Outbreak of Influenza Type A (H1n1) in Kumasi Academy

Kumasi Academy was struck with an unusual health event resulting in the death of four (4) of the students.

The Ministry of Health / Ghana Health Service (GHS) received notification on the 1st December, 2017, concerning death of two students in Kumasi Academy Senior High School (KUMACA) in Ashanti Region, which occurred a day before 30th November, 2017.

The Health Sector immediately (1st December, 2017) activated and deployed a multi-disciplinary Rapid Response Team to start response actions to the threat with the following terms of reference;

  1. Provide Technical and logistics support
  2. Verify the report and identify the underlying factors
  3. Prevent further spread and contain the situation

All the cases first reported at the school infirmary and subsequently referred to KNUST Hospital and other Hospitals. The index (first) case died just about three hours on admission to the hospital and the second case died before arrival to the hospital.

Symptoms were initially mainly fever, headache, neck pains and a few reported of stiff neck. Based on the symptoms and signs of the first cases; coupled with similar event that occurred in April this year in which Meningitis (Neisseria meningitides type C) was confirmed as causative agent, meningitis was highest on the working diagnosis.

On the 02 Dec 2017, autopsy or postmortem was done on the first death and findings revealed features of internal bleeding.  Consequently, Acute Viral Haemorrhagic Fever (VHF) was considered in the differential diagnosis. Again, appropriate samples (blood and cerebrospinal fluid (CSF) were taken, adequately packaged and sent to Noguchi Memorial Institute Medical Research, Kumasi Centre for Collaborative Research, and Public Health Reference Laboratory for laboratory assessment and all were negative for meningitis and VHF. On the 4th day, more cases were reported and this time, the symptoms and signs were suggestive of acute respiratory infection with Fever, Cough, Catarrh, Sore throat, and a few with abdominal symptoms. Based on these new findings, appropriate samples were taken and sent to National Influenza Centre at NMIMR and less than 24 hours, the test confirmed Influenza type A (H1N1). Within six (6) hours upon receipt of the laboratory confirmation, joint press briefing was done by the Ministries of Health and Education to provide information to the public

Though the causative agent has been confirmed to be viral, the cases on admission responded well to antibiotics (probably secondary bacterial infections were present); in this regard, mass chemoprevention using safe and effective antibiotic was given to the student population.

 

CHALLENGES

  1. Panic and parents’ demands resulting in dispersal of majority of the students from the school
  2. Media misinformation
  3. Politicization of events
  4. Spiritualization of the outbreak

 

Way forward

  1. Take immediate steps to access vaccines and antiviral agents as part of response measures
    1. The MoH / GHS / MoE met with the WHO soon after the press brief and arrangement have been made to procure and air lift the anti-viral agent (Tamiflu) and vaccine for use.
  2. Alerts has been sent to all the regions, districts and facilities to enhance surveillance and strengthen systems for prevention, early detection and timely response.
  3. Structured contact management to ensure early detection and minimize secondary and tertiary transmission
  4. Enhance School Health by:
    1. designating a hospital for each second cycle institution and
    2. conducting detailed health screening to obtain adequate health profile for each student an admission
  5. Provide adequate resources (funding, logistics etc) for the management of the outbreak and preposition resources and logistics including PPEs
  6. Conduct National Technical Coordinating (NTCC) meeting to brief and strategize with all relevant stakeholders including international partners
  7. Intensify public education with the aim to prevent further spread and minimize fear and panic
  8. Arrangements have been made for team of pathologists to conduct autopsy on the rest of deceased. This will compliment earlier findings.
  9. The Ministries of Health and Education and the Ghana Health Service and the Ghana Education Service do recommend that students should remain on campus to enable final conclusions on response actions.
  10. Steps should be taken to enhance school health at Kumasi Academy and nation-wide
  11. Strengthen case management including strict adherence to Infection Prevention and Control measures procure antiviral agents (TAMIFLU) for case management
  12. Complete all outstanding laboratory investigations and autopsy
  13. Sensitization on outbreak response at next PTA meeting

 

CONCLUSION

An outbreak of Acute Respiratory Illness has been confirmed in Kumasi Academy (Senior High School). The outbreak began on 30 November 2017. As at Saturday (09/12/2017), a total of 77 incident cases including four (4) deaths have been reported resulting in attack rate of 25.5 per 1,000 population and Case Fatality Rate of 5.2%.  Sixty-two (62) have been treated and discharged, eleven (11) are currently on admission and are in stable condition.

The response actions have been swift and effective; and the situation is being contained.

 

ACKNOWLEDGEMENT

We appreciate the support and collaboration from the following;

  • World Health Organization
  • Centers of Disease Control and Prevention
  • Noguchi Memorial Institute for Medical Research
  • Kumasi Center for Collaborative Research
  • Staff of the Ministry of Health
  • Staff of the Ministry of Education
  • Staff of Ghana Health Service
  • Staff of Ghana Education Service
  • Staff of Regional Coordinating Council – Ashanti Region
  • Staff and students of Kumasi Academy
  • The Media