8-26-2019-RMI Dengue sitrep_FINAL

Outbreak Overview 

First cases: Index case identified in Ebeye, no travel history. Had negative rapid test result. Next suspect case in Ebeye identified on June 24 with + NS1 test. There was a rapid increase in epidemic from that point. First case in Majuro, a traveler from Ebeye, currently residing in Jenrok, detected on August 15 with multiple additional cases among non-travelers identified the following week (27 cases in Majuro, including 8 NS1+ and 2 with travel history from Ebeye). 95 patients hospitalized, one dengue hemorrhagic fever patient evacuated out-of-country and no deaths to date.

Response: EpiNet team in Ebeye and the RMI national Epinet teams were both activated on July 16. Three response goals currently: 1) slow spread in Ebeye and Majuro; 2) Prevent spread to outer islands; 3) assure excellent clinical care- maintain 0 deaths.

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 decrease in platelets). Confirmed case: Suspected case with lab confirmation (+Rapid test (for NS1 or IgM) or +PCR test)

Response Measures:

  • Dengue State of Emergency Declaration (by President Heine, Aug 6) 
  • Surveillance system in place 
  • Increased EpiNet response meeting frequency to every day (4pm) starting Aug 23 
  • Cleanup campaign in place in Ebeye (including spraying & larvicide application) 
  • Outreach to case households in Majuro with search for associated cases and vector control (including spraying). General cleanup campaign also initiated. 
  • Multiple Dengue prevention and control presentations given in Ebeye and Majuro Posters for Dengue prevention distributed to all churches and most public places (stores, community centers, etc) in Ebeye, and started in Majuro
  • Clinical protocols disseminated and reviewed with medical & nursing staff in Ebeye & Majuro 
  • Travel restrictions from Majuro and Ebeye to outer islands put in place, Aug 23 
  • TA and dengue-related materials solicited from WHO, PIHOA, CDC 
  • Cancelling of off-island travel & leave for MOHHS employees 
  • To do items: 
    • Update response plan to fit with recent developments 
    • Re-inventory dengue related supplies 
    • Revise testing protocol to preserve dengue test supplies 
    • Additional surge planning for Majuro, and contingency planning for outer islands 
    • Additional surveillance & clinical management training for outer island health assistants
© RMI Ministry of Health and Human services