High risk for human exposure to Rift Valley fever virus in communities living along livestock movement routes: A cross-sectional survey in Kenya.

INTRODUCTION: Multiple outbreaks of Rift Valley Fever (RVF) with devastating effects have occurred in East Africa. These outbreaks cause disease in both livestock and humans and affect poor households most severely. Communities living in areas practicing nomadic livestock movement may be at higher risk of infection. This study sought to i) determine the human exposure to Rift Valley fever virus (RVFV) in populations living within nomadic animal movement routes in Kenya; and ii) identify risk factors for RVFV infection in these communities. METHODS: A cross-sectional descriptive study design was used. Samples were collected from the year 2014 to 2015 in a community-based sampling exercise involving healthy individuals aged ≥18 years from Isiolo, Tana River, and Garissa counties. In total, 1210 samples were screened by ELISA for the presence of immunoglobulin IgM and IgG antibodies against RVFV. Positive results were confirmed by plaque reduction neutralization test. RESULTS: Overall, IgM and IgG prevalence for all sites combined was 1.4% (95% CI 0.8-2.3%) and 36.4% (95% CI 33.8-39.2%), respectively. Isiolo County recorded a non-significant higher IgG prevalence of 38.8% than Garissa 35.9% and Tana River 32.2% (Chi square = 2.5, df = 2, p = 0.287). Males were significantly at higher risk of infection by RVFV than females (OR = 1.67, 95% CI 1.17-2.39, p<0.005). Age was significantly associated with RVFV infection (Wald Chi = 94.2, df = 5, p<0.0001). Individuals who had regular contact with cattle (OR = 1.38, 95%CI 1.01-1.89) and donkeys (OR = 1.38, 95%CI 1.14-1.67), or contact with animals through birthing (OR = 1.69, 95%CI 1.14-2.51) were significantly at a greater risk of RVFV infection than those who did not. CONCLUSION: This study demonstrated that although the Isiolo County has been classified as being at medium risk for RVF, virus infection appeared to be as prevalent in humans as in Tana River and Garissa, which have been classified as being at high risk. Populations in these counties live within nomadic livestock movement routes and therefore at risk of being exposed to the RVFV. Interventions to control RVFV infections therefore, should target communities living along livestock movement pathways.

Seroepidemiology of selected arboviruses in febrile patients visiting selected health facilities in the lake/river basin areas of Lake Baringo, Lake Naivasha, and Tana River, Kenya.

INTRODUCTION: Arboviruses cause emerging and re-emerging infections affecting humans and animals. They are spread primarily by blood-sucking insects such as mosquitoes, ticks, midges, and sandflies. Changes in climate, ecology, demographic, land-use patterns, and increasing global travel have been linked to an upsurge in arboviral disease. Outbreaks occur periodically followed by persistent low-level circulation. AIM: This study was undertaken to determine the seroepidemiology of selected arboviruses among febrile patients in selected lake/river basins of Kenya. METHODS: Using a hospital-based cross-sectional descriptive survey, febrile patients were recruited and their serum samples tested for exposure to immunoglobulin M (IgM) and IgG antibodies against Crimean-Congo hemorrhagic fever virus (CCHFV), Rift Valley fever virus (RVFV), West Nile virus (WNV), and chikungunya virus (CHIKV). Samples positive for CHIKV and WNV were further confirmed by the plaque reduction neutralization test (PRNT). RESULTS: Of the 379 samples examined, 176 were IgG positive for at least one of these arboviruses (46.4%, 95% confidence interval [CI] 41.4-51.5%). Virus-specific prevalence for CCHF, RVF, WN, and CHIK was 25.6%, 19.5%, 12.4%, and 2.6%, respectively. These prevalences varied significantly with geographical site (p<0.001), with Tana recording the highest overall arboviral seropositivity. PRNT results for Alphaviruses confirmed that the actual viruses circulating in Baringo were Semliki Forest virus (SFV) and CHIKV, o'nyong nyong virus (ONNV) in Naivasha, and SFV and Sindbis virus (SINDV) in Tana delta. Among the flaviviruses tested, WNV was circulating in all the three sites. CONCLUSION: There is a high burden of febrile illness in humans due to CCHFV, RVFV, WNV, and CHIKV infection in the river/lake basin regions of Kenya.

National surveillance data on the epidemiology of cholera in Kenya, 1997-2010.

BACKGROUND: Kenya has experienced multiple cholera outbreaks since 1971. Cholera remains an issue of major public health importance and one of the 35 priority diseases under Kenya's updated Integrated Disease Surveillance and Response strategy. METHODS: We reviewed the cholera surveillance data reported to the World Health Organization and the Kenya Ministry of Public Health and Sanitation from 1997 through 2010 to determine trends in cholera disease for the 14-year period. RESULTS: A total of 68 522 clinically suspected cases of cholera and 2641 deaths were reported (overall case-fatality rate [CFR], 3.9%), affecting all regions of the country. Kenya's largest outbreak occurred during 1997-1999, resulting in 26 901 cases and 1362 deaths (CFR, 5.1%). Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2007-2009 (16 616 cases and 454 deaths; CFR, 2.7%), which declined rapidly to 0 cases. Cases were reported through July 2010, with no cases reported during the second half of the year. About 42% of cases occurred in children aged <15 years. Vibrio cholerae O1, serotype Inaba, was the predominant strain recorded from 2007 through 2010, although serotype Ogawa was also isolated. Recurrent outbreaks have most frequently affected Nairobi, Nyanza, and Coast provinces, as well as remote arid and semiarid regions and refugee camps. DISCUSSION: Kenya has experienced substantial amounts of reported cases of cholera during the past 14 years. Recent decreases in cholera case counts may reflect cholera control measures put in place by the National Ministry of Health; confirmation of this theory will require ongoing surveillance.

Seroprevalence of Crimean Congo hemorrhagic fever virus in Ijara District, Kenya.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease mainly affecting pastoralists who come in contact with animals infested with Hyalomma ticks, which are the key vectors of CCHF virus (CCHFV). CCHFV has been detected among these ticks in parts of North Eastern Kenya. This study aimed to identify acute cases of CCHF, and to determine the extent of previous exposure to CCHFV in an outpatient population attending Sangailu and Ijara health centers, Ijara District, North Eastern Kenya, presenting with acute febrile illnesses. A total of 517 human serum samples were collected from these patients. The samples were screened for the presence of IgM and IgG antibodies to CCHF using CCCHF-IgG and IgM ELISA test kits. A multivariable logistic regression model was used to investigate the risk factors associated with evidence of exposure to CCHFV. A single patient tested positive for anti-CCHF IgM, while 96 were positive for anti-CCHF IgG. The seroprevalence of CCHFV was 23% in Sangailu and 14% in Ijara. Most exposed persons were aged 40-49 years. The likelihood of exposure was highest among farmers (29%). Age, location, and contact with donkeys were significantly associated with exposure to CCHFV. Acute CCHFV infections could be occurring without being detected in this population. This study confirms human exposure to CCHF virus in Ijara District, Kenya, and identifies several significant risk factors associated with exposure to CCHFV.