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Infectious Diseases - Short Incubation

  • Diarrheal Diseases
  • Malaria

  • Arboviral Diseases
  • Sexually Transmitted Diseases
  • Meningococcal Meningitis
  • Ebola-Marburg Virus Disease

    Infectious Diseases - Long Incubation

  • Enterically Transmitted Viral Hepatitis A and E
  • Bloodborne Viral Hepatitis B, D, and C
  • Leishmaniasis
  • Schistosomiasis
  • Tuberculosis

    Other Diseases of Potential Military Significance

  • Animal-Associated Diseases
  • Vector-Borne Diseases
  • Other Infectious Diseases

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    Diarrheal Diseases

    Highly endemic. Bacterial agents that may be a major cause of morbidity among nonindigenous personnel include Campylobacter spp., Escherichia coli, Salmonella spp., and Shigella spp. Resistance to the standard therapeutic agent TMP/SMX has been reported. In 1993, 82 percent of Shigella isolates tested from US forces in Somalia were resistant to ampicillin, 53 percent to TMP/SMX, and 43 percent to doxycycline.

    Endemic protozoans such as Cryptosporidium spp., Entamoeba histolytica, and Giardia lamblia often are associated with more chronic infections, but can cause acute diarrhea.

    In 1993, G . lamblia was isolated from 4 percent of US military personnel with diarrhea in Somalia. A 1984 survey of urban schoolchildren in Mogadishu found infection rates of 45 percent for giardiasis and 23 percent for amoebiasis.

    Rotavirus was isolated from 1 percent of US military Personnel with diarrhea in Somalia in 1993. No specific data are available on other viral agents

    For more information click here: www.cdc.gov/ncidod/dpd/parasiticpathways/diarrhea.htm

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    Malaria

    Endemic at intermediate to high levels in southern areas, with intermediate endemicity in central and northern areas. Countrywide, Plasmodium falciparum accounts for 95 percent of reported cases, followed by P. vivax, P. malariae, and P. ovale.

    Foci of more intense vivax transmission occur, including the Jubba River Valley. A 24 percent attack rate for vivax malaria was reported among US troops at Jilib along the Jubba River in 1993.

    Cyclic epidemics of P.falciparum reportedly occur every 3 to 5 years among central and northern area nomads, who lack sufficient exposure to maintain immunity.

    Falciparum malaria strains are resistant to the standard therapeutic agent chloroquine (likely occurs in all malarious areas; reported from the areas of Mogadishu, Balcad, and Baardheere- 02-20-XXN 042-17-XXE).

    Based on limited data from neighboring Kenya and Ethiopia, resistance also may occur to other standard therapeutic agents, including sulfadoxine/pyrimethamine (Fansidar), mefloquine, and quinine.

    Vivax malaria strains resistant to primaquine have been reported. In 1993, a primaquine terminal prophylaxis failure rate of 16 percent occurred among a group of US military personnel returning from the Jubba River area. Additionally, a Belgian Army unit of 68 paracommandos in Somalia in 1993 reported relapses of 6 vivax malaria cases after prophylaxis, indicating resistance to primaquine.

    For more information click here:
    http://www.cdc.gov/malaria/

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    Dengue Fever

    Vectored by Aedes aegypti mosquitoes, a peridomestic, day-biting, container-breeding species. Risk likely exists countrywide but is elevated in the south, associated with increased vector populations. In 1993, dengue fever was the primary arboviral disease confirmed among US military personnel in southern Somalia (dengue virus serotypes 2 and 3 were isolated).

    In 1989, a limited survey of residents from Berbera, Woqooyi Galbeed Region, found that 59 percent had antibodies indicative of past infection, with 3 percent having serological evidence of recent infection.

    Serological results in 1987 suggested dengue 2 as the likely cause of febrile illness outbreaks in 1985, 1986, and 1987 among refugees in the northwest (Hargeysa vicinity).

