Three cases of a suspected viral hemorrhagic fever, epidemiologically linked by time and place, were reported from Yirol East county, in the Eastern Lakes State, South Sudan, according to the National Ministry of Health. All three cases ended in death.
No etiology has been identified to date.
According to the World Health Organization (WHO), the following details of the cases are known:
The index case was a 30 year old pregnant female who became ill on 7 December 2017 with fever, headache, neck pain, and sudden nose, gum, and injection site bleeding. She was admitted to a health facility the same day and was transferred to a private clinic 8 days later after no improvement in symptoms. She was treated at the clinic for malaria and typhoid fever over 4 days and died at home on 19 December 2017 after her symptoms worsened.
The second case, a 13 year-old female from the same village as the first case, became ill on 20 December 2017 with headache, joint and neck pain, fever, generalized swelling of the joints, and bleeding from the nose and gums. She died at home on 26 December 2017 after developing bleeding from skin blisters.
The third case, a 15 year-old male from the same village as the first two cases, became ill on 24 December 2017 with headache, fever, sweating, neck pain, nose and gum bleeding, vomiting of blood, convulsions, and loss of consciousness. He died at home on 27 December 2017 after failing to respond to treatment at a private clinic.
There was no history of close physical contact between the cases and no cases had a notable travel history. No samples were collected from the cases and supervised burials were not performed. No symptoms were reported among the close contacts of the cases during the course of their clinical illnesses or since their deaths. Sixty contacts were identified and are being followed up by a surveillance team comprised of Ministry of Health and WHO staff.
The investigation found evidence of zoonotic hemorrhagic illness, including two abortions among goats and sheep, and eight goat deaths with evidence of extensive hemorrhage, and one ill cow. Deaths among wild birds were also reported during the time that the cluster of cases was detected.
National and state rapid response teams have been deployed to conduct epidemiological and laboratory investigations of the cases. This includes active case finding, sample collection and monitoring of contacts, and training of health workers in case identification, infection prevention and control, and provision of supportive care.
The Ministry of Health has engaged the Ministry of Animal Health Resources and the Food and Agriculture Organization of the United Nations (FAO) to work with the national taskforce in conducting animal health investigations and implementing containment measures. An outbreak response plan is being developed to guide the investigation and response activities, including the mobilization of stakeholders and resources to control the outbreak.
A multi-sectoral coordination mechanism is planned, including public health, animal heath, entomological, and laboratory surveillance, a risk communication and social mobilization strategy, and case management including infection prevention and control guidance.