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Bakool, Somalia: an unidentified disease that has killed at least several people

Ronan Kelly

Ronan Kelly

Retired 2020
A report of an unidentified disease that has killed at least 64 people. Reportedly most of the patients are women and children.

more...


original link:

Zhttp://www.allheadlinenews.com/articles/90048949?Mysterious%20illness%20kills%2064%20in%20southwestern%20Somalia
 
Last edited by a moderator:
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

That first post is extremely alarming (64 deaths this week of an illness that kills in 2 days? No mention of symptoms?), but the only other article I have found is (and nothing yet in a local source).

There may be something wrong with the original report.

http://allafrica.com/stories/201105180736.html

Diarrhea Claims Three Toddlers in South of Country
18 May 2011

Owdhegle — At least three children on Wednesday were reported to have died of watery diarrhea in the region of Lower Shabelle region in southern Somalia.

Local residents confirmed Shabelle an outbreak of watery diarrhea in many parts of the region.

Witnesses said at lat 7 other children under the age of five are suffering for the same disorder.

Mohamed Ali, a resident in Lower Shabelle region said that the disease always hit the region after rains began and winter (drought) passed away.
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people?

Re: Somalia: a report of an unidentified disease that has killed at least 64 people?

OK. What was wrong with this was the timing - this happened over several months, and the fatalities are not within 48 hours as originally reported.

Unclear the cause, but some kind of poisoning might be involved.

http://reliefweb.int/sites/reliefwe...Humanitarian Bulletin #20, 13-20 May 2011.pdf

In Hudur, Bakool region, there are reports of an unclassified disease that has affected over 90 people with 53 deaths. Signs and symptoms of the cases include fever for one to two months, a high pulse rate, occasionally sore throat, progressive swelling of joints and limbs including pains. It is observed that patients either recover slowly or die. Retrospective data collected indicates that the case fatality rate is a major concern. WHO has dispatched additional supplies including antibiotic syrups and tablets to Hudur to support the mobile clinic in the affected villages for a period of one month.
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

proMED's comments on the first report;

It is impossible to discern the cause of this apparent outbreak
without further information. Enteric infections, including cholera,
other bacterial diarrheas or foodborne illness, influenza and a
variety of other respiratory viral infections could be involved.
Further details from anyone with information from this region would be
welcome. - Mod.LM

[Re the similar outbreak in the same locality in 1999 (see ProMED
ref. below), I commented at that time "Sounds like the usual
unfortunate multiple cause outbreak in an aggravated sanitary
situation."

ProMED/Healthmap location at http://healthmap.org/r/0RM-
- Mod.JW]

[see also:
1999
----
Undiagnosed deaths - Somalia (Bakol): RFI 19990513.0781] http://promedmail.org/pls/apex/f?p=...,F2400_P1001_USE_ARCHIVE:1001,19990513.0781,Y
.................................................lm/ejp/jw


http://promedmail.org/pls/apex/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88517
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

This is the 1999 ProMED posts referenced above.

Could certainly be the same type of situation now, but the UN report above seem to describe an illness of longer duration and high CFR.

http://www.promedmail.org/pls/apex/...,F2400_P1001_USE_ARCHIVE:1001,19990513.0781,Y

Archive Number 19990513.0781
Published Date 13-MAY-1999
Subject PRO/EDR> Undiagnosed deaths - Somalia (Bakol): RFI



UNDIAGNOSED DEATHS - SOMALIA (BAKOL): REQUEST FOR INFO
********************************************************
A ProMED-mail post
<http://www.healthnet.org/programs/promed.html>

Date: 22 April 1999
From: Marjorie P. Pollack <pollackmp@mindspring.com>
Source: Xinhua News Agency [edited]
[The delay in posting is regretted; this item was buried inside a cholera
report & has only just come to our attention - Mod.JW]


Mohamed Dayow, one of the prominent elders of Tieglow of
Bakol region, told journalists on the VHF radio here in Mogadishu
that an unknown disease similar to measles and flu killed many
people in less than a week since its breakout. The local authorities
said that there is no diagnosis so far to cure this disease, which
has spread to more than 16 villages around Tieglow and is killing
four to five people everyday in the Horn of Africa country.

Mohamed Hajji Mohamed, the only medical worker in Dinsor district,
said water shortage is forcing the nomads and their livestock to move
to nearby towns and villages, which further aggravated the spread of
the disease.

Local elders said more than 40 people are infected with the unknown
disease everyday in five villages surrounding Dinsor district, including
the populous Korombod and Raholeh.

Cholera and malnutrition are killing dozens of people in southern
Somalia every week. Dayow said more than 90 people have died
of such diseases in his town in the past three weeks.