    For more information click here: www.cdc.gov/ncidod/dvbid/dengue/facts.htm

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    West Nile Fever and Sindbis Virus Disease

    Transmitted by Culex spp. mosquitoes. Enzootic. Risk likely exists countrywide but is elevated in the south, associated with increased vector populations. In 1993, West Nile virus was serologically identified among US military personnel in Mogadishu, and Sindbis virus was serologically identified among US military personnel in Baidoa.

    A limited 1989 survey of residents of Berbera found that 34 percent had antibodies indicative of past West Nile virus infection, with 4 percent having serological evidence of recent infection.

    For more information click here: www.cdc.gov/ncidod/dvbid/westnile/index.htm

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    Rift Valley Fever (RVF)

    May be transmitted to humans by several species of culicine mosquitoes. Many human infections are associated with slaughtering infected animals or handling infective carcasses or animal products.

    Enzootic. An outbreak late in 1997 and early in 1998 in southern Somalia (Gedo, Hiiraan, and Shabeellaha Hoose Provinces) and northeast Kenya resulted in hundreds of human and livestock deaths. Serologic evidence of past infection with RVF was detected in 7 percent of samples from residents of Berbera in 1989.

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    Yellow Fever

    Transmitted by Aedes spp. mosquitoes. Somalia lies within the yellow fever endemic zone. In 1993, an unspecified number of unconfirmed "yellow fever" cases reportedly were diagnosed among displaced persons treated in a Moroccan hospital deployed in Mogadishu.

    Regionally, an outbreak occurred in Kenya in mid-1992 through March 1993 in Rift Valley Province with an attack rate of 27.4 per 100,000. In 1989, a limited survey of Berbera residents found that 30 percent had antibodies indicative of past infection, with 6 percent having serological evidence of recent infection.

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    Chikungunya Virus Disease

    Transmitted by Aedes spp. mosquitoes. Cyclic outbreaks in Africa primarily have involved rural populations, with transmission often by sylvan mosquito vectors, but some have been urban and explosive. Likely enzootic. Serologic evidence of past infection with chikungunya virus was detected in 4 percent of samples from Berbera residents in 1989 and 43 percent of samples from residents in Kismaayo, Jubbada Hoose Region, in 1983.

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    Crimean-Congo Hemorrhagic Fever (CCHF)

    Transmitted by infective Hyalomma spp. ticks or by exposure to infected animals or humans. Enzootic in widely distributed discrete foci, primarily in agricultural areas. Serologic evidence of past infection with CCHF was detected in 7 percent of samples from residents of Berbera in 1989.

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    O'nyong-Nyong Fever

    Transmitted by Anopheles spp. mosquitoes. Endemic status is unclear. Regionally, an epidemic was ongoing as of mid-1997 in Kenya, Uganda, and Tanzania. An epidemic from 1959 to 1963 involved approximately 2 million people in Democratic Republic of the Congo, Uganda, and Tanzania.

    For more information click here:
    http://www.cdc.gov/ncidod/eid/vol3no1/rwaguma.htm

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    Typhoid and Paratyphoid Fevers

    Tendemic at high levels. The carrier rate probably is high. Regionally, resistance to the standard therapeutic agent chloramphenicol has been reported.

    For more information click here:
    Typhoid Fever (Salmonella typhi Infection)

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    Sexually Transmitted Diseases (STDs)

    STDs, including gonorrhea and chlamydial cervicitis/urethritis, are highly endemic. HIV/AIDS and syphilis.

    For more information click here:
    http://www.cdc.gov/nchstp/dstd/disease_info.htm#GenInfo

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    Meningococcal Meningitis

    Outbreaks were last reported in June and July 1990 in northern Somalia, southeast of Hargeysa. Somalia borders the traditional sub-Saharan meningitis belt, which has a high incidence of infections primarily caused by group A organisms but also involving group C. Regionally, an outbreak in Amhara region of Ethiopia resulted in 70 cases from 1 January to 31 March 2000; serogroup C was isolated.

    A major outbreak of group A in Sudan with spread into Ethiopia affected thousands and caused at least 1,500 deaths from December 1998 through May 1999.

