clustering of suspected measles cases in the southern...
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During this week, 14 suspect cases of four priority diseases were reported by different health facilities:
8 suspected cases of Measles: 1 case respectively
by Musha HC (Gakoma DH), Kabilizi HC (Munini
DH), Nyamyumba HC (Munini DH) and Gataraga
HC (Nyanza DH) while 2 cases were respectively
notified by Kinazi HC (Ruhango DH) and Kigoma
HC (Ruhango DH).
2 suspected cases of Rabies: reported by Gitare
HC of Butaro DH (1 case) and Rango HC of
Kabutare DH (1 case).
1 suspected case of Meningococcal Meningitis:
was notified by Kivumu HC (Kabgayi DH)
4 Cases of AFP: one case was reported by each of
the following health facilities: Byumba DH, Save
HC (Gakoma DH), Nyagihamba HC (Remera
Rukoma DH) and Remera Rukoma DH
Deaths
3 deaths due to Non Bloody Diarrhea were
reported. Nyagatare DH, Ngarama DH and
Nyarubuye HC ( Kirehe DH) reported a death
each.
For this week, timeliness and completeness of
weekly epidemiological reports were
respectively 85% and 93%.
Masaka DH and Nemba DH dis=d not wubmit
their weekly reports. In addition, the following
health centers did not submit their weekly
reports: Kibungo HD: Remera HC, Rubona
(Ngoma ) HC; Nyamata DH: Nyamata HC ;
Kirehe DH: Nasho HC’; Gihundwe DH:
Cyangugu Prison ;Gahini DH: Ryamanyoni HC ;
Kiziguro DH: Gasenge Rugarama HC;
Nyagatare DH: Nyagatare HC ; Ruhengeri DH:
Ruhengeri HC, Gasiza HC, Busogo HC, Kabere
HC, Murandi HC, Nyakinama HC and Rwaza HC;
Byumba DH: Gisizi and Mulindi HC; Kirinda DH:
Munzanga HC; Kibogora DH: Mahembe and
Rangiro HC; Remera Rukoma DH: Kamonyi HC
Munini DH : Muganza HC ; Masaka DH:
Gahanga HC; Kibagabaga DH: Kayanga HC and
Kimironko Prison
Contact Person
Dr. Thierry NYATANYI
Tel: 0788301902
REPUBLIC OF RWANDA
MINISTRY OF HEALTH
Summary
Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control
Kigali - Rwanda,
Fax:0252503980,Tel:0252503979
RBC/IHDPC/ EID Division
B.P: 7162 KIGALI-RWANDA, Toll free No
: 3334-3335, e-mail: trac.simr@gmail.com
Week 1: from 31stDec.2012 to 6th January 2013
No epidemic has been reported or
detected during this week. However, we
have noted a clustering of suspected
measles cases in the Southern province.
A suspected case of measles refers to any
any person with fever and generalised
maculopapular rash (non vesicular)
accompanied by cough, coryza or
conjunctivitis (red eyes) while a confirmed
case is a suspected case with laboratory
confirmation (positive IgM antibody) or
epidemiological link to confirmed cases in
an outbreak. During the week of from 31
December 2012 to 6 January 2013, two
suspected cases of measles were reported
by Kinazi Health Center of Ruhango DH
in the South Province. The 2 cases are a
14 year old male and a 6 year old female
who consulted Kinazi health center on 3rd
January 2013 with generalized
maculopapular rash and fever. The two
cases received their measles vaccination in
accordance with the national
immunization schedule.
Another two cases were reported by
Kigoma HC from the same district and
same sector of Ruhango. The two cases
are respectively a 2 years old girl and 18
months old boy who consulted the health
center on 2nd January 2013. They have
received also measles vaccination.
The cases received treatment and are
doing well.
A clustering of suspected Measles cases in the Southern province
Blood samples have been taken and sent to
the National reference laboratory for
confirmation of the aetiology: results are
expected in the coming week.
During the same reporting period, another
five suspected cases of measles were
reported by five health centers located in
Southern Province; that is one case
respectively by Musha HC (Gakoma DH),
Kabilizi HC (Munini DH), Nyamyumba HC
(Munini DH) and Gataraga HC (Nyanza
DH).
Actions taken: Clinical management of
cases including blood sampling for
confirmation
Recommendations: Measles is a vaccine
preventable disease that is scheduled for
elimination in Rwanda. The clustering of
cases may be the early marker of an
outbreak. For this reason, it is essential that
appropriate measures be taken to identify
the potential threat in time and address the
risk factors. For this reason, the health
authorities of Ruhango DH are advised to:
Conduct an early investigation to find out if
the cases are linked and/or if there are other
unreported cases in the community; Review
immunization data to identify if there is any
gap in immunization coverage in the
affected sectors; and based on the findings
from the 2 actions:
Reinforce surveillance, early reporting and
follow up of all suspected cases; and
undertake measure to address the risk
factors including strengthening sensitization
on immunization.
