H5N1

WHO: Rift Valley fever in Niger

WHO has published Rift Valley Fever in Niger. Excerpt:

On 30 August, the Ministry of Health in Niger notified WHO of unexplained deaths among humans, along with deaths in livestock in the Tahoua region of Niger. On 23 September, human and animal specimens were tested at the Institut Pasteur de Dakar (IPD) and were reported positive for Rift Valley Fever (RVF) virus by PCR and for specific IgM antibodies confirming the first outbreak of RVF in Niger. Initially the outbreak was centered in the north west of the country in areas bordering Mali, in particular around Tassara and Tchintabaraden in the Tahoua Region, however suspected cases of RVF have recently been identified in new areas to the north and south of Tchintabaraden.  

The outbreak also coincided with the annual Cure Salée gathering in Ingall (close to Agadez), Tahoua region, where nomadic stockbreeders from Niger and surrounding countries gather with their animals. It is estimated that around 2 million cattle and smaller ruminants were in the affected area during the beginning of the outbreak. 

Furthermore, there were reports of waves of abortions and deaths among livestock in Boni-Bangou in Niger while human RVF suspected cases and animals were confirmed with specific IgM in the neighbouring region of Menaka in Mali. From 8 August to 21 November, 266 suspected human cases including 32 deaths have been reported from Abalak, Keita, Madaoua, Tilia, Tassara, Tahoua department and Tchintabaraden in the Tahoua Region. 

From 8 August to 18 November, 196 specimens were tested and 17 patients were confirmed positive by RVF PCR and/or serological identification of IgM antibodies. Further testing of RVF negative specimens is being performed at IPD. 

Given that more than 90% of the samples were tested negative for a recent RVF infection (IgG, PCR negative) and the increasing proportion of house wives and children affected there is a need to broaden the investigation to identify possible other underlying cause(s). In this regard an adapted investigation protocol is currently being developed which includes infectious and non-infectious diseases as well as chemicals and toxins.

West Africa tackles human and animal health together to contain diseases

Via Thomson Reuters: West Africa tackles human and animal health together to contain diseases. Excerpt:

A drive by West African nations to tackle zoonotic diseases, those that jump from animals to humans, could help to protect the region from future health crises such as the world's worst Ebola outbreak, a United Nations official said on Thursday. 

Ministers from the region met in Senegal last week to adopt an approach to infectious diseases that will address human and animal health together, and see countries work collaboratively to contain outbreaks of diseases ranging from bird flu to Zika.  

Three-quarters of emerging infectious diseases in recent years have spread to humans from animals or animal products, according to the World Health Organization (WHO). 

The Ebola outbreak in West Africa, which infected more than 28,600 people and killed some 11,300 across Guinea, Liberia and Sierra Leone, began in December 2013 when a young boy in rural Guinea came into contact with an infected animal, the WHO said. 

"There are no boundaries between humans and animals ... we cannot have separate health mechanisms and responses any longer," said WHO representative Ibrahima Soce Fall.  

"Ebola was a turning point in terms of taking a new approach to zoonotic diseases," he told the Thomson Reuters Foundation.  

West Africa is dealing with outbreaks of several zoonotic diseases, such as bird flu in Cameroon and Nigeria, Rift Valley fever in Niger, and the recent emergence of the Zika virus strain from Brazil in Cape Verde and Guinea-Bissau. 

In addition to their health impact, such outbreaks also inflict a heavy toll on the economy. Guinea, Liberia and Sierra Leone are estimated to have lost a collective $2.2 billion in gross domestic product (GDP) in 2015, said the World Bank. 

Countries in the region agreed at the One Health conference in Dakar to carry out national risk assessments, set up alert mechanisms for disease outbreaks, and ensure their laboratories can handle both human and animal samples, according to the WHO.

ECDC: Rift Valley fever outbreak in Niger not a threat to EU

ECDC has published Rift Valley fever (RVF) outbreak in Niger does not pose a new reisk for the EU. Click or tap through to download the full rapid risk assessment. Excerpt:

During August and September 2016, 78 human cases including 26 deaths were reported in the district of Tchintabaraden (Tahoua Region) in Niger. 

