An Epidemic of Scurvy, Identified Based on Lower Extremity Swelling, in a Southern Ethiopian Prison

Abstract

In October 2016, we received reports of five deaths among prisoners with leg swelling of unknown etiology in southwestern Ethiopia. A descriptive cross-sectional study was conducted to investigate the outbreak. A suspected case was defined as a prisoner with leg swelling of unknown etiology noted between May 15, 2016 and November 29, 2016. A total of 118 suspected cases were identified with unilateral or bilateral leg swelling without an identifiable cause from a total of 2,790 prisoners. Eight of the suspected cases were thoroughly examined, and seven of these suspected cases had clinical findings consistent with scurvy. Three of the clinical cases had undetectable vitamin C levels in the serum. The attack rate for the prison was 4.2% (118/2,790), and 11 deaths were identified, making the case fatality rate 9.3% (11/118). Clinical cases of scurvy had symptoms of fatigue, myalgia, arthralgia, and signs of follicular hyperkeratosis, petechiae, peripheral edema, and oral lesions. All clinical cases had severe anemia with hemoglobin <6.0 g/dL. The diet provided by the prison excluded fruits and vegetables. Scurvy was determined to be the cause of the outbreak, and vitamin C supplementation was promptly initiated. All symptomatic prisoners improved, and no further cases were identified in a 4-week follow-up period of active surveillance.

Abdominal Ecchymosis: Emergency, or Urgen-C?

“…In the modern era of fortified diets, scurvy is rare in industrialized countries, except in patients with a history of alcohol or drug dependence with severely restricted diets devoid of fruits and vegetables. Institutionalized and socially isolated patients represent a population at increased risk of the disease [ 2 , 8 ]. Healthy individuals with normal diets transiently hold approximately 1,500mg of total body VC with the highest concentrations found in the cutaneous tissues [ 1 ].…”

The Forgotten Disease in the 21st Century: Scurvy Outbreak in Hawassa Central Prison, Hawassa, Sidama, Southern Ethiopia, 2023

“…It rarely occurs because of the adequate intake of ascorbic acid. 1 , 2 But it can still occur in specifically at-risk groups such as alcoholics with poor nutrition, isolated elderlies, institutionalized patients and patients with malabsorption. 3 …”

“…Over the course of a 4-week active surveillance period, all symptomatic detainees improved, and no new cases were found. 1 …”

Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study

“…Scurvy is currently considered a rare disease, although it is still identified in infants, elderly people living alone, the indigent, alcoholics and people with very limited diets. 1 ),( 3 ) Outbreaks of scurvy can still occur, especially among vulnerable people such as refugees and populations deprived of freedom. In 2016, an outbreak in an Ethiopian prison was investigated, where the occurrence of cases and deaths related to the disease was described.…”