Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019

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.

The importance of a One Health approach for prioritising zoonotic diseases to focus on capacity-building efforts in Uganda

Zoonotic diseases constitute a significant threat to the health of humans, livestock and wildlife, as well as to livestock production, and can also have a negative impact on our shared environment and on livelihoods. Uganda is a hotspot for emerging and re-emerging zoonotic disease threats, with the main drivers of this phenomenon being identified as agricultural intensification, proximity to wildlife reservoirs and climate change. The threat of zoonotic disease outbreaks affects not only human healthcare systems but also livestock production, food security, human capital development, wildlife health, environmental health and privatesector growth. Firstly, to prevent, control and mitigate the threat from zoonotic diseases, in March 2017, Uganda prioritised zoonotic diseases using a One Health approach that focuses the limited resources available on those diseases that have the greatest impact at the national level. The prioritised zoonotic diseases in question are anthrax, zoonotic influenza viruses, viral haemorrhagic fevers, brucellosis, trypanosomiosis (African sleeping sickness), plague and rabies. Secondly, in January 2018, Uganda published a National One Health Strategic Plan, which was developed after these zoonotic diseases had been prioritised. In addition, the Ugandan Government and its partners are currently collaboratively addressing several of these previously neglected, endemic zoonotic diseases, such as anthrax, brucellosis and rabies. As a result of these One Health efforts, capacity has increased for early detection of, reporting on and response to zoonotic diseases at all levels. To consolidate the achievements of the One Health approach, the Ugandan Government and its partners should continue to support capacity building for the prevention and control of zoonotic diseases.

Managing the challenges of a highly pathogenic avian influenza H5N8 outbreak in Uganda: a case study

In 2016-2017, the H5N8 strain of highly pathogenic avian influenza (HPAI) spread worldwide and Uganda reported the first occurrence of the disease in its poultry and wild birds. Genetic analysis revealed that the virus clusters with 2.3.4.4 group B strains from birds in central and southern Asia, and thus forms part of the 2.3.4.4 group B clade. Since Uganda is in the path of two major migratory bird flyways, it is likely that infected migratory wild birds played a crucial role in the introduction of H5N8 HPAI viruses into Uganda. The outbreaks happened in the districts of Wakiso, Masaka and Kalangala and affected domestic and wild birds. A One Health Multisectoral Coordination Committee, consisting of a National Task Force, Technical Working Groups and District Disaster Management Committees, was immediately activated to coordinate the preparedness and response efforts to control the disease. In all the affected districts, surveillance was intensified on both domestic and wild birds; biosecurity measures were increased; and movement controls, culling, cleaning, disinfection and safe disposal of carcasses were implemented. Awareness of the disease was raised through education materials, leaflets and brochures distributed to farmers. Finally, Uganda successfully controlled the H5N8 outbreak, using its national preparedness and response mechanisms and through collaboration with international partners. The emergence and spread of this virus strain in Uganda and other parts of Africa poses a significant threat to the poultry industry and food security.