1. Outbreak of Unknown Diseases in Cafunfo District, Angola 2012 Pedro Lusukamu, C. Teixeira, A. Kapapelo, L. Miguel, C. Sicato, A. Makaia, R. Moreira

2. Introduction Febrile illness: - A public health challenge - Health care systems with clinical diagnosis - Common practice due to scarcity of laboratory diagnostic facilities August 2012 : National Public Health Directorate alerted on a strange disease in Cafunfo district which had resulted in 89 deaths among children

3. Objectives Broad To investigate the outbreak of an unknow disease in Cafunfo during November - 2012 Specifics To describe the outbreak in person, time and place To identify the possible agent causing the disease To identify risk factors associated with the disease

4. Methods Study Design: Unmatched 1:1case – control study Study Settings District Hospital, Cafunfo Case : Any patient who had presented to the health facility with an onset of one the following symptoms:  intermittent fever, headache, shivering and abdominal pains during the outbreak period Control: neighbour to the case who did not suffer from the disease during the past one month

5. Methods Sample size - 125 cases and 125 controls Sampling Methods  Cases were systematically selected from the line list used in the hospital  Controls conveniently selected from neighbourhood of the case  Data Analises Epi Info 7.1.1.0  Frequencies  Univariate  Multivariate

6. Results

7. Environmental Assessment High of mosquitos density (larvae and adults) Anopheles gambiae s.s and funestus Breakdown of malaria vector control measures since May 2012 LLINs coverage < 5%

8. Hospital Assessment High number of Febril Illness cases: 7108/last month High blood transfusion 15/ day Lack of skilled staff at hospital and Health Centers Lab results: 54 positive P. falciparum All other tests negative.

9. Demographic Characteristic of Study Subjects VariableCases n= 125 (%)Controls n=125 (%) Sex : Male: Female : 71 (56.8) 54 (43.2) 45 (36) 80 (64) Age group: < 5 5 - 10 11- 16 17 - 22 23 - 28 29 - 34 35 - 40 41 - 46 +46 77 (61.5) 20 (16) 2 (1.6) 8 (6.5) 6 (4.8) 3 (2.4) 1 (0.8) 2 (1.6) 43 (34.4) 22 (17.6) 7 (5.6) 12 (9.6) 9 (7.2) 15 (12) 2 (1.6) 6 ( 4.8) 9 (7.2) Education Level: None Primmary Secondary 81 (65.3) 39 (31.5) 4 (3.2) 61 (48.8) 55 (44) 9 (7.2) Occupation: Self employed Student Civil Servents 113 (90.4) 10 (8) 2 (1.6) 102 (93.4) 3 (2.8) 4 (3.8)

10. Epi Curve Cafunfo, 2012 at the end of outbreak 17.770 cases, 197 deaths ( CFR 1.1%)

11. VariableUnivariate OR 95% CI Multivariate OR 95% CI No use of repelent1.4 0.5 – 3.9 Vegetation around house3.9 2.3 – 4.12.6 2.7 – 4.2 Living in area not sprayed in past six months 4.2 5.4 – 7.82.8 1.5 – 4.2 Living in an house not sprayed in the past year 4.9 2.1 - 5.73.9 2.1 – 5.7 Sleeping under LLINs in the last 24hrs 0.3 0.2– 0.80.7 0.4 – 0.9 Risk Factors

12. Discussion The causing agent was Plasmodium falciparum Children 0-5 years of age were the most affected Breakdown of malaria control activities in the study area were the main risk factor for contracting malaria. (Puran KS 2005), (A. Woyessa 2011) More than ¼ of cases the diagnostic was not clarified. There was need for further diagnosis methods.

13. Acknowledgement MOH Army Health Service Provincial Government of Lunda Norte Local Administration Distrital Hospital team of Cafunfo Community leaders Other stakeholders

14. Thank You

15. Clinical sample testedTotal tested Positive Plasmodium falciparum54 HBsAG 545 Measles 541 Rubella 540 Dengue 540 Yellow Fever540 Chikungunya540 Outbreak Laboratory investigations on possible causes of the

16. Threshold Graph for Cafunfo area, 2009 to 2012

17. Outbreak Response  Prompt and appropriate treatment  On the job training  LLINS mass distribution  Larval control (Bactivec e Grieselesf)  Indoor and outdoor spraying  Sanitation  IEC activities