Investigation to determine staff exposure and describe animal bite surveillance after detection of a rabid zebra in a safari lodge in Kenya, 2011

Introduction: Rabies is a fatal viral infection, resulting in >55,000 deaths globally each year. In August 2011, a young orphaned zebra at a Kenyan safari lodge acquired rabies and potentially exposed >150  tourists and local staff. An investigation was initiated to determine exposures among the local staff, and to describe animal bite surveillance in the affected district.Methods: We interviewed lodge staff on circumstances surrounding the zebra's illness and assessed  their exposure status. We reviewed animal bite report forms from the outpatient department at the district hospital. Results: The zebra was reported bitten by a dog on 31st July 2011, became ill on  23rdAugust, and died three days later. There were 22 employees working at the lodge during that time. Six (27%) had high  exposure due to contact with saliva (bottle feeding, veterinary care) and received four doses of rabies  vaccine and one of immune-globulin, and 16 (73%) had low exposure due to casual contact and received only four doses of rabies vaccine. From January 2010 to September 2011, 118 cases of animal bites were reported in the district; 67 (57%) occurred among males, 65 (57%) in children <15 years old, and 61  (52%) were inflicted in a lower extremity. Domestic and stray dogs accounted for 98% of reported bites.Conclusion: Dog bites remains the main source of rabies exposure in the district, but exposure can  result from wildlife. This highlights the importance of a one health approach with strong communication between wildlife, veterinary, and human health sectors to improve rabies prevention and control.Key words: Rabies, outbreak, epidemiology, East Africa 

Demographic characteristics of patients with suspected or confirmed typhoid fever, Kasese and Bundibugyo districts, Uganda, August 1, 2009–December 31, 2011.

<p>*Includes 12 patients for whom intestinal perforation status was reported by clinician as “don't know”.</p><p>**Includes 7 patients for whom intestinal perforation status was reported by clinician as “don't know” and 33 patients for whom intestinal perforation status could not be determined from district linelist.</p>†<p>For some items, n may vary by small numbers due to “don't know” or missing responses.</p>‡<p>Wilcoxon rank-sum test (median age) or Fisher's exact test (gender) for difference between Kasese patients with and without intestinal perforation.</p>‡‡<p>Wilcoxon rank-sum test (median age) or Fisher's exact test (gender) for difference between Bundibugyo patients with and without intestinal perforation.</p>a<p>Median age different by gender among all Kasese patients (<i>P</i> = 0.002) and among patients with intestinal perforation from Kasese (<i>P</i> = 0.0004) and Bundibugyo (<i>P</i> = 0.03). Median age did not differ significantly by gender among patients without intestinal perforation in either district.</p

Diversity of PFGE patterns among <i>Salmonella</i> Typhi isolated from Kasese and Bundibugyo patients.

<p>Each <i>Xba</i>I/<i>Bln</i>I PFGE pattern combination is represented by a different shading; pattern combinations designated by letter are shared across districts and/or years. <i>Salmonella</i> Typhi isolated from October 18–December 31, 2011 were from 13 Bundibugyo and 5 Kasese patients; among these, we observed 6 and 4 pattern combinations, respectively. Investigations in Kasese from March 4–April 17, 2009 yielded 33 <i>Salmonella</i> Typhi isolates, among these 13 pattern combinations were identified <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002726#pntd.0002726-Neil1" target="_blank">[6]</a>.</p

Clinical history of typhoid fever patients, Kasese and Bundibugyo Districts, April 15, 2011–January 6, 2012.

†<p>For some items, n may vary by small numbers due to “don't know” responses.</p><p>*Percentage totals may be >100%; respondents could select ≥1 source of care and antibiotic.</p>‡<p>Kasese patients: 1 school nurse; Bundibugyo patients: 5 friend or relative.</p>‡‡<p>Kasese patients: 1 each cephalexin, erythromycin, gentamycin, 4 unknown; Bundibugyo patients: 1 each ceftriaxone and doxycycline, 2 unknown.</p

Cases of typhoid fever in Bundibugyo, by age, gender, and intestinal perforation status.

<p>January 1–December 31, 2011, n = 244 with known age, sex, and intestinal perforation status, *<i>P</i> = 0.03 and **<i>P</i> = 0.0006.</p

Selected characteristics of patients with suspected typhoid fever, by intestinal perforation (IP) status, April 15, 2011–January 6, 2012.

<p>*For some items, n may vary by small numbers due to “don't know” responses.</p><p>**Fisher's Exact test.</p>†<p>Percentage totals may be >100%; respondents could select ≥1 source of care and antibiotic.</p>‡<p>Patients with intestinal perforation: 1 each ceftriaxone, gentamycin, and unspecified; patients without intestinal perforation: 1 each cephalexin, doxycycline, erythromycin, and gentamycin, and 5 unspecified.</p

Clinical features^*of typhoid fever patients reported on case report forms, Kasese and Bundibugyo Districts, April 15, 2011–December 31, 2011.

<p>*Case definition specified that fever and abdominal pain must be present.</p>†<p>For some items, n may vary by small numbers due to “don't know” responses.</p