Tuesday, May 28, 2013

ProMED: Undiagnosed deaths - Benin [Oueme]

Published Date: 2013-05-28 09:47:58
Subject: PRO/AH/EDR> Undiagnosed deaths - Benin: (OU) RFI
Archive Number: 20130528.1740478

Date: Mon 27 May 2013
Source: La Nouvelle Tribune [in French, trans. Mod.MPP, edited]

Dangbo: unidentified epidemic has already caused 100 deaths in Dekin
For about a month the people of Dekin, a town in the municipality of Dangbo [department of Oueme], have witnessed, impotent, the disappearance of dozens of their sons and daughters. An unidentified epidemic, which has resulted in up to 6 deaths per day, has occurred without the knowledge of the public health [authorities] in Benin.

Fever, vomiting, and simultaneous bleeding from the nostrils, followed by strange breathing sounds, and finally the victims' heart stops. These are the visible symptoms of the disease, as yet unidentified, which turned into an epidemic, spreading panic in Dekin, a lakeside and landlocked town in the Dangbo commune. According to relatives of the victims, this has been going on for a month. Dozens of young people of this town, aged 4 to 20 years, have died within 24 hours of the onset of the symptoms described above, without attracting the attention of the authorities in charge of public health in Benin. In addition, several victims, including those whose bodies may have developed resistance against the disease, are still languishing on beds at the clinic in town. But they may succumb in the days to come if nothing is done, because the clinic (and town) does not have adequate staff to administer care to patients in a suitable manner. The existing staff in the health center consist of health attendants [not nurses or doctors]. In addition, some people lack drinking water and are forced to share water sources with animals.

[byline: Camille A Segnigbinde]

communicated by:

Date: Tue 28 May 2013
Source: Xinhua News Agency [in French, trans. Mod.MPP, edited]

According to a Beninese private television station report on Monday morning [27 May 2013], more than 100 people, mostly children aged 4 to 17, have died in the past 4 weeks from a disease not yet identified in Dekin in the commune of Dangbo, located about 50 km [31 mi] south east of Cotonou, Benin's capital.

"During the past 4 weeks Dekin has recorded more than 100 deaths from an epidemic manifested by vomiting blood and a strange respiratory sound coming from the patient," according to the television report.

In addition to the fatal cases, according to the same source, this town in the southeastern part of Benin also has other critically ill cases hospitalized in the local clinic, which has neither a nurse nor a doctor.

"Only a midwife plays the role of doctor in the health center for this town of more than 10 000 people," the source said.

[byline: Li Zhijian]

communicated by:

[The limited description of the outbreak provided in the 2 newswires above suggests there is a febrile illness with hemorrhagic manifestations and pulmonary compromise leading to respiratory distress and rapidly progressing to death, predominantly affecting children between the ages of 4 and 17. While reading these newswires, this moderator was reminded of the outbreak of Marburg fever that affected primarily children in Angola in 2005 (see prior ProMED-mail reports listed below).

The differential diagnosis for a hemorrhagic fever in Benin would include more "common" etiologies such as leptospirosis, yellow fever, malaria, Crimean Congo hemorrhagic fever, and dengue, among others.

The more "exotic" viral hemorrhagic fevers such as _Ebolavirus_, _Lassavirus_, and _Marburgvirus_ have not been reported from Benin. Lassa fever has been identified in West African countries including Nigeria, Sierra Leone, Liberia, and Guinea.

In addition, a returning traveller with Lassa fever had a history of travel to Ghana, Cote d'Ivoire, and Burkina Faso prior to onset of illness (Gunther S, Emmerich P, Laue T, et al. Imported Lassa fever in Germany: molecular characterization of a new lassavirus strain. Emerg Infect Dis. 2000; 6(5): 466-76; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627947/). It is known that rodents of _Mastomys_ species are ubiquitous in Africa, leading to a situation that might be ripe for introduction of Lassa fever virus into Benin. (For a map showing the countries where Lassa fever has been identified, see http://vhfc.org/lassa_fever.

The stated absence of highly trained healthcare personnel in the area may be contributing to the panic that is occurring in the affected zone.

According to Wikipedia, Dangbo is a town, arrondissement [district], and commune in the Oueme Department of south eastern Benin. The commune covers an area of 340 sq km (131 sq mi) and as of 2002 had a population of 66 055 people. A map of the location (available at http://en.wikipedia.org/wiki/Dangbo) shows that Dangbo is located very near the border with Nigeria. For the interactive HealthMap/ProMED map of Benin, see http://healthmap.org/r/71my.

ProMED-mail would greatly appreciate more information on this outbreak from knowledgeable sources in the region. - Mod.MPP]


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