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Bonaparte SC, Adams L, Bakamutumaho B, Barbosa Costa G, Cleaton JM, Gilbert AT, Osinubi M, Pieracci EG, Recuenco S, Tugumizemu V, Wamala J, Wallace RM. Rabies post-exposure healthcare-seeking behaviors and perceptions: Results from a knowledge, attitudes, and practices survey, Uganda, 2013. PLoS One 2021; 16:e0251702. [PMID: 34077427 PMCID: PMC8171952 DOI: 10.1371/journal.pone.0251702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background Rabies is a viral disease of animals and people causing fatal encephalomyelitis if left untreated. Although effective pre- and post-exposure vaccines exist, they are not widely available in many endemic countries within Africa. Since many individuals in these countries remain at risk of infection, post-exposure healthcare-seeking behaviors are crucial in preventing infection and warrant examination. Methodology A rabies knowledge, attitudes, and practices survey was conducted at 24 geographically diverse sites in Uganda during 2013 to capture information on knowledge concerning the disease, response to potential exposure events, and vaccination practices. Characteristics of the surveyed population and of the canine-bite victim sub-population were described. Post-exposure healthcare-seeking behaviors of canine-bite victims were examined and compared to the related healthcare-seeking attitudes of non-bite victim respondents. Wealth scores were calculated for each household, rabies knowledge was scored for each non-bitten survey respondent, and rabies exposure risk was scored for each bite victim. Logistic regression was used to determine the independent associations between different variables and healthcare-seeking behaviors among canine-bite victims as well as attitudes of non-bitten study respondents. Results A total of 798 households were interviewed, capturing 100 canine-bite victims and a bite incidence of 2.3 per 100 person-years. Over half of bite victims actively sought medical treatment (56%), though very few received rabies post-exposure prophylaxis (3%). Bite victims who did not know or report the closest location where PEP could be received were less likely to seek medical care (p = 0.05). Respondents who did not report having been bitten by a dog with higher knowledge scores were more likely to respond that they would both seek medical care (p = 0.00) and receive PEP (p = 0.06) after a potential rabies exposure event. Conclusions There was varying discordance between what respondents who did not report having been bitten by a dog said they would do if bitten by a dog when compared to the behaviors exhibited by canine-bite victims captured in the KAP survey. Bite victims seldom elected to wash their wound or receive PEP. Having lower rabies knowledge was a barrier to theoretically seeking care and receiving PEP among not bitten respondents, indicating a need for effective and robust educational programs in the country.
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Affiliation(s)
- Sarah C. Bonaparte
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Laura Adams
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Galileu Barbosa Costa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julie M. Cleaton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy T. Gilbert
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Modupe Osinubi
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily G. Pieracci
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sergio Recuenco
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Tugumizemu
- Veterinary Public Health Division, Ministry of Health, Kampala, Uganda
| | | | - Ryan M. Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Fall IS, Rajatonirina S, Yahaya AA, Zabulon Y, Nsubuga P, Nanyunja M, Wamala J, Njuguna C, Lukoya CO, Alemu W, Kasolo FC, Talisuna AO. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ Glob Health 2019; 4:e001427. [PMID: 31354972 PMCID: PMC6615866 DOI: 10.1136/bmjgh-2019-001427] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 01/19/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022] Open
Abstract
In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.
