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Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March–July 2005

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  • Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology and Laboratory Training Program, Kenya; United States Naval Medical Research Unit-3, Cairo, Egypt; Disease Detection and Surveillance Response Unit, Kenya Ministry of Public Health and Sanitation, Kenya; International Emerging Infections Program – Kenya, Centers for Disease Control and Prevention; Garissa District Ministry of Health, Kenya
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An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.

Author Notes

*Address correspondence to Mary D. Ari, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS D50, Atlanta, GA 30333. E-mail: mari@cdc.gov

Financial support: This outbreak investigation was supported by core funding of the Kenya Ministry of Health, the International Emerging Infections Program, CDC, and the U.S. Naval Medical Research Unit-3, Egypt.

Authors' addresses: Mary D. Ari, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: mari@cdc.gov. Argata Guracha, WHO Garissa Field Office, Garissa, Kenya, E-mail: gurachaa@ke.afro.who.int. Moustafa Abdel Fadeel, U.S. Naval Medical Research Unit-3 (NAMRU-3), Cairo, Egypt, E-mail: Moustafa.Abdelfadeel.eg@med.navy.mil. Charles Njuguna and Rosalia Kalani, Kenya Ministry of Health, Nairobi, Kenya, E-mails: njugunack@yahoo.co.uk and rosaliakalani@yahoo.co.uk. M. Kariuki Njenga, Victor Omballa, and Robert F. Breiman, KEMRI/CDC, Nairobi, Kenya, E-mails: knjenga@ke.cdc.gov, VOmballa@ke.cdc.gov, and rbreiman@ke.cdc.gov. Hassan Abdi and Osman Warfu, Garissa Ministry of Health, Garissa, Kenya, E-mails: dsoeast@yahoo.com and owarfa@yahoo.com. Guillermo Pimentel, U.S. Naval Medical Research Center, Silver Spring, MD, E-mail: Guillermo.Pimentel@med.navy.mil. Daniel R. Feikin, KEMRI/CDC, Kisumu, Kenya, E-mail: Dfeikin@cdc.gov. Christopher Tetteh, Faculty of Public Health, College of Physicians and Surgeons, P.O. Box MB 429, Ministries–Accra, Ghana, E-mail: Ctettehc@msn.com.

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