<p>We applied mixed methods in the investigation. Quantitative data were collected using structured questionnaires targeting the County health officers and households that had a suspected case. Qualitative data were collected using Focused Group Discussions targeting the community members. We conducted active case search in health facilities and community. A case was any person residing in Shinyalu Sub-County, presenting with pruritic papule on an exposed surface at vesicular stage or depressed black eschar. Verbal autopsies to establish the link to the disease were conducted. We geocoded residences of human and animal cases.</p>