Volume 98, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We report epidemiological and clinical aspects of an outbreak of louse-borne relapsing fever (LBRF) in Asella in Arsi Zone, central Ethiopia, from July to November 2016. A total of 63 LBRF cases were reported. The overall case fatality rate was 13% among treated patients. In this article, the first-line epidemiological assessment, individual prevention and control measures, and public health investigations and interventions in relation to this outbreak are described. Treatment recommendations for resource-limited settings are discussed by review of the latest literature.


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  1. von Both U, Alberer M, , 2016. Borrelia recurrentis infection. N Engl J Med 375: e5. [Google Scholar]
  2. ECDC, 2015. Louse-Borne Relapsing Fever in the EU. Rapid Risk Assessment. Stockholm, Sweden: European Centre for Disease Prevention and Control.
  3. Fauci ASBE, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, , 2008. Harrison’s Principles of Internal Medicine. New York, NY: McGraw-Hill Professional.
  4. Seboxa T, Rahlenbeck SI, , 1995. Treatment of louse-borne relapsing fever with low dose penicillin or tetracycline: a clinical trial. Scand J Infect Dis 27: 2931. [Google Scholar]
  5. EFMHACA, 2014. Standard Treatment Guidelines For General Hospital. Addis Ababa, Ethiopia: Food, Medicine and Healthcare Administration and Control Authority of Ethiopia, 681.
  6. Raoult D, Roux V, , 1999. The body louse as a vector of reemerging human diseases. Clin Infect Dis 29: 888911. [Google Scholar]
  7. Cutler SJ, Abdissa A, Trape JF, , 2009. New concepts for the old challenge of African relapsing fever borreliosis. Clin Microbiol Infect 15: 400406. [Google Scholar]
  8. Yimer M, Mulu W, Ayalew W, Abera B, , 2014. Louse-borne relapsing fever profile at Felegehiwot referral hospital, Bahir Dar city, Ethiopia: a retrospective study. BMC Res Notes 7: 250. [Google Scholar]
  9. Cutler SJ, , 2010. Relapsing fever-a forgotten disease revealed. J Appl Microbiol 108: 11151122. [Google Scholar]
  10. Borgnolo G, Hailu B, Chiabrera F, , 1991. Louse-borne relapsing fever in Ethiopia. Lancet 338: 827. [Google Scholar]
  11. Tizazu G, Anteneh T, , 2006. Relapsing Fever. Addis Abeba, Ethiopia: Carter Center, Ethiopian Ministry of Health, Ethiopian Ministry of Education.
  12. WHO, 2016. Ethiopia–Health Profile. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/countries/eth/coop_strategy/en/. Accessed 2016.
  13. Animut A, Mekonnen Y, Shimelis D, Ephraim E, , 2009. Febrile illnesses of different etiology among outpatients in four health centers in northwestern Ethiopia. Jpn J Infect Dis 62: 107110. [Google Scholar]
  14. Zein ZA, , 1987. Louse borne relapsing fever (LBRF): mortality and frequency of Jarisch-Herxheimer reaction. J R Soc Health 107: 146147. [Google Scholar]
  15. Perine PL, Teklu B, , 1983. Antibiotic treatment of louse-borne relapsing fever in Ethiopia: a report of 377 cases. Am J Trop Med Hyg 32: 10961100. [Google Scholar]
  16. Borgnolo G, Hailu B, Ciancarelli A, Almaviva M, Woldemariam T, , 1993. Louse-borne relapsing fever. A clinical and an epidemiological study of 389 patients in Asella Hospital, Ethiopia. Trop Geogr Med 45: 6669. [Google Scholar]
  17. Ramos JM, Malmierca E, Reyes F, Tesfamariam A, , 2008. Results of a 10-year survey of louse-borne relapsing fever in southern Ethiopia: a decline in endemicity. Ann Trop Med Parasitol 102: 467469. [Google Scholar]
  18. Guerrier G, Doherty T, , 2011. Comparison of antibiotic regimens for treating louse-borne relapsing fever: a meta-analysis. Trans R Soc Trop Med Hyg 105: 483490. [Google Scholar]
  19. Salih SY, Mustafa D, , 1977. Louse-borne relapsing fever: II. Combined penicillin and tetracycline therapy in 160 Sudanese patients. Trans R Soc Trop Med Hyg 71: 4951. [Google Scholar]
  20. Garedew-Kifelew L, Wondafrash N, Feleke A, , 2014. Identification of drug-resistant Salmonella from food handlers at the University of Gondar, Ethiopia. BMC Res Notes 7: 545. [Google Scholar]
  21. WHO, 2016. Analytical Summary–Health Financing System. Geneva, Switzerland: World Health Organization.
  22. Yimer M, Abera B, Mulu W, Bezabih B, Mohammed J, , 2014. Prevalence and risk factors of louse-borne relapsing fever in high risk populations in Bahir Dar city northwest, Ethiopia. BMC Res Notes 7: 615. [Google Scholar]
  23. Antinori S, Mediannikov O, Corbellino M, Raoult D, , 2016. Louse-borne relapsing fever among east African refugees in Europe. Travel Med Infect Dis 14: 110114. [Google Scholar]

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  • Received : 15 Jun 2017
  • Accepted : 24 Feb 2018
  • Published online : 23 Apr 2018

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