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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: Volume 15, No.15 (PDF file, 703 KB)
etween 28 March and 3 April 2005, 3475 cases of cholera including 54 deaths (case fatality rate 1.6%) in the Diourbel region, western Senegal were reported by the Ministry of Health, Senegal (1). Almost half of these cases (1733), including 16 deaths, were reported in the city of Touba, 200km east of Dakar, where the annual Muslim pilgrimage 'le Magal de Touba' occurred 29 March 2005. Over 1.5 million pilgrims from all over Senegal , as well as from other African countries, travelled to Touba to the event
The cholera outbreak began in January 2005 (2), and was exacerbated by the increased numbers of people arriving in the area at the end of March. As of 23 March 2005, Vibrio cholerae was confirmed in 14 of 17 samples tested. Cases associated with the pilgrimage appear to be spreading to other regions of the country and have also been detected in Gambia (including three cases detected in Banjul ); further cases are expected to be reported from other neighbouring countries in the coming days (3).
Cholera is an acute diarrhoeal illness associated with regions of the world where sanitation and food and water hygiene are inadequate or lacking, and can spread very quickly in overcrowded conditions. The last cholera epidemic to occur in Senegal occurred in 1996 when 16,107 cases including 765 deaths were reported (4).
Cholera is rarely reported in England and Wales , with only eleven laboratory-confirmed cases reported in 2003, mainly associated with travel to the Indian sub-continent.
1.World Health Organization. Cholera in Senegal - update 2. Disease Outbreak New s [online]. Geneva : WHO, 8 April 2005 [cited 12 April 2005]. Available at http://www.who.int/csr/don/2005_04_08/en/>.
2.World Health Organization. Cholera in Senegal . Disease Outbreak News [online]. Geneva : WHO, 29 March 2005 [cited 12 April 2005]. Available at
3.UN Integrated Regional Information Networks . Senegal : WHO concerned that cholera will spread to neighbouring countries. In AllAfrica.com [online] 4 April 2005. Available at <http://allafrica.com/>.
4.World Health Organization. Cholera in 1996. Wkly Epidemiol Rec [serial online] 1 August 1997 [cited 12 April 2005]; 72 (31): 229-36. Available at
The World Health Organization (WHO) has recently updated its Global Influenza Preparedness Plan (GIPP) (1). The new plan, which replaces that published in 1999 (2), reflects the output from an international consultation exercise that took place in late 2004, in which the Health Protection Agency (HPA) participated actively. It redefines the phases of a pandemic to bring the transition between phases into closer alignment with the need for changes in public health actions at international and national levels. The new plan is available at:
The previous 'interpandemic' and 'pandemic' periods have been supplemented by a third intermediate 'pandemic alert' period. There are six separate phases, of which three (phases three to five in the pandemic alert period) reflect the possibility that a pandemic will emerge gradually from a virus that initially does not transmit readily from person-to-person, but which subsequently adapts to its new human host and becomes increasingly transmissible from person-to-person. More emphasis is placed on rapid public health interventions, which might contain or delay the spread of a new influenza virus subtype in humans before it reaches phase six – the onset of a pandemic.
The revised GIPP also reflects more explicitly the human health risks posed by non-human influenza viruses (eg, avian viruses). Specific objectives and recommended actions for WHO and national authorities are laid out for each pandemic phase, with subdivison into countries 'affected' and 'not yet affected'. The plan also provides for harmonisation with the new International Health Regulations (3) when they are announced and contains a useful appendix on recommendations for non-pharmaceutical public health interventions. In due course, the HPA Influenza Pandemic Contingency Plan (4) will be revised to reflect the new WHO phases and the relevant recommended national actions.
1.WHO. WHO global influenza preparedness plan. The role of WHO and recommendations for national measures before and during pandemics. Geneva: World Health Organization, April 2005. Available at <http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5/en/>.
2.WHO. Influenza pandemic plan. The role of WHO and guidelines for national and international planning. WHO: Geneva, 1999.
3.WHO [online]. International Health Regulations (IHR). Geneva: World Health Organization, 24 January 2005 [cited 13 April 2005]. Available at <http://www.who.int/csr/ihr/en/>.
4.HPA. Influenza Pandemic Contingency Plan. London: Health Protection Agency, February 2005. Available at: