9-15-2019-RMI Dengue Sitrep

Outbreak Overview 

Cases: To date there have been 425 suspect cases of which 134 have been lab confirmed. This is outbreak week #18 in Ebeye and #6 in Majuro. No cases yet in outer atolls. 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 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; & prevent spread to outer atolls 
  • 2)  Assure excellent clinical care to minimize deaths. 

• Surveillance system with daily updates in place for Ebeye, and Majuro. 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. Majuro completed health presentations for 26 of 26 schools and 37 of 39 churches. Community awareness by mass phone texts, radio, posters,
    public seminars to 15 of 18 target schools and 42 of 42 target churches, and house-to-house across Ebeye and entire Majuro.
  • Rain catchment tanks on Ebeye and Majuro not yet screened or treated (due to 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 is open and dedicated dengue ward scheduled to open on Sept 16.
    • Lab at Ebeye & Majuro fully functional for dengue care. Preparation for outer atolls:
    • Dengue 101 not yet delivered to health assistants; Community cleanup initiated in 3 outer atolls but most still pending; Shipments of dengue-related supplies to go to
      some atolls this week.
    • Travel restrictions for Ebeye & Majuroouter atolls in place since Aug 23. Dengue-related Inventory:
  • Projected inventory gaps identified this week. MOHHS order not yet placed for projected gaps; Some items requested from regional partners (and are pending) 

Priority activities this week: Place inventory gaps orders; Begin treating rain catchment tanks (t/o RMI) as soon as supplies are in. Address Majuro dumps & complete removal of large items. Accelerate Outer Atoll preparationImprove surveillance reporting, Deliver Dengue 101 to health assistants; Institute community clean-ups 

© RMI Ministry of Health and Human services