title: A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012.
abstract: In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.
authors.affiliation: Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. umulisa5@gmail.com.
authors.forename: Irenee
authors.initials: I
authors.lastname: Umulisa
authors.affiliation: CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Jared
authors.initials: J
authors.lastname: Omolo
authors.affiliation: University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Condo
authors.affiliation: Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.
authors.forename: Francois
authors.initials: F
authors.lastname: Habiyaremye
authors.affiliation: Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Uwimana
authors.affiliation: Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Marie Aimee
authors.initials: MA
authors.lastname: Muhimpundu
authors.affiliation: CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Tura
authors.initials: T
authors.lastname: Galgalo
authors.affiliation: Rwanda Field Epidemiology and Laboratory Training Program, School of Public Health, University of Rwanda, Kigali, Rwanda. Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rwunganira
authors.affiliation: CTS Global assigned to U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Anicet G
authors.initials: AG
authors.lastname: Dahourou
authors.affiliation: Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Eric
authors.initials: E
authors.lastname: Tongren
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Koama
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McQuiston
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Pratima L
authors.initials: PL
authors.lastname: Raghunathan
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Massung
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Wangeci
authors.initials: W
authors.lastname: Gatei
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Kigali, Rwanda.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Boer
authors.affiliation: Epidemic Infectious Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Thierry
authors.initials: T
authors.lastname: Nyatanyi
authors.affiliation: University of British Columbia, Vancouver, Canada. University of Ottawa, Ottawa, Canada. Stanford University, Stanford, California.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.affiliation: Ministry of Health Rwanda, Kigali, Rwanda. Harvard Medical School, Boston, Massachusetts. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D018413:Bartonella quintana / Q000302:isolation & purification* / Q000472:pathogenicity; D016022:Case-Control Studies; D060085:Coinfection; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D008003:Phthiraptera / Q000382:microbiology*; D012047:Rehabilitation Centers; D012283:Rickettsia prowazekii / Q000302:isolation & purification* / Q000472:pathogenicity; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D016019:Survival Analysis; D014205:Trench Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D014438:Typhus, Epidemic Louse-Borne / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission