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Namuwulya P, Ashraf S, Niebel M, Ssekagiri A, Tushabe P, Kakooza P, Tong L, Bukenya H, Jerome H, Davis C, Birungi M, Turyahabwe I, Mugaga A, Eliku JP, Francis A, Nakabazzi L, Nsubuga F, Katushabe E, Kisakye A, Ampeire I, Nanteza A, Kaleebu P, Bakamutumaho B, Nsamba P, Kazibwe A, da Silva Filipe A, Tweyongyere R, Bwogi J, Thomson EC. Viruses associated with measles-like illnesses in Uganda. J Infect 2024; 88:106148. [PMID: 38588959 PMCID: PMC11060986 DOI: 10.1016/j.jinf.2024.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES In this study, we investigated the causes of measles-like illnesses (MLI) in the Uganda national surveillance program in order to inform diagnostic assay selection and vaccination strategies. METHODS We used metagenomic next-generation sequencing (M-NGS) on the Illumina platform to identify viruses associated with MLI (defined as fever and rash in the presence of either cough, coryza or conjunctivitis) in patient samples that had tested IgM negative for measles between 2010 and 2019. RESULTS Viral genomes were identified in 87/271 (32%) of samples, of which 44/271 (16%) contained 12 known viral pathogens. Expected viruses included rubella, human parvovirus B19, Epstein Barr virus, human herpesvirus 6B, human cytomegalovirus, varicella zoster virus and measles virus (detected within the seronegative window-period of infection) and the blood-borne hepatitis B virus. We also detected Saffold virus, human parvovirus type 4, the human adenovirus C2 and vaccine-associated poliovirus type 1. CONCLUSIONS The study highlights the presence of undiagnosed viruses causing MLI in Uganda, including vaccine-preventable illnesses. NGS can be used to monitor common viral infections at a population level, especially in regions where such infections are prevalent, including low and middle income countries to guide vaccination policy and optimize diagnostic assays.
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Affiliation(s)
| | - Shirin Ashraf
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Marc Niebel
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | | | | | | | - Lily Tong
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Henry Bukenya
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | - Hanna Jerome
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Chris Davis
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Molly Birungi
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | - Arnold Mugaga
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | - Aine Francis
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | | | | | | | | | - Ann Nanteza
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Peninah Nsamba
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Anne Kazibwe
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Robert Tweyongyere
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Emma C Thomson
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK; London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
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Nanteza MB, Tushabe P, Bukenya H, Namuwulya P, Kabaliisa T, Birungi M, Tibanagwa M, Ampeire I, Kakooza P, Katushabe E, Bwogi J, Bakamutumaho B, Nanyunja M, Byabamazima CR. The road to a polio-free Uganda; contribution of the Expanded Program on Immunization Laboratory (EPI-LAB) at Uganda Virus Research Institute. Afr Health Sci 2023; 23:186-196. [PMID: 38357183 PMCID: PMC10862580 DOI: 10.4314/ahs.v23i3.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The control of poliomyelitis in Uganda dates back as far as 1950 and acute flaccid paralysis (AFP) surveillance has since been used as a criterion for identifying wild polioviruses. Poliovirus isolation was initially pursued through collaborative research however, in 1993, the Expanded Program on Immunization Laboratory (EPI-LAB) was established as a member of the Global Poliovirus Laboratory Network (GPLN) and spearheaded this activity at Uganda Virus Research Institute. Objectives The aim of this report is to document the progress and impact of the EPI-LAB on poliovirus eradication in Uganda. Methods Poliovirus detection and identification were achieved fundamentally through tissue culture and intra-typic differentiation of the poliovirus based on the real-time reverse transcriptase polymerase chain reaction (rRT PCR). The data obtained was entered into the national AFP database and analysed using EpiInfoTM statistical software. Results Quantitative and qualitative detection of wild and Sabin polioviruses corresponded with the polio campaigns. The WHO target indicators for AFP surveillance were achieved essentially throughout the study period. Conclusion Virological tracking coupled with attaining standard AFP surveillance indicators has been pivotal in achieving and maintaining the national wild polio-free status. Laboratory surveillance remains key in informing the certification process of polio eradication.
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Affiliation(s)
- Mary B Nanteza
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Phionah Tushabe
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Henry Bukenya
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Prossy Namuwulya
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Theopista Kabaliisa
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Molly Birungi
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Mayi Tibanagwa
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Immaculate Ampeire
- Ministry of Health, Government of Uganda, Plot 6, Lourdel Road, Nakasero P. O. Box 7272, Kampala, Uganda
| | - Proscovia Kakooza
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Edson Katushabe
- World Health Organization Office, Plot 60 Prince Charles Avenue, Kololo, Kampala
| | - Josephine Bwogi
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute, Plot 51-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Miriam Nanyunja
- World Health Organization AFRO, East and Southern Africa (ESA), Nairobi, 45335 Nairobi, Kenya
| | - Charles R Byabamazima
- World Health Organization AFRO, East and Southern Africa (ESA), Harare, 82-86 Enterprise Road, Highlands, P. O. Box BE 773, Belvedere, Harare, Zimbabwe
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3
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Tushabe P, Bwogi J, Eliku JP, Aine F, Birungi M, Gaizi J, Nakabazzi L, Kabaliisa T, Turyahabwe I, Namuwulya P, Nanteza MB, Bukenya H, Kanyesigye C, Katushabe E, Ampeire I, Kisakye A, Bakamutumaho B, Byabamazima CR. Environmental surveillance detects circulating vaccine-derived poliovirus type 2 that was undetected by acute flaccid paralysis surveillance in 2021 in Uganda. Arch Virol 2023; 168:140. [PMID: 37059887 PMCID: PMC10104764 DOI: 10.1007/s00705-023-05759-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
The success of the global polio eradication initiative is threatened by the genetic instability of the oral polio vaccine, which can result in the emergence of pathogenic vaccine-derived polioviruses following prolonged replication in the guts of individuals with primary immune deficiencies or in communities with low vaccination coverage. Through environmental surveillance, circulating vaccine-derived poliovirus type 2 was detected in Uganda in the absence of detection by acute flaccid paralysis (AFP) surveillance. This underscores the sensitivity of environmental surveillance and emphasizes its usefulness in supplementing AFP surveillance for poliovirus infections in the race towards global polio eradication.
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Affiliation(s)
- Phionah Tushabe
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda.
| | - Josephine Bwogi
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - James Peter Eliku
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Francis Aine
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Molly Birungi
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Gaizi
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Lucy Nakabazzi
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Theopista Kabaliisa
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Irene Turyahabwe
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Prossy Namuwulya
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Mary Bridget Nanteza
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Henry Bukenya
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Edson Katushabe
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | | | - Annet Kisakye
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Barnabas Bakamutumaho
- Expanded Programme on Immunization Laboratory, Uganda Virus Research Institute, Entebbe, Uganda
| | - Charles R Byabamazima
- WHO Inter-Country Support Team Office for Eastern and Southern Africa (IST/ESA), Harare, Zimbabwe
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4
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Aceng JR, Ario AR, Muruta AN, Makumbi I, Nanyunja M, Komakech I, Bakainaga AN, Talisuna AO, Mwesigye C, Mpairwe AM, Tusiime JB, Lali WZ, Katushabe E, Ocom F, Kaggwa M, Bongomin B, Kasule H, Mwoga JN, Sensasi B, Mwebembezi E, Katureebe C, Sentumbwe O, Nalwadda R, Mbaka P, Fatunmbi BS, Nakiire L, Lamorde M, Walwema R, Kambugu A, Nanyondo J, Okware S, Ahabwe PB, Nabukenya I, Kayiwa J, Wetaka MM, Kyazze S, Kwesiga B, Kadobera D, Bulage L, Nanziri C, Monje F, Aliddeki DM, Ntono V, Gonahasa D, Nabatanzi S, Nsereko G, Nakinsige A, Mabumba E, Lubwama B, Sekamatte M, Kibuule M, Muwanguzi D, Amone J, Upenytho GD, Driwale A, Seru M, Sebisubi F, Akello H, Kabanda R, Mutengeki DK, Bakyaita T, Serwanjja VN, Okwi R, Okiria J, Ainebyoona E, Opar BT, Mimbe D, Kyabaggu D, Ayebazibwe C, Sentumbwe J, Mwanja M, Ndumu DB, Bwogi J, Balinandi S, Nyakarahuka L, Tumusiime A, Kyondo J, Mulei S, Lutwama J, Kaleebu P, Kagirita A, Nabadda S, Oumo P, Lukwago R, Kasozi J, Masylukov O, Kyobe HB, Berdaga V, Lwanga M, Opio JC, Matseketse D, Eyul J, Oteba MO, Bukirwa H, Bulya N, Masiira B, Kihembo C, Ohuabunwo C, Antara SN, Owembabazi W, Okot PB, Okwera J, Amoros I, Kajja V, Mukunda BS, Sorela I, Adams G, Shoemaker T, Klena JD, Taboy CH, Ward SE, Merrill RD, Carter RJ, Harris JR, Banage F, Nsibambi T, Ojwang J, Kasule JN, Stowell DF, Brown VR, Zhu BP, Homsy J, Nelson LJ, Tusiime PK, Olaro C, Mwebesa HG, Woldemariam YT. Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019. Global Health 2020; 16:24. [PMID: 32192540 PMCID: PMC7081536 DOI: 10.1186/s12992-020-00548-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies.
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Affiliation(s)
| | - Alex R Ario
- Ministry of Health, Kampala, Uganda.
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.
| | | | - Issa Makumbi
- Ministry of Health, Kampala, Uganda
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | | | | | | | | | | | | | | | - William Z Lali
- World Health Organisation, Country Office, Kampala, Uganda
| | | | - Felix Ocom
- World Health Organisation, Country Office, Kampala, Uganda
| | - Mugagga Kaggwa
- World Health Organisation, Country Office, Kampala, Uganda
| | - Bodo Bongomin
- World Health Organisation, Country Office, Kampala, Uganda
| | - Hafisa Kasule
- World Health Organisation, Country Office, Kampala, Uganda
| | - Joseph N Mwoga
- World Health Organisation, Country Office, Kampala, Uganda
| | | | | | | | | | - Rita Nalwadda
- World Health Organisation, Country Office, Kampala, Uganda
| | - Paul Mbaka
- World Health Organisation, Country Office, Kampala, Uganda
| | | | | | | | | | | | | | - Solome Okware
- Ministry of Health, Kampala, Uganda
- Infectious Disease Institute, Kampala, Uganda
| | | | - Immaculate Nabukenya
- Ministry of Health, Kampala, Uganda
- Infectious Disease Institute, Kampala, Uganda
| | - Joshua Kayiwa
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Milton M Wetaka
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
| | - Carol Nanziri
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Fred Monje
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Dativa M Aliddeki
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Vivian Ntono
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Doreen Gonahasa
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Sandra Nabatanzi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Godfrey Nsereko
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | | | | | | | | | | | | | | | | | | | | | - Harriet Akello
- Ministry of Health, Kampala, Uganda
- Management Sciences for Health, Kampala, Uganda
| | | | | | | | | | | | | | | | | | - Derrick Mimbe
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Denis Kyabaggu
- East African Public Health Laboratory Network, Kampala, Uganda
| | | | - Juliet Sentumbwe
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Moses Mwanja
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Deo B Ndumu
- Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | | | | | | | | | | | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Atek Kagirita
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Susan Nabadda
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Peter Oumo
- Ministry of Internal Affairs, Uganda Police Force, Kampala, Uganda
| | - Robinah Lukwago
- Department for International Development, UKAID, Kampala, Uganda
| | - Julius Kasozi
- United Nations High Commissioner for Refugees, Kampala, Uganda
