strange disease? that has killed more than ten (10) people in Greenville, Sinoe County.

Dr. Kateh said the total deaths have now reached 12 including the two in Montserrado County.

?Some of those who travelled from Greenville in the aftermath of the situation and arrived in Monrovia are being traced and monitored, while at least two are confirmed dead,? Dr. Kateh told the ELBC afternoon news yesterday.

He said six of the nine affected people in Sinoe County have been discharged, while the three are in stable condition at the Francis J. Grant Hospital in Greenville, the county?s political capital.
...
https://www.liberianobserver.com/news/sinoe-health-crisis-enters-monrovia/

 

[alert]

Mystery Liberia disease claims 12th victim

Did the fiancee attend the funeral? If not, is this a case of transmission? - Ro

​Maybe. Some of the earlier cases also took ill or died before the funeral as well, and there are actually at least two funeral where people became ill after attending. It is possible that if indeed this is foodborne, perhaps some of the leftovers were consumed by people who didn't attend the funeral?

​If this really is H2H, the list of suspects is pretty short. Cholera? Another hemorrhagic fever such as CCHF? Meningitis? Plague?

​Also, as the investigation spreads out as they cast a wider net, it is important to continue to test new suspect cases for Ebola, as although the original cluster here is not due to Ebola, there is always the risk that an unrelated new case might be.

 

[alert]

This article states that 60 residents of Monrovia attended the funeral (which one?) in Greenville:

http://www.frontpageafricaonline.co...greenville-victims-confirmed-dead-in-monrovia

 

[alert]

ProMED's thougths:

Published Date: 2017-05-02 05:37:42
Subject: PRO/AH/EDR> Undiagnosed disease - Liberia (05): (SI,MO) fatal
Archive Number: 20170502.5007111
UNDIAGNOSED DISEASE - LIBERIA (05): (SINOE, MONTSERRADO) FATAL
************************************************** ************
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: Mon 1 May 2017
Source: GNN Liberia [edited]
http://gnnliberia.com/2017/05/01/sca...dead-monrovia/


Health authorities have reported 2 deaths in Monrovia from the strange disease that hit Greenville in Sinoe County last week.

The communication director of the Ministry of Health, Mr Sorbor George, told local radio on Monday [1 May 2017] that one of the dead persons was among 60 persons who went to Greenville, Sinoe County from Monrovia to attend a funeral where the victims of the strange disease are said to have contracted it.

According to George, the 2nd victim to die from the disease in Monrovia is the fianc? [likely to be fianc?e. - Mod.SH] of the man who died from the disease following his return from Greenville. He said the deaths of the 2 bring the toll from the disease to 12, and the total number of persons who have contracted the illness to 21. George stressed that 10 of the deaths occurred in Greenville, while the other 2 happened in the capital Monrovia. He said the health ministry has launched a massive search for all 60 Monrovia residents who attended the funeral in Greenville in order to place them in isolation for observation.

He reiterated that initial tests have proved that the deaths are not Ebola-related, and that Lassa fever tests have also proved that the deaths are not related to Lassa fever. Meanwhile, George has reiterated his call on all Liberians, no matter where they live, to alert heath authorities or report to health centers relatives who show symptoms of vomiting, stomach ache and diarrhea. He also reminded Liberians to continue to abide by measures like handwashing and reporting sick and dead relatives to health ministry authorities in communities to prevent the spread of diseases.

George told journalists that blood samples of victims of the disease have been sent to Atlanta, Georgia (United States) for testing, while Liberian health authorities have appealed to the World Health Organization (WHO) to help in conducting an investigation into the causes of the deaths.

[byline: Cholo Brooks]

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

[The total death toll has now increased by one to 12 since the last report. This report raises an important question: is this disease transmissible? Apparently, a man who was exposed in Greenville passed the etiological agent to his fianc?e. Although not explicitly stated, the report implies that the fianc?e had not traveled outside of Monrovia, and that the exposure, therefore, must have been via the man who had been in Greenville. It will be interesting to see whether other secondary cases appear.

Maps of Liberia can be accessed at http://www.geoatlas.com/medias/maps/...iberia_pol.jpg . - Mod.TY

Many thanks to the several correspondents who sent us this report subsequently. - Mod.SH

 

[alert]

Or perhaps a contaminated product was distributed widely?

https://www.liberianobserver.com/news/greenville-calm-but-confused-over-strange-deaths/

​[snip]

Meanwhile, a 17-year old survivor told this newspaper that on Saturday, April 22, while she was selling roasted corn, her friend gave her a Savanna Dry alcoholic drink, which she believes resulted in serious stomach pains and headache, followed by vomiting and a sore throat the next day. She said she was then given ?anointing oil? and later treated at the hospital.

 

[alert]

Apparently, the girlfriend didn't get sick until after the man died:

https://medicalxpress.com/news/2017-...a-capital.html

More die as mysterious illness spreads to Liberia capital

May 2, 2017

More people have died following the outbreak of a mysterious illness that began in southeastern Liberia but has spread to the capital, with 12 unexplained deaths so far, health authorities told AFP Tuesday.




Liberia's health ministry and the World Health Organization (WHO) both confirmed a revised death toll from Friday, with a ministry spokesman, Sorbor George, saying the illness first registered in Sinoe County was now present in Monrovia.
"The illness has entered the capital. A man came from Sinoe to attend a funeral in Monrovia and he got sick. He shows the same symptoms, later on he died," George said.
"After he died his girlfriend got sick showing the same symptoms, she died also," he added.
The Liberian government had given a death toll of nine on Friday, while the WHO had said 11.
The WHO raised the total number of confirmed total cases to 25, from 19 on Friday, and said the "majority" related to the funeral of a religious leader in Sinoe County. Cases started being registered on April 23.
[snip]

 

[alert]

So what does he know that we don't? Did the fianc?e have some additional exposure that we don't know about?

http://www.bushchicken.com/kateh-disease-outbreak-in-sinoe-not-transmissible/

Kateh: ?Disease Outbreak In Sinoe Not Transmissible?

