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Dembek Z, Hadeed S, Tigabu B, Schwartz-Watjen K, Glass M, Dressner M, Frankel D, Blaney D, Eccles Iii TG, Chekol T, Owens A, Wu A. Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges. Mil Med 2024; 189:e1470-e1478. [PMID: 38743575 DOI: 10.1093/milmed/usae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The purpose of this review is to examine African Ebola outbreaks from their first discovery to the present, to determine how the medical and public health response has changed and identify the causes for those changes. We sought to describe what is now known about the epidemiology and spread of Ebola virus disease (EVD) from the significant outbreaks that have occurred and outbreak control methods applied under often challenging circumstances. Given the substantial role that the U.S. Government and the U.S. DoD have played in the 2014 to 2016 West African Ebola outbreak, the role of the DoD and the U.S. Africa Command in controlling EVD is described. MATERIALS AND METHODS A descriptive method design was used to collect and analyze all available Ebola outbreak literature using the PubMed database. An initial literature search was conducted by searching for, obtaining, and reading original source articles on all major global Ebola outbreaks. To conduct a focused search, we used initial search terms "Ebola outbreak," "Ebola virus disease," "Ebola response," "Ebola countermeasures," and also included each country's name where Ebola cases are known to have occurred. From the 4,673 unique articles obtained from this search and subsequent article title review, 307 articles were identified for potential inclusion. Following abstract and article review, 45 original source articles were used to compile the history of significant Ebola outbreaks. From this compilation, articles focused on each respective subsection of this review to delineate and describe the history of EVD and response, identifying fundamental changes, were obtained and incorporated. RESULTS We present known Ebola virus and disease attributes, including a general description, seasonality and location, transmission capacity, clinical symptoms, surveillance, virology, historical EVD outbreaks and response, international support for Ebola outbreak response, U.S. DoD support, medical countermeasures supporting outbreak response, remaining gaps to include policy limitations, regional instability, climate change, migration, and urbanization, public health education and infrastructure, and virus persistence and public awareness. CONCLUSIONS The health and societal impacts of EVD on Africa has been far-reaching, with about 35,000 cases and over 15,000 deaths, with small numbers of cases spreading globally. However, the history of combatting EVD reveals that there is considerable hope for African nations to quickly and successfully respond to Ebola outbreaks, through use of endemic resources including Africa CDC and African Partner Outbreak Response Alliance and the U.S. Africa Command with greater DoD reachback. Although there remains much to be learned about the Ebola virus and EVD including whether the potential for novel strains to become deadly emerging infections, invaluable vaccines, antivirals, and public health measures are now part of the resources that can be used to combat this disease.
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Affiliation(s)
- Zygmunt Dembek
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Steven Hadeed
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Bersabeh Tigabu
- Support to DTRA Technical Reachback, Global Systems Engineering (GSE), Alexandria, VA 22312, USA
| | - Kierstyn Schwartz-Watjen
- Support to DTRA Technical Reachback, Applied Research Associates (ARA), Albuquerque, NM 87110, USA
| | - Michael Glass
- SME Support to DTRA Technical Reachback, Manta Solutions, Charlottesville, VA 22901, USA
| | - Michelle Dressner
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - Dianne Frankel
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - David Blaney
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
- Office of Readiness and Response, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Tesema Chekol
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Akeisha Owens
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| | - Aiguo Wu
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
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Hauner A, Onwuchekwa C, Ariën KK. Sample-to-result molecular diagnostic platforms and their suitability for infectious disease testing in low- and middle-income countries. Expert Rev Mol Diagn 2024; 24:423-438. [PMID: 38747017 DOI: 10.1080/14737159.2024.2353690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Diagnostics are an essential, undervalued part of the health-care system. For many diseases, molecular diagnostics are the gold standard, but are not easy to implement in Low- and Middle-Income Countries (LMIC). Sample-to-result (S2R) platforms combining all procedures in a closed system could offer a solution. In this paper, we investigated their suitability for implementation in LMIC. AREAS COVERED A scorecard was used to evaluate different platforms on a range of parameters. Most platforms scored fairly on the platform itself, ease-of-use and test consumables; however, shortcomings were identified in cost, distribution and test panels tailored to LMIC needs. The diagnostic coverage for common infectious diseases was found to have a wider coverage in high-income countries (HIC) than LMIC. A literature study showed that in LMIC, these platforms are mainly used as diagnostic tools or evaluation of diagnostic performance, with a minority assessing the operational characteristics or the clinical utility. In this narrative review, we identified various points for adaptation of S2R platforms to LMIC conditions. EXPERT OPINION For S2R platforms to be suitable for implementation in LMIC some modifications by the manufacturers could be considered. Furthermore, strengthening health systems and digitalization are vital; as are smaller, cheaper, faster, and sustainable technologies.