| | | | | | | | | | - Joe C Opio
- United Nations Children's Fund, Kampala, Uganda
| | | | - James Eyul
- Civil Aviation Authority, Entebbe, Uganda
| | | | | | - Nulu Bulya
- African Field Epidemiology Network, Kampala, Uganda
| | - Ben Masiira
- African Field Epidemiology Network, Kampala, Uganda
| | | | | | | | | | | | | | | | - Victoria Kajja
- Intenational Organisation for Migration, Kampala, Uganda
| | | | - Isabel Sorela
- Intenational Organisation for Migration, Kampala, Uganda
| | - Gregory Adams
- United States Agency for International Development, Kampala, Uganda
| | - Trevor Shoemaker
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Klena
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Celine H Taboy
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah E Ward
- Division of Global Migration and Quarantine, Global Border Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca D Merrill
- Division of Global Migration and Quarantine, Global Border Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosalind J Carter
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie R Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Flora Banage
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Thomas Nsibambi
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Joseph Ojwang
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Juliet N Kasule
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Dan F Stowell
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Vance R Brown
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jaco Homsy
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa J Nelson
- US Centers for Disease Control and Prevention, Kampala, Uganda
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Nakiire L, Masiira B, Kihembo C, Katushabe E, Natseri N, Nabukenya I, Komakech I, Makumbi I, Charles O, Adatu F, Nanyunja M, Nsubuga P, Woldetsadik SF, Tusiime P, Yahaya AA, Fall IS, Wondimagegnehu A. Healthcare workers' experiences regarding scaling up of training on integrated disease surveillance and response (IDSR) in Uganda, 2016: cross sectional qualitative study. BMC Health Serv Res 2019; 19:117. [PMID: 30760259 PMCID: PMC6374884 DOI: 10.1186/s12913-019-3923-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Integrated Disease Surveillance and Response (IDSR) strategy was adopted as the framework for implementation of International Health Regulation (2005) in the African region of World Health Organisation (WHO AFRO). While earlier studies documented gains in performance of core IDSR functions, Uganda still faces challenges due to infectious diseases. IDSR revitalisation programme aimed to improve prevention, early detection, and prompt response to disease outbreaks. However, little is known about health worker’s perception of the revitalised IDSR training. Methods We conducted focus group discussions of health workers who were trained between 2015 and 2016. Discussions on benefits, challenges and possible solutions for improvement of IDSR training were recorded, transcribed, translated and coded using grounded theory. Results In total, 22/26 FGDs were conducted. Participants cited improved completeness and timeliness of reporting, case detection and data analysis and better response to disease outbreaks as key achievements after the training. Programme challenges included an inadequate number of trained staff, funding, irregular supervision, high turnover of trained health workers, and lack of key logistics. Suggestions to improve IDSR included pre-service and community training, mentorship, regular supervision and improving funding at the district level. Conclusion Health workers perceived that scaling up revitalized IDSR training in Uganda improved public health surveillance. However, they acknowledge encountering challenges that hinder their performance after the training. Ministry of Health should have a mentorship plan, integrate IDSR training in pre-service curricula and advocate for funding IDSR activities to address some of the gaps highlighted in this study.
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Affiliation(s)
- Lydia Nakiire
- Public Health Emergency Operation Centre, Ministry of Health, P.O BOX 7072, Kampala, Uganda.
| | - Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | - Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | | | - Nasan Natseri
- World Health Organization, Country Office, Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health Kampala, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, P.O BOX 7072, Kampala, Uganda
| | - Okot Charles
- World Health Organization, Country Office, Kampala, Uganda
| | | | | | - Peter Nsubuga
- Global Public Health Solutions Inc, Atlanta, Georgia, USA
| | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, Kampala, Uganda
| | - Ali Ahmed Yahaya
- World Health Organization Africa Regional Office, Brazzaville, Congo
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6
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Masiira B, Nakiire L, Kihembo C, Katushabe E, Natseri N, Nabukenya I, Komakech I, Makumbi I, Charles O, Adatu F, Nanyunja M, Woldetsadik SF, Fall IS, Tusiime P, Wondimagegnehu A, Nsubuga P. Evaluation of integrated disease surveillance and response (IDSR) core and support functions after the revitalisation of IDSR in Uganda from 2012 to 2016. BMC Public Health 2019; 19:46. [PMID: 30626358 PMCID: PMC6327465 DOI: 10.1186/s12889-018-6336-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uganda is a low income country that continues to experience disease outbreaks caused by emerging and re-emerging diseases such as cholera, meningococcal meningitis, typhoid and viral haemorrhagic fevers. The Integrated Disease Surveillance and Response (IDSR) strategy was adopted by WHO-AFRO in 1998 as a comprehensive strategy to improve disease surveillance and response in WHO Member States in Africa and was adopted in Uganda in 2000. To address persistent inconsistencies and inadequacies in the core and support functions of IDSR, Uganda initiated an IDSR revitalisation programme in 2012. The objective of this evaluation was to assess IDSR core and support functions after implementation of the revitalised IDSR programme. METHODS The evaluation was a cross-sectional survey that employed mixed quantitative and qualitative methods. We assessed IDSR performance indicators, knowledge acquisition, knowledge retention and level of confidence in performing IDSR tasks among health workers who underwent IDSR training. Qualitative data was collected to guide the interpretation of quantitative findings and to establish a range of views related to IDSR implementation. RESULTS Between 2012 and 2016, there was an improvement in completeness of monthly reporting (69 to 100%) and weekly reporting (56 to 78%) and an improvement in timeliness of monthly reporting (59 to 93%) and weekly reporting (40 to 68%) at the national level. The annualised non-polio AFP rate increased from 2.8 in 2012 to 3.7 cases per 100,000 population < 15 years in 2016. The case fatality rate for cholera decreased from 3.2% in 2012 to 2.1% in 2016. All districts received IDSR feedback from the national level. Key IDSR programme challenges included inadequate numbers of trained staff, inadequate funding, irregular supervision and high turnover of trained staff. Recommendations to improve IDSR performance included: improving funding, incorporating IDSR training into pre-service curricula for health workers and strengthening support supervision. CONCLUSION The revitalised IDSR programme in Uganda was associated with improvements in performance. However in 2016, the programme still faced significant challenges and some performance indicators were still below the target. It is important that the documented gains are consolidated and challenges are continuously identified and addressed as they emerge.
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Affiliation(s)
- Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Lydia Nakiire
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Edson Katushabe
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Nasan Natseri
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Okot Charles
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Francis Adatu
- Epidemiology and Surveillance Division, Ministry of Health, P.O Box 7072, Kampala, Uganda
| | - Miriam Nanyunja
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | | | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, Kampala, Uganda
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Kwagonza L, Masiira B, Kyobe-Bosa H, Kadobera D, Atuheire EB, Lubwama B, Kagirita A, Katushabe E, Kayiwa JT, Lutwama JJ, Ojwang JC, Makumbi I, Ario AR, Borchert J, Zhu BP. Outbreak of yellow fever in central and southwestern Uganda, February-may 2016. BMC Infect Dis 2018; 18:548. [PMID: 30390621 PMCID: PMC6215607 DOI: 10.1186/s12879-018-3440-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On 28 March, 2016, the Ministry of Health received a report on three deaths from an unknown disease characterized by fever, jaundice, and hemorrhage which occurred within a one-month period in the same family in central Uganda. We started an investigation to determine its nature and scope, identify risk factors, and to recommend eventually control measures for future prevention. METHODS We defined a probable case as onset of unexplained fever plus ≥1 of the following unexplained symptoms: jaundice, unexplained bleeding, or liver function abnormalities. A confirmed case was a probable case with IgM or PCR positivity for yellow fever. We reviewed medical records and conducted active community case-finding. In a case-control study, we compared risk factors between case-patients and asymptomatic control-persons, frequency-matched by age, sex, and village. We used multivariate