REPUBLIC OF RWANDA WEEKLY EPIDEMIOLOGICAL

REPUBLIC OF RWANDA REPUBLIC OF RWANDA WEEKLY EPIDEMIOLOGICALWEEKLY EPIDEMIOLOGICAL

MINISTRY OF HEALTH RBC / EID Division B.P. Tel. 3334 - 3335 (free) E-mail : [email protected]

MINISTRY OF HEALTHIntroduction Contents RBC / EID Division B.P. Tel. 3334 - 3335 (free) E-mail : [email protected] MINISTRY OF HEALTH RBC / EID Division B.P. Tel. 3334 - 3335 Introduction(free) Contents E-mail : [email protected] Introduction Contents

EPIDEMIC SURVEILLANCE AND RESPONSE REPUBLIC OF RWANDA EPIDEMICWEEKLY SURVEILLANCE EPIDEMIOLOGICAL WEEKLYAND REPORTRESPONSE WeekWEEKLY 6 from 8th – 14th REPORT January, 2021

RWANDARWANDA BIOMEDICAL BIOMEDICAL CENTRE CENTRE / INSTITUTE/ INSTITUTE OF OF HIV/AIDS, HIV/AIDS, DISEASES DISEASESRBC/EID Division PREV PREV B.P: 7162ENTION&CONTROLENTION&CONTROL Kigali Tél: 114(Free) E-mail: www.rbc.gov.rw KigaliKigali - Rwanda,- Rwanda, Fax Fax 0252 0252 503980, 503980, TEL: TEL: 0252 0252 503979 503979 Week 43, from 19-25, Oct 2015 MINISTRY OF HEALTH RBC / EID Division B.P. Tel. 3334 - 3335 (free) RWANDASUMMARY BIOMEDICAL CENTRE / INSTITUTEE-mail : [email protected] OF HIV/AIDS, DISEASES PREVENTION&CONTROL RWANDA BIOMEDICALRBC/IHDPC/ CENTRE ESR /Division INSTITUTE OF HIV/AIDS, DISEASES PREVENTION&CONTROL KigaliKigali - Rwanda,- Rwanda, Fax Fax 0252 0252 503980, 503980, TEL: PHS&EPRTEL: 0252 0252 Division 503979 503979 I.COMPLETENESS AND TIMELI- Toll free No: 114 REPUBLIC OF RWANDA NESS Introduction Highlight High lightof the of week: the Week: ContentsWEEKLY  Epidemic typhus EPIDEMIOLOGICAL Outbreak in Muhanga prison /Kabgayi DH : following the reporting of • For Public Health Facilities: suspected cases, 982 cases were identified by further investigation. Cont’d on p.2 Completeness: 90.2 % Timeliness: 1. Dog bites in Rubengera Health Center, Karongi District 82. %Summary of surveillance EBOLA VIRUS DISEASE OUTBREAK IN Guinea: indicators leven dog bites cases were reported from Rubengera HC of Kibuye • For Privates Health Facilities:  On 14 FebruaryDistrict 2021, Hospital the Ministry in Karongi of Health district. (MoH) of Eight Guinea of informed them were WHO children of a cluster of • Public Health Facilities: Complete- Ebola VirusE Disease (EVD) cases in the sub-prefecture of Gouécké, Nzérékoré Region. Among ness:o Number 91 % ofand health timeliness: facilities 58.8% submitted the sevenaged cases, less five than have 15 diedyears (4 probablewhile three and 1were confirmed). adults. TheAll other of them two confirmedwere from cases are •their Private reports: Health 121 Facilities: HFs in isolationRubengera in dedicated sector health and care were facilities transferred in Conakry to andthe Gouécké,district hospitalNzérékoré for region. post MINISTRY OF HEALTH Completeness:o Number of health 54.6 %facilities and submitted exposure prophylaxis. The bites were by three different unknown dogs, timeliness:15.3%theirRBC reports / on time:EID 98 HFs Division B.P. Tel. 3334 - 3335 (free) RWANDARWANDA BIOMEDICAL BIOMEDICAL CENTRE CENTRE / INSTITUTE/ INSTITUTE• Overall completeness OF OF HIV/AIDS, HIV/AIDS, andE-mail timeli- DISEASES : DISEASES [email protected] Deathsone of reported which PREV PREV was nationally:ENTION&CONTROL laterENTION&CONTROL killed 2 deaths by the notified community. countrywide KigaliKigali - Rwanda,- Rwanda, Fax Faxness: 0252 81.80252 % 503980,and 503980, 47.9% respec TEL:- TEL: 0252 0252 503979 503979 tively  Malaria :one death from Rwinkwavu DH  Very good performanceIntroduction with 2. National upsurge 100% timeliness: ) : Ngarama, Ga-  Neonatal Tetanus : one death from Gisenyi DH Contents tonde,Summary Nemba, of Ruli, cases Kibuye reported hospi - in malaria cases tals catchmentnationally: