Chad - Dengue outbreak 2023 - 2024

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Appearance of a dengue epidemic in Abéché

Ndalet Pohol
Chad News
Published on 15-08-2023

In a press release, the Ministry of Public Health and Prevention informs the public of the appearance of a dengue epidemic in the health district of Abéché, province of Ouadaï.

As of August 7, 2023, sample samples were analyzed by the National Laboratory for Biosecurity and Epidemics (LaBiEp) in N'Djamena and confirmed this disease, informs the ministry.

Dengue is a disease transmitted to humans by the bite of mosquitoes infected with the dengue virus.

Most dengue patients have symptoms such as high fever, headache, muscle and joint pain, nausea and vomiting, sometimes swollen glands and skin rashes.

''People with these symptoms are advised to go to the nearest health facility for treatment. Patients usually recover in one to two weeks. Some may develop severe dengue with bleeding and are hospitalized. In rare severe cases, dengue can lead to death,” the statement warned.

Guidance from the Ministry of Health

People with these severe symptoms should receive care immediately, the ministry advises. After recovery, people who have had dengue may feel tired for several weeks.

''Residents and travelers staying in districts where dengue fever is currently prevalent should take personal protective measures to avoid being bitten by mosquitoes and those exhibiting a fever within two weeks of returning from a stay in an infected district should consult a health personnel as soon as possible,'' advises the Ministry of Public Health.

Mosquitoes that transmit dengue bite during the day. To reduce the risk of contracting dengue fever, protect yourself from mosquito bites by wearing clothes that cover your body as much as possible; mosquito nets ideally impregnated with repellent, if you sleep during the day; insect screens on windows.

If you contract dengue, it is important to rest; drink plenty of fluids; use paracetamol to relieve pain; avoid nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin

https://tchadinfos.com/apparition-dune-epidemie-de-dengue-a-abeche/

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​Ministry of Public Health of Chad
23h. ·
Press release from the Ministry of Public Health and Prevention.​



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-https://www.facebook.com/ministeresantetchad/

 

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 33: 14 - 20 August 2023
Data as reported by: 17:00; 20 August 2023
...

Chad

Dengue

47 Suspected cases
26 Confirmed
1 deaths
3.8% CFR

EVENT DESCRIPTION

On 15 August 2023, the Ministry of Health in Chad
officially declared an outbreak of Dengue fever in the
country. This declaration followed the confirmation of
Dengue fever through laboratory samples at the National
Laboratory of Biosecurity and Outbreaks in Ndjamena.

Since July to 4 August, 2023, a rise in the number
of patients with fever, unresponsive to antimalarial
treatments, was reported in two health centres, in
Abéché Health District. The patients exhibited symptoms
of high fevers surpassing 38°C, joint pains (arthralgia),
headaches, vomiting, and, in certain instances, loss of
appetite and hemoglobinuria. As the cases continued
to surge and the rapid malaria diagnostic tests were
negative, an alert was issued based on suspicion of both
Chikungunya and Dengue fever.

Following the epidemiological investigation conducted in
Abéché Health District, 12 initial samples were collected
from the two health centres and sent on 7 August 2023
to the Laboratory of Biosafety and Epidemics at the
central level in Ndjamena for analysis. A total of eight
(66.7%) out of 12 samples tested positive for Dengue
fever by RT- PCR. The same samples were sent to the
Institut Pasteur Laboratory in Yaounde, Cameroon for
confirmation, the viral genome for Dengue fever was
detected in 10 over 12 samples. All samples were
negatives for Chikungunya, Zika and yellow fever. All the
sampled patients reside in Abéché, with no travel history
in the past two weeks. However, four of the patients
have a history of Chikungunya. In addition, a total of 35
samples from Abeche, N’Djamena, and Wadi Fira were
tested at Lab Epi in Ndjamena and 12 tested positives
for dengue fever.

From 3 August to 27 August 2023, a total 47 suspected
cases, including 26 confirmed cases and one death for
Dengue fever were reported in three provinces, namely
Ouadai/Abeche (n=28), Wadi Fira/Biltine (n=11) and
N’Djamena (n=8). The majority of confirmed cases,
73% (19/26) were reported in Ouddai/Abeche followed
by Wadi Fira/Biltine, 15% (4/26), and N’Djamena,
11.5%(3/26). The age group from 25 to 34 years old is
the most affected (30.7% of all cases). The median age
of all cases is 25 years (Min=12, max=70). The sex ratio
Male/Female is one.