Definition
Rabies is a zoonotic disease (a disease that is transmitted to
humans from animals) that is caused by a virus: the Lyssaviruses of the Rhabdoviridae family. The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches. Once symptoms of the disease develop, rabies is nearly always fatal.
Worldwide, Rabies occurs in more than 150 countries and
territories and kills more than 55 000 people every year, mostly in
Asia and Africa. 40% of people who are bitten by suspect rabid
animals are children under 15 years of age and dogs are the source
of the vast majority of human rabies deaths. Wound cleansing and
immunization within a few hours after contact with a suspect
rabid animal can prevent the onset of rabies and death.
Transmission
People are infected following a deep bite or scratch by an infected
animal. Dogs are the main host and transmitter of rabies. They are
the source of infection in all of the estimated 50 000 human rabies
deaths annually in Asia and Africa. Bats are the source of most
human rabies deaths in the United States of America and Canada
and more recently in Australia, Latin America and Western
Europe.
Transmission can also occur when infectious material – usually
saliva – comes into direct contact with human mucosa or fresh
skin wounds.
Human-to-human transmission by bite is theoretically possible but
has never been confirmed. Rarely, rabies may be contracted by
inhalation of virus-containing aerosol or via transplantation of an
infected organ. Ingestion of raw meat or other tissues from
animals infected with rabies is not a source of human infection
The incubation period for rabies is typically 1-3 months. This however could vary from 1 week to a year. Initial symptoms of rabies are usually non-specific and include fever and often pain or unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.
As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. Two forms of the disease can follow:
Furious rabies during which people infected by the virus exhibit signs of hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardio-respiratory arrest.
Paralytic rabies which accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease.
Clinical case definition:
A person presenting with an acute neurological syndrome
(encephalitis) dominated by forms of hyperactivity (furious
rabies) or paralytic syndromes (dumb rabies) progressing
towards coma and death, usually by respiratory failure, within 7-
10 days after the first symptom if no intensive care is instituted.
Laboratory confirmation One or more of the following:
Detection of rabies viral antigens by direct fluorescent antibody test (FAT) or by ELISA in clinical specimens, preferably brain tissue (collected post mortem).
Detection by FAT on skin biopsy (ante mortem).
FAT positive after inoculation of brain tissue, saliva or CSF in cell culture, or after intracerebral inoculation in mice or in suckling mice.
Detectable rabies-neutralizing antibody titre in the serum or the CSF of an unvaccinated person.
Detection of viral nucleic acids by PCR on tissue collected post mortem or intra vitam in a clinical specimen (brain tissue or skin, cornea, urine or saliva).
However, laboratory confirmation is not yet available in Rwanda and other developing countries; is not essential for treatment and diagnosis is mainly based on clinical presentation
Diagnosis No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Diagnosis depends on history of exposure.
Continue to page 3
Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control
Kigali - Rwanda,
Fax:0252503980,Tel:0252503979
DISEASE HIGHLIGTHS: Every week, a disease is highlighted in the weekly Epidemiological bulletin to sensitize and familiarize readers with the various diseases under surveillance. This week, Rabies is featured
Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva) using the fluorescent antibody test (FAT).
Treatment All cases of suspected exposure to rabies should be treated as soon as possible to prevent the onset of symptoms and death. Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate anti rabies vaccination.
Local treatment of the wound
Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important. Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.
Post-exposure prophylaxis (PEP)
Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death. Post-exposure prophylaxis (PEP) consists of:
Local treatment of the wound, initiated as soon as possible after exposure;
A course of potent and effective rabies vaccine that meets WHO recommendations; and
Administration of rabies immunoglobulin in cases of single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks or exposures to bats.
Prevention
Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America and is also feasible in other countries including Rwanda.
Preventive immunization in people
Safe, effective vaccines can be used for pre-exposure immunization.
This is recommended for travelers spending a lot of time
outdoors, especially in rural areas, involved in activities such as
bicycling, camping, or hiking as well as for long-term travelers
and expatriates living in areas with a significant risk of exposure.
Pre-exposure immunization is also recommended for people in
certain high-risk occupations such as laboratory workers dealing
with live rabies virus and other lyssaviruses, and people involved
in any activities that might bring them professionally or
otherwise into direct contact with bats, carnivores, and other
mammals in rabies-affected areas
Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control
Kigali - Rwanda,
Fax:0252503980,Tel:0252503979
Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control
Kigali - Rwanda,
Fax:0252503980,Tel:0252503979
Acknowledgement
To all staff working on Disease Surveillance from
health centers to district hospitals for their efforts and
commitment to avail data for elaboration of this
bulletin.
