During this week, 14 suspect cases of four priority diseases were reported by different health facilities:

8 suspected cases of Measles: 1 case respectively

by Musha HC (Gakoma DH), Kabilizi HC (Munini

DH), Nyamyumba HC (Munini DH) and Gataraga

HC (Nyanza DH) while 2 cases were respectively

notified by Kinazi HC (Ruhango DH) and Kigoma

HC (Ruhango DH).

2 suspected cases of Rabies: reported by Gitare

HC of Butaro DH (1 case) and Rango HC of

Kabutare DH (1 case).

1 suspected case of Meningococcal Meningitis:

was notified by Kivumu HC (Kabgayi DH)

4 Cases of AFP: one case was reported by each of

the following health facilities: Byumba DH, Save

HC (Gakoma DH), Nyagihamba HC (Remera

Rukoma DH) and Remera Rukoma DH

Deaths

3 deaths due to Non Bloody Diarrhea were

reported. Nyagatare DH, Ngarama DH and

Nyarubuye HC ( Kirehe DH) reported a death

each.

For this week, timeliness and completeness of

weekly epidemiological reports were

respectively 85% and 93%.

Masaka DH and Nemba DH dis=d not wubmit

their weekly reports. In addition, the following

health centers did not submit their weekly

reports: Kibungo HD: Remera HC, Rubona

(Ngoma ) HC; Nyamata DH: Nyamata HC ;

Kirehe DH: Nasho HC’; Gihundwe DH:

Cyangugu Prison ;Gahini DH: Ryamanyoni HC ;

Kiziguro DH: Gasenge Rugarama HC;

Nyagatare DH: Nyagatare HC ; Ruhengeri DH:

Ruhengeri HC, Gasiza HC, Busogo HC, Kabere

HC, Murandi HC, Nyakinama HC and Rwaza HC;

Byumba DH: Gisizi and Mulindi HC; Kirinda DH:

Munzanga HC; Kibogora DH: Mahembe and

Rangiro HC; Remera Rukoma DH: Kamonyi HC

Munini DH : Muganza HC ; Masaka DH:

Gahanga HC; Kibagabaga DH: Kayanga HC and

Kimironko Prison

Contact Person

Dr. Thierry NYATANYI

Tel: 0788301902

REPUBLIC OF RWANDA

MINISTRY OF HEALTH

Summary

Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control

Kigali - Rwanda,

Fax:0252503980,Tel:0252503979

RBC/IHDPC/ EID Division

B.P: 7162 KIGALI-RWANDA, Toll free No

: 3334-3335, e-mail: trac.simr@gmail.com

Week 1: from 31stDec.2012 to 6th January 2013

No epidemic has been reported or

detected during this week. However, we

have noted a clustering of suspected

measles cases in the Southern province.

A suspected case of measles refers to any

any person with fever and generalised

maculopapular rash (non vesicular)

accompanied by cough, coryza or

conjunctivitis (red eyes) while a confirmed

case is a suspected case with laboratory

confirmation (positive IgM antibody) or

epidemiological link to confirmed cases in

an outbreak. During the week of from 31

December 2012 to 6 January 2013, two

suspected cases of measles were reported

by Kinazi Health Center of Ruhango DH

in the South Province. The 2 cases are a

14 year old male and a 6 year old female

who consulted Kinazi health center on 3rd

January 2013 with generalized

maculopapular rash and fever. The two

cases received their measles vaccination in

accordance with the national

immunization schedule.

Another two cases were reported by

Kigoma HC from the same district and

same sector of Ruhango. The two cases

are respectively a 2 years old girl and 18

months old boy who consulted the health

center on 2nd January 2013. They have

received also measles vaccination.

The cases received treatment and are

doing well.

A clustering of suspected Measles cases in the Southern province

Blood samples have been taken and sent to

the National reference laboratory for

confirmation of the aetiology: results are

expected in the coming week.

During the same reporting period, another

five suspected cases of measles were

reported by five health centers located in

Southern Province; that is one case

respectively by Musha HC (Gakoma DH),

Kabilizi HC (Munini DH), Nyamyumba HC

(Munini DH) and Gataraga HC (Nyanza

DH).

Actions taken: Clinical management of

cases including blood sampling for

confirmation

Recommendations: Measles is a vaccine

preventable disease that is scheduled for

elimination in Rwanda. The clustering of

cases may be the early marker of an

outbreak. For this reason, it is essential that

appropriate measures be taken to identify

the potential threat in time and address the

risk factors. For this reason, the health

authorities of Ruhango DH are advised to:

Conduct an early investigation to find out if

the cases are linked and/or if there are other

unreported cases in the community; Review

immunization data to identify if there is any

gap in immunization coverage in the

affected sectors; and based on the findings

from the 2 actions:

Reinforce surveillance, early reporting and

follow up of all suspected cases; and

undertake measure to address the risk

factors including strengthening sensitization

on immunization.