The current Rift Valley fever (RVF) outbreak in Niger does not pose a new risk for the European Union, concludes ECDC risk assessment: 

• The outbreak is currently affecting rural areas that are not considered touristic areas. Travellers staying in urban areas or in areas not affected by the RVF outbreak are not at risk of infection. Travellers visiting affected areas are at risk of infection and should avoid contacts with ruminants and use protection against mosquitoes. 

• Importation of human cases from Niger cannot be excluded but is unlikely, given the number of cases that have been imported to the EU in previous years - between 2010 and 2015, four cases of RVF were reported in the EU, all imported. The risk of RVF cases being imported into the EU is not new as RVF is endemic in many African countries and in Saudi Arabia, a country to which many EU citizens travel. 

• Imports into the EU of live animals and their meat and milk from Niger are prohibited. 

• Should the virus be imported, the risk of it spreading among humans within the EU appears to be very low. There is no evidence of direct human-to-human transmission. The risk of transmission to humans through an infected mosquito bite cannot be excluded.

ECDC: Rapid risk assessment of Rift Valley fever outbreak in Niger

ECDC has published Rapid risk assessment: Outbreak of Rift Valley fever in Niger - Risk for the European Union. The abstract:

​Rift Valley fever (RVF) is an acute febrile disease affecting ruminants and humans caused by a virus of the genus Phlebovirus. The disease has been reported in regions of eastern and southern Africa, and in most of the sub-Saharan and West African countries, Egypt, Madagascar, Saudi Arabia and Yemen. 

During August and September 2016, 78 human cases including 26 deaths were reported in the district of Tchintabaraden (Tahoua Region) in Niger. However, the outbreak is currently affecting rural rather than touristic areas. 

The risk of RVF cases being imported into the EU is not new as RVF is endemic in many African countries and in Saudi Arabia, a country to which many EU citizens travel. 

However, to date, no autochthonous cases or outbreaks of RVF have been reported in the European Union (EU) and the four cases of RVF reported in the EU between 2010 and 2015 were all imported.

WHO: Rift Valley fever in Niger

WHO has published Rift Valley fever in Niger. Excerpt:

On 30 August 2016, WHO received reports about unexplained deaths among humans, along with death and abortion in livestock in the North Western parts of Niger, and the areas bordering Mali. 

From 2 August to 22 September 2016, 64 human cases including 23 deaths have been reported in Tchintabaraden health district in Tahoua region. The area is mainly populated by nomadic stockbreeders.  

Most of the cases are male (62.5%), and work as farmers or animal breeders. In the affected area, an epizootic outbreak is also reported among livestock during the same time duration, including deaths and abortions among cattle and small ruminants.  

As of 16 September 2016, 6 of the 13 human specimens tested at Institute Pasteur (IP), Dakar were positive for Rift Valley Fever (RVF). Among the 6 animal specimens tested, 3 were positive for RVF. Sequencing and further laboratory testing is ongoing. Genetic sequence data is required to confirm or refute the endogenous origin of the outbreak. Moreover, laboratory support for Niger is being considered. 

Public Health Response 

On 31 August, a multisectoral national rapid response team, including members from the Ministry of Health, veterinary services and Centre de Recherche Médicale et Sanitaire (CERMES), and World Health Organization, was deployed for field investigation. Ministries of Health and Agriculture/Livestock have developed a national response plan. 

The WHO Country Office continues to provide technical and financial support for surveillance, outbreak investigation, technical guidelines regarding case definition, case management, shipment of samples and risk communication.  

FAO, OIE, and WHO are coordinating on animal and human health and providing additional support to Niger for the outbreak response WHO is working with partners in the Global Outbreak Alert and Response Network (GOARN) to coordinate international support for the response. IFRC, and Unicef are supporting outbreak response. 

The NGO ALIMA and the Nigerian NGO BEFEN are providing support for case management and social mobilisation on the ground. 

Currently, in conjunction with the Ministry of Public Health, an entomological survey is being prepared for urgent implementation with WHO technical and financial support. This is to identify potential vectors for RVF in the region and it is considered to be in the definition of vector control activities.  

