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Afghanistan: Mystery Illness Diagnosed As Flu

Prague, 5 March 1999 (RFE/RL) -- Late last month, health officials in Central Asia warned that a new epidemic of cholera was spreading in northern Afghanistan.

But now the World Health Organization (WHO) says the illness that led to the deaths of at least 196 people in several remote mountain villages was not cholera but a severe outbreak of the flu.

Guenael Rodier -- a medical doctor -- was in charge of a WHO team sent to investigate the outbreak. He says the illnesses in Afghanistan were part of an outbreak of influenza that has affected almost every country in the world this year.

"We all have a more intense activity of flu this year than last year, including Asia. A few weeks ago, northern China had a significant outbreak, and many other countries ... in Asia have also been affected. No countries have been left completely free of influenza."

Influenza is caused by a virus, which is spread from person to person through the air. You can catch it simply by being in the same room with someone who already has the flu. Viruses change every year and cause slightly different kinds of illnesses. Usually, the symptoms include fever, coughing, headaches and body pains. There is no cure. But in people who are healthy to begin with, the flu goes away on its own in about a week.

Cholera -- the disease that was first suspected -- is caused by a bacteria and is spread through contaminated water and food.

Rodier says that, this year, the flu virus circling the globe has spread more easily than normal and has made people sicker. Even so, the outbreak in Afghanistan was especially harsh. It affected nearly 80 per cent of the population in parts of northeastern Afghanistan. And about two per cent of those who were made sick died. That's more than twice the number of people who usually die.

Rodier says crowded conditions in the affected villages contributed to the severity of the outbreak. In some homes, up to 20 people live in the same room, making it easy for the virus to spread. And because it's winter and the only water supply in those villages is from a creek, people don't wash regularly. Rodier says:

"Poor hygiene simply gives more opportunities for infection. Simply because if you don't wash yourself regularly, if you don't wash your clothes [or] you don't wash your hands, you carry a lot of microbes ... that you can transmit to others around you, and you can transmit to yourself."

Most of the people who died in the outbreak didn't die of the flu itself. Rather, they died of complications such as pneumonia, which is caused by a bacteria. Pneumonia can usually be cured with drugs known as antibiotics. But there are no health facilities nearby and people could not get access to the treatment. Rodier says that some people whose bodies were already weakened by the flu could not fight the infection on their own.

"When you have a flu, you get a viral infection and most of your upper respiratory tract and the lungs get inflamed. Then they get more susceptible to bacterial infections which are in the environment. The patient after that would develop pneumonia and without any treatment, particularly antibiotics, and especially for fragile people -- the elderly and the very young or people with [poor nutrition] -- the result of that could be death."

The outbreak in the region is almost over. The last known case was reported on February 26. The WHO is organizing an airlift of antibiotics to the area to treat people who have developed secondary infections. Doctors say the best way to prevent more outbreaks in the future is to give people a flu vaccine at the beginning of every flu season -- usually in November or December. But even having a vaccine doesn't guarantee people won't get the flu. If they do and the symptoms last for more than 10 days, Rodier recommends a visit to a doctor, who can decide if you have another infection that can be treated with antibiotics.