EDITORIAL BOARD
1.Dr.Thierry NYATANYI
2.Dr.José NYAMUSORE
3.Dr. Marie Aimée MUHIMPUNDU
4.Adeline KABEJA
5.Dr. Veronicah MUGISHA
6.Dr.André RUSANGANWA
7. Robert K. MUGABE
8.Emmanuel NSHIMIYIMANA
Uganda free of Marburg
The Ministry of Health on 3rd January 2013 ,declared Uganda
free of Marburg, two months after the disease broke out in
Kabale District.
At least 15 people died in the epidemic.
The declaration follows the full observation of 42 days of post-
outbreak surveillance as recommended by the World Health
Organization(WHO).
The haemorrhagic fever was confirmed in Kabale on October
19, 2012 before spreading to Mbarara, Ibanda, and Fort Portal.
The ministry says the last patient admitted to the Marburg
Virus Isolation Centre at Rushoroza Health Centre III in
Kabale was discharged on November 15.
There have not been any new cases or suspected cases of the
virus reported in the area.
However, the ministry has asked the public to remain vigilant
and report any suspected strange illness or death to the nearest
health facility.
The Ministry also advised health workers to take precautions
while handling and treating patients, especially those suffering
from highly infectious haemorrhagic fevers.
Abroad
ANNEX 1: SUMMARY OF CASES NOTIFIED, TIMELINESS AND COMPLETENESS DURING WEEK 01, 2013
Province District Hospital% of
Completeness
% of
Timeliness
Sum of
Blood
Diarrhea
Cases
Sum of
Non Blood
Diarrhea
Cases
Sum of
Cholera
Cases
Sum of
Meningitis
Cases
Sum of
Acute
Flaccid
Paralysis
Cases
Sum of
Measles
Cases
Sum of
Neo Natal
Tetanos
Cases
Sum of
E.Typhus
Cases
Sum of
Y.fever
Cases
Sum of
H.fever
Cases
Sum of
Pestis
Cases
Sum of
Rabies
Cases
Sum of
Confirmed
Malaria
CasesCas
Sum of
Pneumoni
a Cases
Sum of
Influenza
Like
Illiness
Cases
Sum of
Chickenpo
x Cases
Sum of
Rubella
Cases
Sum of
Food
Poisoning
Cases
Sum of
Diphteria
cases
Sum of
Pertuisis
cases
Sum of
Typhoid
Fever
cases
Sum of
Mumps
Cases
Sum of
viral
Conjunctiv
itis cases
Gahini HD 88 75 0 21 0 0 0 0 0 0 0 0 0 0 232 3 109 0 0 0 0 0 0 0 0
Kibungo HD 86 64 0 76 0 0 0 0 0 0 0 0 0 0 1183 16 820 0 0 0 0 0 0 0 0
Kirehe HD 93 71 0 113 0 0 0 0 0 0 0 0 0 0 2079 27 919 1 0 0 0 0 0 0 0
Kiziguro HD 83 83 0 31 0 0 0 0 0 0 0 0 0 0 205 2 320 0 0 0 0 0 0 0 0
Ngarama HD 100 100 0 65 0 0 0 0 0 0 0 0 0 0 217 11 461 0 0 0 0 0 0 0 0
Nyagatare HD 95 86 1 144 0 0 0 0 0 0 0 0 0 0 2670 40 673 0 0 0 0 0 0 0 0
Nyamata HD 94 94 0 81 0 0 0 0 0 0 0 0 0 0 1000 7 690 0 0 0 0 0 0 0 0
Rwamagana HD 100 100 0 94 0 0 0 0 0 0 0 0 0 0 1186 8 734 0 0 0 0 0 0 0 0