areas, CHUK, RMH here has been a and CHUB. Tsteady increase in • Non-­bloody diarrhea: 4,138 II. Casesthe numberreported of by malaria Public and Private HFs: • Flu Good syndrome: Performance 12,686 (Timeliness •between Malaria: 80 54,424 and 99%): Murunda, • Malaria:cases 5964 reported cases country- •Kibungo, Severe pneumonia Nyamata,Shyira, in under Gisenyi, five • Flu syndromewide during : 12109 the caseslast 12 Remera years: 131 Rukoma, Kibogora, Ru- • Non-bloodyweeks. Diarrhoea: As seen 4,753 in figurecases •tongo, Shigellosis: Kigeme, 46 Masaka,suspected Kibilizi, cases Ki- • Severe1, Pneumoniathe number in of children all ma under- Figure five 1: years:Trends 201 of Malaria, cases Epidemiological weeks 32-43, Rwanda •nihira, Chicken Ruhengeri, pox: 43 Gitwe, Kabgayi, • Shigelosis: 54 susepected cases ; 20 of them were reported from Nyamagabe health center •Munini. Mumps: Rwinkwavu, 22 Nyarugenge, of Kigemelaria DH cases , 14 increasedfrom Biryogo from health center of Nyarugenge DH six from Mbuga health •Ruhango, Dog bites Bushenge,(suspected Mugonero;rabies center 14,747of Kigeme in DH,week three 32 from(early Karwasa health center of Ruhengeri RH, two each from Kiziguro, exposure): Gakoma, 13 Kirinda, Nya- Kitabi August)health center to 54,424of Kigeme in DH and Nyakiliba health center of Shyira DH; and one each •gatare, Typhoid Butaro fever: Hospitals’2 suspected catchment cases from Biguguweek 43.health A total center of of 327, Kibuye RH Biruyi health center of Murunda DH, Mbuye and •areas. Acute Flaccid Paralysis: 1 case Ruhango health center of Ruhango PH, Plateau Clinic / Nyarugenge District Ruhuha health • Cholera: 1 suspected case center 814of Nyamata cases wereDH and reported Rwerere health center of Butaro DH  Low performance (timeliness • Chickenduring pox: the five 12-­week cases betweenSummary 50 and of deaths80% ): reportedByumba, • Choleraperiod. : one Eight suspected districts case from Nkombo health center of Gihundwe DH. Kirehe, Muhima,nationally Mibilizi, Kibaga- • Epidemic(figure thypus: 2) accounted 137 suspected for cases from Muhanga Prison /Kabgayi DH baga, Kabutare, Kabaya, Muhororo • Mumps50% : one (164,833) case. of the •,Gahini 9 deaths ,Kaduha, due to Malaria: Nyanza Gihundwe hospitals’ • Neonatal Tetanus: One case from Gisenyi DH DHcatchment (1), Nemba areas. DH (1), Nga- • Dog malariabites / Rabies cases Exposure: reported six casesFigure including 2: Top 8 sub-districttwo each hospitals from Kibigora reporting malaria and Nyagatare cases, rama DH (1), Rwinkwavu DH (1), DH andduring one each same from period. Mugonero DH and Kibungo epidemiological RH. weeks, 32-43, Rwanda Kinihira Very poorDH (1), performance Kiziguro DH (timeli (1), - Kibogoraness less thanDH (2), 50%) Rutongo : Gihundwe DH (1) and Rwamagana hospitals’ catchment Editorial team: Dr J. Nyamusore, Dr L. Hakiz- •areas 2 deaths Caraes due Ndera to severe , and pneumonia KFH. imana, Dr J. Omolo, A. Kabeja, E. Nshimiyimana, in under five from Muhororo DH H. Balisanga, F. Nizeyimana, A. Mutoni Editorial team: V. Ndagijimana, A. Kapiteni, F. Nizeyimana, I. Itanga, L. Ruyange, A. Kabeja, RWANDARWANDA BIOMEDICAL BIOMEDICAL CENTRE H.CENTRE Balisanga, / INSTITUTE/ INSTITUTE A. Umutoni, OF OF HIV/AIDS, HIV/AIDS, Dr Edson DISEASES DISEASES Rwagasore PREV PREVENTION&CONTROLENTION&CONTROL KigaliKigali - Rwanda,- Rwanda, Fax Fax 0252 0252 503980, 503980, TEL: TEL: 0252 0252 503979 503979 For more information, contact the Division Manager of Public Health Surveillance and Emergencies Preparedness and Response Division, For more information, contact the Ag. DivisionDr. Manager Edson Rwagasore, of Epidemic Tel:Surveillance 0788599240 and Response,or Toll free 114 Dr. José NYAMUSORE, Tel: 0788467187

