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Communicable Diseases Communiqué JANUARY 2016, Vol Communicable Diseases Communiqué JANUARY 2016, Vol. 15(1) CONTENTS 1 ZOONOTIC AND VECTOR–BORNE DISEASES Page a Rabies update 2 2 SEASONAL DISEASES a Malaria update, and insecticide resistance in northern KwaZulu-Natal Province 3 b An outbreak of a vesicular rash at the National School Sport Championships, 4 3 TUBERCULOSIS AND HIV Implementation of a National HIV rapid testing quality assurance and quality im- a 5 provement programme 4 ENTERIC DISEASES a Sporadic cases of typhoid in South Africa over January 2016 6 Investigation of food and water-borne outbreaks and contact details of important b 7 resources INTERNATIONAL OUTBREAKS OF IMPORTANCE TO SOUTH AFRICAN TRAVELLERS AND 5 HEALTHCARE WORKERS a Ebola virus disease (EVD) outbreak: update 8 b Zika virus 9 c Yellow fever 11 6 MEASLES AND RUBELLA a A change in the measles vaccination schedule 11 b A cluster of rubella cases in Limpopo Province 13 7 SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE a Update on carbapenemase-producing Enterobacteriaceae 13 b Global spread of antimicrobial resistance to colistin 15 8 BEYOND OUR BORDERS 15 1 Communicable Diseases Communiqué JANUARY 2016, Vol. 15(1) 1 ZOONOTIC AND VECTOR-BORNE DISEASES a Rabies update A total of eight laboratory-confirmed cases of the public; 2) incorrect risk assessments by health human rabies was reported in South Africa during care workers (HCW), who may not administer PEP 2015. The most affected provinces were Limpopo or who prescribe PEP incorrectly (this may happen and the Eastern Cape (EC) with three reported if the injury is a seemingly minor scratch, or small cases each. Single cases were also verified from laceration, and the attending HCW does not KwaZulu-Natal (KZN) and the Free State provinces. consider rabies, or incorrectly judges that rabies In addition, there were three probable cases, of transmission is unlikely); 3) incomplete adherence which two originated from the EC and one from to the PEP regimen—for example if the victim is KZN. A single suspected case was reported from the correctly initiated on PEP but fails to complete the EC. In 2014, there were seven confirmed human vaccination schedule. rabies cases and five probable cases, and the same number reported in 2014. Human rabies case definitions* Confirmed: Laboratory confirmed through The first case of rabies in 2016 was confirmed in a detection of rabies viral antigen in human 16-year-old boy from Zululand District, KZN tissue by Province who developed a fatal encephalitis. He had Fluorescent antibody test been bitten by a domestic cat approximately eight Animal inoculation weeks prior to becoming symptomatic. The cat was PCR owned by his grandmother, and had reportedly started attacking people. The boy presented to his Probable: Clinically compatible with rabies local clinic two days after being injured and was and a history of contact with a suspected given tetanus toxoid, paracetamol and a single dose rabid animal. of rabies vaccine. Rabies is well documented in cats in South Africa. Given the behaviour of this cat, full Suspected: Clinically compatible with rabies: rabies post-exposure prophylaxis should have been – a person presenting with an acute neuro- administered. In this case, molecular typing of the logical syndrome (encephalitis) dominated by patient’s rabies virus confirmed a canid biotype. forms of hyperactivity, (furious rabies) or paralytic syndrome (dumb rabies) progress- Rabies is invariably fatal after onset of symptoms, ing towards coma and death, usually by res- but disease is preventable by the administration of piratory failure, within 7-10 days after the rabies post-exposure prophylaxis (PEP). All first symptom if no intensive care is insti- instances of exposure to animal bites should be tuted. evaluated to determine the risk of rabies virus transmission and the need for PEP. A rabies risk assessment is based on the presence of broken *Case definitions obtained from ‘WHO recommended standards and strategies for surveillance, prevention and control of communicable skin, and animal factors including the species of diseases.’ animal, the behaviour and condition of the animal http://www.who.int/rabies/epidemiology/Rabiessurveillance.pdf and the animal’s rabies vaccination status. The local prevalence of canine rabies is an important Source: Centre for Emerging and Zoonotic Diseases, consideration when assessing risk. NICD-NHLS; ([email protected]) Most rabies exposures will result in a category III injury (break in skin or lick of mucous membrane). Post-exposure prophylaxis must include rabies immune-globulin and a four dose course of rabies vaccine following thorough wound cleaning. An Figure 1. Sites of ap- updated poster, published in 2015 summarizing the propriate or inappropri- South African guidelines for rabies PEP is available ate administration of on the NICD website (www.nicd.ac.za). rabies vaccine (An ex- cerpt from the new In South Africa, reasons for failure of PEP include: poster describing PEP 1) lack of awareness of rabies risk and poor health- available on the NICD seeking behaviour following bite wounds amongst website). 