A study of viral and rickettsial exposure and causes of fever in Juba, southern Sudan

Abstract

Patients presenting at the Juba Teaching Hospital, either with fever of undetermined origin or with a clinical cause of fever, gave evidence of exposure to a wide range of viral and rickettsial agents. Serological tests showed high antibody levels to flaviviruses (56.9%) and alphaviruses (29.2%), with lesser levels of bunyamweraviruses (3.8%), Rift Valley fever (2.3%), and sandfly fever (0.75%). Flavivirus exposure was significantly associated with clinical evidence of liver disease; repeated exposure to flaviviruses was particularly prevalent in those with poor sanitation and who had received previous injections. A significant focus of Ebola and Marburg exposure in Juba has been identified. Clinical evidence of liver disease was evident in 37% of patients studied, and 24.6% were HBsAg positive. The first 2 HIV-positive individuals from the southern Sudan are reported, including one with clinical AIDS. A high prevalence of positive antibodies to Rickettsia typhi in the population indicated that murine typhus was common locally. This study indicates the need for further public health measures in the southern Sudan to control the spread of these infections.

Evaluation of arthropod-borne viruses and other infectious disease pathogens as the causes of febrile illnesses in the Khartoum Province of Sudan

“…The results of this study supported previous observations that associated several arboviruses with outbreak of disease in Sudan [Eisa et al, 1977[Eisa et al, , 1980Hyams et al, 1986;Woodruff et al, 1988;Watts et al, 19941. Among the viruses considered during the outbreak of febrile illness in Khartoum, phleboviruses were the most frequent cause of morbidity. These viruses were also associated with an outbreak of human disease along the Nile River in Northern Sudan [Watts et al, 19941.…”

“…Epidemics and sporadic cases of acute febrile diseases among human populations in Sudan have been associated with infection by several arboviruses including yellow fever (YF), Rift Valley fever (RVF), sandfly fever Sicilian (SFS), sandfly fever Naples (SFN), and dengue (DEN) viruses [Taylor RM et al, 1955;Eisa et al, 1977Eisa et al, , 1980Woodruff et al, 1988;Watts et al, 19941. However, the relative public health importance of these and other pathogens, such as Ebola, hepatitis, bacterial entero-pathogens, and malaria species, is largely unknown [Bowen ET et al, 1977;Hyams KC et al, 1986;CDCP, 19891. A major outbreak of acute febrile illness occurred following heavy rains during August 1988, in the Khartoum Province of Sudan.…”

The 2007 Rift Valley Fever Outbreak in Sudan

“…The 2007 outbreak was most severe in White Nile, El Gezira, and Sennar state near to the White Nile and the Blue Nile Rivers, the main branches of the Nile River in Sudan (Figure 1) [19]. Outbreaks of RVF were described during 1973, 1976, and 1981 [20]–[23], and serological surveys in several parts of Sudan have detected antibodies both in livestock [24], [25] and humans [17], [18], [23], [26]. RVF cases were also reported in 2007 from the states of Kassala, Khartoum, and River Nile, although the cases in Khartoum may have been acquired in other affected areas [9].…”

Rift Valley Fever, Sudan, 2007 and 2010

“…Serologic surveys have detected RVFV antibodies in domestic livestock ( 14 , 15 ) and in humans from different Sudanese states, including Nile, Khartoum, Kassala, El Gezira, Sennar, and White Nile ( 16 – 18 ). A recent seroepidemiologic survey reported a high prevalence of RVFV IgG among febrile patients admitted to New Halfa Hospital in Kassala State ( 19 ).…”