Paederus Dermatitis Outbreak in Addis Ababa, Ethiopia: A Case-Control Study

BACKGROUND: Paederus dermatitis is an irritant contact dermatitis caused by crushing insects of the genus Paederus, which releases a vesicant toxin called pederin. On July 28, 2018, the district health office received a report of cases with erythema, itching, and burning after contact with the Paederus insect. In response, we investigated the outbreak intending to describe, confirm, and identify the risk factors associated with the country's first reported outbreak. METHODS: A community-based unmatched case-control study was conducted from August 10 to 22, 2018. Two hundred twenty-five (75 cases and 150 controls) study participants were involved in the study. Cases were defined as Bole subcity residents who had acute contact dermatitis after contact with the insect, while controls were persons who did not have contact with the insect. Cases were recruited consecutively as they present, whereas controls were selected by the neighborhood sampling method. An interviewer-administered questionnaire was used for the data collection, and multiple logistic regression was applied to determine the independent risk factors. The results were expressed as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS: A total of 122 cases were reported from the three districts of the subcity. The mean age of cases and controls was 23.6 (SD ± 16.4) and 29.4 (SD ± 10.9) years, respectively. Multivariate analysis showed that the presence of outdoor light (AOR = 5.1; 95% CI (2.5, 10.9), presence of rotten leaves (AOR = 6.4; 95% CI (2.9, 15.7)), sleeping on the floor (AOR = 6.1; 95% CI (2.5, 15.7)), wearing protective clothing (AOR = 0.2; 95% CI (0.1, 0.4)), and use of insect repellant (AOR = 0.1; 95% CI (0.0, 0.4)) were significantly associated with Paederus dermatitis outbreak. CONCLUSION: The investigation identified exposure to artificial light and the presence of rotten leaves around the residential area as important factors leading to an increase in the odds of Paederus dermatitis. In contrast, the use of insect repellant and wearing protective clothing were shown to provide protection. The investigation determined that reducing burning outdoor lights, cleaning excess vegetation, avoiding sleeping on the floor, using insect repellants, and wearing protective clothing can reduce the risk of contracting Paederus dermatitis.