Re-emergence of Yellow Fever-South Ethiopia, 2018

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Background: Yellow Fever (YF) is a viral hemorrhagic disease transmitted by Aedes mosquito species, with prior Ethiopian outbreaks in 1966 and 2013 in Southern Nations, Nationalities, and Peoples Regional State (SNNPRS). The index case developed illness on 21 August 2018 and presented with jaundice and bleeding was reported from Offa District on September 29th, 2018. There was little information about the factors. Thus, we aimed to describe the outbreak, identify associated factor.
Methods: We conducted unmatched case control study (ratio 1:2) between August 21 and October 16, 2018 in Offa district, SNNPRS. Cases were patients had fever and jaundice and /or YF specific IgM antibody or polymerase chain reaction (PCR) or plaque reduction neutralization test (PRNT) positive; Controls were asymptomatic individuals selected randomly from the house hold or neighbor during outbreak period. Data were collected reviewing medical record, laboratory findings, and field visits. We also measured the mosquito larva density using Breteau Index (BI). We summarized the data by Attack rate and AOR.
Results: We identified 5 lab-confirmed and 30 suspected YF cases; ten deaths (28.6%). Males (attack rate [AR] =5.4/10,000) and females (AR=5.6/10,000) were similarly-affected, highest in Kodo village (AR=44.5/10,000). BI in the district were highest ranged from 40-109 (safe level <20). The odds of disease among people with presence of breeding sites around households were five times higher [aOR4.5; (95% CI: 1.5-13)], proximity of households and farm lands to jungle were 10 times higher [aOR10; (95%CI: 1.4-76)], and 54% lower (aOR=0.46; 95% CI: 0.004-0.52) among those sleeping under long-lasting bed net.
Conclusions: We concluded, the outbreak was contributed by 4-week reporting delay and the second after 50 years. It was controlled with reactive YF vaccination, larviciding, indoor residual spray and distribution of mosquito nets. We recommended regular vector surveillance and inclusion of preventive vaccination within routine immunization schedule.

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