Febrile illness outbreak investigation in sundarharicha-5, Foklan tapu Morang District.

Research Report.

SUMMARY: On the date of 24 July 2017, the major national daily newspapers reported that there were two death cases from unknown disease were found in the Morang district, Sundarharicha Municipality 5, Foklan Tapu. According to news, the death cases were the 14-year-old male child and 5-year-old female child. The common symptom of the disease was fever, coryza, headache, drowsiness. Addressing the outbreak, a descriptive study was conducted with the team of experts in affected area to investigate and identify the etiological and epidemiological causes, how this happens in the outbreak area for the period of July 2017 to December 2017. Verbal Autopsy (VA) and Key in-depth guidelines were used to identify the major causes of febrile illness. Verbal autopsy interview and Key in-depth interview was done and once the diagnosis was confirmed the patient (134 patients, 37 household) was sent for the further full treatment also. The leptospirosis to a human being is contracted through the contaminated urine of infected domestic and wild animals. The disease is common in summer and rainy season. Socioeconomic factors, environmental conditions, and geographical areas are the associated with the risk factors of Leptospirosis. Leptospirosis is a widespread water-borne spirochetal zoonotic disease caused by leptospires. The analysis was done in SPSS Statistics 20 version. Descriptive and inferential statistics was done to determine the association of major risk factors to the disease occurrence. Qualitative data (VA and KII) was analyzed manually. Ethical approval was obtained from ethical review board at the NHRC (Reg. no. 382/2017) on expedited process according to the outbreak investigation provision of national ethical guidelines. Findings suggested that out of 83 blood samples 5 were antibody G and antibody M positive for leptospira, 20% were exposed to respiratory illness and three participants below 9 years have fA (H1N1) Pdmo9. Study suggested that large portion i.e. 49% were Igm positive, 375 were Igm negative where as 13% stayed equivocal. Total of 87% of participants were found exposed to domestic animals including pets, 20% exposed to insects bites, 15% with closed exposure with swine and 2.4% exposed to animal necropsy. Participants were found 8.4% with receiving regular immunization vaccine, 1.2% received influenza vaccine and 1.2% were on medications. Research hence concluded that not just exposure to ill contributed to the risk of developing illness but also increases the risk of infection. Also, Leptospira was responsible agent for the manifestation of an outbreak. Raising awareness of disease patterns and epidemiology of incidence may enrich practices of prevention of leptospirosis. This research finding could be used by concerned stakeholders in emergency and outbreak response to manage risk factors at outbreak sites. This finding may be used for further to assessing the capacity of outbreak response teams, to provide an evidence-based for planning and allocating outbreak management and public health resources and the overall disease burden of leptospirosis.