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1. A protracted cholera outbreak in Nairobi City County accentuated by mass gathering events, Kenya, 2017.

Author

Philip Ngere, Daniel Langat, Isaac Ngere, Jeanette Dawa, Emmanuel Okunga, Carolyne Nasimiyu, Catherine Kiama, Peter Lokamar, Carol Ngunu, Lyndah Makayotto, M Kariuki Njenga, and Eric Osoro

Subjects
Medicine, Science
Abstract

Cholera continues to cause many outbreaks in low and middle-income countries due to inadequate water, sanitation, and hygiene services. We describe a protracted cholera outbreak in Nairobi City County, Kenya in 2017. We reviewed the cholera outbreak line lists from Nairobi City County in 2017 to determine its extent and factors associated with death. A suspected case of cholera was any person aged >2 years old who had acute watery diarrhea, nausea, or vomiting, whereas a confirmed case was where Vibrio cholerae was isolated from the stool specimen. We summarized cases using means for continuous variables and proportions for categorical variables. Associations between admission status, sex, age, residence, time to care seeking, and outbreak settings; and cholera associated deaths were assessed using odds ratio (OR) with 95% confidence interval (CI). Of the 2,737 cholera cases reported, we analyzed 2,347 (85.7%) cases including 1,364 (58.1%) outpatients, 1,724 (73.5%) not associated with mass gathering events, 1,356 (57.8%) male and 2,202 (93.8%) aged ≥5 years, and 35 deaths (case fatality rate: 1.5%). Cases were reported from all the Sub Counties of Nairobi City County with an overall county attack rate of 50 per 100,000 people. Vibrio cholerae Ogawa serotype was isolated from 78 (34.8%) of the 224 specimens tested and all isolates were sensitive to tetracycline and levofloxacin but resistant to amikacin. The odds of cholera-related deaths was lower among outpatient cases (aOR: 0.35; [95% CI: 0.17-0.72]), age ≥5 years old (aOR: 0.21 [95% CI: 0.09-0.55]), and mass gathering events (aOR: 0.26 [95% CI: 0.07-0.91]) while threefold higher odds among male (aOR: 3.04 [95% CI: 1.30-7.13]). Nairobi City County experienced a protracted and widespread cholera outbreak with a high case fatality rate in 2017.

Published
2024
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2. High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015

Author

Isaac Ngere, Doris Marwanga, Eric Osoro, Athman Mwatondo, Mathew Muturi, Peninah Munyua, Marc-Alain Widdowson, Clayton Onyango, Kariuki Njenga, Elizabeth Hunsperger, Rebekah Tiller, and Philip Ngere

Subjects
Male, Rural Population, Bacterial Diseases, Epidemiology, RC955-962, Fevers, Pathology and Laboratory Medicine, Polymerase Chain Reaction, Geographical Locations, Medical Conditions, 0302 clinical medicine, Interquartile range, Surveys and Questionnaires, Zoonoses, Arctic medicine. Tropical medicine, Medicine and Health Sciences, 030212 general & internal medicine, Enzyme-Linked Immunoassays, Child, Animal Management, biology, Incidence (epidemiology), Agriculture, Antibodies, Bacterial, Bacterial Pathogens, Infectious Diseases, Medical Microbiology, Child, Preschool, Cohort, Population study, Female, Pathogens, Public aspects of medicine, RA1-1270, Research Article, Neglected Tropical Diseases, Adult, medicine.medical_specialty, Livestock, Adolescent, 030231 tropical medicine, Pastoralism, Enzyme-Linked Immunosorbent Assay, Brucella, Research and Analysis Methods, Microbiology, Brucellosis, Young Adult, 03 medical and health sciences, Signs and Symptoms, Internal medicine, medicine, Humans, Serologic Tests, Immunoassays, Microbial Pathogens, Bacteria, business.industry, Organisms, Public Health, Environmental and Occupational Health, Infant, Biology and Life Sciences, Tropical Diseases, medicine.disease, biology.organism_classification, Kenya, Case definition, Health Care, Immunoglobulin M, Health Care Facilities, Immunoglobulin G, People and Places, Africa, Immunologic Techniques, Clinical Medicine, business
Abstract

Background Brucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya. Methods Between February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population. Results We enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months– 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28–53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence. Conclusion We report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community., Author summary Brucellosis is a bacterial disease that affects both humans and animals. Humans get infected via ingestion of unpasteurized animal products from infected animals and direct contact during animal abortions and deliveries. Infected animals shed bacteria for life through milk and during deliveries posing a risk to those with occupational exposure to infected animals. As such, human disease is disproportionately high in regions with high prevalence of animal brucellosis. While human brucellosis is distributed globally, incidence is low in North America and Western Europe and high in Asia and the Middle East where the disease is endemic. Data from Africa are scarce. We set out to estimate the incidence of brucellosis in a pastoralist community with documented high Brucella sero-prevalence in humans and livestock. We followed up a cohort of 804 households for one year and tested household members who became ill in three designated health facilities. We estimated an incidence of 84 cases per 100,000 persons per year in this community. We also found that Brucella was the most common pathogen among persons who had febrile illness highlighting the importance of this pathogen in this rural pastoralist community. No brucellosis intervention measures were being implemented.

Published
2021

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