Rwinkwavu HD 100 100 9 60 0 0 0 0 0 0 0 0 0 0 532 28 222 1 0 0 0 0 0 0 0
Butaro HD 100 94 0 85 0 0 0 0 0 0 0 0 0 1 75 18 724 0 0 0 0 0 0 0 0
Byumba HD 86 77 0 95 0 0 1 0 0 0 0 0 0 0 83 16 636 0 0 0 0 0 0 0 0
Nemba HD 92 85 1 74 0 0 0 0 0 0 0 0 0 0 26 1 327 1 0 0 0 0 0 0 0
Ruhengeri HD 53 33 0 68 0 0 0 0 0 0 0 0 0 0 16 1 214 0 0 0 0 0 0 0 0
Ruli HD 100 100 3 43 0 0 0 0 0 0 0 0 0 0 23 0 98 0 0 0 0 0 0 0 0
Rutongo HD 100 100 0 73 0 0 0 0 0 0 0 0 0 0 173 18 377 0 0 0 0 0 0 0 0
Bushenge HD 100 75 0 72 0 0 0 0 0 0 0 0 0 0 65 11 221 0 0 0 0 0 0 0 0
Gihundwe HD 88 88 0 37 0 0 0 0 0 0 0 0 0 0 82 24 372 0 0 0 0 0 0 0 0
Gisenyi HD 100 92 0 141 0 0 0 0 0 0 0 0 0 0 16 2 724 0 0 0 0 0 0 0 0
Kabaya HD 100 0 0 15 0 0 0 0 0 0 0 0 0 0 28 20 42 0 0 0 0 0 0 0 0
Kibogora HD 85 85 0 100 0 0 0 0 0 0 0 0 0 0 102 2 283 0 0 0 0 0 0 0 0
Kibuye HD 100 90 0 60 0 0 0 0 0 0 0 0 0 0 21 6 207 0 0 0 0 0 0 0 0
Kirinda HD 86 71 0 8 0 0 0 0 0 0 0 0 0 0 18 0 21 0 0 0 0 0 0 0 0
Mibilizi HD 100 100 0 98 0 0 0 0 0 0 0 0 0 0 308 4 416 0 0 0 0 0 0 0 0
Mugonero HD 100 100 3 25 0 0 0 0 0 0 0 0 0 0 43 35 104 0 0 0 0 0 0 0 0
Muhororo HD 100 89 2 46 0 0 0 0 0 0 0 0 0 0 8 5 85 2 0 0 0 0 0 0 0
Murunda HD 100 100 10 93 0 0 0 0 0 0 0 0 0 0 16 58 288 0 0 0 0 0 0 0 0
Shyira HD 100 100 0 86 0 0 0 0 0 0 0 0 0 0 21 31 338 0 0 0 0 0 0 0 0
BUTARE CHU 100 0 0 8 0 0 0 0 0 0 0 0 0 0 15 4 11 1 0 0 0 0 0 0 0
Gakoma HD 100 100 0 28 0 0 1 1 0 0 0 0 0 0 321 0 90 0 0 0 0 0 0 0 0
Gitwe HD 100 100 0 24 0 0 0 0 0 0 0 0 0 0 31 12 95 0 0 0 0 0 0 0 0
Kabgayi HD 80 80 20 112 0 1 0 0 0 0 0 0 0 0 149 154 437 2 0 0 0 0 0 0 14
Kabutare HD 100 94 4 147 0 0 0 0 0 0 0 0 0 1 1276 33 503 0 0 0 0 0 0 0 0
Kaduha HD 100 89 0 23 0 0 0 0 0 0 0 0 0 0 38 41 59 0 0 0 0 0 0 0 0
Kibilizi HD 100 100 0 73 0 0 0 0 0 0 0 0 0 0 628 11 322 0 0 0 0 0 0 0 0
Kigeme HD 100 100 44 122 0 0 0 0 0 0 0 0 0 0 50 11 264 5 0 0 0 0 0 1 0
Munini HD 94 82 0 77 0 0 0 2 0 0 0 0 0 0 204 6 400 0 0 0 0 0 0 0 0
Nyanza HD 100 100 8 67 0 0 0 1 0 0 0 0 0 0 613 24 170 2 0 0 0 0 0 0 8
Remera Rukoma HD92 92 2 84 0 0 2 0 0 0 0 0 0 0 449 13 279 0 0 0 0 0 0 0 0
Ruhango HD 100 100 1 37 0 0 0 4 0 0 0 0 0 0 198 7 198 2 0 0 0 0 0 0 0
CHK/CHUK 100 100 0 12 0 0 0 0 0 0 0 0 0 0 3 1 3 0 0 0 0 0 0 0 0
Kibagabaga HD 83 72 0 123 0 0 0 0 0 0 0 0 0 0 648 16 981 0 0 0 0 0 0 0 0
Masaka HD 78 67 2 25 0 0 0 0 0 0 0 0 0 0 114 18 206 1 0 0 0 0 0 0 0
Muhima HD 100 90 2 114 0 0 0 0 0 0 0 0 0 0 94 3 595 1 0 0 0 0 0 0 0
93 85 112 2980 0 1 4 8 0 0 0 0 0 2 15259 748 15038 19 0 0 0 0 0 1 22
EAST
NORTH
WEST
SOUTH
KIGALI TOWN
TOTAL
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