Outbreaks and Emergencies Bulletin, Week 30: 21- 27 July 2018
Rift Valley fever, Crimean-Congo haemorrhagic fever Nakivale Refugee Settlement,
Isingiro District, Uganda
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EVENT DESCRIPTION
The Nakivale Refugee Settlement, Isingiro District, is suffering twin outbreaks
of Rift Valley fever (RVF) and Crimean-Congo haemorrhagic fever (CCHF). The
settlement is in Isingiro District in the south of the country, bordering Tanzania.
RVF cases have also occurred in Mbarara and Kasese districts. Isingiro District
is host to 113 444 registered refugees, 106 592 of whom live in Nakivale
Refugee Settlement. Uganda hosts a total of 1 470 981 refugees and asylum
seekers.
On 13 July 2018, a case of CCHF was confirmed by the Uganda Virus Research
Institute (UVRI) in a 30-year-old female, originally from Rwanda and Democratic
Republic of the Congo, living in Katojo Camp in Nakivale Refugee Settlement.
She presented with a four-day history of fever and a bleeding diathesis on 7 July
2018. By 17 July 2018 the husband of the index case had tested positive for
CCHF. No deaths have been reported and both cases are in isolation in Mbarara
Regional Referral Hospital. A total of 42 contacts were listed on 17 July 2018,
all household and close community contacts to both confirmed cases.
On 28 June 2018, the Uganda Ministry of Health notified WHO of two laboratory
confirmed cases of RVF, following positive reverse transcription polymerase
chain reaction (RT-PCR) results from UVRI. Both samples were taken on 23
June 2018 from patients originating from Isingiro and Kasese districts. Both
patients died in hospitals in Mbarara and Kasese. The case patient was a
35-year-old Rwandan refugee from Nakivale Refugee Settlement, working as a
herdsman in Kabele Village, Isingiro District, admitted with signs and symptoms
suggestive of a viral haemorrhagic fever (VHF), who was immediately referred
to Mbarara Regional Referral Hospital and isolated. He died on 30 June 2018
and a safe burial was conducted by the VHF team. A total of 55 animal and
25 human samples have been collected from the farm where he was working
and from Isingiro abattoir to assess the extent of RVF.
Two weeks before this case, another 25-year-old male who was grazing his animals on the same land reportedly died, after showing similar signs and symptoms. Both case patients had a history of skinning and eating animals that had died of unknown causes. The animal was one of 12 head of cattle that had died on the same farm in June 2018, shared by seven people.
A 47-year-old butcher from Kanyatsi Village, Kasese District fell ill on 20 June 2018, with a high fever and headache and was found dead by family members on 21 June 2018. A nasal swab sent to UVRI the same day tested positive for RVF.
As of 9 July 2018, there were eight reported cases of RVF, four suspected and four laboratory confirmed, from Isingiro (4), Ibanda (3) and Kasese (1). Of the four laboratory confirmed cases, two were from Isingiro, one from Ibanda and one from Kasese. There were two deaths among the four confirmed cases, one in Kasese and one in Isingiro (case fatality ratio 50%). Two confirmed cases have recovered and been discharged from hospital. One new suspected case originating from the Democratic Republic of the Congo was reported as of 9 July 2018. As of 17 July 2018, samples have been collected from 125 animals – 95 cattle, 27 goats and three sheep.
PUBLIC HEALTH ACTIONS
A rapid response team (RRT) was deployed by the Ministry of Health, supported by WHO, to establish outbreak response. The team comprised members with expertise on case management, epidemiology and surveillance, risk communication, laboratory testing and veterinary medicine.
WHO is participating in the National Task Force and providing technical guidance at national level. A district task force, chaired by the RDC, is coordinating the response at district level.
Case management is being provided at the isolation facility at Mbarara Regional Referral Hospital, and health workers are being instructed by clinicians deployed as part of the RRT. Affected districts are being prepared to manage cases at source. All suspected cases are being investigated promptly according to protocol, which includes laboratory sampling and dissemination of results.
WHO had prepositioned personal protective equipment (PPE) for VHF management in 2016, which is now being used in initiation of infection, prevention and control (IPC) measures. Supplies for supportive treatment have been mobilized by Mbarara Regional Referral Hospital.
Surveillance teams have initiated field investigation and active case search in Isingiro and Ibanda districts and are developing a line list and case definition to support effective case identification and referral.
Social mobilization and community engagement is being initiated by the risk communication team and some information, education and communication materials have been produced.
SITUATION INTERPRETATION
Uganda lies between countries that have frequent outbreaks of RVF and in which CCHF is endemic – Kenya, Somalia, Tanzania and Sudan. A recent Food and Agriculture Organization risk analysis identified Uganda as at very high risk of amplification in some districts of the cattle corridor, which covers 52 districts cutting across the central part of the country from the south west in Ankole-Kigezi to the northeastern region in Karamoja. The RVF virus has been isolated frequently in domestic animals in all affected areas. In addition, the practice of eating ‘Sanga meat’, meat harvested from sick animals, in some districts heightens the risk of zoonotic transmission of both VHFs. At present, there is inadequate community engagement and social mobilization around the risks posed by these practices. Most of the 52 districts in the cattle corridor lack such engagment.
Challenges around inadequate surveillance, poor case identification, point source tracing of contacts with possible contaminated animals and active case search further hamper prevention and response efforts, increasing the risk of further transmission and geographical spread of both diseases. A strong One Health response is needed, which encompasses both animal health management and surveillance by the Ministry of Agriculture, Animal Husbandry and Fisheries and is not limited to the inclusion of veterinarians in a RRT team after the event. A comprehensive multi-sector response to these twin threats is needed.
http://apps.who.int/iris/bitstream/h...2127072018.pdf
https://www.afro.who.int/health-topi...encies-updates
