Rift Valley Fever Outbreak during COVID-19 Surge, Uganda, 2021

Abstract

R ift Valley fever (RVF), a zoonotic mosquitoborne disease of livestock caused by Rift Valley fever virus (RVFV), is endemic throughout most of Africa and the Arabian Peninsula (1,2). Humans can be infected with RVFV through contact with blood, body fluids, products from infected livestock, or bites from infected mosquitoes (1,3). No human-to-human transmission has been documented (4). In humans, infections are typically asymptomatic or result in mild influenza-like illness (1). Severe illness, including hemorrhagic manifestations, occurs in ≈1%-2% of cases; the case-fatality rate among severe cases is ≈10%-20% (1,5). No approved human vaccine or specific treatment is available, but early supportive care may prevent complications and decrease death (1). In livestock, RVFV infection can cause abortions and high mortality, leading to substantial economic losses (1,6). We describe a fatal human case of RVF and the subsequent investigation and identification of 6 additional cases in Kiruhura District, Uganda, in 2021. We also note the role a COVID-19 surge played in delayed testing and patient care. The StudyOn May 7, 2021, fever, headache, fatigue, arthromyalgia, nausea, vomiting, and diarrhea developed in a previously healthy woman 19 years of age (P1), who sought treatment at a private clinic in Kinoni Subcounty, Kiruhura District, Uganda (Figure 1). She was treated empirically for malaria with no improvement. On May 9, after hematemesis developed, she sought treatment at and was admitted to another local private clinic. On May 11, the patient was transferred to the regional referral hospital in Mbarara District for further disease management (Figure 1). Anuric acute kidney injury, chest pain, and respiratory distress complicated her hospital course. She was transferred by ambulance the same day to the national referral hospital in Kampala (Figure 1) for critical care but was not admitted because the hospital had no available dialysis unit. She was subsequently referred to a nearby nonprofit private hospital but was not admitted because the intensive care unit was at capacity with patients with COVID-19. During transfer, P1's clinical status deteriorated, and her hemorrhagic signs worsened.On May 12, she was admitted to a private tertiary hospital with fever (38.0°C), jaundice, epistaxis, ecchymoses, gingival hemorrhage, respiratory distress, hypotension, focal seizures, and altered mentation. At admission, she was thrombocytopenic and anemic with deranged liver and renal function and electrolyte abnormalities (Table ). The clinical team suspected a viral hemorrhagic fever (VHF) and collected blood for testing at the Uganda Virus Research Institute (UVRI). The patient died on May 13. UVRI testing confirmed RVFV infection by realtime reverse transcription PCR (rRT-PCR) (7) and

The Re-Emergence of Rift Valley Fever in Mananjary District, Madagascar in 2021: A Call for Action

“…In Kenya, a significant delay in the detection of suspected and confirmed cases was attributed to the low sensitivity of passive surveillance, which is used for RVF surveillance [ 22 , 23 ]. In Uganda, during the COVID-19 pandemic in 2021, delays in accessing healthcare centers for patients with RVF were reported [ 24 ]. In Madagascar, a delay may be attributed to the concurrent occurrence of the RVF outbreak and the COVID-19 wave observed during the first months of 2021 [ 25 , 26 ].…”

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Computational prediction of phytochemical inhibitors against the cap-binding domain of Rift Valley fever virus

“…The World Health Organization (WHO) has expressed the need to accelerate research and development towards effective therapies and vaccines against RVFV, since the virus has potential to cause world-wide outbreak and public health emergency [10,11]. During the COVID-19 pandemic, there are also reports of Rift Valley fever outbreak in Uganda [12], and more recently in Mauritania [13]. Although, the overall documented human mortality rate for RVFV infections is less than 1% [14], in the case of severe infection, the human mortality rate can steeply increase to 10-20% [15].…”