An Outbreak of Hemorrhagic Symptoms –Behira Governorate, Egypt, 2018

  • Occupational and environmental health
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Background:
On June 17, 2018, the hot line of the emergency unit of Ministry of Health and Population preventive sector was notified of cluster of 13 cases with coagulopathy and hemorrhagic diathesis in a village in Lower Egypt. Cases were from one extended family living in three adjacent houses. Recently many outbreaks of hemorrhagic fevers were announced in near African countries. Epidemiological investigation was conducted to confirm outbreak, identify causative agent and implement control measures.

Methods:
Active case finding was performed in the village households and patients’ medical records reviewed in two hospitals where patients admitted for treatment. Cases were defined as anyone having hemorrhagic symptoms with or without fever during last 12 months. Patients were interviewed using questionnaire that include demographic information, signs and symptoms, history of hemorrhagic genetic disorders. Household observation and environmental investigations were conducted. Patients’ blood collected and tested for Q fever, Chikungunya and Rift Valley by ELISA and PCR, while environmental samples tested for inorganic toxins.

Results:
A total of 18 cases with hemorrhagic symptoms were detected. Their median age was 15 (Range: 2-63 years), and 12 (66.7%) were females. The index case occurred back in November 2017. Symptoms included subcutaneous hemorrhage in 17 (94.4%), hemolytic anemia 14 (77.8%), hematuria 12 (66.7%), nose and gum bleeding 9 (50.0%), and intracranial hemorrhage in 3 (16.7%) with no fever or genetic disorders reported. Same type of rodenticide was observed at the kitchens of affected households. Blood samples were negative for arboviruses, bromadiolone was detected in wheat sample. Patients treated with Vitamin K orally or intravenously 15 (83.3%) and blood transfusion in 3 (16.7%), no deaths reported.

Conclusion:
An outbreak of bromadiolone rodenticide poisoning reported in a Village in Lower Egypt. Community health education is essential for proper safe handling of rodenticides and pesticides to prevent such serious incidents.

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