Location: Sudan: 12 localities in South, East, Central, West and North Darfur
Disease: Suspected viral hemorrhagic fever (VHF)
Recap: The Ministry of Health (MoH) of Sudan and the World Health Organization (WHO) on 27 October reported an outbreak of viral hemorrhagic fever in Darfur, though no diagnostic proof of VHF has been publically provided. Suspected VHF cases total at 182, with 103 deaths, from 29 August to 25 October. Thirty-six samples were taken from both suspected cases and those who had contact with the infected. Eight samples from North, West and Central Darfur tested positive for West Nile virus, and four samples from West and Central Darfur were positive for Chikungunya virus; none of the samples were positive for Rift Valley fever, Yellow fever, Crimean Congo hemorrhagic fever, or Dengue fever. It is important to note that both West Nile and Chikungunya viruses are not VHF pathogens, in contrast to erroneous reporting from UN OCHA.
Signature Pattern: Aside from a claim of suspected viral hemorrhagic fever, the event signature pattern is not consistent with an Ebola signature pattern. This generally implies one of several scenarios:
Our current assessment is the etiology is not due to Ebola virus, however the situation is worthy of prioritized scrutiny and ground verification as is being done currently.
IDIS Level: CAT 3; on 23 October, local medical sources stated that Darfur lacked medication to treat VHF and stressed the need to declare a “State of Health Emergency”, according to local media. Health teams from the WHO arrived in Darfur on 1 November and are expected to have begun assisting the MoH earlier this week, according to local media sources. Based on prior contact with Ebola, we assess the Sudan would be unlikely to progress beyond an IDIS Cat 3 based on prior, albeit limited, experience. Prior experience responding to outbreaks of filoviruses is a leading indicator for mitigated socio-economic disruption, where we expect to see Cat 3 conditions being more probable versus Cat 6/7.
Relevance: Given the international sensitivity to the Ebola disaster in West Africa, any report of suspected viral hemorrhagic fever is likely to receive high media attention. In contrast to West Africa, Sudan has experienced outbreaks of filoviruses before and have gained containment more quickly as a result. The potential for response delays contributing to uncontrolled spread of a filovirus remains a consideration.
Current vs. Forecast: This event has been reported to occur in the context of Sudan’s rainy season. Outbreaks of Ebola virus, and specifically the Sudan strain of Ebola, have been statistically associated with the rainy season in Sudan and Uganda. A cautionary statement should be noted regarding the low sample size associated with historical outbreaks in this region of Africa. We consider the pattern of potential seasonal emergence of filovirus to therefore be plausible.
Guidance: There is no treatment or established cure for VHF, aside from supportive therapy. Isolation efforts are helpful if the causative agent is a virus that can cause person to person transmission. However, viruses that cause most VHFs are zoonotic, according to the Centers for Disease Control. Prevention efforts should also focus on controlling rodent populations, safe cleanup of rodent nests and droppings, along with arthropod and insect control. Hospital-based guidelines developed by the WHO and CDC can be found here: Infection Control for Viral Haemorrhagic Fevers In the African Health Care Setting.
Critical Indicators: Important indicators include any further medical or community strain, increasing rate of disease spread, and diagnostic proof of specific hemorrhagic fever.