In northern Kenya’s Marsabit County, nomadic farmers herd their animals to water sources across grazelands prone to drought and flooding.
Agriculture is the livelihood of more than 80% of Kenya’s population. It contributes to one-third of the country’s gross domestic product.
Farmers’ livelihoods, the national economy and the region’s food supply depend on preventing disease outbreaks among livestock.
When Marsabit County’s livestock — and people — experienced an infectious disease outbreak last year, FHI 360 and our collaborators helped address the outbreak and provided insight into how to improve future responses.
A mosquito-borne pathogen
After four consecutive drought seasons, Marsabit and neighboring counties were pounded with torrential El Niño rains in late 2023. Flooding ensued.
Rainfall and flooding can increase mosquitoes, which spread diseases such as Rift Valley fever when they bite animals. Infected animals can then transmit the virus to people who handle their blood or tissue.
In adult animals, Rift Valley fever’s mortality rate is around 20%, and it causes the loss of nearly all livestock pregnancies. In humans, while the morality rate is low, more severe cases can cause encephalitis, hemorrhagic fever and/or blindness.
The World Health Organization lists Rift Valley fever as a priority pathogen because of its epidemic potential and because a vaccine only exists for animals.
Prevent, detect and respond
Kenya, where Rift Valley fever is endemic, is identified as a priority country for infectious disease control by the Global Health Security Agenda.
To help Kenya and 16 other priority countries improve their ability to prevent, detect and respond to infectious diseases, FHI 360 leads the Enhancing Global Health Security (EGHS) project.
EGHS, which began in 2020, is funded by the U.S. Centers for Disease Control (CDC). The CDC provides technical assistance as part of its endeavor to protect human and animal health worldwide.
The EGHS project works to improve countries’ abilities to detect priority infectious diseases and strengthen disease surveillance systems for more effective outbreak responses.
Enacting prevention measures
Marsabit County’s Rift Valley fever outbreak was not a complete surprise.
Kenyan public health authorities, with assistance from FHI 360, had been mapping weather patterns and anticipated that El Niño rains would increase the risk of an outbreak.
So, they notified and trained communities about the risk and symptoms of Rift Valley fever. They used maps of area slaughterhouses to identify communities at high risk and made efforts to vaccinate livestock.
Responding to the outbreak
In early 2024, a farmer arrived at the Marsabit County Referral Hospital with a fever. She was the first person to be diagnosed with Rift Valley fever.
Health care workers were already on alert, as they had been notified about an outbreak in camels. The hospital notified the county surveillance officer of the suspected case, who then alerted public health authorities.
Throughout the process of detecting the disease, notifying authorities and responding, FHI 360 worked closely with the CDC Kenya office and supported the Kenyan Ministry of Health and county-level public health authorities to strengthen Kenya’s infectious disease surveillance systems.
FHI 360 leveraged the Field Epidemiology and Laboratory Training Program, a partnership between country ministries of health and CDC field offices that trains early career epidemiologists in outbreak investigation, to quickly deploy personnel to support the Marsabit county team.
Applying the 7-1-7 framework
To provide recommendations for what can be improved in Marsabit County’s response to the outbreak, FHI 360 and the African Field Epidemiology Network (AFENET) analyzed the response using the 7-1-7 framework.
Developed by the nonprofit Resolve to Save Lives, the 7-1-7 framework provides simple, time-based targets to identify opportunities and bottlenecks when responding to disease outbreaks. Entities should detect an outbreak within seven days, notify public health authorities within one day, and initiate an effective response within seven days.
Using the framework helped FHI 360 and local colleagues assess and adjust the Rift Valley fever response in real time. For example, they found that Marsabit County’s chief obstacle to meeting the 7-1-7 target was the delay in testing. Specimens were being sent to the national testing laboratory over 300 miles away in Nairobi.
The analysis revealed that a Marsabit County laboratory could test for Rift Valley fever, but it lacked adequate supplies of testing chemicals. So, the county health authorities committed to supplying the chemicals.
While Marsabit County reported animal illnesses and deaths, the outbreak was contained quickly, and no human deaths were reported.
Furthermore, the exercise of applying the 7-1-7 framework and the subsequent analysis already has yielded dividends. Since the Rift Valley fever outbreak, Kenya’s public health authorities have applied the 7-1-7 target to outbreaks of malaria and anthrax.
One world, One Health
The response to Marsabit County’s Rift Valley fever outbreak took a One Health approach, defined by the CDC as recognizing “that the health of people is closely connected to the health of animals and our shared environment.”
As the climate crisis causes more spread of disease, animal-transmitted diseases are expected to increase and enter new geographic areas.
“The investigation in Marsabit County illustrates the importance of collaboration between the animal health sector and the human health sector,” says Mungai Ndung’u, country representative for Kenya on FHI 360’s global health security team. “Continuing to support these types of investigations will strengthen the One Health approach worldwide.”
The U.S. Centers for Disease Control and Prevention (CDC) logo is a trademark owned by the U.S. Department of Health and Human Services (HHS) and is used with permission. Use of the CDC logo is not an endorsement by HHS or CDC of any enterprise, or its products or services. Any views expressed are those of the owners of the materials and do not necessarily represent the views or policies of HHS or CDC.
The Enhancing Global Health Security project is a five-year project funded by CDC. FHI 360 leads the project, with a consortium composed of PATH, CRDF Global, and the Association of Public Health Laboratories. The consortium collaborates with regional and national stakeholders, country Ministry of Health directorates, and international and national partners.
In Kenya, CDC supports the national laboratory testing facilities at the Kenya Medical Research Institute (KEMRI) through the Diagnostic and Laboratory Systems Program (DLSP), where specimens from across the country can be sent for confirmatory testing. Additionally, CDC Kenya supports the Integrated Facility-Based Surveillance (IFBS) program, which played a vital role in rapid case investigations at the Marsabit County Referral Hospital.
For more information on the outbreak response, a technical brief is available.