--
ProMED-mail
<promed@usa.healthnet.org>

[Sounds like the usual unfortunate multiple cause outbreak in an
aggravated sanitary situation. If anyone has seen any followup
to this report of an unknown disease, we would very much
like to receive it - Mod.JW]
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88547

Archive Number 20110522.1557
Published Date 22-MAY-2011
Subject PRO/EDR> Undiagnosed illness, fatal - Somalia (02): (BK) RFI

UNDIAGNOSED ILLNESS, FATAL - SOMALIA (02): (BAKOOL), REQUEST FOR
INFORMATION
****************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 21 May 2011
Source: OCHA Weekly Humanitarian Bulletin No. 20, 13-20 May 2011 via
Somaliweyn [edited]
<http://www.somaliweyn.org/pages/news/May_11/21May18.html>


In Hudur, Bakool region, there are reports of an unclassified disease
that has affected over 90 people with 53 deaths. Signs and symptoms of
the cases include fever for one to 2 months, a high pulse rate,
occasionally sore throat, and progressive swelling of joints and limbs
including pain. It is observed that patients either recover slowly or
die.

Retrospective data collected indicates that the case fatality rate is
a major concern. WHO has dispatched additional supplies including
antibiotic syrups and tablets to Hudur to support the mobile clinic in
the affected villages for a period of one month.

--
Communicated by:
Ronan Kelly for FluTrackers.com
<http://www.flutrackers.com>

[This may be the same cluster described in an earlier report (archive
number 20110521.1534) reporting 64 deaths in the same region due to an
undefined illness. Those deaths were reported to be mainly in women
and children. It is hard to fit the clinical syndrome into any one
disease entity, and one wonders whether there are multiple
contributing etiologies: respiratory viruses, arboviruses
(chikungunya?), malaria, enteric infections (including typhoid), and
hepatitis, all in the setting of more chronic maladies such as
malnutrition, HIV and tuberculosis. Any additional information would
be welcomed. - Mod.LM]
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88578


Archive Number 20110525.1583
Published Date 25-MAY-2011
Subject PRO/EDR> Undiagnosed illness, fatal - Somalia (03): (BK) RFI

UNDIAGNOSED ILLNESS, FATAL - SOMALIA (03): (BAKOOL), REQUEST FOR
INFORMATION
****************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 23 May 2011
From: A. Mark Joffe [edited]
<mjoffe@ualberta.ca>


The fatal illness reported in Somalia has some similarity to
epidemics reported in neighbouring Ethiopia - Epidemic Dropsy. This is
a syndrome caused by tainting of cooking oil with the Mexican poppy,
_Argemone mexicana_, that is now grown in Ethiopia, India, U.S. and
India (and perhaps elsewhere). Epidemics have been reported in South
Africa as well as Ethiopia.

The syndrome is usually associated with G.I. symptoms (diarrhea and
vomiting) but presents with continuous or intermittent fevers and
bilateral symmetrical pitting edema and burning paresthesias of the
legs. The edema is a result of a capillary leak syndrome that can
progress to non-cardiogenic pulmonary edema, cough, dyspnea and
death.

--
A. Mark Joffe
Professor of Medicine, Division of Infectious Diseases, University of
Alberta
Senior Medical Director, Infection Prevention and Control
Alberta Health Services
<mjoffe@ualberta.ca>

[ProMED-mail thanks Dr. Joffe for his contribution on a possible
cause for the outbreak in Somalia. This outbreak has affected more
than 90 people with 53 deaths and has been characterized by "fever for
one to 2 months, a high pulse rate, occasionally sore throat, and
progressive swelling of joints and limbs including pain."

ProMed-mail has previously posted reports on epidemic dropsy: see
Epidemic dropsy - India (UP): mustard oil susp. 20050207.0412.
Epidemic dropsy is an intoxication with benzophenanthridine alkaloids,
sanguinarine and dihydrosanguinarine, present in argemone oil, mainly
derived from the seeds of _Argemone mexicana_ (Mexican prickly poppy),
that has adulterated cooking oil, usually mustard oil
(<http://www.ncbi.nlm.nih.gov/pubmed/10621875>). Several outbreaks of
epidemic dropsy have occurred in the past in India as well as in
Mauritius, Fiji Island, and South Africa
(<http://www.ncbi.nlm.nih.gov/pubmed/9189656>).

More information concerning the clinical picture and epidemiology of
the Somali outbreak would be greatly appreciated.
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Today's WHO release indicates 134 cases, not 90, with the same 53 deaths, greatly reducing the apparent CFR from 60% to less than 40%.

Same symptomatic description, though.

http://www.who.int/hac/crises/som/sitreps/somali_eha_27may2011.pdf

In Huddur, Bakool region there are reports of an unclassified disease that has now affected over 134
people with 53 deaths. Signs and symptoms of the cases include fever for 1 to 2 months, a high pulse
rate, occasionally sore throat, progressive swelling of joints and limbs including pains. It is observed
that patients either recover slowly or die. Retrospective data collected indicates that the case fatality
rate is a major concern.
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

alert said:
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88578



The fatal illness reported in Somalia has some similarity to
epidemics reported in neighbouring Ethiopia - Epidemic Dropsy. This is
a syndrome caused by tainting of cooking oil with the Mexican poppy,
_Argemone mexicana_, that is now grown in Ethiopia, India, U.S. and
India (and perhaps elsewhere). Epidemics have been reported in South
Africa as well as Ethiopia.

