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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.
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: email@example.com, firstname.lastname@example.org, and email@example.com. Jared Omolo, CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda, E-mail: firstname.lastname@example.org. 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: email@example.com. Jeannine Condo, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, E-mail: firstname.lastname@example.org. Marie Aimee Muhimpundu and Thierry Nyatanyi, Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda, E-mails: email@example.com and firstname.lastname@example.org. 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: email@example.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: firstname.lastname@example.org. 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: email@example.com. Eric Tongren, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda, E-mail: firstname.lastname@example.org. 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: email@example.com, firstname.lastname@example.org, and email@example.com. 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: firstname.lastname@example.org and email@example.com. 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: firstname.lastname@example.org. Edward J. Mills, University of British Columbia, Vancouver, Canada, University of Ottawa, Ottawa, Canada, and Stanford University, Stanford, California, E-mail: email@example.com. Agnes Binagwaho, Ministry of Health, Kigali, Rwanda, Harvard Medical School, Boston, Massachusetts, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, E-mail: firstname.lastname@example.org.