|Press Release WHO/14
2 March 1999
BEHIND DEADLY AFGHAN OUTBREAK
On their return from Afghanistan, two World Health Organization medical experts said a mysterious disease that has claimed dozens of lives in a remote mountainous area of northern Afghanistan is an "influenza-like" acute respiratory infection.
The high death toll has been caused by secondary bacterial infections which have been made more serious by poor hygiene and nutrition and a lack of antibiotics. Provisional reports covering two most populous clusters of villages speak of 196 deaths. Overall number of deaths cannot be determined as reports are not available from various other places, some of them simply out of reach due to climatic conditions.
Dr Thomas Grein and Dr Takaaki Ohyama, who travelled to Afghanistan from WHO headquarters in Geneva soon after the first reports of the disease in mid-February, returned to Dushanbe, Tajikistan, last Sunday. They said they had treated 20 patients with an antibiotic chloramphenicol which had greatly improved their condition, and that health authorities were informed of this.
Clinical specimens collected by the two doctors are to be analyzed shortly to determine the exact nature of the disease.
The outbreak of an unidentified disease in Darwaz, Badakhstan, in northern Afghanistan, was initially reported to WHO on 13 February. On 26 February, the specialized WHO team arrived by helicopter at one of the affected villages, Jamarche Bala, with the logistical support of the United Nations. Other villages were visited by Médecins sans Frontières and Focus (the Aga Khan Foundation).
The outbreak began in mid-January after two young men returned from the village of Waram, both suffering from an acute respiratory infection. They were housed by the village chief at his place. Over the next two days, about 40 persons living in the same and neighbouring households became ill. The disease then spread through the whole village, affecting 70%-80% of households, with a total population of 5,400. The deaths occurred among both men and women but mostly among infants and the elderly. According to the village chief, the ones who were seriously affected by the disease were "those who had problems with their health before". The most recent case was reported on 26 February.
The disease is influenza-like and characterized by abrupt onset of fever, headaches and muscle pain, followed by chest pain and cough. Living and sanitary conditions are crowded all persons of a household (approximately 7 to 20) living in one room. Water supply is unprotected. Water is obtained from a creek that runs through the village. People do not wash because of the cold. Nutrition is of poor quality. In wintertime, the local population subsists on a diet of bread and onions. There are no health services in this remote area, which has not been reached by routine immunization teams. The nearest basic health centre is six days by foot in summer.
The preliminary conclusions of the WHO team in the field are that the outbreak, which is now declining, was of an influenza-like illness which has affected a large proportion of this remote and isolated population, possibly not frequently exposed to influenza . The rate of secondary complications, mainly pneumonia, was high. Unusually steep (for influenza) mortality was 1%-2% of the total population, primarily due to bacterial superinfections and unavailability of antibiotics and overall poor living and nutritional conditions.
WHO and its partners on the ground are now helping local authorities to organize follow-up treatment and arranging for additional medical supplies to be delivered to the affected area.
For further information, journalists can contact Mr Valery Abramov, Office of Press and Public Relations, WHO, Geneva. Telephone (+41 22) 791 25 43; Fax (+41 22 ) 791 48 58. E-Mail: firstname.lastname@example.org
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