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Affiliation(s)
- Anne Hauner
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Izudi J, Komakech A, Morukileng J, Bajunirwe F. Ebola incidence and mortality before and during a lockdown: The 2022 epidemic in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002702. [PMID: 38133997 PMCID: PMC10745136 DOI: 10.1371/journal.pgph.0002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
On September 20, 2022, an Ebola Disease (EBOD) outbreak was declared in Mubende district, Central Uganda. Following a rapid surge in the number of cases and mortality, the Government of Uganda imposed a lockdown in the two most affected districts, Mubende and Kassanda. We describe the trends in EBOD incidence and mortality nationally and in the two districts before and during the lockdown and the lessons learned during the epidemic response. We retrieved data from the Ministry of Health situation reports from September 20, 2022, when the EBOD outbreak was declared until November 26, 2022, when the lockdown ended. We graphed trends in EBOD morbidity and mortality during a 3-week and 6-week lockdown, computed the EBOD case fatality rate, and summarized the major lessons learned during the epidemic response. We found case fatality rate during the pre-lockdown, 3-week lockdown, and 6-week lockdown period was 37.9% (22/58), 39.3% (53/135), and 38.7% (55/142), respectively. In the early weeks of the lockdown, EBOD incidence and mortality increased nationally and in Kassanda district while Mubende district registered a decline in incidence and stagnation in mortality. With the extension of the lockdown to six weeks, the EBOD incidence and mortality during the 4-6-week lockdown declined compared to the pre-lockdown period. In conclusion, the EBOD incidence and mortality remained higher in the early weeks of the lockdown than during the pre-lockdown period nationally and in one of the two districts. With extended lockdown, incidence and mortality dropped in the 4-6-week period than the pre-lockdown period. Therefore, reliance on known public health measures to control an EBOD outbreak is important.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Allan Komakech
- Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Job Morukileng
- Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Jegede OS, Ijitade G, Fatoye OA, Jegede TM, Aderinto N, Oguntoye OA, Oguntoye OO, Ilori OR, Abodunrin OL, Olugbenga-Bello AI, Bamidele J, Parakoyi DB. International health regulations and pre-travel health practices of international travelers at Nigerian airport: a cross-sectional study. Trop Dis Travel Med Vaccines 2023; 9:21. [PMID: 38049921 PMCID: PMC10696719 DOI: 10.1186/s40794-023-00207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND International Health Regulations (IHR) were developed by the World Health Organization (WHO) to curb the trans-border spread of epidemics. To our knowledge, no airport-based studies have assessed travelers' health practices against a combination of diseases subject to IHR 2005. Therefore, we aimed to generate and describe the baseline travelers' pre-travel health practices towards Cholera, Yellow Fever (YF), and Plague at Murtala Muhammed International Airport (MMIA) in Nigeria. METHODS A cross-sectional study was employed to collect data from 486 international travelers using a multistage sampling technique. Pre-travel health practices (a combination of pre-travel consultation, pre-travel vaccination, and preventive measures against insect bites) were assessed using an interviewer-administered questionnaire. Logistic regression models were used to estimates the association between selected variables and pre-travel health practices. Statistical significance level was set at 5%. RESULTS A total of 479 complete questionnaires were analyzed. The median age of respondents was 34.0 years Interquartile range (IQR) = 28.0, 44.0). Of the total respondents, 311 (64.3%) were aware of pre-travel health consultation and sources of information, amongst others, including friends/relatives in 180 (37.6%) travelers, social media/internet in 155 (32.4%) travelers, and health professionals in 102 (21.3%) travelers. Two hundred and seventy-one (56.6%) had pre-travel consultation, 156 (32.6%) had YF vaccination, and 226 (47.2%) were prepared to use preventive measures against insect bites. Only 10.6% had good pre-travel practices against the diseases subject to 2 International Health Regulations (IHR). Travelers with bachelor/college degrees, when compared to those with secondary/high education, had 2.91 times higher odds of having good practices when adjusting for other factors (95% C.I: 1.10, 7.70; p < 0.03). Also, those traveling to destinations endemic for YF infection, when compared to those who are not traveling to endemic countries/areas, had 48% lower odds of having good practices after adjusting for other factors (95% C.I: 1.41, 7.77; p < 0.01). CONCLUSIONS Our study revealed a low prevalence of good pre-travel health practices among participants. Educational level and endemicity of YF at the destination were predictors of pre-travel health practices. Introducing topics on travelers' health into schools' curriculums may have a ripple positive effect on health practices among international travelers. Also, there is a need for public enlightenment programs on pre-travel health practices using social media platforms.
