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Hospital outbreak of Lassa fever, Aboh Mbaise, 1989

Hospital outbreak of Lassa fever, Aboh Mbaise, 1989. 20 cases, 16 deaths (80%). Effect of parenteral route: Lassa fever. 20 cases, 16 deaths, mortality 80% (vs 16%). Hafizabad. ‘Outbreak of jaundice”.

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Hospital outbreak of Lassa fever, Aboh Mbaise, 1989

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  1. Hospital outbreak of Lassa fever, Aboh Mbaise, 1989 20 cases, 16 deaths (80%)

  2. Effect of parenteral route: Lassa fever 20 cases, 16 deaths, mortality 80% (vs 16%)

  3. Hafizabad ‘Outbreak of jaundice” Marketing town of 125,000 in a fertile agricultural region of Punjab, with a single 30 bed hospital Numerous private clinics run either by ‘physicians’ or by pharmaceutical dispensers

  4. Hafizabad Hepatitis SerosurveyBackground • From July 1990 through June 1992 • 41 persons with jaundice • Among 1300 Ismailis • Some associated with end stage liver disease • No serologic data available from the population • marketing town of 125,000 in a fertile agricultural region of Punjab

  5. 1993 Hafizabad Hepatitis Serosurvey Community survey results • anti HCV antibody present 20/309 (6.5%) • anti HCV antibody absent 277/309 (90%) • anti HCV indeterminate 12/309 (4%) • We estimate there are 109 deaths each year from HCV in Hafizabad. • Cohort studies report that 30% of HCV infected persons progress to cirrhosis of whom 2.8% per year die annually of end stage liver disease. • 1.7% per year die of hepatocellular carcinoma

  6. Study of Injection Practices and Attitudes of GPs Karachi, Pakistan • 81% of patients > 20 years exiting the 22 general practitioners serving Dur Mohd Goth reported receiving injections at that visit. On only 1/12 occasions was a new syringe and needle used On 11/12 occasions the syringe was reused and in 9/12 the needle was reused. • None of the GPs, when questioned, were aware that hepatitis C could be transmitted by needles • One patient receiving an injection was observed at 12 different GP offices

  7. 44% (59/135) of patients were infected with hepatitis C (vs. general population 4-7%) • 29% (26/135) of patients were hepatitis B surface antigen positive (vs. general population 3-5%) Study of Injection Practices and Attitudes of GPs Karachi, Pakistan

  8. Steve Luby Linkage Between Unsafe Injections and Hepatitis in Pakistan • Aga Khan Health Services, Pakistan • A Shah, F Hoodbhoy, H Esan • Community Health Sciences, AKU • S Luby, O Pasha, AJ Khan, A Omair, JB McCormick • Pathology, AKU S Fisher-Hoch, K. Qamruddin

  9. The new vectors A little knowledge can be a dangerous thing. Modern medicine without adequate education.

  10. insufficient water: quality and quantity Crumbling infrastructure

  11. Cholera in Karachi In 1993 there were concurrent epidemics of serogroups 01 and 0139

  12. Rate of multi-drug resistant S. typhi, AKU laboratory, 1990 - 1994.

  13. Age of patients with S. typhi bacteremia, AKU laboratory, 1990 - 1994 32% of all laboratory blood culture isolates were S. typhi. A further 5% were S. paratyphi

  14. Tuberculosis in Karachi (HIV prevalence >>0.001%) 25% were resistant to two or more drugs

  15. environmental pollution: • ill-maintained motor vehicles • industries • unmanaged solid wastes.

  16. Social impacts: • Violence • Accidents • Drugs

  17. economic impacts • low industrial productivity • illness • absenteeism

  18. Augsburg, 2001 Est. pop 1535: 25,800

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