.
Click to expand...

We actually have a previous outbreak of dropsy from India which is a very good symptomatic match:

http://www.flutrackers.com/forum/showthread.php?t=146857

At the time, I did not understand exactly what was being implied by "drposy".
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

http://reliefweb.int/sites/reliefweb.int/files/reliefweb_pdf/node-406066.pdf

WHO mobile teams continue to provide access to basic health services in Huddur district, Bakool
region in response to a unclassified disease reported in previous weeks. Six serum samples have
been collected and results are still pending. A second batch of blood samples will be collected and
sent for laboratory diagnosis in Nairobi. Following rumors of a similar unclassified disease in
Tiyeglow district, WHO will send an investigation team to collect samples.
 
Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Re: Somalia: a report of an unidentified disease that has killed at least 64 people

Notably, the CFR among cases in this chart is about 3%, far lower than previously reported, inidicating that patients might be responding to treatment, or that the previous number of deaths reported may have been exaggerated.

http://www.who.int/hac/crises/som/sitreps/somali_eha_27may2011.pdf

A WHO mobile team is visiting the affected villages
in Huddur district in Bakool region to investigate
and respond to reports of an unclassified disease
affecting the villagers (see table). From 20-25
May, around 100 cases were examined including
eight (8%) children under the age of five; 81% are
female. Patients were then treated with antibiotics
and vitamins. The team that is currently in Hoogor
has collected samples from patients that have
been sent for virology tests. This response activity
is expected to continue. WHO is also investigating
similar rumors of this unknown disease reported
from Tiyeglow district.

Villages/ Cases< five/Cases> five/Deaths> five
Hawal Hirabay - 5
Baano - 15
Gersiiley 1 12
Abal 2 18
Busley 4 24 2 (female)
Dinni 1 20 1 (female)
 
Re: Bakool, Somalia: an unidentified disease that has killed at least several people

If they are testing for dengue and chikungunya, we may also have a bad symptomatic description.

Keep in mind only one article provided any symptoms at all, and its wording was very confusing.

http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_1402.pdf

WHO mobile team continue activities in Huddur district, Bakool region in response to reports of an
unclassified disease. The results for six serum samples collected from patients tested negative for
dengue fever, chikungunya and other arboviruses. Results for virus cell culture are still pending. New
blood samples will be collected from Huddur and Tiyeglow districts and referred to Nairobi for
laboratory confirmation.
 
Re: Bakool, Somalia: an unidentified disease that has killed at least several people

This is in a summary report. Apparently some of the cases may be due to dengue or to beriberi, but investigations continue.

http://reliefweb.int/sites/reliefweb.int/files/reliefweb_pdf/node-423027.pdf

Since mid May, WHO mobile teams conducted outbreak investigation
in Huddur district (Bakool) in response to rumours of an unspecified
disease. As of 23 May, 21 patients (81% of them female) were
identified by the team. Core symptoms for all patients were recorded
as slight fever with general body weakness, swelling of legs (non
pitting), back ache, skin lesions (not rash), mild diarrhoea and mouth
ulcers. All patients were above 5 years (age range: 25-70). The onset
of symptoms ranges from the period between February and May, and
new cases continue to be identified by the investigation teams. The
teams were equipped with two basic units of the Interagency Emergency
Health Kit (IEHK) which cover a population of 4,000 for 3 months, a Health Post Kit which serves
as the equipment module, and vitamin B supplements which are being prescribed to all patients. During
the visit, 8 serum samples were collected to be tested for Dengue Fever and micro-nutrient deficiency
(to rule out Beriberi). At the same time, WHO prepositioned an additional IEHK and Diarrhoeal Disease
Kit (DDK) in Wajid to ensure continuity of activities and outbreak response capacity in case of AWD.
• In May, cases with similar symptoms were reported also from Tieglow.

[snip]

In May, WHO received rumours of increasing cases of unspecified,
prolonged fever among patients in Berbera Port town
(W’ Glabeed) in Somaliland. Outbreak investigation was conducted together with MoH. Of the 30
serum samples which were collected from the hospital, 9 tested positive for Dengue Fever.
 
Re: Bakool, Somalia: an unidentified disease that has killed at least several people

http://reliefweb.int/sites/reliefweb.int/files/resources/Full Report_23.pdf

[snip]

WHO mobile team continues activities in Tayeeglow and Hudur districts, Bakool region providing basic health services for the
underserved population in the affected areas. Results of blood samples collected from patients, following reports in previous
weeks of an unclassified disease are undergoing tests.
 
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