Currently, some of the main challenges include under-detection of human cases. The risk that only severe cases are being detected and reported cannot be ruled out. There is no national local capacity to test the specimens. For laboratory confirmation for RVF, the samples are being shipped to WHO regional collaborating centres. Moreover, to ascertain the extent of this outbreak, the involvement of the national livestock department is required.

Rift Valley fever: Still an emerging infection after 3,500 years

Via The Lancet Global Health: Rift Valley fever: still an emerging infection after 3500 years. Excerpt:

In the Book of Exodus, the description of the fifth plague of Egypt evokes a high mortality epizootic disease affecting livestock such as camels, goats, and sheep. It is debatable whether Rift Valley fever was that biblical plague but it is undeniably an ancient zoonosis and its modern history is no less dramatic. 

The virus was first isolated in 1930 after a heavy mortality of newborn lambs was reported on a Merino sheep farm in Naivasha, Rift Valley, Kenya following unusually heavy rainfall. The associated human disease was identified 20 years later in South Africa and the relevant microbiology, clinical disease, ecology, and epidemiology seemed to be well established. This dominant disease narrative continues to be punctuated by multiple novel revelations including those reported in The Lancet Global Health by Maria Baudin and colleagues. 

Rift Valley fever is mainly a disease of animals with enzootic and epizoonotic mosquito-borne transmission cycles associated with corresponding endemic and epidemic disease in human beings based on a complex set of relationships between domesticated animals, the vectors, human behaviours, local ecology, and climate. 

The disease has long been characterised by waves of spontaneous abortions among domesticated animals and severe illness of pregnant animals and newborns that often heralds human infections. Human infections are generally subclinical or self-limited although it can be associated with a severe febrile illness and jaundice. Less than 5% develop the three major complications: encephalitis, retinitis and other ocular lesions, and a haemorrhagic fever. 

Transmission to human beings is mainly from direct or indirect contact with infected animals and their organs but disease has also been transmitted by mosquitoes and by aerosols generated in the laboratory. Vaccines are available for animals to limit the substantial economic impact of the disease. 

Rift Valley fever was considered to be limited to sub-Saharan Africa until it caused an epidemic in Egypt in 1977. It was then considered confined to Africa until an outbreak in Saudi Arabia and Yemen in 2000. Now it is recognised as an agricultural threat to the rest of the Middle East and other countries with competent mosquito vectors. 

Similarly, the disease has never been associated with person-to-person transmission including the reassuring lack of nosocomial infections even among health-care workers tending to patients with haemorrhagic fever. This dogma was altered in this century by two case reports of vertical transmission. 

Baudin and colleagues extend these case reports with a large study that presents the unique observation of spontaneous abortions among febrile patients in Port Sudan infected with Rift Valley fever.

Uganda Ebola scare: Masaka samples negative (so what is it?)

Via the Sunday Monitor in Kampala: Ebola scare: Masaka samples negative. Excerpt and then a comment:

Preliminary results from the samples taken from suspected Ebola victims in Masaka Regional Referral Hospital have tested negative, easing tension that had gripped health workers and residents in the area. 

The hospital currently has six patients admitted with a strange illness that has symptoms similar to those of the deadly haemorrhagic fever - Ebola and Marburg diseases or Rift Valley fever. 

Prior to admission of the patients, the district had registered four deaths with similar symptoms in one-and-half months. The deaths were reported in the parishes of Kasaka and Mazinga in Buwunga Sub-county. 

But Dr Stuart Musisi, the district health officer, said they preferred to conduct expert medical tests on the samples taken from the victims to establish the actual type of infection bothering the community. 

However, on Thursday, Dr Musisi said the preliminary results from tests taken to the Uganda Virus Research Institute in Entebbe have so far tested negative to Ebola, Marburg, Rift Valley fever viruses that had highly been suspected. 

He urged the public to remain calm as they wait for comprehensive examinations on other possible fevers. 

Dr Musisi also appealed to residents to report all similar cases they come across and avoid seeking services of traditional healers.

The Ugandans know their stuff about Ebola, and did good work in helping fight the West African outbreak. If they don't think this is Ebola, I'll take their word for it.