conditional logistic regression to evaluate risk factors. We also conducted entomological studies and environmental assessments. RESULTS From February to May, we identified 42 case-persons (35 probable and seven confirmed), of whom 14 (33%) died. The attack rate (AR) was 2.6/100,000 for all affected districts, and highest in Masaka District (AR = 6.0/100,000). Men (AR = 4.0/100,000) were more affected than women (AR = 1.1/100,000) (p = 0.00016). Persons aged 30-39 years (AR = 14/100,000) were the most affected. Only 32 case-patients and 128 controls were used in the case control study. Twenty three case-persons (72%) and 32 control-persons (25%) farmed in swampy areas (ORadj = 7.5; 95%CI = 2.3-24); 20 case-patients (63%) and 32 control-persons (25%) who farmed reported presence of monkeys in agriculture fields (ORadj = 3.1, 95%CI = 1.1-8.6); and 20 case-patients (63%) and 35 control-persons (27%) farmed in forest areas (ORadj = 3.2; 95%CI = 0.93-11). No study participants reported yellow fever vaccination. Sylvatic monkeys and Aedes mosquitoes were identified in the nearby forest areas. CONCLUSION This yellow fever outbreak was likely sylvatic and transmitted to a susceptible population probably by mosquito bites during farming in forest and swampy areas. A reactive vaccination campaign was conducted in the affected districts after the outbreak. We recommended introduction of yellow fever vaccine into the routine Uganda National Expanded Program on Immunization and enhanced yellow fever surveillance.
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Affiliation(s)
- Leocadia Kwagonza
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda. .,Ministry of Health of Uganda, Kampala, Uganda. .,Makerere University school of Public Health, Kampala, Uganda.
| | - Ben Masiira
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda.,Ministry of Health of Uganda, Kampala, Uganda.,Makerere University school of Public Health, Kampala, Uganda
| | - Henry Kyobe-Bosa
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda.,Ministry of Health of Uganda, Kampala, Uganda
| | - Emily B Atuheire
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda.,Ministry of Health of Uganda, Kampala, Uganda.,Makerere University school of Public Health, Kampala, Uganda
| | | | | | - Edson Katushabe
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | | | | | - Joseph C Ojwang
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, P.O. Box 7272, Kampala, Uganda.,Ministry of Health of Uganda, Kampala, Uganda
| | - Jeff Borchert
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Bao-Ping Zhu
- United States Centers for Disease Control and Prevention, Kampala, Uganda.,Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kihembo C, Masiira B, Nakiire L, Katushabe E, Natseri N, Nabukenya I, Komakech I, Okot CL, Adatu F, Makumbi I, Nanyunja M, Woldetsadik SF, Tusiime P, Nsubuga P, Fall IS, Wondimagegnehu A. The design and implementation of the re-vitalised integrated disease surveillance and response (IDSR) in Uganda, 2013-2016. BMC Public Health 2018; 18:879. [PMID: 30005613 PMCID: PMC6045850 DOI: 10.1186/s12889-018-5755-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/26/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Uganda adopted and has been implementing the Integrated Disease Surveillance (IDSR) strategy since 2000. The goal was to build the country's capacity to detect, report promptly, and effectively respond to public health emergencies and priorities. The considerable investment into the program startup realised significant IDSR core performance. However, due to un-sustained funding from the mid-2000s onwards, these achievements were undermined. Following the adoption of the revised World Health Organization guidelines on IDSR, the Uganda Ministry of Health (MoH) in collaboration with key partners decided to revitalise IDSR and operationalise the updated IDSR guidelines in 2012. METHODS Through the review of both published and unpublished national guidelines, reports and other IDSR program records in addition to an interview of key informants, we describe the design and process of IDSR revitalisation in Uganda, 2013-2016. The program aimed to enhance the districts' capacity to promptly detect, assess and effectively respond to public health emergencies. RESULTS Through a cascaded, targeted skill-development training model, 7785 participants were trained in IDSR between 2015 and 2016. Of these, 5489(71%) were facility-based multi-disciplinary health workers, 1107 (14%) comprised the district rapid response teams and 1188 (15%) constituted the district task forces. This training was complemented by other courses for regional teams in addition to the provision of logistics to support IDSR activities. Centrally, IDSR implementation was coordinated and monitored by the MoH's national task force (NTF) on epidemics and emergencies. The NTF and in close collaboration with the WHO Country Office, mobilised resources from various partners and development initiatives. At regional and district levels, the technical and political leadership were mobilised and engaged in monitoring and overseeing program implementation. CONCLUSION The IDSR re-vitalization in Uganda highlights unique features that can be considered by other countries that would wish to strengthen their IDSR programs. Through a coordinated partner response, the program harnessed resources which primarily were not earmarked for IDSR to strengthen the program nation-wide. Engagement of the local district leadership helped promote ownership, foster accountability and sustainability of the program.
