Tests underway to ID cause of febrile illness outbreak in eastern DRC

The Democratic Republic of Congo (DRC) health ministry announced yesterday that it has received reports of 25 fever cases with symptoms similar to Ebola in North Kivu province in the eastern part of the country.

In a statement, it said the affected area is in the Mangina health district.

Samples have been collected from patients and are being sent to Kinshasa for testing at the National Institute for Biomedical Research.

A 3-person investigation team from the health ministry is slated to arrive in the city of Beni as soon as today to help provincial health officials. The DRC's health ministry urged health workers to take personal protective measures and for the public to remain calm, stay vigilant, and to practice hygiene measures, especially hand washing.

According to an African media report, the outbreak began in early July in the village of Mangina near the town of Beni, which has a population of about 232,000. Illness symptoms include fever, diarrhea, vomiting, and nose bleeds.

Last week the country declared the end of an Ebola outbreak in the western part of the country in Equateur province. The event, which began in early May, resulted in 54 cases, 38 of them confirmed by lab tests and 16 classified as probable. Thirty-three deaths were reported.
Jul 30 DRC health ministry statement
Jul 30 African media report

FSIS issues warning about Cyclospora risk in sandwich wraps

The US Department of Agriculture's Food Safety and Inspection Service (FSIS) issued a public health alert yesterday concerning possible Cyclospora contamination in beef, pork, and poultry salad and wrap products distributed by Caito Foods LLC, of Indianapolis.

The salads and wraps in question are labeled with "Best By," "Enjoy by," "Best if Sold By," or "Sell By " dates ranging from Jul 18 through July 23. Both salads and wraps contain lettuce from Fresh Express, a supplier that alerted Caito of potential contamination. Fresh Express recently recalled chopped romaine.

"FSIS is concerned that some product may be in consumers' refrigerators and that consumers may be at risk due to the length of the Cyclospora incubation period. Consumers who have purchased these products are urged not to consume them," the agency said in a press release.

Cyclospora is an intestinal parasite with an incubation period ranging from 2 days to 2 weeks. Two other Cyclospora outbreaks took place earlier this summer, one linked to Del Monte vegetable trays and the other to McDonald's salads. So far, it's not known if Fresh Express is connected to those outbreaks, or if the earlier outbreaks are related to each other.
Jul 30 FSIS statement

Two viral hemorrhagic fever outbreaks detected at Uganda refugee settlement

Uganda's health officials have reported two different outbreaks—Rift Valley fever (RVF) and Crimean-Congo hemorrhagic fever (CCHF) at the Nakivale Refugee Settlement, located in the Isingiro district in the south of the country near the border with Tanzania, the World Health Organization (WHO) African regional office said in its latest weekly health emergencies report. The settlement houses nearly 107,000 people.

On Jul 13 the Uganda Virus Research Institute (UVRI) confirmed a CCHF case involving a 30-year-old woman originally from Rwanda and the Democratic Republic of Congo (DRC). Four days later tests confirmed a CCHF infection in her husband. Both patients are isolated at Mbarara Regional Reference Hospital, and health officials have identified 42 contacts.

CCHF virus is carried by ticks, and many animals, including cattle, sheep, goats, and hares, serve as amplifying hosts. Humans catch the disease through tick bites or contact with animal blood, and the virus can spread from person to person via body fluids.

Also, Uganda's health ministry on Jun 28 notified the WHO of two confirmed RVF cases, both related to samples obtained on Jun 23 from patients in Isingiro and Kasese districts, both of whom died at different hospitals. One was a 35-year-old man from Rwanda from the Nakivale refugee settlement who worked as a herder and died on Jun 30, after which a safe burial was performed. Two weeks earlier, a 25-year-old man grazing animals on the same land reportedly died after experiencing similar symptoms. Both patients had a history of skinning and eating animals that had died of unknown causes. The other confirmed case-patient is a 47-year-old butcher from Kasese district who got sick on Jun 20 and was found dead a day later.

As of Jul 9, Uganda has reported eight RVF cases, including four suspected and four confirmed cases. Four deaths have been reported. The most recent report is a suspected case reported on Jul 9 involving a person from the DRC.

The WHO said Uganda is located between countries that have frequent RVF cases and where CCHF is endemic. It said RVF has been isolated often in domestic animals, and that people in some districts eat "sanga meat", which is meat harvested from sick animals, which the WHO said heightens the zoonotic risk of both types of viral hemorrhagic fever. It added that more community engagement is needed to explain the health risks that come with the practices.
Jul 30 WHO African regional office weekly report

Central African Republic records new monkeypox cases

The Central African Republic (CAR) now reports 29 monkeypox cases since Mar 2, with one fatality, according to the latest update from the World Health Organization (WHO) African Regional Office.

Since 2013, CAR has recorded at least one annual outbreak of the orthopoxvirus. This year's cases are in three health districts, including the central Bambari, Bangassou in the eastern part of the country and more recently Mbaïki in the south.

Since May 16, no cases have been reported from Bambari and Bangassou districts.

Authorities have identified the index case as a male merchant who developed symptoms on Mar 29 in Dembia village. The fatality occurred in a 33-year-old woman who perished 3 days after developing a rash.

Monkeypox is commonly transmitted through the eating or handling of bushmeat.
Jul 27 WHO report

Travel-related dengue cases in China involved all 4 strains

In Emerging Infectious Diseases, researchers describe how travel-related dengue (DENV) activity in China near the Myanmar border involved cocirculation of all four strains.

After a 2013 dengue outbreak in Yunnan Province, China, which was triggered by travelers, the government began taking the temperature of visitors at border crossings. This study, conducted in 2017, included 1,667 travelers screened for dengue, of which 301 were confirmed to have the flavivirus.

One hundred samples were randomly selected for further genetic sequencing and analysis. All four DENV serotypes were found in this population, even though DENV-3 (4 cases) and DENV-4 (17 cases) had not been previously detected in Yunnan Province. DENV-1, the dominant serotype in the 2013 outbreak, was the most prevalent serotype in 2017 (77 cases); only 1 case of DENV-2 was detected.

"Among the travelers entering Yunnan Province from Myanmar in 2017, dengue infections showed not only inherited characteristics of previous epidemic DENV-1 and DENV-2 but also the circulation of additional serotypes and genotypes," the authors wrote. "This importation of all serotypes of DENV may result in simultaneous or sequential epidemics of the local population in Yunnan Province."

Southeast Asia is a prime location for dengue outbreaks, and this study confirmed China as a potential site of future outbreaks.
Jul 30 Emerg Infect Dis study