2 Communicable Diseases Communiqué JANUARY 2016, Vol. 15(1) 2 SEASONAL DISEASES a Malaria update, and insecticide resistance in northern KwaZulu-Natal Malaria in South Africa during 2015 has adopted a malaria elimination agenda and has The number of malaria cases reported to the Na- scaled up vector control activities accordingly. How- tional Department of Health in 2015 decreased to ever, despite these plans local transmission contin- 11 245, compared to 13 988 cases in 2014. There ues and is most likely due to outdoor feeding by was a corresponding decrease in deaths, from 174 populations of the major vector species Anopheles in 2014 to 135 in 2015. Figure 1 describes the num- arabiensis. An outdoor Anopheles surveillance sys- bers of reported cases and deaths by month over tem has been set up in three sections of the Mam- 2015. It is anticipated that the number of cases will fene district in northern KwaZulu-Natal Province in increase during the first quarter of 2016 in keeping order to assess the extent of outdoor resting with seasonal trends. An. arabiensis in Mamfene and to assess the cur- rent insecticide susceptibility status of this popula- Travellers to malaria endemic areas in South Africa tion. The An. arabiensis samples tested showed and surrounding countries are advised to take ap- evidence of resistance to deltamethrin (pyrethroid), propriate chemoprophylaxis, as well as observe DDT (organochlorine) and bendiocarb (carbamate), measures to prevent mosquito bites. Currently rec- and full susceptibility to the organophosphates ommended chemoprophylactic regimens include pirimiphos-methyl and fenitrothion. These results one of the following: mefloquine, doxycycline or affirm the presence of pyrethroid and DDT resis- atovaquone-proguanil. tance previously detected in this population and also indicate the comparatively recent emergence of An acute febrile or flu-like illness in a resident of a resistance to the carbamate insecticide bendiocarb. malaria endemic area, or traveller recently returned The implications of these findings are that special from a malaria area, should prompt immediate test- attention and commitment needs to be given to the ing for malaria. Artemeter-lumefantrine (Coartem principles of insecticide resistance management as ®) is recommended for uncomplicated malaria. Par- well as to investigations into alternative control enteral artesunate is the preferred treatment for techniques designed to target outdoor-resting complicated malaria, with intravenous quinine as an An. arabiensis in northern KwaZulu-Natal Province. alternative (with an initial loading dose of 20mg/kg Full details of these findings can be found in the over four hours in 5% dextrose). South African Journal of Science at http:// dx.doi.org/10.17159/sajs.2015/20150261. Insecticide resistance monitoring Source: Centre for Opportunistic, Tropical & The control of malaria vector mosquitoes in South Hospital Infections, NICD-NHLS; Africa’s endemic provinces is primarily based on ([email protected]); Malaria Control indoor spraying of long-lasting residual insecticides. Programme, National Department of Health; South Africa’s National Malaria Control Programme Figure 2. Total malaria cases and deaths re- ported to the National Department of Health Malaria Control Pro- gramme, from October 2014 until December 2015. Data courtesy of the National Depart- ment of Health. 3 Communicable Diseases Communiqué JANUARY 2016, Vol. 15(1) b An outbreak of a vesicular rash at the National School Sport Champion- ships, December 2015 The NICD was alerted to an outbreak of peri-oral netball, football, and rugby. Thereafter no further vesicular lesions affecting learners attending the cases were reported. The tournament ended on the National School Sport Championships in Tshwane 15th December, with all participants returning by during December 2015. The index case was a 13- bus. year-old male learner from a school in Mpumalanga Province who arrived at the training camp on 7th Unfortunately, none of the three cases taken to December with peri-oral lesions. This was followed Steve Biko Academic Hospital had sufficient by a second case on the 8th December. An vesicular fluid, so swabs of the lesions were taken, additional six learners developed symptoms by the and transported in viral transport media. Stool 11th December, at which point, medical personnel specimens were also taken from each of the three were
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