Definition

Rabies is a zoonotic disease (a disease that is transmitted to

humans from animals) that is caused by a virus: the Lyssaviruses of the Rhabdoviridae family. The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches. Once symptoms of the disease develop, rabies is nearly always fatal.

Worldwide, Rabies occurs in more than 150 countries and

territories and kills more than 55 000 people every year, mostly in

Asia and Africa. 40% of people who are bitten by suspect rabid

animals are children under 15 years of age and dogs are the source

of the vast majority of human rabies deaths. Wound cleansing and

immunization within a few hours after contact with a suspect

rabid animal can prevent the onset of rabies and death.

Transmission

People are infected following a deep bite or scratch by an infected

animal. Dogs are the main host and transmitter of rabies. They are

the source of infection in all of the estimated 50 000 human rabies

deaths annually in Asia and Africa. Bats are the source of most

human rabies deaths in the United States of America and Canada

and more recently in Australia, Latin America and Western

Europe.

Transmission can also occur when infectious material – usually

saliva – comes into direct contact with human mucosa or fresh

skin wounds.

Human-to-human transmission by bite is theoretically possible but

has never been confirmed. Rarely, rabies may be contracted by

inhalation of virus-containing aerosol or via transplantation of an

infected organ. Ingestion of raw meat or other tissues from

animals infected with rabies is not a source of human infection

The incubation period for rabies is typically 1-3 months. This however could vary from 1 week to a year. Initial symptoms of rabies are usually non-specific and include fever and often pain or unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.

As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. Two forms of the disease can follow:

Furious rabies during which people infected by the virus exhibit signs of hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardio-respiratory arrest.

Paralytic rabies which accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease.

Clinical case definition:

A person presenting with an acute neurological syndrome

(encephalitis) dominated by forms of hyperactivity (furious

rabies) or paralytic syndromes (dumb rabies) progressing

towards coma and death, usually by respiratory failure, within 7-

10 days after the first symptom if no intensive care is instituted.

Laboratory confirmation One or more of the following:

Detection of rabies viral antigens by direct fluorescent antibody test (FAT) or by ELISA in clinical specimens, preferably brain tissue (collected post mortem).

Detection by FAT on skin biopsy (ante mortem).

FAT positive after inoculation of brain tissue, saliva or CSF in cell culture, or after intracerebral inoculation in mice or in suckling mice.

Detectable rabies-neutralizing antibody titre in the serum or the CSF of an unvaccinated person.

Detection of viral nucleic acids by PCR on tissue collected post mortem or intra vitam in a clinical specimen (brain tissue or skin, cornea, urine or saliva).

However, laboratory confirmation is not yet available in Rwanda and other developing countries; is not essential for treatment and diagnosis is mainly based on clinical presentation

Diagnosis No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Diagnosis depends on history of exposure.

Continue to page 3

Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control

Kigali - Rwanda,

Fax:0252503980,Tel:0252503979

DISEASE HIGHLIGTHS: Every week, a disease is highlighted in the weekly Epidemiological bulletin to sensitize and familiarize readers with the various diseases under surveillance. This week, Rabies is featured

Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva) using the fluorescent antibody test (FAT).

Treatment All cases of suspected exposure to rabies should be treated as soon as possible to prevent the onset of symptoms and death. Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate anti rabies vaccination.

Local treatment of the wound

Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important. Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

Post-exposure prophylaxis (PEP)

Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death. Post-exposure prophylaxis (PEP) consists of:

Local treatment of the wound, initiated as soon as possible after exposure;

A course of potent and effective rabies vaccine that meets WHO recommendations; and

Administration of rabies immunoglobulin in cases of single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks or exposures to bats.

Prevention

Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America and is also feasible in other countries including Rwanda.

Preventive immunization in people

Safe, effective vaccines can be used for pre-exposure immunization.

This is recommended for travelers spending a lot of time

outdoors, especially in rural areas, involved in activities such as

bicycling, camping, or hiking as well as for long-term travelers

and expatriates living in areas with a significant risk of exposure.

Pre-exposure immunization is also recommended for people in

certain high-risk occupations such as laboratory workers dealing

with live rabies virus and other lyssaviruses, and people involved

in any activities that might bring them professionally or

otherwise into direct contact with bats, carnivores, and other

mammals in rabies-affected areas

Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control

Kigali - Rwanda,

Fax:0252503980,Tel:0252503979

Rwanda Biomedical Centre/Institute of HIV/AIDS,Diseases Prevention & Control

Kigali - Rwanda,

Fax:0252503980,Tel:0252503979

Acknowledgement

To all staff working on Disease Surveillance from

health centers to district hospitals for their efforts and

commitment to avail data for elaboration of this

bulletin.

