9-1-2019-RMI Dengue Outbreak SitRep

Outbreak Overview 

Cases: 276 suspect cases to Aug 30. Index case identified in Ebeye on May 15 with no travel history. Had negative rapid test result, no off island testing. Next suspect case in Ebeye identified on June 24 with + NS1 test. There was a rapid increase in case #s from that point. First case in Majuro, a traveler from Ebeye, detected on August 15 with multiple additional cases soon following. Case counts appear to have peaked in Ebeye, still rising in Majuro and no cases yet in outer atolls. Symptom profile of cases is typical for dengue fever. One severe dengue patient evacuated out-of-country. No deaths 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. 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 decrease in platelets). Confirmed case: 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;
    2) Prevent spread to outer atolls;
    3) Assure excellent clinical care- maintain 0 deaths. 

  • Highlights: 

  • RMI Dengue Response Plan put in to effect on August6.

  • Surveillance system with daily updates in place for Ebeye, Outer Islands and Majuro. (most outer islands not reporting daily though) 

  • Vector activities:

  • Vigorous community engagement & cleanup campaign launched with help from partners- WUTMI, Kalgov, Malgov, Breeding site elimination campaign in both Ebeye & Majuro (but not yet in most outer Atolls) Vigorous, multi-pronged public info campaign in place in both Ebeye & Majuro

  • Ebeye: Larvacide & household spraying complete for entire Ebeye community (screening of water catchment tanks not yet done).

  • Majuro: Illegal dumps in Majuro identified (but not yet remediated). Residual spraying of schools, hospital & churches initiated (but not yet complete). Covering of catchment tanks initiated (but not yet complete).

  • Clinical capacity: 

  • Dengue ward set-up in Majuro initiated (but not yet complete); Surge planning using NPs in process.
    Clinical protocols disseminated and reviewed with med & nursing staff in Ebeye & Majuro (not yet to NPs, HAs) TA and dengue-related materials requests to WHO, PIHOA,CDC (but inventory of on-hand materials not complete) 

  •  Other: Travel restrictions from Majuro and Ebeye to outer islands put in place, Aug 23 

© RMI Ministry of Health and Human services