VC2C VC WASH Cluster – Emergency Training 1 Vector control Module 2C Diseases from rodent vectors

VC2C VC WASH Cluster – Emergency Training 2 Rat morphology & diseases Lassa fever Flea borne Typhus Leptospirosis

VC2C VC WASH Cluster – Emergency Training 3 Known Distribution of the Lassa rat - Mastomys MASTOMYS DISTRIBUTION MASTOMYS DISTRIBUTION LASSA discovered in 1969

VC2C VC WASH Cluster – Emergency Training 4 Lassa Fever Viral haemorrhagic fever 300, ,000 infections/year, with 5000 deaths Rodent-to-human transmission (Mastomys species-complex) Secondary human-to-human transmission Nosocomial outbreaks with high case-fatality

VC2C VC WASH Cluster – Emergency Training 5 Viral hemorrhagic fevers share the following characteristics –They are all RNA viruses –They are all zoonotic (natural reservoir is an arthropod or other animal host) –Disease is restricted to habitat of the host –Humans become infected by contact with host –Some viruses can be transmitted from human to human

VC2C VC WASH Cluster – Emergency Training 6 Marburg Marburg Virus –Transmission from animal host (unknown/rodent possible) –Human to Human (Close Contact and change of fluids highly suspect source of transmission)

VC2C VC WASH Cluster – Emergency Training 7 Marburg Outbreaks 1967 Hamburg and Marburg, Germany and Belgrade, Yugoslavia 1975 Johannesburg, South Africa, 3 died 1980 Western Kenya, 2 Died (Physician died in Nairobi) 1987 Young man traveling extensively in Kenya Durba, Republic of Congo –Cases linked to workers in a gold mine

VC2C VC WASH Cluster – Emergency Training 8 Signs and Symptoms - Marburg 3 to 9 day incubation period Sudden onset of back pain, sore throat, muscle pain, headache, and nausea Skin rash (papular or maculopapular), fever, low platelets, gastrointestinal bleeding Rapid progression to jaundice; increased bleeding abnormalities Death (3-9 days) from encephalitis, fulminant hepatitis, pulmonary and gastrointestinal hemorrhage

VC2C VC WASH Cluster – Emergency Training 9 Mastomys species complex Taxonomy still unclear M. huberti: more common in peridomestic habitat M. erytholeucus: more common in brush habitat Others Rodent Reservoir

VC2C VC WASH Cluster – Emergency Training 10 Rodent-to-human: 1.Inhalation of aerosolized virus 2.Ingestion of food or materials contaminated by infected rodent urine / excreta 3.Catching and preparing Mastomys as a food source 4.Handling dead rats that have urine/virus on them Transmission

VC2C VC WASH Cluster – Emergency Training 11 Human-to-human: 1.Direct contact with blood, tissues, secretions or excretions of infected humans 2.Needle stick or cut 3.Inhalation of aerosolized virus

VC2C VC WASH Cluster – Emergency Training 12 Current Therapy for Lassa & Marburgh Supportive therapy with oxygen, nutritional support, and hydration. Hemorrhage is managed by replacement of blood, platelets, and clotting factors Ribavirin is a synthetic nucleoside analog that is of use in treating Lassa fever but not useful for Marburgh. Passive transfer of human antibodies has remained inconclusive in its benefit to Marburg.

VC2C VC WASH Cluster – Emergency Training 13 1.Village based programmes for rodent control and avoidance 2.Active case detection and reporting 3.Hospital training programmes to avoid nosocomial spread: barrier nursing 4.Early diagnosis 5.Early antiviral therapy Prevention and Control

VC2C VC WASH Cluster – Emergency Training 14 1.Proper storage of food in rodent proof containers 2.Cleaning around house 3.Repairing holes in wall and doors to block rat entry into house 4.Trapping and killing rodents with proper and safe disposal of carcasses 5.Avoid rodents as a food source Rodent Control

VC2C VC WASH Cluster – Emergency Training 15 Protection for Culture (P4) Protection for Clinical Care – Ideally Respirator Lassa / Marburg Prevention and Control