An epidemic of bloody diarrhea: Escherichia coli O157 emerging in Cameroon?

In December 1997, an epidemic of bloodydiarrhea was reported in Ngoila, a village ofapproximately 500 inhabitants, approximately400 km from YaoundO. Canoes and motorbikesare necessary to reach Ngoila, which is linked toLomiO by a difficult road across the Dja River.The remote zone to the south of the river isinhabited by 2,610 persons, who belong to twoethnic groups (Bantus and Baka Pygmies) andlive in 22 villages (Figure 1). The population ofthe outbreak area is 20,600. The sanitationsystem is weak, latrines do not exist, and humanfeces are used as fertilizer. No village hasrunning water; drinking water, which is neitherchlorinated nor filtered, comes from wells orsmall streams.Between December 1997 and March 1998,teams from LomiO Hospital and the EastProvincial Delegation of Health went to Ngoila totreat patients and make an inventory of thecases. After a March 19, 1998, wire service reportof a possible viral hemorrhagic fever epidemic inNgoila, a joint mission of Centre Pasteur duCameroun and the World Health Organizationvisited the area March 25-28, 1998.