Bloody diarrhoea on the rise as cholera declines

The World Health Organisation in Liberia said the cholera epidemic in Liberia was declining, but it was investigating reports of a steady increase in cases of bloody diarrhoea. WHO said in a statement that the new form of diarrhoea, suspected to be shigella, had been on the rise since mid-August. The organisation said it was particularly rife in Bong County in northern Liberia, where several large camps housing people displaced by civil war are situated. An average of 240 new cases of bloody diarrhoea were reported each week during October and by 5 November, a total of 1,857 cases had been registered countrywide, it added. However, Mekonnen Adamassu, an WHO official in Liberia, told IRIN that a cholera epidemic in the capital Monrovia, which led to more than 2,000 cases being reported each week at its height in September, was subsiding. The number of new cholera cases reported from 31 health centres and hospitals in Monrovia and nearby towns and camps for displaced people fell from 1,566 in the week to October 12 to 1,005 in the week to 26 October, he said. Mekonnen said medical experts were trying to determine why bloody diarrhoea was on the rise while cholera, which had affected thousands of Liberians, especially people displaced by fighting in Monrovia, was declining. Several cases of bloody diarrhoea had been registered in the Bushrod Island and Paynesville suburbs of Monrovia, but the focus of the outbreak was Bong County, to the north of the capital, he said. "Bong County alone reported 112 cases of bloody diarrhoea between 20-26 October. A two-man team was sent there on Saturday to investigate the cases," Mekonnen said Most of the cases were reported in the towns of Totota, Salala, Gbarnga and Palala. The first two are surrounded by camps where almost 100,000 displaced people live. Mekonnen said the investigation would try to determine whether those affected were suffering from shigella, an infectious water-borne disease caused by bacteria. Shigella causes diarrhoea, fever, and stomach cramps and can lead to seizures in children less than two years old. "We are investigating because shigella can cause bloody diarrhea, but it is not the only cause of the disease," Mekonnen added. "About one third of the cases were children less than five years old. Specimens were collected from some patients in Monrovia, but no shigella dysenteriae Type 1 has been isolated so far," he added. Mekonnen said the WHO had not received any reports of deaths from bloody diarrhoea yet. He said WHO had sent out drugs to try and contain the outbreak and was coordinating efforts with UNICEF to ensure that people in the affected areas had access to safe water and sanitation facilities.