1. RIFT VALLEY FEVER INFECTIOUS DISEASES

2. Patient no 1 24yr farm labourer from Edenburg Presented with upper GIT bleeding to surgery on 10/3/2010 4/7 days prior to presentation, he slaughtered and ate the meat of a dead sheep. PCR (+), IgM (+)

3. 10/3/201011/3/201012/3/201013/3/201014/3/2010 AST474231954508> 10 0008791 ALT29912269233437012378 HB14.312108.68.8 PL12125939 PT (s)1663> 12056 PTT (s)492235 UREA59 1345.128.9 CREATININE14211481152514801075

4. He was admitted to High Care and managed supportively with blood products and dialysis. His condition deteriorated and he was admitted to Multi, where he passed away on 15/3/2010.

5. Patient no 2 76 yr male from Bainsvlei Farmed with rabbits Presented to Trauma with racoon eyes, found to be secondary to a bleeding tendency

6. Renal failure, deranged liver enzymes as well as thrombocytopenia He died 2 days after admission to Multi @ Pelonomi.

7. Patient no 3 55yr male, farming near Bloemfontein Presented to Cardiology with rapid AF, cardiac failure and headache No clear history of contact with carcasses or infected livestock

8. Serology 1. - initial PCR weak positive for RVF - cultures positive 2. West Nile virus: titre 680 Multi-organ failure

9. Patient no 4 44yr old farmer from Koffiefontein He handled the carcasses of sheep, with confirmed rift valley fever Presented to Pelonomi with headache, neck stiffness and GIT bleeding

10. 13/4/201014/4/201015/4/201016/4/2010 AST8192267218932063 ALT3395146411611149 HB14.511.29.08.4 PL781913 PT201415 PTT49403736 UREA2736.54044.6 CREATININE286524534563

11. PCR (+), IgM (+) Died after massive GIT bleeding

12. Patient no 5 18 yr old male from Bainsvlei No contact with any livestock Presented with bloody diarrhoea and heamatemesis Serology confirmed RVF

13. Deranged liver enzymes and thrombocytopenia Discharged Seen yesterday @ COE with no residual complications

14. Patient no 6 46 yr old male from Soutpan He works at the salt works Had no contact with livestock Elevated AST and ALT, but improved D/C

15. Patient no 7 49yr old male from Soutpan – lives in town He had no contact with animals ? ? He ate meat at a funeral Presented to ENT with an uvula mass, with excessive haemorrhage post biopsy Recovered and d/c

16. Patient no 8 33yr old abattoir worker from Philipolis Presented with bleeding haemorrhoids, with preceding headache and fever 3/52 earlier. Serology confirmed RVF Liver functions, clotting profile and platelets were normal D/C

17. Patient no 9 40yr hunter, culls springbok throughout the Free State Had confirmed RVF 1/12 ago Presented with unrelated complaints, but did have visual disturbances Biochemically no abnormalities

18. 9 patients: 4 had a clear history of contact with infected meat / carcasses - 2 of whom died 5 had no contact with meat = mosquito bites - 1 of whom died

19. RIFT VALLEY FEVER Family: Bunyaviridae Genus: Phlebovirus

20. Distribution

21. Zoonosis Epizoonosis

22. Excessive rainfall and flooding Cycles of 10-15yrs 1993 Aswan dam in Egypt 1987 Diama dam in Mauritania

23. VECTOR AEDES MCINTOSHI

26. Culex, Plebotomus

27. Culex, Plebotomus

28. Clinical picture Incubation period 2-5 days Flue-like picture: Febrile-myalgic syndrome Hepatitis / liver necrosis Haemorrhagic (1%) --- 50% mortality Renal failure

29. Clinical picture Meningo- encephalitis Retinopathy – 3/52 - up to 10% - macular oedema - retinitis - infarctions blindness

32. Diagnosis History PCR Antibodies

33. Diagnosis History PCR Antibodies EXCLUDE Crimean Congo Fever

34. Treatment No specific treatment Supportive Isolate haemorrhagic cases until CCHF excluded Standard infection control measures Confirmed cases need not be isolated

35. Prevention Avoid high risk slaughtering practises Avoid consumption of fresh blood, raw milk or fresh meat Slaughtering of animals should be discouraged during outbreaks Personal protection against mosquito bites

36. Personal protection DEET containing insect repellents

37. Vaccines Live and attenuated Formalin inactivated vaccine – not registered in SA

38. In short… Preventative measures Exclude CCHF in endemic areas High index of suspicion for complicated cases

39. Bibliography Harrison’s Principles of Internal Medicine, 17 th edition Mandell, Douglas and Bennet’s Principles and Practice of Infectious Diseases, 5 th edition Uptodate Google images www.nicd.ac.za/outbreaks/rvf/rvf_outbreak. htm

40. Acknowledgements Dr D. Steyn Dr van Vuuren Dr N. Rossouw Dr. Elliot Dr D. Greyling Dr JL. Pretorius Dr G. Harris Dr D. Aucamp Dr K. Behrens Dr S. Moholo Dr P. Sonnekus Dr D. v Jaarsveld Dr R. Swart Mr G. Carter Dr Gouws Lucille Bloomberg (NICD) NHLS