Ouaddaï Province, which is the epicenter of this outbreak,
located in the eastern part of the country and bordering
the Republic of Sudan, is one of the largest among the
23 health provinces of Chad. The Province is the most
affected by the Sudan crisis, accounting for 82.7% of all
refugees arriving in Chad. In addition, the district is facing
various disease outbreaks, including malaria.

The Ouaddai Province experienced a Chikungunya
epidemic in 2020, with a total of 34 052 cases and one
death recorded from 14 August to 2 October 2020. The
age group most affected was 15 years and older, with a
predominance of females.

PUBLIC HEALTH ACTIONS

The Ministry of Health declared the outbreak of
Dengue fever in Chad on 15 August 2023.
Coordination at the central level is ongoing, including
regular meetings and elaboration of the response
plan. At the National level with support from WHO. In
addition a provincial plan was developed for Ouaddaï
province

Epidemiological activities, including epidemiological
investigation and surveillance, are ongoing in the
affected districts. Preparation for the deployment of
AVoHC-SURGE rapid investigation and intervention
teams is underway

Laboratory activities, including sampling and testing
cases, continue. In total, eight out of 26 samples
tested were positive for Dengue fever. Twelve Samples
were sent to the Institute Pasteur in Cameroon for
confirmation and 10 of them tested positive for
Dengue fever.

Preparation for the deployment of a mobile laboratory
in Abeche is ongoing

Case management of suspected and confirmed cases
is ongoing. WHO has provided essential medicines to
the provincial delegation of health and prevention in Ouaddaï
province.

Risk communication and community engagement activities are ongoing, including raising awareness among urban
political and administrative authorities about environmental sanitation (cleaning and management of wastewater,
disposal of used tires, etc.) and the spraying of insecticides around residential areas and mosquito breeding sites.”

SITUATION INTERPRETATION

The recent declared outbreak of Dengue fever in Chad is the first the country has experienced. Confirming this outbreak
in the Abeche district, home to a population of many refugees from Sudan, raises concerns. The risk of transmission
among this population is considerably high due to the challenging living conditions in the refugee camps. Furthermore,
the district is currently facing outbreaks of other diseases, such as malaria and measles, which could strain the district’s
ability to effectively address the dengue outbreak. While a comprehensive strategy must be put into action to address
this outbreak, the need to secure the necessary funding to successfully execute the response id imperative.


https://apps.who.int/iris/bitstream/handle/10665/372631/OEW33-1420082023.pdf

 

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WHO: Dengue - Chad (16 October 2023)

Source: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON491

Dengue - Chad
16 October 2023

Situation at a Glance

On 15 August 2023, a dengue outbreak was declared by the Ministry of Public Health and Prevention in Chad. As of 1 October, there have been 1 342 suspected cases, including 41 confirmed cases reported across eight health districts in four provinces. Among the confirmed cases, one death was reported. Abéché health district in Ouaddaï province, is the current epicentre of the outbreak. The Ministry of Public Health and Prevention has initiated a number of key response activities by implementing, in collaboration with WHO and partners, the national contingency plan for dengue preparedness and response. Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes. Many dengue infections produce only mild flu-like illness and over 80% of cases are asymptomatic. There is no specific treatment for dengue; however, timely detection of cases and appropriate case management are key elements of care to prevent severity and fatality of dengue. This is the first dengue outbreak reported in Chad, and the country has limited surveillance, clinical and laboratory capabilities. Given the favorable environmental conditions for mosquito spread, an ongoing humanitarian crisis due to a massive influx of refugees and returnees from Sudan and limited response capacities, WHO assesses the risk posed by this outbreak as high at the national level.
Description of the Situation

On 15 August 2023, the Ministry of Public Health and Prevention of the Republic of Chad officially declared an outbreak of dengue in Abéché health district, Ouaddaï province, in the east of the country, representing the first dengue outbreak ever reported in Chad.
The declaration was made after the confirmation of dengue infection in eight out of 12 blood samples tested using real-time polymerase chain reaction (real-time PCR) at the national Biosafety and Epidemics Laboratory (LaBiEp) in N'Djamena. Subsequently, the samples were sent to the Institut Pasteur in Cameroon for confirmation, which was completed on 22 August by PCR and ELISA, confirming the presence of dengue.
As of 1 October, there have been 1 342 suspected cases, including 41 confirmed cases reported across eight health districts in four provinces. Among the confirmed cases, one death was reported (Case Fatality Ratio (CFR) among confirmed cases 2.4%).
The dengue serotype responsible for this outbreak remains unknown.
Eight districts in four provinces (NDjamena, Ouaddaï, Sila, and Wadi Fira) have reported confirmed dengue cases. Notably, Ouaddaï, the epicentre of the outbreak, has reported the highest number of confirmed cases, accounting for 31 out of the total 41 confirmed cases (76% of confirmed cases). The age group most affected by this outbreak are those between 15 to 34 years old, representing 27% of the reported confirmed cases.

