@article{8c7f6979f6244a07806ef12d09862cd8,
title = "A study of viral and rickettsial exposure and causes of fever in juba, southern sudan",
abstract = "Patients presenting at the Juba Teaching Hospital, either with fever of undetermined origin or with a clinical cause of fever, gave evidence of exposure to a wide range of viral and rickettsial agents. Serological tests showed high antibody levels to flaviviruses (56·9%) and alphaviruses (29·2%), with lesser levels of bunyamweraviruses (3·8%), Rift Valley fever (2·3%), and sandfly fever (0·75%). Flavivirus exposure was significantly associated with clinical evidence of liver disease; repeated exposure to flaviviruses was particularly prevalent in those with poor sanitation and who had received previous injections. A significant focus of Ebola and Marburg exposure in Juba has been identified. Clinical evidence of liver disease was evident in 37% of patients studied, and 24·6% were HBsAg positive. The first 2 HIV-positive individuals from the southern Sudan are reported, including one with clinical AIDS. A high prevalence of positive antibodies to Rickettsia typhi in the population indicated that murine typhus was common locally. This study indicates the need for further public health measures in the southern Sudan to control the spread of these infections.",
author = "Woodruff, {P. W.R.} and Morrill, {J. C.} and Burans, {J. P.} and Hyams, {K. C.} and Woody, {J. N.}",
note = "Funding Information: P. W. R. Woodru.@*, J. C. Morrill{\textquoteright}, J. P. Burans{\textquoteright}, K. C. Hyams{\textquoteright} and J. N. Woody{\textquoteright} {\textquoteleft}US Naval Medical Research Unit No. 3, Cairo, Egypt, Fleet Post Office, New York, 09527-1600, USA; {\textquoteleft}International Health Program, University of Maryland, Baltimore, USA (in collaboration with the University ofJuba Medical School Department of Medicine and the Ministry of Health, Southern Sudan) Abstract Patients presenting at the Juba Teaching Hospital, either with fever of undetermined origin or with a clinical cause of fever, gave evidence of exposure to a wide range of viral and rickettsial agents. Serological tests showed high antibody levels to flaviviruses (56.9%) and alphaviruses (29*2%), with lesser levels of bunyamweraviruses (3*8%), Rift Valley fever (2.3%), and sandfly fever (0.75%). Flavivirus exposure was significantly associated with clinical evidence of liver disease; repeated exposure to flaviviruses was particularly prevalent in those with poor sanitation and who had received previous injections. A significant focus of Ebola and Marburg exposure in Juba has been identified. Clinical evidence of liver disease was evident in 37% of patients studied, and 24.6% were HBsAg positive. The first 2 HIV-positive individuals from the southern Sudan are reported, including one with clinical AIDS. A high prevalence of positive antibodies to Rickettsia typhi in the population indicated that murine typhus was common locally. This study indicates the need for further public health measures in the southern Sudan to control the spread of these infections. Funding Information: We that&especiallyth elate Dr E. T. W. Bowen,a nd the technical staff at the Public Health Service Laboratory Centre for MicrobiologicalR esearch,P orton Down, England, for performinga rbovirala ssayso n the samplesa nd for giving much expert advice. We also thank Dr S. Y. Ambajoro,M inistry of Health, EquatoriaRl egion,S udanf or permissiont o publish theser esults.L aboratorya ssistance from Dr A. Soliman,D r A. Salib and Mr J. Gonzalezi n performingt estsa t NAMRU-3 is gratefullya cknowledged. We thankD r I. El Attar for statisticahl elp and Dr A. Main (NAMRU-3) and Dr G. T. Strickland( MarylandU niversi-ty) for advice and comments. This study was supportedb y NMRDC, Bethesda,M D work unit no. 3M161102BSlO.AA.421 and no. 3M46310SDH29.AA.002T.h e opinionsa nd assertioncso n- to be construeda s officialo r as reflectingt he views of the Departmento f the Navy, the naval servicea t large or the SudaneseM inistry of Health.",
year = "1988",
month = sep,
doi = "10.1016/0035-9203(88)90229-5",
language = "English (US)",
volume = "82",
pages = "761--766",
journal = "Transactions of the Royal Society of Tropical Medicine and Hygiene",
issn = "0035-9203",
publisher = "Oxford University Press",
number = "5",
}