RWANDARWANDA BIOMEDICAL BIOMEDICAL CENTRE CENTRE / INSTITUTE/ INSTITUTE OF OF HIV/AIDS, HIV/AIDS, DISEASES DISEASES PREV PREVENTION&CONTROLENTION&CONTROL KigaliKigali - Rwanda,- Rwanda, Fax Fax 0252 0252 503980, 503980, TEL: TEL: 0252 0252 503979 503979 P. 2 EPIDEMIC SURVEILLANCE AND RESPONSE WEEKLY REPORT

From P.1

Background: Outbreak investigation

On 29 January 2021, a suspected outbreak of epidemic typhus was reported from Muhanga prison through Kabgayi district hospital. A team composed by staff from Rwanda Biomedical Center (RBC) and Kabgayi DH was deployed on the field for an outbreak investigation from 01st to 13th February 2021.

Objectives: a. Confirm the diagnosis b. Characterize the outbreak (Time, place and person) c. Identify potential exposures to the outbreak d. Assess the magnitude of the outbreak e. Set up preventive and control measures f. Develop the line list of all cases

2. METHODS

The methods used for the field investigation were the following: • Review of medical records information in prison dispensary from 14th November 2020 to 13th February 2021 • Conduct environment assessment • Interview with patients • Interview with Kabgayi DH staff and Muhanga Prison Dispensary staff • Develop the Line List

2.1 Case definition

The case of Epidemic Typhus outbreak was defined as: 1) A suspected case was defined as any patient with fever not due to confirmed malaria or other common causes of febrile illness from 14th November 2020 to 13th February 2021 in Muhanga prison, Muhanga district. 2) A confirmed case is a suspected case with whole blood or serum specimen that will be tested positive for Epidemic Typhus through serology or polymerase chain reaction (PCR) illness from 14th November 2020 to 13th February 2021 in Muhanga prison, Muhanga district

3. FINDINGS

3.1. Patient characteristics A total of 982 cases meet case definition and were recorded on the line list among 5,941 population of male inmates. The age range is 17-99 years and the mean is 35 years. All cases reported fever, 809 (82.4%) had headache, 388(39.5%) had joint pain, 287 (29.2%0 had chills, 47 (4.8%) had cough, 4(0.4%) had myalgia, 3 (0.3%) had confusion and 1(0.1%) had itching, while 163 (16.6%) presented other symptoms. All cases were from male Blocs.

3.2 Attack rate

The overall epidemic typhus attack rate is 16.5% a. Distribution of Epidemic Typhus cases by age in Muhanga prison The Minimum age of cases is 17 years while the maximum is 99years old. The mean age is 35years. The most affected age group is 26-34 years with 336 (34.2%) cases. P. 2 P. 3 EPIDEMIC SURVEILLANCE AND RESPONSE WEEKLY REPORT From P.1 Graph 1. Distribution of Epidemic Typhus cases by age in Muhanga prison

b. Symptoms presented by cases The first choice drug to treat epidemic typhus is doxycycline. It was systematically provided to all suspected cases since 3rd February 20121. c. Case management

The first choice drug to treat epidemic typhus is doxycycline. It was systematically provided to all suspected cases since 3rd February 20121. Out 0f 982 cases, 409 (41.6%) received doxycycline, while 355 (36.2%) received other antibiotics.

4. PREVENTION AND CONTROL MEASURES

Nb Interventions Status Observation

1 Provision Doxycycline prophylaxis to all inmates Completed 5941 inmates have received Doxycycline chemoprophylaxis. Fe- male and minors inmates did not receive doxycycline chemopro- phylaxis because they were not affected by the outbreak

2 Spraying of insecticide Completed Insecticide(Fludora: with active ingredients: Clothianidin(500g/ kg and Deltamethrin(62.5g/kg)) has been used for spraying on both beds, clothes and walls

3 Soak and Wash clothes with boiling water to kill lice Ongoing

4 Separation of cases from other inmates ongoing From the 7th February 2021, every suspected case was put in ob- servation area set up in the compound of the prison

5 Sensitization of inmates on personal hygiene Ongoing There is ongoing sensitization of all inmates on personal hygiene such as Shaving, bathing...

6 Increasing the number of water taps Done Two water taps were added EPIDEMIC SURVEILLANCE AND RESPONSE WEEKLY REPORT P. 4

 Worldwide COVID19 situation in Number by WHO regions as of 14th February 2021

Region Number of cases Number of deaths

Americas 48,228,712 1,138,906

Europe 36,575,529 812,410

South East Asia 13,188,211 202,607

Eastern Mediterranean 5,998,998 139468

Africa 2,723,431 68,294

Western Pacific 153,366 27,019

other 745 13

total

106,868,991 2,388,717 Source : WHO Weekly epidemiological update P. 5 EPIDEMIC SURVEILLANCE AND RESPONSE WEEKLY REPORT

Summary of cases notified during week 6/ 2021