A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012

Irenee Umulisa Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.

Search for other papers by Irenee Umulisa in
Current site
Google Scholar
PubMed Close
,
Jared Omolo CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Jared Omolo in
Current site
Google Scholar
PubMed Close
,
Katherine A. Muldoon University of British Columbia, Vancouver, Canada.
University of Ottawa, Ottawa, Canada.

Search for other papers by Katherine A. Muldoon in
Current site
Google Scholar
PubMed Close
,
Jeanine Condo School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.

Search for other papers by Jeanine Condo in
Current site
Google Scholar
PubMed Close
,
Francois Habiyaremye Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.

Search for other papers by Francois Habiyaremye in
Current site
Google Scholar
PubMed Close
,
Jean Marie Uwimana Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.

Search for other papers by Jean Marie Uwimana in
Current site
Google Scholar
PubMed Close
,
Marie Aimee Muhimpundu Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.

Search for other papers by Marie Aimee Muhimpundu in
Current site
Google Scholar
PubMed Close
,
Tura Galgalo CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Tura Galgalo in
Current site
Google Scholar
PubMed Close
,
Samuel Rwunganira Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.
Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.

Search for other papers by Samuel Rwunganira in
Current site
Google Scholar
PubMed Close
,
Anicet G. Dahourou CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Anicet G. Dahourou in
Current site
Google Scholar
PubMed Close
,
Eric Tongren Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Eric Tongren in
Current site
Google Scholar
PubMed Close
,
Jean Baptiste Koama Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Jean Baptiste Koama in
Current site
Google Scholar
PubMed Close
,
Jennifer McQuiston National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.

Search for other papers by Jennifer McQuiston in
Current site
Google Scholar
PubMed Close
,
Pratima L. Raghunathan Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Pratima L. Raghunathan in
Current site
Google Scholar
PubMed Close
,
Robert Massung National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.

Search for other papers by Robert Massung in
Current site
Google Scholar
PubMed Close
,
Wangeci Gatei Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Wangeci Gatei in
Current site
Google Scholar
PubMed Close
,
Kimberly Boer Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.

Search for other papers by Kimberly Boer in
Current site
Google Scholar
PubMed Close
,
Thierry Nyatanyi Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.

Search for other papers by Thierry Nyatanyi in
Current site
Google Scholar
PubMed Close
,
Edward J. Mills University of British Columbia, Vancouver, Canada.
University of Ottawa, Ottawa, Canada.
Stanford University, Stanford, California.

Search for other papers by Edward J. Mills in
Current site
Google Scholar
PubMed Close
, and
Agnes Binagwaho Ministry of Health Rwanda, Kigali, Rwanda.
Harvard Medical School, Boston, Massachusetts.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Search for other papers by Agnes Binagwaho in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.15-0643
Volume/Issue:
Volume 95: Issue 2
Page(s):
452–456
Restricted access
Get Permissions

In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1–5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6–9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0–11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10–0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.

Author Notes

* Address correspondence to Irenee Umulisa, Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, KK19 Avenue, Kigali, Rwanda. E-mail: umulisa5@gmail.com

Financial support: This article was supported by Cooperative Agreement No. 5U2GPS002048 from the U.S. President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

