10-27-2019-RMI Dengue Sit Rep

Outbreak Overview 

Cases: To date, there has been 914 dengue-like illness of which 280 have been lab-confirmed. This is outbreak week #24 in Ebeye, #12 in Majuro, #2 in Utrik and #1 in Aur. Symptom and age profile of cases is typical for dengue fever. One death and one severe dengue patient evacuated out-of-country to date.

Organization of Response: EpiNet team in Ebeye and the RMI national Epinet teams were both activated on July 16, with daily meetings currently. Presidential Declaration of Health Emergency and activation of multi-ministry and NGO National Emergency Operations Center on August 6 with weekly meetings. RMI Dengue Response Plan finalized Aug 6. Weekly conference calls with technical assistance partners also being held.

Case Definitions (based on PPHSN):
Suspected case: Acute fever > 2 days with two or more of the following: anorexia and nausea; aches and pains; rash; low white blood cell count; tourniquet test positive; warning signs (abdominal pain or tenderness; persistent vomiting; mucosal bleeding; liver enlargement >2 cm; fluid accumulation; lethargy, restlessness; increase in hematocrit with a decrease in platelets).
Confirmed case: a Suspected case with lab confirmation (+Rapid test (for NS1 or IgM) or +PCR test)

Response Summary*

Current Response Goals:
1) Slow spread in Ebeye and Majuro; & prevent spread to outer atolls, 2) Assure excellent clinical care to minimize deaths. Surveillance:
• Surveillance system with daily updates in place for Ebeye, Majuro, and Outer Islands
Community Engagement & Vector Control:

  • Vigorous community engagement, ongoing with help from partners- Red Cross, WUTMI, Kalgov, Malgov. Ebeye complete for community clean-up and spraying of hospital, schools, and churches. Community awareness by mass phone texts, radio, posters, and public seminars.

  • Vector Control: 54/54 churches completed; 22/22 schools completed in Majuro. As of Sept. 24, 59% of rainwater tanks (3500) repaired with screens.

  • Health Education: 54/54/churches completed; 19/22 schools completed in Majuro.

  • Rain catchment tanks on Ebeye and Majuro not yet screened or treated (due to the absence of screening materials & larvicide. Majuro: Trash and large item pickup completed in Ebeye and in

    about 1⁄2 of Majuro (from Rita-Rairok villages). Four Illegal dumps in Majuro found (but not yet addressed). Clinical capacity:

    • Dengue 101 clinical seminars completed in Ebeye: 100% of doctors & 100% clinical nurses and Majuro: 100% of doctors, 100% NPs, 100% triage & ward nurses. Fast track outpatient

      dengue clinic using NPs in Majuro Hospital was stopped in Week 8 due to a decreasing number of Dengue Fever seen.

    • Surge Capacity Team completed and passed the CDC DF Module Post Test week of Sept 16-23.

    • Ebeye & Majuro was fully functional for dengue care. Preparation for outer atolls:

    • Dengue 101 training to health assistants is still ongoing; Community cleanup initiated in 3 outer atolls but most still pending; Shipments of dengue-related supplies to go to some atolls

      this week.

    • A total of 6 Health Assistants for Jabor Jaluit, Kaven Maleolap, Tokewa Mili, Wormej Wotje and 2 from Majuro were trained in DF, management of DF Category A, B, and C; Surveillance

      forms, Active Surveillance, and OI response plan for prevention of DF with the traditional and Govt leaders, Churches, NGOs, etc..

    • Travel restrictions for Ebeye & Majuro outer atolls in place since Aug 23.

      Rongrong: On Oct. 11, 2019, OI protocol was activated in RongRong and Jelter: 2 NPI, lab tech and 1 health assistant will be deployed to RongRong to manage DF patients and stabilizing patients that need medivac. House to house visit was carried out. Mosquito nets and repellents were distributed to every Dengue Like Illness cases, households, pregnant women and disabled patients. Vector breeding sites surveillance was carried out by the NPs. Vector Control and WASH Team continued to fumigate the whole Majuro villages with the highest attack rate including Rongrong and Uliga. Aside from fumigation, mosquito dunks were distributed to the wells and water catchments.

      Utrik: With 1 admitted case and 2 suspected cases from Utrik Atoll, OI Dengue Response team immediately deployed to Utrik on October 19, 2019. Response measures have done: Fumigation of the whole island, case investigations, and other clinical measures. 177 Health Care Program chartered the plane and notified the Utrik community. Logistics prepared Medical Counter Measures and other supplies. 53 houses were fumigated, 16 water wells, 40 plastic water catchments, 5 abandoned concrete water catchments were treated with mosquito dunks. Mosquito control education was delivered on house to house visits. Adult mosquito and larvae were collected for testing.
      Plan for Aur Dengue Response: 1) Risk assessment, 2) Epidemiology investigation, 3) set up a station on Aur and Tobal, 4) Vector control and surveillance

© RMI Ministry of Health and Human services

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