Epidemiology

Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes and is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. The primary vectors that transmit the disease are Aedes aegypti mosquitoes and, to a lesser extent, Aedes albopictus.
Dengue virus (DENV) has four serotypes (DENV-1, DENV-2, DENV-3, DENV-4). Infection with one serotype provides long-term immunity to the homologous serotype but not to the other serotypes; sequential infections with a different serotype put people at greater risk for severe dengue. Many DENV infections produce only mild flu-like illness and over 80% of cases are asymptomatic.
There is no specific treatment for dengue; however, the timely detection of cases, identifying any warning signs of severe dengue infection, and appropriate case management are key elements of care to lower the CFR during an outbreak to less than 1%.
Although Chad has previously experienced outbreaks of arboviruses such as chikungunya and yellow fever, this is the first dengue outbreak ever reported in the country. Chad, including the Ouaddaï province, experienced a chikungunya outbreak in 2020, with a total of 34 052 cases recorded and one associated death.

Public Health Response

The Ministry of Public Health and Prevention has initiated a number of key response activities, with the support of WHO and other partners, including:

• Mobilizing resources for the implementation of the national contingency plan for dengue preparedness and response, developed with WHO assistance.
• Strengthening surveillance and coordinating the response, including active case finding in healthcare facilities and the community and in-depth epidemiological investigations including regularly updating the case line list.
• Increasing early case detection capacity by disseminating community alert definition of cases and procuring rapid diagnostic tests (Bioline Dengue Duo (DENGUE NS1 Ag + IgG/IgM)) for health facilities.
• Ensuring effective logistics and operational support, including the transportation of samples for confirmation.
• Developing standard operating procedures (SOPs) for clinical management of suspected and confirmed dengue cases, including severe dengue and ensuring inventory of existing case management kits and address gaps.
• Strengthening cross-border collaboration and implementing prevention and vector control measures in border areas.
• Strengthening entomological surveillance, including aquatic and adult stages of the vectors, and characterizing vector bionomics.
• Implementing effective vector control measures as part of integrated vector management.
• Strengthening community mobilization and commitment to disseminate key information on transmission and control to the population.

WHO Risk Assessment

This is the first dengue outbreak reported in Chad, and the country lacks the necessary public health preparedness and response capacities.
Community cases are likely underreported because dengue is unknown to the general public and clinicians are not yet sensitised to its presentation, which is sometimes confused with those of other common febrile infections, making early diagnosis challenging, particularly in settings with lack of laboratory facilities for testing.
There is a high risk of spread due to the presence of mosquitoes in large, densely populated cities in eastern Chad near the Sudan border, with a tropical climate, and poor sanitation conditions suitable for mosquito development.
The province of Ouaddaï, which borders Sudan, is the epicentre of the outbreak and is also the province most affected by the ongoing humanitarian crisis due to a massive influx of refugees and returnees from Sudan. According to the United Nations High Commissioner for Refugees (UNHCR), the number of refugees in the Ouaddaï province is currently more than 400 000.
The movement of returning Sudanese refugees and Chadian nationals has the potential to spread the outbreak to new provinces and across the border.
Based on the information available for this event, WHO assesses the risk posed by this outbreak as high at the national level, moderate at regional level, and low at global level.

