Rift Valley Fever widely distributed in Kenya and Somalia
Rift Valley Fever (RVF) is widely distributed in Kenya and Somalia, primarily in animals but also in humans, World Health Organization (WHO) officials investigating the disease outbreak in the two countries say. The estimated number of deaths in Kenya is now 350-400. These deaths are concentrated in Kenya's Northeastern Province and in southern Somalia, where after a critical review of the data from Somalia, a revised count indicates that 80 deaths are suspected to be due to haemorrhagic fever.
RVF is widely distributed throughout Kenya and Somalia, a pattern expected as virus-infected eggs of floodwater breeding mosquitoes hatch from many endemic sites. With the heavy rainfall in East Africa during November, December and January, emergence of RVF can be expected from areas that have had infections in previous years. Health and veterinary officials in neighbouring countries affected by the heavy rains have been alerted to increase their vigilance for reports of disease.
A Task Force consisting of representatives from the Kenyan ministries of health and agriculture, international organizations and nongovernmental organizations involved in fighting the outbreak has been established. WHO, secretariat of the Task Force, has implemented a surveillance system for haemorrhagic fevers in Kenya and Somalia. Specimens from both humans and animals are being collected and referred to the African Medical Research Foundation (AMREF) and the Kenya Medical Research Institute (KEMRI) in Nairobi for testing.
In addition, the secretariat is regularly receiving reports about suspected cases. A Rumour List containing this information has been established and is the basis for follow-up investigation. Response teams comprising health and veterinary staff have been organized and are travelling to sites where cases are reported.
Representatives from the Kenyan Ministries of Health and Agriculture, the WHO offices in Geneva, Kenya and Somalia, the Food and Agriculture Organization, the World Food Programme, the International Federation of Red Cross and Red Crescent Societies, Medecins Sans Frontiers coordinator for nongovernmental organizations in Somalia have attended meetings of the Coordinating Group of the Task Force. Reports were presented by team members, including Ministry of Health officials, who had recently travelled to affected areas, including Garissa in the Northeastern Province. The vast majority of the deaths are in this remote province and in Southern Somalia.
Epidemiologic analysis of the available information indicates that while RVF infections are occurring in the inhabitants in these areas and may be responsible for some cases of haemorrhagic fever, RVF is not the only cause of disease that is being observed in this outbreak. The Coordinating Group recognizes the need for comprehensive and well-designed studies and will request technical assistance and materials from international institutions. This will occur immediately.
Prompt investigation of active cases is required to determine the other causes of disease in this complex outbreak. Lack of the appropriate air transport needed to gain access to remote or flooded areas has been the single greatest impediment to the investigation. An appeal for helicopter transport is being made to other agencies.
Recommendations for the prevention of RVF, avoidance of insect bites and contact with sick livestock are still in effect. WHO recommends that travellers do not cancel their journeys to Kenya but they should be aware that Rift Valley fever is transmitted by mosquitoes. If they travel to areas near where outbreaks have been reported, they should take appropriate anti-insect measures. These include wearing long-sleeved shirts and long trousers and using mosquito repellant and bednets. Barrier nursing precautions are advised when caring for patients who are bleeding. More specific recommendations will be issued after the causes of other diseases involved in the epidemic are known.
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