LEVEL 2 CASE 2

Problem title: WASHED OUT

Investigator: Brent Ronald S. Almerol
Number sick: 828
Hospitalizations: 213
Deaths: 55
Location: Ethiopia
Overview:
3 refugees from South Sudan have symptoms of fever, fatigue, nausea, and yellow eyes
have died in the past week, and more might be sick with the same symptoms.
Steps that were taken in investigating the outbreak:
1. Refugees in camp Jengo is concerned with the overcrowding, flooding, and the
recent deaths of 2 pregnant women and 1 child. All the 3 patients were reported to
have the following symptoms:
 Yellow eyes (jaundice)
 Fever
 Fatigue
 Nausea
2. The Ethiopian refugee camp Jengo has surged to over 100,000 refugees,
coinciding with the onset of heavy rains and flooding. The United Nations’ High
Commissioner for refugees is working to assess the public health and WASH need
of the population (Water, Sanitation, and Hygiene).
3. The investigators assess the camp, and gathered data to know the source of the
outbreak.
4. According to the data:
 The camp experienced heavy rains and have led to swarms of mosquitos
and standing water surrounding refugees’ tents.
 Flooding in the camp has caused the few latrines (a toilet or outhouse) to
flood, contaminating the groundwater supply with feces.
5. Camp doctors suspect that the deaths are from yellow fever or malaria, which are
common illnesses in the region.
6. The doctors can’t make a final diagnosis, they are overwhelmed with people who
are sick. For now, they are treating all patients by giving them oral rehydration
solution. Sicker patients are hospitalized for IV fluid replacement.
7. The investigator analyse the information about the people who have become sick
with jaundice. There are 11 patients have been diagnosed with jaundice and 7
have died, but only 4 of the 11 patients have tested positive for malaria.

8. According to the data, pregnant women are more seriously affected by jaundice.
9. As investigation continues, the community health workers have surveyed almost
400 people in the camp about hygiene and sanitation practices.
10. After analysing, the inadequate number and use of latrines, contaminated drinking
water, and lack of good hand hygiene all contribute to the diarrhea problem in the
camp.
11. After two months, several more patients have jaundice again after the number of
cases of diarrhea and jaundice begins to fall. More pregnant women are dying
again.
12. The new group of people arriving in the camp have not been exposed to the virus,
therefore, they do not have immunity and is in danger of infection.The investigator
studied once again the epi curve, and it shows the number of cases over a 3-month
period of time.

13. The team tried again to get lab results. The investigators collected more blood
samples and make sure that they are properly packed.
14. The lab test results are finally out and it turns out the mysterious disease was
Hepatitis E.
 15. The investigators wrote a report with recommendations for controlling Hepatitis E,
and began to look at the key risk factors.
16. The investigator analyse the data again to see what the cases have in common.
The table shows that adults between 25-54 years old are most likely to be infected.

17. There is a
possibility that Hepatitis E will surge again because of remote control areas, there
are lack of equipment and people could be in danger and continue to be infected.

Discussion:

Step 10 is the most important part, because after identifying what contributes to the
problem, the authorities has taken action to it. The authorities added latrines, clean
drinking water, and hand washing sanitations in order to improve the overall health of the
refugees in the camp.
Results:

 After the next trial of lab results, it was confirmed that Hepatitis E was the
mysterious disease.
 There is no specific treatment for Hepatitis E, but the authorities are doing projects
in order to reduce and prevent diseases.
 The authorities continued to carry out improving water, sanitation, and hygiene
projects.
Reflection:

After studying and investigating this case, Hepatitis E or any disease should always be
taken into action immediately after its too late. My realization to this, is that we should
always practice proper hygiene, proper hand hygiene, drink clean water, and always
improve sanitation because we don’t know what kind or microorganisms are there in an
unfiltered water and other contaminants. We should always prioritize our health above
anything.