RVF outbreak in SA, Feb - May 2010

JOINT BRIEFING BY: DEPARTMENT OF AGRICULTURE, FORESTRY AND FISHERIES (DAFF) AND

DEPARTMENT OF HEALTH

Outline

Introduction RVF in South Africa Current outbreak National Response Provincial Response Challenges Recommendations

INTRODUCTION

RVF- Viral zoonosis that can cause severe disease in low proportion of infected humans

Virus transmitted by mosquitoes and causes outbreak of abortion and death of young livestock (sheep, goats, and cattle)

Humans infected from contact with infected animals

Disease occurs in Africa and Middle East Asia where exceptionally heavy rains favour breeding of mosquitoes vectors

RVF IN SOUTH AFRICA (i)

RVF was first reported in SA - 1950-1951 (100 000 died, 500 000 aborted) Last major outbreak of RVF in SA -1974-1976

caused 10,000 to 20 000 human cases Virus thought to be endemic in low lying coastal

areas of KZN (small outbreak in dairy herd in Empangeni 1981) and Kruger National Park

Small outbreak occurred (abortions in captive bred buffaloes) in Skukuza, 1999

RVF IN SOUTH AFRICA (ii)

Fourteen Small outbreaks of RVF occurred in animals MP, LP, GP and NW in 2008

RVF outbreak occurred on farms along Orange River, Northern Cape; two confirmed human cases November- December 2009

CURRENT OUTBREAK 12 Feb.2010, RVF confirmed on 2 sheep farms in Bulfontein

area, Free State

RVF outbreak confirmed in humans 24 Feb 2010 by Outbreak Response Unit, NICD

First confirmed Case; Vet surgeon based in Bloemfontein, has a farm in Winburg, does field visits to farmers in Free State did postmortem on dead lambs (specimen confirm RVF) at a farm 30km from Brandfort, Bulfontein

By 30 April:- farms with confirmed animal cases were reported in 7 provinces (except KZN, LP).- > 9000 animal cases with over 5000 deaths

CASE DEFINITION/ CRITERIA FOR LAB TESTING

Any person with recent close contact with livestock in or from suspected RVF areas, presenting with:

Flu-like illness (may include fever, muscle ache, or headache) or

Fever and features of encephalitis, haemorrhage, hepatitis disease and/or occular pathology

Areas with human cases (i) (as of 11 May 2010)

Province Cases DeathsFree State 108 9Eastern Cape 13 0Northern Cape 58 8North West 3 0Western Cape 3 1Unknown 1 0Total 186 19

Over 1200 samples tested to date(11 new cases reported last week)

Geographic spread of cases

Distribution of cases by District in Free State, 2010 (N = 103 with 18 missing information)

10

50

16

9

00

10

20

30

40

50

60

Fezile Dabi Lejweleputswa Xhariep Motheo Tabomofutsa

District

Fre

qu

ency

(N

)

Distribution of Cases in NC

Distribution of confirmed Rift Valley Fever cases and deaths in the Northern Cape, 2010

1 2

8

27

38

0 1 2 14

0

5

10

15

20

25

30

35

40

Siyanda Namakwa Frances Baard Pixley-ka-Seme Total

District

Freq

uenc

y

Epidemic curve of lab confirmed RVF cases by date of onset, 6 May 2010

Number of lab confirmed RVF cases by occupation, SA 3 May 2010

Case management

Most cases are mild, managed on outpatient basis (84%); 30 in-patients

Distribution of symptoms: majority presented with fever, muscle pains and headache

Manifestation of RVF disease in fatal cases (N=15)

Response by DoH Multisectoral National Outbreak Response (MNORT)

team meets regularly – coordination of response Support visits to provinces Regular press releases, media interviews and

situation reports being prepared. All the Provincial Communicable Diseases Co-

ordinators have been alerted, EPR guidelines and Health workers guidelines for management of RVF disseminated;

WHO providing additional technical support. Follow up visit by MNORT to Free State and

Northern Cape

Actions by Provincial DoH

Outbreak investigations by PDoH and DoA on-going supported by SA-FELTP and NICD

Alert and guidelines on RVF have been sent to all districts

Investigation of suspects Health promotion and Media briefing

Key issues addressed

Strengthened notification of human cases and maintained regular reporting at all levels

Provincial Outbreak Response Teams implemented comprehensive action plans;

Need to strengthen Health promotion

CHALLENGES Implementation of the communication strategy on

prevention and control of RVF (e.g behavior change)

Voluntary vaccination of livestock No vaccine available for humans Early detection of the disease:

- Most infections in humans asymptomatic- Most people experience flu like illnesses (acute on set of fever, headache, myalgia and photophobia)

No specific treatment Rapid spread of infection due to environmental

circumstances

Recommendations

Implementation of PoA and strengthen coordination of response at all levels

Additional resources needed to support the provinces Application was made for additional funding

Strengthen health promotion and communication campaign in provinces

Thank you.