Sorcery, village conflict and an outbreak of febrile illness; an investigation on Siassi Island - Morobe Province, Papua New Guinea, June 2017

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Background:
On June 9, 2017, we received notification of a sudden increase in febrile illness cases, including three deaths, from two villages in Morobe Province. Belief that the outbreak was caused by sorcery led to violent conflict between the affected villages. We conducted an outbreak investigation in order to verify the outbreak, determine its aetiology and dispel supernatural beliefs to minimize civil unrest.

Methods:
A house-to-house survey of all homes in the two villages was conducted for active case finding. Cases were defined as ‘any resident of Marile or Yaga village with an onset of self-reported fever from Apr 30, 2017 to June 24, 2017’. Serum was obtained for malaria and dengue rapid tests and further testing at a referral laboratory. Water specimens from village wells were obtained for contaminant testing. Medical records of hospitalized patients were reviewed. Demographic and clinical data were analyzed. Village meetings were held to update residents of both villages on the investigation’s progress.

Results:
A total of 98 cases from the two villages (attack rate 18%) met the case definition. Age of cases ranged from 2.5 months to 62 years (median 11 years); 57% were male. Three deaths (3%) occurred, all boys aged 8 years. Nine of forty (23%) sera tested positive for Malaria and two of nineteen (11%) for Dengue. Water specimens were negative for E. coli and Salmonella. Eighteen blood specimens that were sent to a referral laboratory were all negative for Zika and chikungunya. Two village meetings assisted in bringing a peaceful resolution to the armed conflict.

Conclusion:
An outbreak of an unknown febrile illness/illnesses occurred in these two villages. Given endemic dengue and malaria, aetiology was not determined. Despite that, the investigation alleviated fears and helped bring peace to the villages. Mosquito nets were distributed. Enhanced febrile illness surveillance initiated post-investigation showed no recurrent outbreaks.

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