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Affiliation(s)
- Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Lydia Nakiire
- Public Health Emergency Operations Centre, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Edson Katushabe
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Nasan Natseri
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Immaculate Nabukenya
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Innocent Komakech
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Charles Lukoya Okot
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | - Francis Adatu
- Epidemiology and Surveillance Division, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Centre, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Miriam Nanyunja
- World Health Organization, Uganda Country Office, P.O BOX 24578 Kampala, Uganda
| | | | - Patrick Tusiime
- National Disease Control, Ministry of Health, P.O BOX 7072 Kampala, Uganda
| | - Peter Nsubuga
- Global Public Health Solutions LLC, Atlanta, GA 30326 USA
| | - Ibrahima Soce Fall
- World Health Organization, Africa Regional Office, Brazzaville, Republic of Congo
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Nanteza MB, Bakamutumaho B, Kisakye A, Namuwulya P, Bukenya H, Katushabe E, Bwogi J, Byabamazima CR, Williams R, Gumede N. The detection of 3 ambiguous type 2 vaccine-derived polioviruses (VDPV2s) in Uganda. Virol J 2018; 15:77. [PMID: 29699577 PMCID: PMC5922010 DOI: 10.1186/s12985-018-0990-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Oral Polio Vaccine (OPV or Sabin) is genetically unstable and may mutate to form vaccine-derived polioviruses (VDPVs). METHODS In 2014, two VDPVs type 2 were identified during routine surveillance of acute flaccid paralysis (AFP) cases. Consequently, a retrospective VDPV survey was conducted to ensure that there was no circulating VDPV in the country. All Sabin poliovirus isolates identified in Uganda 6 months before and 6 months after were re-screened; Sabin 1 and 3 polioviruses were re-screened for Sabin 2 and Sabin 2 polioviruses were re-screened for VDPVs type 2. The Poliovirus rRT-PCR ITD/VDPV 4.0 assay and sequencing were used respectively. RESULTS The first two VDPVs type2 were identified in Eastern Uganda and the third was identified during the survey from South-western Uganda. These regions had low OPV coverage and poor AFP surveillance indicators. CONCLUSION The retrospective VDPV survey was a useful strategy to screen for VDPVs more exhaustively. Supplementary surveillance methods need to be encouraged.
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Affiliation(s)
- Mary Bridget Nanteza
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Annet Kisakye
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Prossy Namuwulya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Henry Bukenya
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Edson Katushabe
- World Health Organization (WHO), Plot 60 Prince Charles Avenue, Kololo, P.O. Box 24578, Kampala, Uganda
| | - Josephine Bwogi
- Uganda Virus Research Institute (UVRI), Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | | | - Raffaella Williams
- National Institute for Communicable Diseases (NICD), 1 Modderfontein Road Sandringham Johannesburg. Private Bag x4, Sandringham, 2131, South Africa.,NSW HIV State Reference Laboratory, St Vicent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Nicksy Gumede
- World Health Organization, Regional Office for Africa, P.O. Box 06, Brazzaville, Republic of Congo
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