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Unknown illness in Angola 16 November 2007 An outbreak of a disease of unknown etiology is currently ongoing in Cacuaco municipality, Angola. The first cases were reported on 2 October. As of 15 November 2007, a total of 370 cases had presented for treatment at the Municipal Hospital in Cacuaco. It is anticipated that additional unreported cases may be occurring within communities among patients preferring to remain at home or to receive treatment from traditional healers. The clinical symptoms of the disease are extreme drowsiness, waking only to painful stimuli. Patients recover slowly, over a number of days, but remain ataxic with many unable to walk unaided. The symptoms are most extreme in children. The neurological indication is of a cerebellar abnormality with no sign of peripheral neuropathy. Reflexes are normal. The case presentation suggests a toxicological cause, however, the etiological agent has not yet been identified. Samples taken from patients have been tested for 300 organic solvents and a general drug screen covering 800 compounds has also been carried out. These tests have so far proved negative. Tests for cadmium, lead, mercury and manganese have shown levels within the normal range. Environmental samples, as well as food and drinking water, have also been taken and results of tests are awaited. Epidemiological investigations so far have not revealed a common source or route of exposure, and these investigations are now being extended in scope.
Location of Angola within Africa.
Health authorities from the World Health Organization (WHO) and the government of Angola have revealed that bromide poisoning may be the source of a mystery illness first reported in early October.

The outbreak of over 400 reported cases of a neurological disorder was centred in the Cacuaco district of Angola's capital city Luanda. A majority of the afflicted have been children under the age of 15. There have been no deaths attributed directly to the disorder.

According to a statement in the state-run ''AngolaPress'', symptoms have included "sleepiness, blear-eyedness, dizziness and difficulty to speak, walk and extreme tiredness." WHO described the drowsiness as being so severe that the patient would require "painful stimuli" to be awoken.
Sodium bromide.
Results from laboratory tests carried out in London and Munich indicated elevated levels of bromide present in the blood and kitchen salt samples examined. It is suspected that sodium chloride (table salt) may have been contaminated with sodium bromide, an agent used in pharmaceuticals and industry.

However, authorities caution that more investigation is required to determine the source and cause of the illness. Consequently, further testing of blood, food and water has been initiated.

On Wednesday, WHO dispatched additional technical and support personnel to Angola to assist local health officials.