EDITORIAL BOARD

1.Dr.Thierry NYATANYI

2.Dr.José NYAMUSORE

3.Dr. Marie Aimée MUHIMPUNDU

4.Adeline KABEJA

5.Dr. Veronicah MUGISHA

6.Dr.André RUSANGANWA

7. Robert K. MUGABE

8.Emmanuel NSHIMIYIMANA

Uganda free of Marburg

The Ministry of Health on 3rd January 2013 ,declared Uganda

free of Marburg, two months after the disease broke out in

Kabale District.

At least 15 people died in the epidemic.

The declaration follows the full observation of 42 days of post-

outbreak surveillance as recommended by the World Health

Organization(WHO).

The haemorrhagic fever was confirmed in Kabale on October

19, 2012 before spreading to Mbarara, Ibanda, and Fort Portal.

The ministry says the last patient admitted to the Marburg

Virus Isolation Centre at Rushoroza Health Centre III in

Kabale was discharged on November 15.

There have not been any new cases or suspected cases of the

virus reported in the area.

However, the ministry has asked the public to remain vigilant

and report any suspected strange illness or death to the nearest

health facility.

The Ministry also advised health workers to take precautions

while handling and treating patients, especially those suffering

from highly infectious haemorrhagic fevers.

Abroad

ANNEX 1: SUMMARY OF CASES NOTIFIED, TIMELINESS AND COMPLETENESS DURING WEEK 01, 2013

Province District Hospital% of

Completeness

% of

Timeliness

Sum of

Blood

Diarrhea

Cases

Sum of

Non Blood

Diarrhea

Cases

Sum of

Cholera

Cases

Sum of

Meningitis

Cases

Sum of

Acute

Flaccid

Paralysis

Cases

Sum of

Measles

Cases

Sum of

Neo Natal

Tetanos

Cases

Sum of

E.Typhus

Cases

Sum of

Y.fever

Cases

Sum of

H.fever

Cases

Sum of

Pestis

Cases

Sum of

Rabies

Cases

Sum of

Confirmed

Malaria

CasesCas

Sum of

Pneumoni

a Cases

Sum of

Influenza

Like

Illiness

Cases

Sum of

Chickenpo

x Cases

Sum of

Rubella

Cases

Sum of

Food

Poisoning

Cases

Sum of

Diphteria

cases

Sum of

Pertuisis

cases

Sum of

Typhoid

Fever

cases

Sum of

Mumps

Cases

Sum of

viral

Conjunctiv

itis cases

Gahini HD 88 75 0 21 0 0 0 0 0 0 0 0 0 0 232 3 109 0 0 0 0 0 0 0 0

Kibungo HD 86 64 0 76 0 0 0 0 0 0 0 0 0 0 1183 16 820 0 0 0 0 0 0 0 0

Kirehe HD 93 71 0 113 0 0 0 0 0 0 0 0 0 0 2079 27 919 1 0 0 0 0 0 0 0

Kiziguro HD 83 83 0 31 0 0 0 0 0 0 0 0 0 0 205 2 320 0 0 0 0 0 0 0 0

Ngarama HD 100 100 0 65 0 0 0 0 0 0 0 0 0 0 217 11 461 0 0 0 0 0 0 0 0

Nyagatare HD 95 86 1 144 0 0 0 0 0 0 0 0 0 0 2670 40 673 0 0 0 0 0 0 0 0

Nyamata HD 94 94 0 81 0 0 0 0 0 0 0 0 0 0 1000 7 690 0 0 0 0 0 0 0 0

