Gulran Disease Cases by Week of Onset

WeeklyEpidemiological Monitor Volume 1, Issue 19, Sunday 11 May 2008

Reported Gulran Disease Cases by Week of Onset, . Current major events Gulran District, 2007-2008 G n=175 n=175 Gulran Disease Food 25 replacement An Outbreak in Afghanistan begun in affected 20 villages On 2 April 2008, the Ministry of Public Number Health (MOPH), Afghanistan reported of cases 15 an outbreak in Western Afghanistan, in the Gulran district of Herat Province. 10 The outbreak presented as hepatic veno- occlusive disease (VOD). 5

This outbreak started in November 0

t c p t v n b r r c e e a 2007. As of April 2008 a total of 175 e o D a S O N J F M Ap cases, including 13 deaths were reported from more than 17 villages. The disease Symptoms: Patients may present with vomiting and severe abdominal pain. Hepatomegaly, right upper quadrant abdominal sensitivity, and ascites follow. Jaundice is seen inconsistently. is believed to be caused by exposure to pyrrolizidine alkaloids (PAs). Preliminary results of charmac samples from Gulran Some Facts on PAs: Update on outbreaks tested in the National Institute for Pub- • Acute dosing with large amounts of pyr- lic Health and the Environment (RIVM) rolizidine alkaloids (PA) produces primar- Cholera: (Sudan) reported from s. Su- Laboratory, The Netherlands show high ily liver disease in humans, but gastroen- dan; AWD: in Somalia; VOD: More new levels of PAs, mostly heliotrine and teritis may also be seen. cases reported from Afghanistan lasiocarpine. • Diagnosis is often difficult, because pyrrolizidine alkaloids are usually excreted within 24 hours, but the symptoms may not ap- Current public health events of On 3 May 2008, WHO and MOPH vis- pear for days or weeks. international concern ited the Gulran district headquarters of • Toxicity may result from both subacute [cumulative No of cases (deaths), CFR %] Qarabagh and the village of Zergy, the and chronic exposures, is more likely to first village to report Gulran disease. occur in children, and may be passed Avian influenza transplacentally from mother to fetus

• Veno-occlusive disease is the primary Egypt [50 (22), 44%] symptom seen in humans Editorial note Indonesia [133 (108), 81.2%] • Prevention of absorption is only useful if Since the first week of April, WHO and an ingestion has just occurred Cholera partners have been assisting the Ministry of Public Health in Afghanistan to re- Kenya [1243 (67), 5.4%] of similar disease to the outbreak were spond to an outbreak of a disease that Sudan [23 (2), 8.7%] presents with hepatic veno-occlusive observed in the past. syndrome. The outbreak affected the VOD of the liver is a form of toxic liver Wild Polio Virus Gulran District of Herat Province. The damage caused by pyrrolizidine alkaloids. One case detected in S. Sudan, living onset of the outbreak is reported to be It has been observed in many rural in Ethiopia. [1 (0), 0%] November 2007, thus indicating the population around the world and other VOD: (Pyrrolizidine Poisoning) insidious nature of evolution of the out- outbreaks have been documented from break. Jamaica, South Africa and Iraq (1994). Afghanistan [175 (13), 7.4%] Veno-occlusive disease of the liver is not The ultimate control of VOD outbreaks Hand Mouth & Foot Disease new in this part of Afghanistan. In 1974, caused by PAs in Afghanistan should China [6545(22), 0.3%] a similar outbreak was reported from the focus on agriculture sector. In the short Yellow fever same districts of north-western Afghani- term, patients need to be cared for, the stan. It was traced to consumption of population should be educated and pro- C.A.R. [8(0), 0%] bread made from wheat contaminated vided with safe grains. In the long term, with seeds of Heliotropium plants the government need to focus on agri- Dengue fever (Charmac), which are shown to contain culture policies that will reduce the inci- Brazil [121586 (103), 0.1%] pyrrolizidine alkaloids. Investigation at dence of contamination of grains with (*=Unofficial figures) the time disclosed that occasional cases Heliotropium (Charmac) weeds. CFR=Case-Fatality Rate

Published by the World Health Organization (WHO), Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt. • weeks. 19