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Affiliation(s)
- Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Soatiana Rajatonirina
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Yoti Zabulon
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | | | - Joseph Wamala
- World Health Organization, Country Office, Juba, South Sudan
| | - Charles Njuguna
- World Health Organization, Country Office, Free Town, Sierra Leone
| | - Charles Okot Lukoya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | | | - Francis Chisaka Kasolo
- World Health Organization, Regional Office for Africa, Country Support, Brazzaville, Congo
| | - Ambrose Otau Talisuna
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
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Wallace RM, Mehal J, Nakazawa Y, Recuenco S, Bakamutumaho B, Osinubi M, Tugumizemu V, Blanton JD, Gilbert A, Wamala J. The impact of poverty on dog ownership and access to canine rabies vaccination: results from a knowledge, attitudes and practices survey, Uganda 2013. Infect Dis Poverty 2017; 6:97. [PMID: 28569185 PMCID: PMC5452361 DOI: 10.1186/s40249-017-0306-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 09/23/2016] [Accepted: 04/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Rabies is a neglected disease despite being responsible for more human deaths than any other zoonosis. A lack of adequate human and dog surveillance, resulting in low prioritization, is often blamed for this paradox. Estimation methods are often employed to describe the rabies burden when surveillance data are not available, however these figures are rarely based on country-specific data. Methods In 2013 a knowledge, attitudes, and practices survey was conducted in Uganda to understand dog population, rabies vaccination, and human rabies risk factors and improve in-country and regional rabies burden estimates. Poisson and multi-level logistic regression techniques were conducted to estimate the total dog population and vaccination coverage. Results Twenty-four villages were selected, of which 798 households completed the survey, representing 4 375 people. Dog owning households represented 12.9% of the population, for which 175 dogs were owned (25 people per dog). A history of vaccination was reported in 55.6% of owned dogs. Poverty and human population density highly correlated with dog ownership, and when accounted for in multi-level regression models, the human to dog ratio fell to 47:1 and the estimated national canine-rabies vaccination coverage fell to 36.1%. This study estimates there are 729 486 owned dogs in Uganda (95% CI: 719 919 – 739 053). Ten percent of survey respondents provided care to dogs they did not own, however unowned dog populations were not enumerated in this estimate. 89.8% of Uganda’s human population was estimated to reside in a community that can support enzootic canine rabies transmission. Conclusions This study is the first to comprehensively evaluate the effect of poverty on dog ownership in Africa. These results indicate that describing a dog population may not be as simple as applying a human: dog ratio, and factors such as poverty are likely to heavily influence dog ownership and vaccination coverage. These modelled estimates should be confirmed through further field studies, however, if validated, canine rabies elimination through mass vaccination may not be as difficult as previously considered in Uganda. Data derived from this study should be considered to improve models for estimating the in-country and regional rabies burden. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0306-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jason Mehal
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yoshinori Nakazawa
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sergio Recuenco
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Modupe Osinubi
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victor Tugumizemu
- Veterinary Public Health Division, Ministry of Health, Kampala, Uganda
| | - Jesse D Blanton
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Gilbert
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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Idro R, Opar B, Wamala J, Abbo C, Onzivua S, Mwaka DA, Kakooza-Mwesige A, Mbonye A, Aceng JR. Is nodding syndrome an Onchocerca volvulus-induced neuroinflammatory disorder? Uganda's story of research in understanding the disease. Int J Infect Dis 2016; 45:112-7. [PMID: 26987477 DOI: 10.1016/j.ijid.2016.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022] Open
Abstract
Nodding syndrome is a devastating neurological disorder, mostly affecting children in eastern Africa. An estimated 10000 children are affected. Uganda, one of the most affected countries, set out to systematically investigate the disease and develop interventions for it. On December 21, 2015, the Ministry of Health held a meeting with community leaders from the affected areas to disseminate the results of the investigations made to date. This article summarizes the presentation and shares the story of studies into this peculiar disease. It also shares the results of preliminary studies on its pathogenesis and puts into perspective an upcoming treatment intervention. Clinical and electrophysiological studies have demonstrated nodding syndrome to be a complex epilepsy disorder. A definitive aetiological agent has not been established, but in agreement with other affected countries, a consistent epidemiological association has been demonstrated with infection by Onchocerca volvulus. Preliminary studies of its pathogenesis suggest that nodding syndrome may be a neuroinflammatory disorder, possibly induced by antibodies to O. volvulus cross-reacting with neuron proteins. Histological examination of post-mortem brains has shown some yet to be characterized polarizable material in the majority of specimens. Studies to confirm these observations and a clinical trial are planned for 2016.
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Affiliation(s)
- Richard Idro
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
| | - Bernard Opar
- Ministry of Health Headquarters, Kampala, Uganda
| | | | - Catherine Abbo
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
| | | | - Deogratius Amos Mwaka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
| | | | - Jane R Aceng
- Ministry of Health Headquarters, Kampala, Uganda
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Knust B, Schafer IJ, Wamala J, Nyakarahuka L, Okot C, Shoemaker T, Dodd K, Gibbons A, Balinandi S, Tumusiime A, Campbell S, Newman E, Lasry E, DeClerck H, Boum Y, Makumbi I, Bosa HK, Mbonye A, Aceng JR, Nichol ST, Ströher U, Rollin PE. Multidistrict Outbreak of Marburg Virus Disease-Uganda, 2012. J Infect Dis 2015. [PMID: 26209681 DOI: 10.1093/infdis/jiv351] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription-polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.
