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RVF Situation Update #8 RSS 16 Feb 2018 Eastern Lakes State

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RVF Situation Update #8 RSS 16 Feb 2018 Eastern Lakes State Rift Valley Fever (RVF) outbreak – Yirol East, Eastern Lakes State, Republic of South Sudan Situation Report (Sitrep No. 8) as at 17.00 Hours; 16 February 2018 Summary Statistics No. Summary of cases Total 1 New suspect cases (deaths) – week ending 18th February 2018 0(0) 2 Cumulative suspect cases (deaths) in • Health Facilities 02(0) • Community 26(03) 3 Total number of suspect cases on admission 00 4 Cumulative suspect cases discharged 08 5 Epidemiological classification of human cases • Suspect (pending lab results) 8 • Confirmed by IgG + IgM 01 • Confirmed by IgG 04 • Confirmed – total 05 • Probable 03 • Non-cases (RVF lab test negative) 12 03(18.75%) • Deaths (CFR%) – excluding none-cases 6 Number of domestic animal events I. Abortion in goats 01 II. Abortion in sheep 01 III. Domestic animal abortions 02 IV. Dead goats (with bleeding into tissues) 08 V. Disease in cattle 01 7 Wild bird deaths 01 8 Specimens collected Human – new since last update 02 Human – cumulative 26 Animal – new since last update 21 Animal – cumulative 28 9 Total samples shipped to WHO/FAO collaborating laboratories Human 18 Animal 28 10 Cumulative specimens (blood) collected Human 26 Animal 28 11 Number of cases with laboratory confirmation Human samples - PCR negative for Ebola, Marburg, CCHF, RVF, Sosuga 18 Human samples - RVF serology – IgM and IgG positive (high titres) 01 Human samples - RVF serology – IgG positive (high titres) 04 Animal samples - RVF serology – IgG positive (high titres) 01 1 Situation update • Since the last update (of 9 February 2018), no new suspect human RVF cases have been reported in Yirol East. However, two alerts were reported during the week, but the case-based details were not available at the time of writing this update. • There are currently no suspect human cases on admission in Yirol East. • Human RVF alerts in Eastern Lakes have continued on a steady decline in the last four weeks. • During the week, eight human samples were shipped to Uganda Virus Research Institute (UVRI) in Entebbe, Uganda for laboratory testing. • Overall, out of the 18 human samples tested for RVF (since the onset of the current event – 7 Dec 2017), five have been RVF positive with one sample being RVF IgM and IgG positive while the other four samples were RVF IgG positive. • Test results from the 21 animal (Livestock) samples shipped to South Africa for laboratory testing are still pending. Initial reports on the event • On 28 December 2017, the Eastern Lakes Ministry of Health reported a suspect viral hemorrhagic fever cluster to the National Ministry of Health and WHO. The initial cluster involved three deaths in Thonabutkok village, Yali Payam, Yirol East county with 7 December 2017 as the earliest date of onset. • Preliminary investigations conducted by the County Health Department, State and National MoH, CUAMM, and WHO showed that the three deaths had a severe hemorrhagic illness and were epidemiologically linked by place (Thonabutkok 2 village) and time (with 49 and 51 as the respective epidemiological weeks of illness onset). However, there was no history of close physical contact between the cases, and travel history was not significant. Also, the symptoms were not reported in the respective close case contacts during the clinical illness or even after death. • These initial investigations showed significant history suggestive of a zoonotic hemorrhagic illness as abortions in goats and sheep; deaths/disease in goats and cows; wild bird die-offs were reported in association with this event cluster. Brief Case Clinical and Epidemiological Findings • The putative initial case was a 30-year-old female Gravida 5 Para 4+0; housewife from Thonabutkok village in Yirol East county. Her illness started on 7th December 2017 with fever, headache, neck pain and sudden nose, gum, and injection site bleeding. She reported to a health facility the same day where she was admitted to maternity ward since she was pregnant. After 8days of treatment with no improvement, she moved to a private clinic for 4days where she was treated for malaria and typhoid fever. The illness worsened on 19th December 2017 and requested to return home. She died at home the same day. No supervised burial was done, and no symptomatic cases have been reported among the close contacts during the clinical illness and after death. • The second case was a 13-year-old female from Thonabutkok village (approximately 150 meters from the putative initial case). Her illness started on 20th December 2017 with a headache, joint pain, neck pain, fever, generalized swelling at the joints which were painful (ecchymosis), bleeding from the nose and gums. She died at home on 26th December 2017 after she developed bleeding from the skin