"[The following report is thanks to Dr. Louise Martin, DVM, and Dr. Doug Klaucke, MD, Acting WHO Representative in Nairobi, who corrected and updated (Thu, 01 Jan 1998 13:06:02 +0300) my original draft of Dr. Martin's Monday conversation with me. You cannot get closer to the horse's mouth than this and we at ProMED-mail greatly appreciate their sharing this information. We look forward to updates. Dr. Martin is presently on her way back to Garissa. - Mod.MHJ] On Monday (12-29-97), I spoke by telephone with my ex-student Dr. Louise Martin, who is in Garissa. She is the only veterinarian with the international team there and the only vet in the region known to be working on this outbreak. On the animal side, thousands of livestock - cattle but especially sheep and goats - are dying or dead. Martin estimates the livestock mortality rate to be 50% to 75% in the area. The animals show a fever, with or without constipation, passing to diarrhea and snotty noses with or without blood, and then a terminal diarrhea (also with or without blood). There is a "viral soup" of conditions there, with a wide variety of conditions, some very suggestive of FMD (foot lesions but as yet she has seen no mouth lesions), foot rot, pleuropneumonia, you-name-it. The area has been without veterinary coverage for some time apparently due to severe flooding. Many of the dying and dead stock are being butchered and eaten. She has examined a 14 year-old girl who had just been taught how to butcher goats and who had fluid and pus-filled vesicular lesions on her hands, and lymphadenitis of axillary nodes. A frequently volunteered comment by the meat consumers is that the cooked meat is tasteless and soft like "over-ripe fruit", this is characteristic of high lactic acid levels. [Historically, this affected area is close to one of the areas where Rinderpest was not eradicated in the previous African campaign of the '60s & '70s. MHJ] They have confirmed over 300 human deaths to date. Most died within 3-4 days, some within 12 hours, of falling ill. The condition characteristically starts with a high fever, bad headache, abdominal pain, passing to vomiting and diarrhea. If they vomit blood it is a lethal prognosis, passing to epistaxis, shock, and death. Because this area is affected by undernutrition, unclean drinking water, multiple diseases and limited health services it is difficult to estimate the number of non-fatal cases that may be occurring so an accurate estimate of the case fatality rate is not possible. So far they have only got to some 12-15 villages, but there has been a stream of people sent from further villages in attempts to get help. One very ill small boy who had been vomiting blood was treated with penicillin and is now sitting up in bed. The medical facilities there are less than minimal, compounded by the two months nurses strike. Treatment seems to be limited at this time to chloroquine and penicillin. While the national government initially claimed that the "bleeding disease" is due to malaria (and there are plenty of mosquitoes and malaria), of the 22 samples checked in Nairobi for clinical malaria, none were positive. But this disease along with many others will be present in this area where there is extensive and widespread malnutrition. There is cholera in the same general area. Initial results of testing the [21] human serum samples at the National Institute of Virology in South Africa found no evidence of Ebola, Marburg, Chikungunya, Sindbis, West Nile Fever, dengue, tick-borne encephalitis complex, Lassa fever, Crimean-Congo hemorrhagic fever, and hantaviruses. Sera tested at the Kenya Medical Research Institute in Nairobi were negative for yellow fever. Testing for anthrax and Rift Valley fever are not yet complete. There were three sera positive for IgG to _B. anthracis_ and one possibly positive for [PA] antigen. Four of 22 sera were positive by PCR for Rift Valley fever virus (RVFV) RNA. Three of these four were negative for IgM antibodies to RVFV antigens, so confirmatory tests are being done. On the Somali side of the border the disease situation is very similar. Case finding there has been made harder by the Muslim need to bury corpses expeditiously. The single telephone line is in to the International Red Cross compound. The health team of some 8 individuals is made up of the Provincial medical health staff, WHO, AMREF, Medicines sans Frontieres, International Red Cross, and Medicines du Monde. The Kenya army fled. Local transport to check villages is through the Rural Food Program vehicles. The tracks are soft, deep mud. Thanks to the rains some villages when reached are found to have been abandoned. There is one helicopter, and banditry. Thanks to the national election (29-30 December) and the holiday season (25 December through 30 December were all national holidays), it has been difficult to mobilize national government support. All ministers were running for re-election and the country is between governments. The investigation is expected to continue to confirm the diagnosis [= or diagnoses], to obtain a better estimate of the magnitude of the problem, and to determine whether it is spreading. Prevention and treatment measures are also being planned.--Martin Hugh-Jones, ProMED-AHEAD moderator, <mehj2020@vt8200.vetmed.lsu.edu> on ProMED-mail <promed@usa.healthnet.org>