Establishing Influenza Surveillance in Two Refugee Camps in Kenya, 2006–2008
Session I – Ahmed, Jamal
Establishing Influenza Surveillance in Two Refugee Camps in Kenya, 2006–2008
Ahmed, Jamal;1 Bunei, Milka;1 Kahi, Vincent;2 Pruess, Felicitas;3 Njenga, Kariuki;1 Muthoka, Phillip;4 Kalani, Rosalia;4 Musulo, Isa;5 Burton, John Wagacha;5 Qassim, Mohamed;5 Burke, Heather;6 Kapella, Bryan;6 Baer, Carolyn;1 Breiman, Robert;1 Weinberg, Michelle;6 Eidex, Rachel;1 Katz, Mark1
1 Global Disease Detection Division, CDC-Kenya; 2 International Rescue Committee; 3 German Technical Corporation; 4 Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Kenya; 5 United Nations High Commission for Refugees; 6 Division of Global Migration and Quarantine, CDC
Background: Dadaab and Kakuma refugee camps in Kenya house nearly 300,000 refugees. Acute respiratory infections (ARI) are leading causes of both morbidity and mortality in these camps and the contribution of influenza to this syndrome is unknown. To guide prevention and therapeutic strategies, the burden and etiologies of respiratory disease must be established. CDC in collaboration with United Nations High Commissioner for Refugees, German Technical Cooperation and the International Rescue Committee, built upon Kenya’s national influenza surveillance system to establish influenza surveillance with enhanced diagnostic capacity in both refugee camps.
Methods: We targeted patients with ARI visiting inpatient and outpatient medical facilities at each camp. Health-care workers were trained in national standardized case definitions for ARI including suspected avian influenza (SAI). For patients meeting these case definitions who visited inpatient and outpatient medical facilities, a questionnaire was administered, and combined nasopharyngeal and oropharyngeal swab samples were taken. Specimens were tested for influenza A and B by real-time RT-PCR in Nairobi.
Results: From May 2007 through September 2008, 1,368 samples submitted from Dadaab refugee camps were tested for influenza A and B. Of these, 4.8% were positive for influenza A and 3.7% for influenza B. Peak months for Dadaab were December 2007 (influenza A at 26.3%) and May 2007 (influenza B at 25.0%). From October 2006 through September 2008, 2,182 samples submitted from Kakuma refugee camp were tested for influenza A and B. A total of 5.7% were positive for influenza A and 4.5% for influenza B. Peak months for Kakuma were February and March 2008 (influenza A at 25.0%) and April 2007 (influenza B at 20.3%). One patient with SAI was identified at Kakuma and was determined to be negative for avian influenza.
Conclusions: A sentinel surveillance system for influenza was effective in identifying patients with influenza at two refugee camps in Kenya. Sentinel surveillance systems can be implemented in refugee camp settings to establish baselines of specific pathogens, monitor trends, help detect clusters of respiratory illness, and guide prevention strategies.
