Unknown illness in Angola - Update
21 November 2007
The investigation of an outbreak of unknown origin in Angola has revealed extremely high levels of bromide in plasma sampled from several affected patients.
As of 19 November 2007, over 390 cases had been identified and treated at the Municipal Hospital in Cacuaco. About 64% of those affected are children below 15 years old.
Toxicological tests carried out in Munich, Germany, detected very high levels of bromide in 5 out of 6 plasma samples taken from affected patients. Bromide intoxication has been one of the working hypotheses being explored by WHO and partners as a cause of the outbreak.
The laboratory results provide an important focus for testing on human, environmental and food samples to confirm these bromide levels. Additional samples are currently on the way to a laboratory in the UK for testing for bromides.
On Wednesday 21 November WHO deployed further technical and operational support to assist Angolan health authorities, including a field coordinator, clinician, two epidemiologists, food safety expert, laboratory specialist, and a logistician. This team will support further epidemiological studies, case management, social mobilization and risk communication, environmental investigations and laboratory testing to confirm the cause of the outbreak, and to support response and control measures.
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.