Compiled Body Of Works In Field Epidemiology

Introduction: Relapsing fever is a recurrent febrile infection caused by various Borrelia spirochrnetes transmitted either by lice (epidemic louse born relapsing fever LBRF) or by ticks (endemicrntick born relapsing fever TBRF). It was once a disease of global epidemic importance. However,rnlargely as a result of the demise of the clothing louse Pediculus humanus, it is now restricted to arnreas where clothing lice are still common place.rnTwo species of Borrelia are associated with a relatively high rate of relapsing fever–relatedrnfatality include B recurrentis (the cause LBRF and the focus of this study) and B duttoni (the caurnse of TBRF). The body louse spreads during direct contact with infected people or indirectly whernn infested clothing is shared. In the 1st half the 20th century there were 50 million affected by RFrnwith case fatality rates of 10% - 40%. Largest epidemics claimed 1 million lives during World wrnars I and II. Epidemics have been common in overcrowded situations with poor hygiene, childrenrnand women are more affected.Relapsing fever was the 7th most common cause of hospital admisrnsion and 5th most common cause of death in Ethiopia in 2004. Laboratory confirmed RF cases wrnere identified in prison camps of Bahirdar and Mekele during civil war in Ethiopia in 1991.rnSeveral confirmed cases of RF were identified in Yirgalem town prison in January 2012. The prnurpose of this investigation was to determine magnitude and etiology of the outbreak, to identifyrnrisk factors and risk group and use findings to undertake evidence based interventions.rn2rnMethods: Surveillance data of RF from line list and log books were reviewed. Clinical examinatrnion of suspect cases was done. Blood samples were taken from suspected cases and laboratory ternsted using Gimisa stain. Thick blood film was used. A case control study was conducted on 78rncases and 108 controls. Data were analyzed using Excel, Epi – Info 3.5.1 and ARC GIS was usedrnto create maps.rnResults: From2604 prisoners a total of 831 cases and 1 death registered from January 15 to Feb.rn14, 2012 in prison and after two weeks, due to relapse, 24 cases were confirmed and treated.Thernoverall attack rate was 32% and case fatality rate 0.12%. Among cases 100% (831) were males arnnd the age range from 15 to 78 years, median age 20, Mode 20 and mean age 22. From total surnspected cases 560 (67%) were laboratory tested and 345 (62%) were confirmed cases of relapsinrng fever as evidenced by presence of Borrelia recurrentis spps. in the thick blood samples tested. Frnrom total cases 823(99%), 780 (94%), 771 (93%), 756 (91%) and 20 (2.4%) developed, head achrne, vomiting, fever, Chills and jaundice respectively.rnFrom respondents of the case contol study 29/78(37%) cases and 57/108(53%) took a body bathrnweekly (OR = 0.52, 95% CI (0.29-0.96) and From total cases 63/ 78 and 101/108 controls werernliterate, OR=0.29,95%CI (0.1-0.75),the association was also significant. 37/78 cases and 66/108rncontrols wash their clothes weekly (OR = 0.57, 95% CI, (0.30-1.02), whichrnwas not significant.rnConclusion & Recommendations: Overcrowding, close contact , water shortage and gap in keernping personal hygiene in the prison contributed to the outbreak, The outbreak was contained duern3rnto prompt intervention measures taken and intervention activities were recommended to prevent trnhe emergence of future outbreaks of relapsing fever.rnKey Words: Crowding, close contact, Borrelia recurrentis, Relapsing fever, Sidama, Ethiopia

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