COVID-19 Outbreak Investigation in Herat Province Prison, Afghanistan, 2022

Respiratory Diseases
Vaccine preventable diseases

Background: COVID-19 pandemic is still not over and small pocket of outbreaks are reported in congregational settings. Case detection and control in crowded locations such as prisons are important. On July 2022, an outbreak of COVID-19 was reported from Herat prison, in western region of Afghanistan. We investigated to elucidate epidemiological features of this outbreak.

Methods: This outbreak was detected and investigated using case definitions of National Diseases Surveillance and Response (NDSR) of Ministry of Public Health for COVID-19 for suspected, probable and confirmed cases. On July, 14, 2022 an unexpected increase in number of Acute Respiratory Infections (ARI) were received from Herat prison. Five teams of Surveillance Support Teams were formed by NDSR to investigate and respond this outbreak. Line list were developed and nasopharyngeal specimen were collected and shipped to Herat Reference Laboratory (HRL) for testing SARS-CoV2 by Polymerase Chain Reaction (PCR). Data analysis was performed using Epi Info V7.2.1.

Results: There were 1450 prisoners of whom 327 (22.55%) were suspected for COVID-19 and 142 were confirmed (attack rate=9.8%). Mean age was 34.5 years with 282 (86%) males and 45 (14%) females. Fever 137(96%), headache 135(95%), sore throat 128(90%) and shortness of breath 94(66%) were the most common clinical features while only 9(6.4%) had diarrhea. Cases peaked in July 20th with decline starting from August 2nd. Poor social distancing was observed in prison cells and some cases reported meetings with their families considering no infection preventive measures such as wearing masks.

Conclusions: Majority of cases were males possibly due to predominant male population in prison. Like other settings, fever and headache were common clinical features. Being a congregational setting, prisoners and visitors should be encouraged to consider preventive measures. Optimum number of prisoners should be accommodated in cells. Early detection, reporting and response to infectious diseases is recommended.