RVF outbreak in SA, Feb - May 2010 JOINT BRIEFING BY: DEPARTMENT OF AGRICULTURE, FORESTRY AND FISHERIES (DAFF) AND DEPARTMENT OF HEALTH

Outline Introduction RVF in South Africa Current outbreak National Response Provincial Response Challenges Recommendations

INTRODUCTION RVF- Viral zoonosis that can cause severe disease in low proportion of infected humans Virus transmitted by mosquitoes and causes outbreak of abortion and death of young livestock (sheep, goats, and cattle) Humans infected from contact with infected animals Disease occurs in Africa and Middle East Asia where exceptionally heavy rains favour breeding of mosquitoes vectors

RVF IN SOUTH AFRICA (i) RVF was first reported in SA ( died, aborted) Last major outbreak of RVF in SA caused 10,000 to human cases Virus thought to be endemic in low lying coastal areas of KZN (small outbreak in dairy herd in Empangeni 1981) and Kruger National Park Small outbreak occurred (abortions in captive bred buffaloes) in Skukuza, 1999

RVF IN SOUTH AFRICA (ii) Fourteen Small outbreaks of RVF occurred in animals MP, LP, GP and NW in 2008 RVF outbreak occurred on farms along Orange River, Northern Cape; two confirmed human cases November- December 2009

CURRENT OUTBREAK 12 Feb.2010, RVF confirmed on 2 sheep farms in Bulfontein area, Free State RVF outbreak confirmed in humans 24 Feb 2010 by Outbreak Response Unit, NICD First confirmed Case; Vet surgeon based in Bloemfontein, has a farm in Winburg, does field visits to farmers in Free State did postmortem on dead lambs (specimen confirm RVF) at a farm 30km from Brandfort, Bulfontein By 30 April: - farms with confirmed animal cases were reported in 7 provinces (except KZN, LP). - > 9000 animal cases with over 5000 deaths

CASE DEFINITION/ CRITERIA FOR LAB TESTING Any person with recent close contact with livestock in or from suspected RVF areas, presenting with: Flu-like illness (may include fever, muscle ache, or headache) or Fever and features of encephalitis, haemorrhage, hepatitis disease and/or occular pathology

Areas with human cases (i) (as of 11 May 2010) Province Cases Deaths Free State 1089 Eastern Cape130 Northern Cape588 North West 30 Western Cape 31 Unknown 10 Total Over 1200 samples tested to date (11 new cases reported last week)

Geographic spread of cases

Distribution of cases by District in Free State, 2010 (N = 103 with 18 missing information)

Distribution of Cases in NC

Epidemic curve of lab confirmed RVF cases by date of onset, 6 May 2010

Number of lab confirmed RVF cases by occupation, SA 3 May 2010

Case management Most cases are mild, managed on outpatient basis (84%); 30 in-patients Distribution of symptoms: majority presented with fever, muscle pains and headache

Manifestation of RVF disease in fatal cases (N=15)

Response by DoH Multisectoral National Outbreak Response (MNORT) team meets regularly – coordination of response Support visits to provinces Regular press releases, media interviews and situation reports being prepared. All the Provincial Communicable Diseases Co- ordinators have been alerted, EPR guidelines and Health workers guidelines for management of RVF disseminated; WHO providing additional technical support. Follow up visit by MNORT to Free State and Northern Cape

Actions by Provincial DoH Outbreak investigations by PDoH and DoA on-going supported by SA-FELTP and NICD Alert and guidelines on RVF have been sent to all districts Investigation of suspects Health promotion and Media briefing

Key issues addressed Strengthened notification of human cases and maintained regular reporting at all levels Provincial Outbreak Response Teams implemented comprehensive action plans; Need to strengthen Health promotion

CHALLENGES Implementation of the communication strategy on prevention and control of RVF (e.g behavior change) Voluntary vaccination of livestock No vaccine available for humans Early detection of the disease: - Most infections in humans asymptomatic - Most people experience flu like illnesses (acute on set of fever, headache, myalgia and photophobia) No specific treatment Rapid spread of infection due to environmental circumstances

Recommendations Implementation of PoA and strengthen coordination of response at all levels Additional resources needed to support the provinces  Application was made for additional funding Strengthen health promotion and communication campaign in provinces

Thank you.