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Affiliation(s)
- Oluwatosin Samson Jegede
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Grace Ijitade
- Department of Biostatistics and Epidemiology, College of Public Health, Johnson City, East Tennessee State, USA
| | | | - Timilehin Mercy Jegede
- Department of Anesthesia and Intensive Care Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
| | | | | | - Oluwatosin Ruth Ilori
- Department of Community Medicine, College of Health Sciences, Ladoke Akintola, University of Technology, Ogbomoso, Nigeria
| | - Olugbemiga Lanre Abodunrin
- Department of Community Medicine, College of Health Sciences, Ladoke Akintola, University of Technology, Ogbomoso, Nigeria
| | | | - James Bamidele
- Department of Community Medicine, Ekiti State University, Ado Ekiti, Nigeria
| | - Dauda Bayo Parakoyi
- Department of Community Medicine, College of Health Sciences, Ladoke Akintola, University of Technology, Ogbomoso, Nigeria
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Bentahir M, Barry MD, Koulemou K, Gala JL. Providing On-Site Laboratory and Biosafety Just-In-Time Training Inside a Box-Based Laboratory during the West Africa Ebola Outbreak: Supporting Better Preparedness for Future Health Emergencies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811566. [PMID: 36141839 PMCID: PMC9517019 DOI: 10.3390/ijerph191811566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/13/2023]
Abstract
The Biological Light Fieldable Laboratory for Emergencies (B-LiFE) is a box-based modular laboratory with the capacity to quickly deploy on-site in cases of uncontrolled spread of infectious disease. During the 2014-2015 West Africa Ebola outbreak, this tent laboratory provided diagnostic support to the N'Zerekore Ebola Treatment Center (ETC), Guinea, for three months. One of the objectives of B-LiFE deployment was to contribute, as much as possible, to national capacity building by training local scientists. Two Guinean biologists were selected according to their basic biological knowledge and laboratory skills among 50 candidate trainees, and were integrated into the team through "just-in-time training" (JiTT), which helped the biologists acquire knowledge and laboratory skills beyond their expertise. The JiTT program was conducted according to standard laboratory procedures, in line with international biosafety guidelines adapted to field conditions. Supervised acquisition of field-laboratory practices mainly focused on biochemical testing and Ebola viral load quantification using routine PCR-based detection, including the Biofire FilmArray® system (BFA), a novel, as yet non-validated, automated assay for diagnostic testing of Ebola virus disease at the time of B-LiFE deployment. During the JiTT, the two biologists were closely involved in all laboratory activities, including BFA validation and biosafety procedures. Meanwhile, this successful JiTT enhanced the B-LiFE in-field operational capacity and contributed to national capacity building. A post-training evaluation and contacts were organised to assess the evolution and technical skills gained by the two researchers during the B-LiFE mission. At the end of the B-LiFE mission, both biologists were enrolled in follow-on programmes to curb the epidemic spreading in Africa. These results demonstrate that during infectious disease outbreaks or major crises, the JiTT approach can rapidly expand access to critical diagnostic testing and train local staff to do so.
