Investigating an outbreak of acute fever in Chuuk, Federated States of Micronesia

Abstract

Clinical diagnosis of acute febrile illness (AFI) can often be difficult and misleading. This can mean that opportunities for preventive measures early on in an outbreak are missed. In any outbreak, descriptive epidemiological analyses are valuable in helping to ascertain the cause of the outbreak.

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta‐analysis of published literature, 2010–2019

“…There was seven reported outbreaks in PNG [8,13–18]; six in each of Solomon Islands, [19–25] French Polynesia, [25–30] and FSM [31–36]; three in each of American Samoa[37–39] and Marshall Island[40–42]; two from Fiji [43,44] and Guam [45,46] and one in each of Kiribati, [47] Tuvalu, [48] New Caledonia, [30] and Wallis and Futuna [30]. The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp . ( n = 3), [13,16,38] Vibrio cholerae ( n = 2), [18,15,14,46] mumps virus ( n = 2), [32,45] Rotavirus ( n = 2), [21,47] Zika virus ( n = 2), [27,37] measles Rubeola virus ( n = 1), [33] Mumps, circulating vaccine‐derived poliovirus type 1 ( n = 1), [8] and Rickettsia parasite causing scrub typhus ( n = 1) [20].…”

“…For 15 reports, the first author was a staff member at a national institution including ministries of health, national laboratories and universities [8,13,17,18,25,22,26–29,35,34,42,44,47]. Of international first authors, nine were from the United States Centers for Disease Control and Prevention [33,32,39,37,38,40,41,46,45]; seven were staff of WHO or the Pacific Community (the two main technical agencies providing outbreak‐related support to PICTs) [15,16,14,24,23,31,36]; five were academics from non‐PICT countries [19,21,20,43,48]; and one was from the French Government, which has responsibility for French Pacific territories [30].…”

“…The method by which most published outbreaks came to the attention of the national public health authority was formal health worker notification ( n = 30; 77%). Of these, 22 reports were made by clinicians (doctors and nurses) who signalled an outbreak based on their clinical judgement or after noticing temporospatial clustering of cases, [30,33,46,45,38,23,16,31,36,20,44,25,22,17,13,34,35,42,43,28] and eight were detected by laboratories. [24,26,29,32,39,37,40,41].…”

“…Ten reports, all based on primary reporting from clinicians, provided enough information to calculate (or reliably estimate) the time from outbreak onset to detection. These included a dengue outbreak in French Polynesia in 2009 [26]; a mumps outbreak in Guam in 2009‐10 [45]; enteric disease outbreaks in the Marshall Islands in 2009 [42] and in the FSM in 2010 [36]; rotavirus outbreaks in Kiribati in 2013 [47] and Solomon Islands in 2014 [21]; hepatitis A outbreaks in Fiji in 2013 [44] and the Marshall Islands in 2016/17 [40]; and acute respiratory illness outbreaks in Fiji in 2006 [43] and FSM in 2014 [31]. Analysis of data extracted from these reports indicated that the median time from onset to detection was 17 days (range: <1 to 44 days).…”

“…The aetiological agent responsible for the outbreak was confirmed in 34 of the 39 outbreaks; 16 by domestic laboratory services alone, [13,17,21,25–30,33,35,40,44,45,48] eight via testing within the domestic setting (e.g. through use of rapid diagnostic test kits or preliminary laboratory analysis) with confirmation provided by an overseas laboratory at a later date, [19,23–25,30,34,39,41,46] and five through transport of specimens to an overseas laboratory for primary testing [20,31,37,38,47]; the location where testing was performed was not reported for five confirmed outbreaks. While the number of reports that provide details about the time between outbreak detection and aetiology confirmation was small ( n = 3) [8,32,33], it appears that at least in some cases, long delays are experienced, particularly if domestic capacity for confirmatory diagnosis was not available.…”