Journal Article

Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study

Hewson, Roger, Slack, Gillian S., Taha, Rihab, Bower, Hilary, Carter, Daniel, Fletcher, Tom E., Atkinson, Barry, Furneaux, Jenna, Bausch, Daniel G., Osborne, Jane, El Karsany, Mubarak, Gannon, Benedict, Whitworth, Jimmy, Brooks, Tim, Mohamed, Rehab, Eldegail, Mawahib, Mahmoud, Iman, Beeching, Nicholas J., Alzain, Mazza, Graham, Victoria, Osman, Abdalla, Mohamednour, Salim, Mellors, Jack, Pullan, Steven T., Semper, Amanda, Dowall, Stuart

2019

Overview

Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown. We report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays. CCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Aetiology / Archives & records / Arthralgia / Bleeding / Care and treatment / Child / Child, Preschool / Cohort analysis / Cohort Studies / Cohorts / Communicable diseases / Control / Crimean hemorrhagic fever / Detection / Diagnostic systems / Disease Outbreaks / DNA / Ebola virus / Epidemics / Epidemiology / Female / Fever / Fever - diagnosis / Fever - epidemiology / Fever - virology / Gram-negative bacteria / Haemorrhage / Headache / Hemorrhage / Hemorrhagic Fever, Crimean - diagnosis / Hemorrhagic Fever, Crimean - epidemiology / Hemorrhagic Fever, Crimean - virology / Hemorrhagic fevers / Human diseases / Humans / Hygiene / Illnesses / Infection / Infections / Infectious diseases / Laboratories / Low income areas / Malaria / Male / Medical personnel / Medical research / Medicine / Medicine and Health Sciences / Novels / Nucleotide sequence / Occupational health / Outbreaks / Pathogenic microorganisms / Pathogens / PCR / People and Places / Polymerase chain reaction / Prevention / Public health / Real-Time Polymerase Chain Reaction / Retrospective Studies / Reverse transcription / Risk factors / Samples / Security / Sudan - epidemiology / Transcription / Transmission / Tropical diseases / Vector-borne diseases / Viral diseases / Virology / Viruses / Workers / World health / Young Adult