WHO Advice

The proximity of mosquito breeding sites to human habitation is a significant risk factor for dengue virus infection. The prevention and control of dengue depend on effective vector control. Vector control activities should focus on all areas where there is a risk of human-vector contact (place of residence, workplaces, schools, and hospitals). WHO promotes a strategic approach known as Integrated Vector Management (IVM) to control Aedes species, the vector of dengue. IVM should be enhanced to remove potential breeding sites, reduce vector populations, and minimize individual exposure. This should involve vector control strategies for larvae and adults (i.e. environmental management and source reduction), especially of water storage practices, and include covering, draining and cleaning household water storage containers on a weekly basis, applying larvicide in non-potable waters using WHO-prequalified larvicides at correct dosages, distribution of insecticide-treated nets (ITNs) for fever/dengue inpatients to contain spread of virus from health facilities, as well as strategies for protecting people and households. Indoor space spraying (fogging) is another approach for rapid containment of dengue-infected mosquitoes but may be challenging to deliver in densely populated areas of camps.
Personal protective measures during outdoor activities include topical application of repellents to exposed skin or treatment of clothing, and wearing long-sleeved shirts and pants. Indoor protection can include household insecticide aerosol products, or mosquito coils. Window and door screens can reduce the probability of mosquitoes entering the house. Insecticide-treated nets offer good protection against mosquito bites while sleeping during the day. Since Aedes mosquitoes (the primary vector for transmission) are active at dawn and dusk, personal protective measures are recommended, particularly at these times of day, both in residential areas and also at places of work and schools for children.
Entomological surveillance should be undertaken to assess the breeding potential of Aedes mosquitoes in containers and monitor insecticide resistance to help select the most effective insecticide-based interventions. There is no specific treatment for dengue infection, but early detection and access to appropriate healthcare for case management can reduce mortality. Case surveillance should continue to be enhanced in all affected areas and nationwide. Where feasible, resources should be allocated to strengthen a sample referral mechanism for the confirmation and sub-typing of the dengue virus.
Communities play a major role in the success and sustainability of vector control activities. While coordination among many stakeholders is required, vector control is critically dependent on ensuring that communities are aware of the risk of infection and know which measures to take to protect themselves. Community engagement and mobilization involve working with local residents to improve vector control and build resilience against future disease outbreaks. Where appropriate participatory community-based approaches are in place, communities are supported to take responsibility for and implement vector control. Participatory community-based approaches aim to ensure that healthy behaviours become part of the social fabric and that communities take ownership of vector control at both inside and outside households.
Based on the information available for this event, WHO does not recommend travel or trade restrictions be applied to Chad.


Further Information

• WHO Dengue and severe dengue factsheet
• WHO Dengue guidelines, for diagnosis, treatment, prevention and control
• WHO Handbook for clinical management of dengue
• UNHCR CHAD| Influx of Refugees from Sudan (as of 22 September 2023)
• Health Sector Weekly Situation Report No. 006 (August 10, 2023)
• Situation report on the dengue epidemic in Chad n°01 (Period from 14 to 27 August 2023)
• UNCHR. UNHCR’s Grandi praises Chad’s role hosting Sudanese; more aid urgently needed

Citable reference: World Health Organization (16 October 2023). Disease Outbreak News; Dengue - Chad. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON491



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Dengue epidemic: Chad still alert

January 15, 2024

August 2023, the Minister of Public Health and Prevention officially declared a Dengue epidemic outbreak in Chad.

As of October 1 , 2023, 1,342 suspected cases of Dengue, including 41 confirmed cases, were reported in 8 health districts in 4 provinces (Ndjamena, Ouaddaï, Sila and Wadi-Fira). Among confirmed cases, 1 death recorded, i.e. a case fatality rate among confirmed cases of 2.4%. The Ouaddaï region, the epicenter of the outbreak, recorded the highest number of cases (31 out of a total of 41, or a percentage of 76%) due to the massive influx of refugees and returnees from Sudan.

Although the Ministry of Public Health and Prevention has launched a certain number of response activities mainly by implementing the national emergency plan for preparation and response to Dengue, Chad's response capacities are limited and the World Health Organization (WHO) has assessed that the risk posed by this epidemic outbreak is high at the national level.

The 4 regions still in epidemic, we must take shelter. And this involves personal protection measures. “To avoid contracting Dengue, you must avoid being bitten by mosquitoes. And especially in case of suspicion, go to the nearest health facility to receive immediate care. In the district of Abéché, where many Sudanese refugees live, the risk of transmission of Dengue fever among the population is considerably high due to the difficult living conditions in the refugee camps,” said a health district agent. of Abéché.

With the resurgence of epidemics such as measles and poliomyelitis and the appearance of new epidemics, 2024 promises to be a tight year for Chad's health system and the challenges are numerous. The main question here is how to improve the country's routine vaccination rate. “We intend to continue in 2024 with awareness, advocacy and vaccination campaigns to limit the occurrence of epidemics. In 2024, a campaign against yellow fever is also planned for the benefit of 94% of the Chadian population,” informed the Minister of Public Health and Prevention, Dr Abdelmadjid Abderahim. And added, “Our priority areas revolve around the implementation of universal health coverage, as well as training and capacity building of staff.”

Kedai Edith

https://www.lepaystchad.com/33967/