blisters. Goat and sheep abortions were reported in association with this case. No supervised burial was done, and no symptomatic cases have been reported among the close contacts during the clinical illness and after death. • The third case was a 15-year-old male from Thonabutkok village. His illness started on 24th December 2017 with a headache, fever, sweating, and neck pain, nose bleeding, vomiting of blood and gum bleeding, convulsions and loss of consciousness. He died at home on 27th December 2017 after failing to improve on treatment in a private clinic. Eight goat deaths with extensive hemorrhage were reported in the case neighborhood (the goats were skinned, cooked and eaten). No supervised burial was done, and no symptomatic cases have been reported among the close contacts during the clinical illness and after death. Timeline of the Rift Valley Fever outbreak in Yirol East, week 49, 2017 to week 5, 2018 Key PA: 49 Yr Old F, 1st probable Case Index Case AM: 13 Yr Old F, 2nd Probable case Possibly MM : 15 Yr Old M, 3rd Probable case exposed DOO: Date of Onset at around 3 Days from DOO to death this time. Exposure preceeded by reports of deaths After 8 days MM Detection in animals of symptom and treatment onset notification DOO of IgG DOO of IgM PA PA moved AM by SMOH Pos Case & IgM symptom to Privated Symptom MM was never taken positive onset clinic onset to a health facility, case Zoonotic events noted (8 deaths in goats ) 1st Dec 7th Dec 15th Dec 19th Dec 20th Dec 24th Dec 26th Dec 27th Dec 28th Dec 30th Dec 2nd Dec 3rd Dec AM was never taken Sample collected PA was pregnant to a health facility, Sample collected NRRT Deployed on 6th Jan PA Death Zoonotic events noted AM death on 6th Jan MM Death & 7 samples collected (abortion and deaths Safe burial in goats and sheep) 12 days from 5 days from DOO to death DOO to death • In the period 7 December 2017 to 16 February 2018, a total of 28 suspect RVF cases were reported in Eastern Lakes state. These were reclassified based on epidemiological investigations and laboratory test results, such that as of 16th February 2018, there were a total of five (5) RVF confirmed cases,1 three (3) probable, and eight (8) suspect RVF cases 1 Subject to change as the RVF laboratory case classification algorithm is currently being reviewed. 3 (laboratory results are pending). Twelve (12) cases were discarded as non-cases following negative laboratory results for RVF and other common causes of viral haemorrhagic fever. • The case fatality rate among suspect, probable and confirmed cases (excluding non-cases) is 18.75% (3/16). More cases have been reported among females 10 (62.50%) than males 6 (37.50%) (Figure 1). • Most of the cases have been reported in the 20-29-year and 30-39-year age-groups with most cases occurring the 20- 29-year age-group in the males while in the females, most cases are reported in the 20-29-year and 30-39-year age- groups (Figure 2). The deaths occurred in the 10-19-year and 30-39-year age-groups (Figure 3). • Figures 4 and 5 show the distribution of cases by time and outcome/epi-classification. The initial probable cases occurred between week 49-52, 2017. Most suspect cases have been reported in week four though only two have been confirmed as RVF IgG. • Figure 6 shows the distribution of clinical symptoms among suspect, probable, and confirmed cases (excluding none- cases). The most frequent symptoms are non-specific and include fever, headache, neck pains, and joint pains. Bleeding has been reported in 63% of suspect cases, but none of the five confirmed cases had bleeding. • All the 16 probable, confirmed, and suspect cases (excluding the non-cases) have been reported from Yirol East county in Eastern Lakes state (Figure 7). In Yirol East county, cases have been reported from five payams with most 9 (56.25%) cases and all the three deaths reported from Yali payam. • All the probable and confirmed cases are clustered in Yali Payam, Thonabutkok village (Figures 8 and 9). South Sudan: Rift Valley Fever by Epi classification , Yirol East County, Week 49 of 2017 to Week 5 of 2018 h c o W M h Panyijiar . it R e N i le Twic East m e t A . R Rumbek East R . L o u (D o k /D h o k ) Yirol East Lake Yirol Case classification by Payam W Payam Confirmed Suspected Probable Total Cases h i t e Mangar 1 0 0 1 Bor South N i l Yali 4 2 3 9 e Wonthou 0 4 0 4 Moger 0 1 0 1 Yirol West Khap 0 1 0 1 Total cases 5 8 3 16 Awerial Map creation date: 06.02.2018 4 Decimal Degrees 0 0.05 0.1 0.2 Disclaimer: The boundaries and names shown and the designations used on this map do not imply official endorsement by the United Nations Response updates Overall coordination of investigation and response activities • The overall coordination of investigation and response activities is currently coordinated by a multi-sectoral task force that is meeting weekly at the national level and sub-national (Yirol East) level.
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