But I really hope it's not a whole new awful virus. Not when we're still dealing with everything else.

Uganda: Suspected Rift Valley fever patient dies in Kabale

Via New Vision in Kampala: Suspected Rift Valley Fever Patient Dies In Kabale. Excerpt:

A patient admitted at Kabale Regional Referral Hospital suspected of contracting Rift Valley fever has passed away. 

Issah Ndimurukundo a truck driver from Burundi died at the hospital after being admitted on Monday morning bearing symptoms of Rift Valley Fever. 

Bernard Lubwama, an epidemiologist at the Ministry of Health on Tuesday evening made the revelation while addressing the media at Kabale district Rukiiko Hall. 

“This evening at around 7pm, the long truck driver who reported to us and was admitted at the regional referral hospital succumbed and died of a disease suspected to be RVI. He was vomiting a lot of blood” Lubwama said. 

“The health workers there did all they could but unfortunately, they were not able to save his life. We had not yet received his lab results. Our burial team shall conduct his burial after clearance from his family and other structures in the Ministry of Health,” Lubwama added. 

The deceased was married to three women; one in Burundi and the others in Katuna and Entebbe. 

According to health officials, there are 3 more suspects still admitted in Kabale with two of them at Kabale Regional Referral Hospital and the other at Rugarama Hospital. The two confirmed cases of the disease are said to be improving.

Uganda: Two diagnosed with Rift Valley fever in Kabale

Via New Vision: Two Diagnosed With Rift Valley Fever In Kabale. Excerpt:

The Ministry of Health has instituted a task force to combat an outbreak of Rift Valley Fever in Kabale district. 

This comes after two people in Kabale town council were diagnosed with the disease and referred to Kabale Regional Referral Hospital for treatment while three other cases have so far been identified in the same area. 

Dr. Ruth Aceng the director general of health services in the ministry said the task force is comprised of experts from the ministries of health, agriculture and animal husbandry in addition to the Uganda Wildlife authority. 

“The multi-sectorial task force has boosted surveillance programs in Kabale, Rwanda and DRC borders. So far a total of 59 animal and 11 human samples have been collected for testing at the Uganda Virus Research Institute” Aceng said.    

Aceng noted that the disease is an acute fever that is transmitted by mosquitoes during the rainy season and affects animals such as cattle, sheep, goats, and buffaloes. 

The disease presents symptoms of fever, general weakness, back pain, dizziness and weight loss at the onset of the illness. 

“We urge the general public to report any suspected patient or sick animal to a nearby health facility or veterinary clinic respectively” Aceng added.

Uganda: Rift Valley fever in Kabale

Via allAfrica.com, a report from The Monitor: Uganda: Experts Rush to Probe New Fever in Kabale.

Kampala — The Ministry of Health has dispatched a team of epidemiologists to investigate the outbreak of the Rift Valley fever reported in Kabale District last week. 

The Permanent Secretary to the Ministry of Health, Dr Asuman Lukwago, yesterday told Daily Monitor that a team of health workers will investigate and provide surveillance in the district to curb further spread of the disease. 

The disease outbreak was confirmed by the Kabale District health officer, Dr Patrick Tusiime, after blood samples taken from two patients at Kabale Regional Referral Hospital tested positive at the Uganda Virus Research Institute based in Entebbe. 

"It is the first time we are confirming an outbreak of the disease. It mostly affects animals that later spread it to human beings through mosquito bites," Dr Lukwago said. 

Earlier last Thursday, tension had engulfed health workers and caretakers at the hospital following the admission of two patients bearing symptoms similar to those of Ebola. 

Rift valley haemorrhagic fever manifests with symptoms such as high fever, intense fatigue, anorexia, headache, cough, jaundice and an explained bleeding from all body openings. 

Dr Lukwago asked all Kabale District residents to stay calm and report any suspicious cases to the health workers as early as possible to enable control. "We shall give a brief on the disease after our team has prepared an assessment report on the situation," Dr Lukwago said, adding that if it necessitates, veterinary people will have to screen and vaccinate all animals in the district.