Investigating outbreaks of initially unknown aetiology in complex settings: findings and recommendations from 10 case studies

International Health · 6 authors, 6 centres

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TL;DR

This study retrospectively reviewed 10 outbreaks of unknown cause in African and Asian settings to identify challenges and best practices for investigation.

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The investigations were documented through interviews with involved personnel and triangulated with available documents. Common challenges across investigations included incomplete or delayed patient descriptions, comorbidities confounding clinical pictures, incorrect case definitions, and limited capacity for sample shipment. The study did not identify specific activities that led to prompt cause identification. Limitations include potential recall gaps and reliance on non-verified accounts.

STUDY TYPE

other

SPECIALTY

epidemiology

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ORIGINAL PAPER

PMC10472873

Investigating outbreaks of initially unknown aetiology in complex settings: findings and recommendations from 10 case studies

International Health

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ABSTRACT

Abstract Background Outbreaks of unknown aetiology in complex settings pose challenges and there is little information about investigation methods. We reviewed investigations into such outbreaks to identify methods favouring or impeding identification of the cause. Methods We used two approaches: reviewing scientific literature and soliciting key informants. Case studies were developed through interviews with people involved and triangulated with documents available from the time of the investigation. Results Ten outbreaks in African or Asian countries within the period 2007–2017 were selected. The cause was identified in seven, of which two had an unclear mode of transmission, and in three, neither origin nor transmission mode was identified. Four events were caused by infectious agents and three by chemical poisoning. Despite differences in the outbreaks, similar obstacles were noted: incomplete or delayed description of patients, comorbidities confounding clinical pictures and case definitions wrongly attributed. Repeated rounds of data collection and laboratory investigations were common and there was limited capacity to ship samples. Discussion It was not possible to define activities that led to prompt identification of the cause in the case studies selected. Based on the observations, we conclude that basing case definitions on precise medical observations, implementing initial comprehensive data collection, including environmental, social and behavioural information; and involving local informants could save precious time and hasten implementation of control measures. Keywords: communicable diseases, data collection, falsified drugs, low- and middle-income countries, outbreak, poisoning

CITATION EXPORT

Anne Perrocheau, Freya Jephcott, Nima Asgari-Jirhanden et al.. Investigating outbreaks of initially unknown aetiology in complex settings: findings and recommendations from 10 case studies. International Health. (2023). https://doi.org/10.1093/inthealth/ihac088

AUTHORS

6 · 6 CENTRES

Anne Perrocheau, Freya Jephcott, Nima Asgari-Jirhanden, Jane Greig, Nicolas Peyraud, Joanna Tempowski

1 Health Emergencies Programme, World Health Organization, Geneva 1211, Switzerland
2 Health Emergencies Programme, World Health Organization, Geneva 1211, Switzerland
3 Asia Pacific Observatory on Health Systems and Policies, World Health Organization, New Delhi 110 001, India
4 Manson unit, Médecins Sans Frontières, London EC4A 1AB, UK
5 Médecins Sans Frontières International, Geneva 1211, Switzerland
6 Chemical Safety and Health, World Health Organization, Geneva 1211, United Kingdom