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Affiliation(s)
- Mostafa Bentahir
- Centre for Applied Molecular Technologies (CTMA), Institute of Clinical and Experimental Research, Université Catholique de Louvain, Avenue Hippocrate 54-55, B1.54.01, B-1200 Brussels, Belgium
| | - Mamadou Diouldé Barry
- Laboratoire des Fièvres Hémorragiques Virales de Guinée, N’Zérékoré P.O. Box 50, Guinea
| | - Kekoura Koulemou
- Laboratory of the Prefectural Hospital of Gueckedou, Gueckedou P.O. Box 82, Guinea
| | - Jean-Luc Gala
- Centre for Applied Molecular Technologies (CTMA), Institute of Clinical and Experimental Research, Université Catholique de Louvain, Avenue Hippocrate 54-55, B1.54.01, B-1200 Brussels, Belgium
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Crozier I, Britson KA, Wolfe DN, Klena JD, Hensley LE, Lee JS, Wolfraim LA, Taylor KL, Higgs ES, Montgomery JM, Martins KA. The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps. Vaccines (Basel) 2022; 10:1213. [PMID: 36016101 PMCID: PMC9415766 DOI: 10.3390/vaccines10081213] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
The Ebola virus disease outbreak that occurred in Western Africa from 2013-2016, and subsequent smaller but increasingly frequent outbreaks of Ebola virus disease in recent years, spurred an unprecedented effort to develop and deploy effective vaccines, therapeutics, and diagnostics. This effort led to the U.S. regulatory approval of a diagnostic test, two vaccines, and two therapeutics for Ebola virus disease indications. Moreover, the establishment of fieldable diagnostic tests improved the speed with which patients can be diagnosed and public health resources mobilized. The United States government has played and continues to play a key role in funding and coordinating these medical countermeasure efforts. Here, we describe the coordinated U.S. government response to develop medical countermeasures for Ebola virus disease and we identify lessons learned that may improve future efforts to develop and deploy effective countermeasures against other filoviruses, such as Sudan virus and Marburg virus.
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Affiliation(s)
- Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA;
| | - Kyla A. Britson
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Oak Ridge Institute for Science and Education (ORISE) Postdoctoral Fellow, Oak Ridge, TN 37831, USA
| | - Daniel N. Wolfe
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Lisa E. Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD 12116, USA;
| | - John S. Lee
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
| | - Larry A. Wolfraim
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Kimberly L. Taylor
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Elizabeth S. Higgs
- U.S. Department of Health and Human Services (DHHS), National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Rockville, MD 20852, USA; (L.A.W.); (K.L.T.); (E.S.H.)
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (J.D.K.); (J.M.M.)
| | - Karen A. Martins
- U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Preparedness and Response (ASPR), Biomedical Advanced Research and Development Authority (BARDA), Washington, DC 20201, USA; (K.A.B.); (D.N.W.); (J.S.L.)
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Nyakarahuka L, Mulei S, Whitmer S, Jackson K, Tumusiime A, Schuh A, Baluku J, Joyce A, Ocom F, Tusiime JB, Montgomery JM, Balinandi S, Lutwama JJ, Klena JD, Shoemaker TR. First laboratory confirmation and sequencing of Zaire ebolavirus in Uganda following two independent introductions of cases from the 10th Ebola Outbreak in the Democratic Republic of the Congo, June 2019. PLoS Negl Trop Dis 2022; 16:e0010205. [PMID: 35192613 PMCID: PMC8896669 DOI: 10.1371/journal.pntd.0010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/04/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Uganda established a domestic Viral Hemorrhagic Fever (VHF) testing capacity in 2010 in response to the increasing occurrence of filovirus outbreaks. In July 2018, the neighboring Democratic Republic of Congo (DRC) experienced its 10th Ebola Virus Disease (EVD) outbreak and for the duration of the outbreak, the Ugandan Ministry of Health (MOH) initiated a national EVD preparedness stance. Almost one year later, on 10th June 2019, three family members who had contracted EVD in the DRC crossed into Uganda to seek medical treatment.
Samples were collected from all the suspected cases using internationally established biosafety protocols and submitted for VHF diagnostic testing at Uganda Virus Research Institute. All samples were initially tested by RT-PCR for ebolaviruses, marburgviruses, Rift Valley fever (RVF) virus and Crimean-Congo hemorrhagic fever (CCHF) virus. Four people were identified as being positive for Zaire ebolavirus, marking the first report of Zaire ebolavirus in Uganda. In-country Next Generation Sequencing (NGS) and phylogenetic analysis was performed for the first time in Uganda, confirming the outbreak as imported from DRC at two different time point from different clades. This rapid response by the MoH, UVRI and partners led to the control of the outbreak and prevention of secondary virus transmission.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda
- * E-mail:
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kyondo Jackson
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Amy Schuh
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Allison Joyce
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Felix Ocom
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | | | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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