Authors' addresses: Irenee Umulisa, Francois Habiyaremye, and Jean Marie Uwimana, Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda, E-mails: umulisa5@gmail.com, hbfra2040@gmail.com, and uwimanajeanmarie@yahoo.fr. Jared Omolo, CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda, E-mail: jomolo@cdc.gov. Katherine A. Muldoon, Liu Institute for Global Studies, School of Population and Public Health, University of British Columbia, Vancouver, Canada and University of Ottawa, Ottawa, Canada, E-mail: katherine.muldoon@gmail.com. Jeannine Condo, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, E-mail: jcondo@nursph.org. Marie Aimee Muhimpundu and Thierry Nyatanyi, Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda, E-mails: mmuhimpundu@gmail.com and tiero2020@yahoo.com. Tura Galgalo, CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda and Kenya Field Epidemiology Program, Nairobi Kenya, E-mail: turaboru@gmail.com. Samuel Rwunganira, Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda and Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda, E-mail: samuel.rwunganira@gmail.com. Anicet G. Dahourou, CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda and Vermont Department of Health, Burlington, VT, E-mail: anicet.dahourou@state.vt.us. Eric Tongren, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda, E-mail: jjt9@cdc.gov. Jean Baptiste Koama, Pratima L. Raghunathan, and Kimberly Boer, Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Port au Prince, Haiti, E-mails: jkoama@cdc.gov, pgr4@cdc.gov, and wlk8@cdc.gov. Jennifer McQuiston and Robert Massung, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, E-mails: fzh7@cdc.gov and rfm2@cdc.gov. Wangeci Gatei, Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Port au Prince, Haiti and Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, E-mail: wgg3@cdc.gov. Edward J. Mills, University of British Columbia, Vancouver, Canada, University of Ottawa, Ottawa, Canada, and Stanford University, Stanford, California, E-mail: edward.mills@uottawa.ca. Agnes Binagwaho, Ministry of Health, Kigali, Rwanda, Harvard Medical School, Boston, Massachusetts, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, E-mail: dr.agnes.binagwaho@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2016
Received:
03 Sep 2015
|
Accepted:
05 May 2016
|
Published Online:
03 Aug 2016
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Tarasevich I, Rydkina E, Raoult D, 1998. Outbreak of epidemic typhus in Russia. Lancet 352: 1151.

  • 2.

    Brouqui P, Lascola B, Roux V, Raoult D, 1999. Chronic Bartonella quintana bacteremia in homeless patients. N Engl J Med 340: 184–189.

  • 3.

    Perine L, Krause D, Awoke S, McDade JE, 1974. Single dose doxycycline treatment of louse-borne relapsing fever and epidemic typhus. Lancet 2: 742–744.

  • 4.

    Raoult D, Ndihokubwayo JB, Tissot-Dupont H, Roux V, Faugere B, Abegbinni R, Birtles RJ, 1998. Outbreak of epidemic typhus associated with trench fever in Burundi. Lancet 352: 353–358.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Bechah Y, Capo C, Mege JL, Raoult D, 2008. Epidemic typhus. Lancet Infect Dis 8: 417–426.

  • 6.

    Perine P, Chandler B, Krause D, 1992. A clinico-epidemiological study of epidemic typhus in Africa. Clin Infect Dis 14: 1149–1158.

  • 7.

    Raoult D, Roux V, 1992. The body louse as a vector of reemerging human diseases. Clin Infect Dis 14: 1149–1158.

  • 8.

    Parola P, Paddock C, Raoult D, 2005. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 18: 719–756.

  • 9.

    World Health Organization, 1994. Epidemic typhus risk in Rwandan refugee camps. Wkly Epidemiol Rec 34: 259.

  • 10.

    World Health Organization, 1993. Global surveillance of rickettsial diseases: memorandum from a WHO meeting. Bull World Health Organ 71: 293–296.

  • 11.

    Dill T, Dobler G, Saathoff E, Clowes P, Kroidl I, Ntinginya E, Machibya H, Maboko L, Löscher T, Hoelscher M, Heinrich N, 2013. High seroprevalence for typhus group rickettsiae, southwestern Tanzania. Emerg Infect Dis 19: 317–320.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    McDade J, 1980. Evidence of Rickettsia prowazekii infections in the United States. Am J Trop Med Hyg 29: 277–283.

  • 13.

    Green CR, Fishbein D, Gleiberman I, 1990. Brill-Zinsser: still with us. JAMA 264: 1811–1812.

Past two years Past Year Past 30 Days
Abstract Views 1078 815 29
Full Text Views 649 15 1
PDF Downloads 218 12 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save