​ GREENVILLE, Sinoe ? Liberia?s chief medical officer, Dr. Francis Kateh, says the unknown disease outbreak in Greenville, Sinoe ? which has so far killed 12 people ? is not transmissible.
?Health authorities are 99 percent sure that the disease is not transmissible,? Kateh said on a local radio station.
According to Kateh, about 60 persons from Monrovia and other parts of the country attended a funeral in Sinoe where they came in contact with the disease.
He explained that 22 persons became affected by the unknown disease, with 10 deaths reported in Sinoe.
Kateh said two other persons died in Monrovia as a result of the disease, bringing the death toll to 12.
Kateh indicated that one of the patient health practitioners were searching for was found on Monday, May 1, in Sinoe, adding, ?the patient was unconscious after being found and has been stabilized.?

​[snip]
The Liberian chief medical officer said one of the persons who attended the funeral from Monrovia returned from Sinoe and started showing signs of diarrhea, vomiting, weakness, abdominal pains, and later died.
After a few days, the victim?s fianc?e also fell ill with similar symptoms and died. The scenario of the victim?s fianc?e also falling ill and dying raises suspicions about Kateh?s statement that the cause of the deaths is not transmissible, as numerous news reports have indicated that the fianc?e had not traveled to Sinoe.
[snip]

 

[alert]

http://allafrica.com/stories/201705030949.html

​[snip]
The Health Ministry's Communications Director said until now, the actual cause of deaths has not been established.
George explained that the Liberian Government and partners including World Health Organization and Center for Disease Control and Prevention (CDC) of the United States have conducted about 15 tests, but yet to establish the identity of the strange disease.
He disclosed that specimens of the victims have been sent to CDC headquarters in Atlanta Georgia, USA for further testing and the result is expected in three weeks.
George clarified that all of the tests conducted so far have ruled out Ebola and Leaser Fever.
Meanwhile, George has disclosed that the government has made arrangement to bring in a pathologist to conduct autopsy on the victims' bodies to establish cause of death. He said the pathologist is expected in Liberia this week.

 

[Pathfinder]

Translation Google

12 deaths in 10 days

Liberia: "This disease could be a collective intoxication"

By Anne-Laure Lebrun

A week after the suspicious death of 12 people in Liberia, investigations are continuing. The path of intoxication is explored.

Published on 04.05.2017 at 14h07

The unexplained death of 12 people in Liberia once again makes the country tremble. In 10 days, this unknown disease struck 21 people in the province of Sinoe, 4 hours drive from the capital, Monrovia, as well as in the latter.

Virus, bacteria, parasite? For the moment, nobody knows what has been able so quickly to overthrow this dozen people. High fever, vomiting, diarrhea and headaches immediately resembled the Ebola virus or Lassa fever. But on Friday (April 28th), the World Health Organization (WHO) said all the samples tested returned negative for both viruses. A pate of relief that leaves room for questions.

Possible food poisoning

"I'm kind of like you right now. I ask myself a lot, says to Pourquoidocteur Professor Denis Malvy of the department of infectious diseases of the CHU Bordeaux and member of the team Inserm "Infectious diseases in resource-limited countries". There seems to be a group effect. This could be severe poisoning or collective intoxication. In this case, it should remain circumscribed ".

Among the 20 or so patients, several were said to have participated in a funeral in the province of Sinoe. In the field, experts take samples of the food and beverages served at the ceremony. They also investigate whether foodstuffs have been transported, particularly in the capital Monrovia, where cases have been reported. Analyzes are currently underway at the US Centers for Disease Prevention (CDC) in Atlanta. The pathogen should not be identified for several weeks.
...
Fear of an epidemic

"If it is not an intoxication, it will be necessary to make sure that it is not the emergence of an epidemic, in particular an outbreak that would resemble Ebola," says the French specialist, adding that if there is an epidemic, "we will know very soon".
...
Pending CDC results, patients hospitalized at Francis Grant Hospital in Sinoe province are receiving antimalarials, antibiotics and painkillers. WHO teams are working closely with the Liberian health authorities to provide logistical and personal support. Like Ebola, the patients are isolated, relatives are sought after for examination, and funeral rites are discouraged.

https://www.pourquoidocteur.fr/Arti...ette-maladie-pourrait-intoxication-collective

 

[alert]

Whatever the cause, cases continue to be reported from Greenville, suggesting ongoing exposure. Alternatively, perhaps unrelated cases are now being counted (note the CFR is dropping over time as new non-fatal cases are being reported), further muddying the waters.

http://journalducameroun.com/en/numb...o-28-dr-kateh/
Liberia&#146;s chief medical officer, Dr. Francis Kateh, Thursday disclosed that seven additional cases of the &#145;strange disease&#146; have been reported in Greenville, bringing the number of infected persons to 28.Briefing journalists in Monrovia Thursday, Dr. Kateh said the number of deaths still stands at 12 &#150; ten in Greenville and two in Monrovia &#150; and that the sick persons are responding to treatment..
He said two pathologists are expected in Liberia on Friday to conduct autopsies on the bodies of the victims of the &#145;strange disease&#146; to establish the cause of death.
Dr. Kateh reiterated that the deaths are not Ebola-related, and called on Liberians to exercise patience as the ministry of health institutes measures to establish the cause of the deaths in Greenville in Sinoe County and in Monrovia.