Visceral Leishmaniasis That Went Undetected; a Revelation of an Outbreak Investigation in Tharaka Nithi County, Kenya, 2021
Background: Visceral Leishmaniasis (VL), with a case fatality rate (CFR) of 95% if untreated, is endemic in 9 of 47 counties in Kenya. Between January 2020 and August 2021, Kenya reported 1,152 VL cases with 10 facility deaths (CFR 1%). Tharaka Nithi County, a non-endemic VL county, reported 18 suspected VL cases in September 2021. We sought to establish the magnitude of VL and inform public health response in Tharaka Nithi County.
Methods: We conducted the investigation in Tharaka North Sub-county from October 29, 2021, through November 3, 2021. A confirmed case was defined as a person with clinical signs and symptoms of VL, whose blood sample turned positive with Rk39TM or Direct Antigen Test (DAT) between January 2019 and October 2021. Through community health volunteers and snowballing, we actively searched for cases in the community within the sub-county, reviewed personal medical records, and administered a semi-structured questionnaire. Data were analyzed using descriptive statistics.
Results: A total of 32 confirmed VL cases were identified, with 28 (88%) being male. Median age was 24 years (Interquartile Range [IQR]: 4–59 years). Age groups 5–14 years old and those above 40 years old contributed 10 (31%) cases each. Three active cases were linked medical care. Clinical symptoms included abdominal swelling (74%), general malaise (44%), significant weight loss (44%), poor appetite (44%), and fever (38%). Kathangacini sub-location was the epicentre with 50% of cases. The index case was identified in a neighbouring county in March 2019, and 84% of all cases had been identified and treated without being reported in county surveillance reports.
Conclusions: VL cases were confirmed in the county, with the disease going undetected for more than 2 years. The disease mostly affected males and those in the youthful age group. We conducted training on VL diagnosis and case management for 24 health care workers.