    For more information click here: www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_t.htm

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    Ebola-Marburg Virus Disease

    Endemic status is unclear. In 1989, a limited survey among residents of Berbera detected low levels of serologic evidence of past infection with "Ebola" and "Marburg" viruses. Regionally, Ebola hemorrhagic fever outbreaks have occurred in southern Sudan, cases of Marburg virus disease have occurred in northwestern Kenya and northern Democratic Republic of the Congo, and serological studies have detected antibodies to the viruses in Ethiopia, Kenya, and Sudan.

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    Enterically Transmitted Viral Hepatitis A and E

    Viral hepatitis A (see CCDM) is highly endemic. Most Somalis contract hepatitis A virus infection during childhood. A 1992 survey detected antibodies for hepatitis A virus among 90 percent of Somalians tested. In 1993, viral hepatitis E outbreaks were confirmed among Somalis, and cases were reported among nonindigenous personnel involved in relief operations.

    For more information click here: www.cdc.gov/ncidod/disease/heptitis/a/index.htm

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    Bloodborne Viral Hepatitis B/D and C

    Viral hepatitis B is highly endemic. During 1993, surveys of Somalians found the hepatitis B virus (HBV) carrier rate to be between 10 and 27 percent. Viral hepatitis D infection has been reported in more than 17 percent of HBV carriers. Limited serosurveys during the early 1990s found hepatitis C virus (HCV) antibodies in approximately 2 percent of healthy adults tested. Among patients with chronic liver disease, up to 20 percent were HCV positive. A 1987 survey detected HCV (see CCDM) antibodies in 2 percent of 600 children in an orphanage near Mogadishu.

    For more information click here:
    http://www.cdc.gov/ncidod/diseases/hepatitis/

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    Leishmaniasis

    Endemic, with sporadic cases of visceral leishmaniasis and cutaneous leishmaniasis reported. Regionally, a large outbreak of visceral leishmaniasis was "an emergency health problem" in Eritrea, Ethiopia, and eastern Sudan from late 1997 to mid 1999. VL has resulted in the deaths of 100,000 of the 300,000 population in an area in the Western Upper Nile region of southern Sudan.

    For more information click here:
    Click Here to see Full Article

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    Schistosomiasis

    Urinary schistosomiasis caused by S. haematobium is focally endemic. Infection rates exceeding 60 percent were reported from some foci in the early 1980s, with the highest rates reported from areas where irrigation systems had provided snail-breeding sites.

    For more information click here:
    Click Here to see this article

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    Tuberculosis

    Highly endemic. "Most" Somalis working at the United Nations military compound in 1993 were found to be skin test positive, and up to 50 percent of those who had chest x-rays had signs indicating active disease.

    In 1991, WHO estimated that nearly 80 percent of adults had been infected and that 3.5 to 5 percent of all children were infected each year. In neighboring Ethiopia, the 1997 annual incidence was estimated to be 169 cases per 100,000 population, and prevalence was 338 per 100,000.

    Resistance likely occurs to the standard therapeutic agents ethambutol, isoniazid, and rifampin, based on data from Ethiopia.

    For more information click here:
    www.cdc.gov/nchstp/tb/faqs/qa.htm

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    Anthrax

    Outbreaks in livestock have been reported. Regionally, human cases frequently are associated with eating meat or handling carcasses or hides from affected animals.

    For more information click here:
    http://www.bt.cdc.gov/agent/anthrax/index.asp
     

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    Brucellosis

    Human cases usually are due to consumption of unpasteurized dairy products or raw animal products, or occupational exposure.

    For more information click here: www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_t.htm

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    Hantaviral Diseases

    Enzootic status is unclear. No human cases have been reported, but limited surveys have detected "hantaviral antibodies" in rodent sera in Mogadishu.

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    Q Fever

    Common in farmers and workers with occupational exposure to livestock. A 1992 survey of Somali refugees found 25 percent antibody prevalence. A limited 1989 survey of residents from Berbera, Woqooyi Galbeed Region, found a 39 percent antibody prevalence.