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Affiliation(s)
- Barbara Knust
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ilana J Schafer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Trevor Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Kimberly Dodd
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aridth Gibbons
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Balinandi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Alex Tumusiime
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Entebbe
| | - Shelley Campbell
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Edmund Newman
- Microbiology Services- Research, Public Health England, Porton Down, United Kingdom
| | | | | | | | | | | | | | | | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ute Ströher
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre E Rollin
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Okware SI, Omaswa F, Talisuna A, Amandua J, Amone J, Onek P, Opio A, Wamala J, Lubwama J, Luswa L, Kagwa P, Tylleskar T. Managing Ebola from rural to urban slum settings: experiences from Uganda. Afr Health Sci 2015; 15:312-21. [PMID: 25834568 DOI: 10.4314/ahs.v15i1.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. METHODS Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. RESULTS Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. CONCLUSION Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.
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Affiliation(s)
- Sam I Okware
- Uganda National Health Research Organisation, Entebbe, Uganda
| | - Francis Omaswa
- African Centre for Health and Social Transformation, Kampala
| | - Ambrose Talisuna
- Public Health and Health Systems Research, University of Oxford- KEMRI Welcome Trust Program, Nairobi, Kenya
| | | | - Jackson Amone
- Curative Services, Ministry of Health,, Kampala, Uganda
| | - Paul Onek
- District Director Health Services, Gulu district, Uganda
| | - Alex Opio
- Department disease Control, Ministry of Health, Kampala, Uganda
| | - Joseph Wamala
- Division of Epidemiology and Disease Control, Ministry of Health, Uganda
| | | | - Lukwago Luswa
- Division of Epidemiology and Disease Control, Ministry of Health, Uganda
| | - Paul Kagwa
- Health Education Division, Ministry of Health, Uganda
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Iyengar PJ, Wamala J, Ratto J, Blanton C, Malimbo M, Lukwago L, Becknell S, Downing R, Bunga S, Sejvar J, Makumbi I. Prevalence of nodding syndrome--Uganda, 2012-2013. MMWR Morb Mortal Wkly Rep 2014; 63:603-6. [PMID: 25029112 PMCID: PMC5779414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nodding syndrome (NS) is a seizure disorder of unknown etiology, predominately affecting children aged 3-18 years in three sub-Saharan countries (Uganda, South Sudan, and Tanzania), with the primary feature of episodic head nodding. These episodes are thought to be one manifestation of a syndrome that includes neurologic deterioration, cognitive impairment, and additional seizure types. NS investigations have focused on clinical features, progression, and etiology; however, none have provided a population-based prevalence assessment using a standardized case definition. In March 2013, CDC and the Ugandan Ministry of Health (MOH) conducted a single-stage cluster survey to perform the first systematic assessment of prevalence of NS in Uganda using a new consensus case definition, which was modified during the course of the investigation. Based on the modified definition, the estimated number of probable NS cases in children aged 5-18 years in three northern Uganda districts was 1,687 (95% confidence interval [CI] = 1,463-1,912), for a prevalence of 6.8 (CI = 5.9-7.7) probable NS cases per 1,000 children aged 5-18 years in the three districts. These findings can guide the MOH to understand and provide the health-care resources necessary to address NS in northern Uganda, and provide a basis for future studies of NS in Uganda and in other areas affected by NS.
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Affiliation(s)
| | | | - Jeffrey Ratto
- Division of Global Health Protection, Center for Global Health, CDC
| | - Curtis Blanton
- Division of Global Health Protection, Center for Global Health, CDC
| | | | | | | | - Robert Downing
- Division of Global HIV/AIDS, Center for Global Health, CDC
| | - Sudhir Bunga
- Division of Global Health Protection, Center for Global Health, CDC
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging Zoonotic and Infectious Diseases, CDC
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Roddy P, Howard N, Van Kerkhove MD, Lutwama J, Wamala J, Yoti Z, Colebunders R, Palma PP, Sterk E, Jeffs B, Van Herp M, Borchert M. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One 2012; 7:e52986. [PMID: 23285243 PMCID: PMC3532309 DOI: 10.1371/journal.pone.0052986] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/23/2012] [Indexed: 01/06/2023] Open
Abstract
A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007–February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect.