Rwamagana HD 100 100 0 94 0 0 0 0 0 0 0 0 0 0 1186 8 734 0 0 0 0 0 0 0 0

Rwinkwavu HD 100 100 9 60 0 0 0 0 0 0 0 0 0 0 532 28 222 1 0 0 0 0 0 0 0

Butaro HD 100 94 0 85 0 0 0 0 0 0 0 0 0 1 75 18 724 0 0 0 0 0 0 0 0

Byumba HD 86 77 0 95 0 0 1 0 0 0 0 0 0 0 83 16 636 0 0 0 0 0 0 0 0

Nemba HD 92 85 1 74 0 0 0 0 0 0 0 0 0 0 26 1 327 1 0 0 0 0 0 0 0

Ruhengeri HD 53 33 0 68 0 0 0 0 0 0 0 0 0 0 16 1 214 0 0 0 0 0 0 0 0

Ruli HD 100 100 3 43 0 0 0 0 0 0 0 0 0 0 23 0 98 0 0 0 0 0 0 0 0

Rutongo HD 100 100 0 73 0 0 0 0 0 0 0 0 0 0 173 18 377 0 0 0 0 0 0 0 0

Bushenge HD 100 75 0 72 0 0 0 0 0 0 0 0 0 0 65 11 221 0 0 0 0 0 0 0 0

Gihundwe HD 88 88 0 37 0 0 0 0 0 0 0 0 0 0 82 24 372 0 0 0 0 0 0 0 0

Gisenyi HD 100 92 0 141 0 0 0 0 0 0 0 0 0 0 16 2 724 0 0 0 0 0 0 0 0

Kabaya HD 100 0 0 15 0 0 0 0 0 0 0 0 0 0 28 20 42 0 0 0 0 0 0 0 0

Kibogora HD 85 85 0 100 0 0 0 0 0 0 0 0 0 0 102 2 283 0 0 0 0 0 0 0 0

Kibuye HD 100 90 0 60 0 0 0 0 0 0 0 0 0 0 21 6 207 0 0 0 0 0 0 0 0

Kirinda HD 86 71 0 8 0 0 0 0 0 0 0 0 0 0 18 0 21 0 0 0 0 0 0 0 0

Mibilizi HD 100 100 0 98 0 0 0 0 0 0 0 0 0 0 308 4 416 0 0 0 0 0 0 0 0

Mugonero HD 100 100 3 25 0 0 0 0 0 0 0 0 0 0 43 35 104 0 0 0 0 0 0 0 0

Muhororo HD 100 89 2 46 0 0 0 0 0 0 0 0 0 0 8 5 85 2 0 0 0 0 0 0 0

Murunda HD 100 100 10 93 0 0 0 0 0 0 0 0 0 0 16 58 288 0 0 0 0 0 0 0 0

Shyira HD 100 100 0 86 0 0 0 0 0 0 0 0 0 0 21 31 338 0 0 0 0 0 0 0 0

BUTARE CHU 100 0 0 8 0 0 0 0 0 0 0 0 0 0 15 4 11 1 0 0 0 0 0 0 0

Gakoma HD 100 100 0 28 0 0 1 1 0 0 0 0 0 0 321 0 90 0 0 0 0 0 0 0 0

Gitwe HD 100 100 0 24 0 0 0 0 0 0 0 0 0 0 31 12 95 0 0 0 0 0 0 0 0

Kabgayi HD 80 80 20 112 0 1 0 0 0 0 0 0 0 0 149 154 437 2 0 0 0 0 0 0 14

Kabutare HD 100 94 4 147 0 0 0 0 0 0 0 0 0 1 1276 33 503 0 0 0 0 0 0 0 0

Kaduha HD 100 89 0 23 0 0 0 0 0 0 0 0 0 0 38 41 59 0 0 0 0 0 0 0 0

Kibilizi HD 100 100 0 73 0 0 0 0 0 0 0 0 0 0 628 11 322 0 0 0 0 0 0 0 0

Kigeme HD 100 100 44 122 0 0 0 0 0 0 0 0 0 0 50 11 264 5 0 0 0 0 0 1 0

Munini HD 94 82 0 77 0 0 0 2 0 0 0 0 0 0 204 6 400 0 0 0 0 0 0 0 0

Nyanza HD 100 100 8 67 0 0 0 1 0 0 0 0 0 0 613 24 170 2 0 0 0 0 0 0 8

Remera Rukoma HD92 92 2 84 0 0 2 0 0 0 0 0 0 0 449 13 279 0 0 0 0 0 0 0 0

Ruhango HD 100 100 1 37 0 0 0 4 0 0 0 0 0 0 198 7 198 2 0 0 0 0 0 0 0

CHK/CHUK 100 100 0 12 0 0 0 0 0 0 0 0 0 0 3 1 3 0 0 0 0 0 0 0 0

Kibagabaga HD 83 72 0 123 0 0 0 0 0 0 0 0 0 0 648 16 981 0 0 0 0 0 0 0 0

Masaka HD 78 67 2 25 0 0 0 0 0 0 0 0 0 0 114 18 206 1 0 0 0 0 0 0 0

Muhima HD 100 90 2 114 0 0 0 0 0 0 0 0 0 0 94 3 595 1 0 0 0 0 0 0 0

93 85 112 2980 0 1 4 8 0 0 0 0 0 2 15259 748 15038 19 0 0 0 0 0 1 22

EAST

NORTH

WEST

SOUTH

KIGALI TOWN

TOTAL