    For more information click here: www.cdc.gov/ncidod/dvrd/qfever/index.htm

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    Leptospirosis

    Enzootic in rural and urban areas. In the early 1980s, seropositivity rates of 37 and 64 percent were found among residents in Mogadishu and among nomadic cattle herders in villages on the Shabeelle River, respectively.

    For more information click here: www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_t.htm

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    Rabies

    Enzootic countrywide, particularly in urban areas. Stray dogs likely are the primary reservoir and the main source for human exposure. Also likely enzootic in wildlife populations, including hyenas, jackals, and foxes.

    For more information click here: www.cdc.gov/ncidod/dvrd/rabies/diagnosis/diagnosi.htm

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    African Tick Typhus: Boutonneuse fever

    Tick-borne. Enzootic countrywide in widespread rural and periurban foci. In 1992, a case was documented in a US soldier deployed to Mogadishu. A 1992 survey of Somali refugees found nearly 16 percent had serologic evidence of recent infection. A 1989 survey found serologic evidence of previous infection in 40 percent of sampled Berbera residents.

    For more information click here:
    www.cdc.gov/ncidod/dvrd/branch/vrzb.htm
    www.cdc.gov/ncidod/dvrd/rmsf/index.htm

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    Filariasis, Bancroftian

    Mosquito-borne. Cases historically have been reported. Foci likely occur in southern Somalia, bordering endemic areas of Kenya.

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    Plague, Flea-Borne

    Enzootic foci likely exist in urban and rural areas, based on regional data.

    For more information click here:
    www.cdc.gov/ncidod/dvbid/plague/facts.htm

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    Relapsing Fever, Tick-Borne

    Endemic, likely countrywide.

    For more information click here:
    www.cdc.gov/ncidod/eid/vol6no2/robertsG1.htm

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    Typhus, Flea-Borne (Murine)

    Widespread enzootic foci likely occur in urban and rural areas. A 1992 survey of Somali refugees found nearly 11 percent had serologic evidence of recent infection. A 1989 survey found serologic evidence of previous infection in 13 percent of sampled Berbera residents.

    For more information click here:
    www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_t.htm
    www.cdc.gov/travel/disease/typhoid.htm

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    Cholera

    Outbreaks are increasingly being reported from new areas. As of December 1999, districts officially reported as infected were Baidoa, Bardera, Belet Uen, Bossaso, Bur Hakaba, Johar, Kismayo, Marca, and Mogadishu.

    As of March 2000, an outbreak that began in December 1998 still was ongoing in Mogadishu and surrounding areas. Marca district has been hardest hit. As of August 1999, over 7,000 cases officially had been reported from this outbreak. Affected areas included Mogadishu (Banaadir Region), Gedo, Bay, Jubbada Hoose, and Shabeellaha Hoose.

    Countrywide outbreaks in 1997 resulted in more than 5,500 reported cases. Epidemics in 1996 and 1995 each resulted in more than 10,000 cases, and the 1994 total was greater than 8,000 cases.

    Resistance has been reported to the standard therapeutic agents macrolides, tetracyclines, and TMP/SMX.

    For more information click here: www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_t.htm

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    Intestinal Helminthic Infections

    Regionally, a limited 1998 study of schoolchildren in Kisumu District, Kenya, found the following prevalences: hookworm, 63 percent; ascaris, 16 percent; and trichura, 24 percent.

    For more information click here: www.dpd.cdc.gov/dpdx/HTML/Ascariasis.htm
    www.dpd.cdc.gov/dpdx/HTML/Hookworm.htm
    www.dpd.cdc.gov/dpdx/HTML/Trichuriasis.htm

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    Trachoma

    In neighboring Ethiopia, a 1997 population-based study of 7,423 people in Kefa Province found signs of infection in 33 percent, of which 24.5 percent had active disease.

    For more information click here:
    http://www.cdc.gov/ncidod/dbmd/diseaseinfo/trachoma_t.htm

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