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Affiliation(s)
- Paul Roddy
- Medical Departments of Médecins Sans Frontières, Barcelona, Spain.
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Abstract
BACKGROUND Since the year 2000, Uganda has experienced repeated outbreaks of viral hemorrhagic fevers (VHF). Ebola VHF outbreak occurred in the districts of Gulu in 2000, Bundibugyo, 2007, Luwero, 2011, Kibaale in July 2012, Luwero in November 2012. Marburg VHF was earlier reported in Ibanda in 2007. More recently in 2012, two outbreaks of Marburg VHF have occurred in Ibanda and Kabale districts. OBJECTIVE To present the epidemiological picture of the Marburg VHF recently reported in Ibanda and Kabale districts and propose research questions to generate evidence to mitigate future epidemics. METHODS A case definition for a VHF was developed. A frequency distribution of symptoms of confirmed and probable cases was done. Descriptive analyses of reported cases using simple percentages, percent distributions and computation of means was performed. RESULTS The Marburg epidemic was reported in early September and by November 2012, a cumulative of 14 cases (9 confirmed and 5 probable) including 7 deaths had been registered, giving a case fatality rate (CFR) of 50%. A total of 202 contacts had been listed; out of which 193 had completed the 21-day follow-up period. The index case was a 33-year old male, a teacher at Nyakatukura Secondary School in Ibanda district. He travelled to Ibanda from Kabale, his home district on 31st August 2012, reportedly healthy. He fell sick on 3rd September 2012 with complaints of fever, headache, loss of appetite and general body weakness. Overall, the dominant symptoms for all cases were fever, vomiting, loss of appetite, headache, abdominal pain, fatigue, diarrhea, and the least in occurrence was bleeding which accounted for 35.5% of all the cases. CONCLUSION The source of infection for all the five Ebola Hemorrhagic fever outbreaks in Uganda and the recent Marburg VHF outbreak in Ibanda and Kabale is not known. Currently there is suspicion that there could be an animal reservoir of the Ebola and Marburg viruses from where occasional spillage into the human population occurs resulting in disease outbreaks. This and other hypotheses require further investigation.
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Affiliation(s)
- A Mbonye
- Ministry of Health Head Quarters, P.O Box 7272 Kampala, Uganda.
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Lukwago L, Nanyunja M, Ndayimirije N, Wamala J, Malimbo M, Mbabazi W, Gasasira A, Nabukenya IN, Musenero M, Alemu W, Perry H, Nsubuga P, Talisuna A. The implementation of Integrated Disease Surveillance and Response in Uganda: a review of progress and challenges between 2001 and 2007. Health Policy Plan 2012; 28:30-40. [PMID: 22669899 PMCID: PMC3538461 DOI: 10.1093/heapol/czs022] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions. Methods We used a monitoring framework recommended by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)-Atlanta to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. To determine the performance of IDSR at district and health facility levels over a 5-year period, we compared the evaluation results of a 2004 surveillance survey with findings from a baseline assessment in 2000. We also examined national-level funding for IDSR implementation during 2000–07. Results Our findings show improvements in the performance of IDSR, including: (1) improved reporting at the district level (49% in 2001; 85% in 2007); (2) an increase and then decrease in timeliness of reporting from districts to central level; and (3) an increase in analysed data at the local level (from 10% to 47% analysing at least one target disease, P < 0.01). The case fatality rate (CFR) for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. A comparison before and after implementation showed increased funding for IDSR from government and development partners. However, funding support decreased ten-fold from the government budget of 2000/01 through to 2007/08. Per capita input for disease surveillance activities increased from US$0.0046 in 1996–99 to US$0.0215 in 2000–07. Conclusion Implementation of IDSR was associated with improved surveillance and response efforts. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
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McNabb S, Wamala J, Naz A, Hartrampf A, Samoly D, Mutonga D, Park M. Novel conceptual framework and toolset for country-wide assessments of opportunities and challenges for public health interventions. Emerging Health Threats Journal 2011. [DOI: 10.3402/ehtj.v4i0.11169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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MacNeil A, Farnon EC, Wamala J, Okware S, Cannon DL, Reed Z, Towner JS, Tappero JW, Lutwama J, Downing R, Nichol ST, Ksiazek TG, Rollin PE. Proportion of deaths and clinical features in Bundibugyo Ebola virus infection, Uganda. Emerg Infect Dis 2011; 16:1969-72. [PMID: 21122234 PMCID: PMC3294552 DOI: 10.3201/eid1612.100627] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The first known Ebola hemorrhagic fever (EHF) outbreak caused by Bundibugyo Ebola virus occurred in Bundibugyo District, Uganda, in 2007. Fifty-six cases of EHF were laboratory confirmed. Although signs and symptoms were largely nonspecific and similar to those of EHF outbreaks caused by Zaire and Sudan Ebola viruses, proportion of deaths among those infected was lower (≈40%).
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Affiliation(s)
- Adam MacNeil
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Lukwago L, Wamala J, Erima B, Okot C, Bakamutumaho B, Nabukenya I, Lutwama J. H1N1 Pandemic: From imported cases in July 2009 to sustained transmission in school clusters in September, Uganda, 2009. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bazeyo W, Lukwago L, Wamala J, Obayo S, Bua J, Ecumu J, Baluku P, Mukobi P. Suspected outbreak of cutaneous anthrax in Kasese district, the investigation and response, April to May 2007. East Afr J Public Health 2009; 6:235-239. [PMID: 20803911] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND A report of suspected anthrax was submitted by the Kasese District Health Office to the Epidemiology Surveillance Division of Ministry of Health. A joint team comprising officers from MOH, IPH and MPH officers proceeded to the district to investigate the reported threat of anthrax. The investigations were conducted in Bwera HSD, Bukonjo West County, in communities bordering Queen Elizabeth National Park. OBJECTIVES The main objectives of the study were to verify the existence of anthrax and assess the risk factors for the suspected outbreak of anthrax in Kasese district. METHODS The methods involved discussion with the DHT members; reviewing the surveillance data and hospital records, and reorienting the case definitions to the specific type of anthrax. In addition tracing the reported cases in the community in order to establish exposure to the risk factors and sensitize the community. RESULTS Cutaneous anthrax was clinically diagnosed as the cause of the reported anthrax, both from the medical records and observation of cases found during the investigation. The index case was a 44 year old male, from Hurukungu village, Kyempara parish, a household with one wife and 4 children. This case skinned a goat that had died under mysterious circumstances and the meat was eaten with family members. Two other cases were members of the same family and the fourth case was from the same community and bought meat from the index case. All the four cases presented with a history of blister like lesions that eventually ulcerated with swelling of surrounding skin in different parts of the body. There were no other systemic symptoms reported in all the cases. All the suspected cases received antibiotics to which anthrax is sensitive. There were no laboratory investigations done by the time of the investigations since many of the cases identified were already on treatment and recovering from the infection, therefore no samples were taken from them. Review of records revealed that reporting of anthrax has continued since the year 2005 with cases ranging from I to 4 from villages that shares a common boarder with Queen Elizabeth National Game Park. This particular outbreak was associated with eating of meat from a goat that had died of unknown cause. The health workers from the health units where cases were reported were found to have the basic knowledge and skills to suspect anthrax. However, they had no guidelines to help them identify cases of anthrax accurately. The available Standard Case Definition (SCD) booklets, IDSR Technical Guidelines, and laboratory SOPs have no information on anthrax. No samples have ever been removed from suspected cases for laboratory investigation. The health units have the appropriate antibiotics for treatment of suspected case. The Local Council Chairpersons, Veterinary extension workers, and the health educators have sensitized the community in the past against eating dead animals and that they should notify the authorities, and bury all dead animals immediately. However this hasn't yet been done for the current outbreak. CONCLUSION The outbreak of anthrax in Bwera sub-county followed eating of meat from a goat which had died from unknown causes. Suspected cases have not been confirmed by laboratory but treated empirically with antibiotics. All new cases of suspected anthrax that report at the lower health units without laboratory facilities should be referred to hospital for investigation to confirm the diagnosis. There is need to include guidelines on anthrax in the SCD Booklets, laboratory SOPs and IDSR technical guidelines. Resensitization of the affected communities about the prevention of anthrax should be done immediately.
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Affiliation(s)
- William Bazeyo
- Makerere University School of Public Health, P.O. Box 7072, Kampala
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