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Nyakarahuka L, Kyondo J, Telford C, Whitesell A, Tumusiime A, Mulei S, Baluku J, Cossaboom CM, Cannon DL, Montgomery JM, Lutwama JJ, Nichol ST, Balinandi SK, Klena JD, Shoemaker TR. Seroepidemiological investigation of Crimean Congo hemorrhagic fever virus in livestock in Uganda, 2017. PLoS One 2023; 18:e0288587. [PMID: 37943886 PMCID: PMC10635543 DOI: 10.1371/journal.pone.0288587] [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: 08/09/2022] [Accepted: 07/01/2023] [Indexed: 11/12/2023] Open
Abstract
Crimean-Congo Hemorrhagic fever (CCHF) is an important zoonotic disease transmitted to humans both by tick vectors and contact with fluids from an infected animal or human. Although animals are not symptomatic when infected, they are the main source of human infection. Uganda has reported sporadic human outbreaks of CCHF in various parts of the country since 2013. We designed a nationwide epidemiological study to investigate the burden of CCHF in livestock. A total of 3181 animals were sampled; 1732 cattle (54.4%), 1091 goats (34.3%), and 358 sheep (11.3%) resulting in overall livestock seropositivity of IgG antibodies against CCHF virus (CCHFV) of 31.4% (999/3181). Seropositivity in cattle was 16.9% and in sheep and goats was 48.8%. Adult and juvenile animals had higher seropositivity compared to recently born animals, and seropositivity was higher in female animals (33.5%) compared to male animals (24.1%). Local breeds had higher (36.8%) compared to exotic (2.8%) and cross breeds (19.3%). Animals that had a history of abortion or stillbirth had higher seropositivity compared to those without a history of abortion or stillbirth. CCHFV seropositivity appeared to be generally higher in northern districts of the country, though spatial trends among sampled districts were not examined. A multivariate regression analysis using a generalized linear mixed model showed that animal species, age, sex, region, and elevation were all significantly associated with CCHFV seropositivity after adjusting for the effects of other model predictors. This study shows that CCHFV is actively circulating in Uganda, posing a serious risk for human infection. The results from this study can be used to help target surveillance efforts for early case detection in animals and limit subsequent spillover into humans.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Carson Telford
- 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
| | - Amy Whitesell
- 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
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Caitlin M. Cossaboom
- 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
| | - Deborah L. Cannon
- 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
| | - 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
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Stuart T. Nichol
- 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 K. Balinandi
- Department of Arbovirology, Emerging and Reemerging 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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Balinandi S, Whitmer S, Mulei S, Nassuna C, Pimundu G, Muyigi T, Kainulainen M, Shedroff E, Krapiunaya I, Scholte F, Nyakarahuka L, Tumusiime A, Kyondo J, Baluku J, Kiconco J, Harris JR, Ario AR, Kagirita A, Bosa HK, Ssewanyana I, Nabadda S, Mwebesa HG, Aceng JR, Atwine D, Lutwama JJ, Shoemaker TR, Montgomery JM, Kaleebu P, Klena JD. Molecular characterization of the 2022 Sudan virus disease outbreak in Uganda. J Virol 2023; 97:e0059023. [PMID: 37750724 PMCID: PMC10617429 DOI: 10.1128/jvi.00590-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
Abstract
IMPORTANCE Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks.
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Affiliation(s)
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Godfrey Pimundu
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Tonny Muyigi
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Markus Kainulainen
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Shedroff
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inna Krapiunaya
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Florine Scholte
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Luke Nyakarahuka
- Uganda Virus Research Institute, Entebbe, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Jimmy Baluku
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Alex R. Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Henry K. Bosa
- Ministry of Health, Kampala, Uganda
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Isaac Ssewanyana
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | - Susan Nabadda
- Uganda National Health Laboratory Services, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pontiano Kaleebu
- Uganda Virus Research Institute, Entebbe, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - John D. Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nyakarahuka L, Kyondo J, Telford C, Whitesell A, Tumusiime A, Mulei S, Baluku J, Cossaboom CM, Cannon DL, Montgomery JM, Lutwama JJ, Nichol ST, Balinandi S, Klena JD, Shoemaker TR. A Countrywide Seroepidemiological Survey of Rift Valley Fever in Livestock, Uganda, 2017. Am J Trop Med Hyg 2023; 109:548-553. [PMID: 37524326 PMCID: PMC10484263 DOI: 10.4269/ajtmh.22-0504] [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: 08/08/2022] [Accepted: 05/01/2023] [Indexed: 08/02/2023] Open
Abstract
In 2016, an outbreak of Rift Valley fever was reported in the Kabale District in Uganda for the first time in 48 years. Three human cases were confirmed by polymerase chain reaction, and subsequent serological investigations revealed an overall IgG seropositivity of 13% in humans and 13% in animals. In response to this reemergence, we designed a countrywide survey to determine the seropositivity of anti-Rift Valley fever virus (RVFV) IgG antibodies in livestock. Samples were collected from 27 districts and tested for RVFV anti-IgG antibodies. A total of 3,181 livestock samples were tested, of which 54.4% were cattle (1,732 of 3,181), 34.3% were goats (1,091 of 3,181), and 11.3% were sheep (358 of 3,181). Overall RVFV seropositivity was 6.9% (221 of 3,181). Seroprevalence was greater in cattle (10.7%) compared with goats (2.6%) and sheep (2.0%), among females (7.5%) compared with males (5.2%), and among adults (7.6%) compared with juveniles (4.9%) and nurslings (6.4%). Exotic breeds and animals with a history of abortion or stillbirth also had greater odds of RVFV seropositivity. Animals grazed under tethering and paddocking had greater RVFV seropositivity compared with animals that grazed communally, and livestock in the western and eastern regions had the greatest seroprevalence. In a multivariate regression model, animal species (odds ratio [OR], 6.4; 95% CI, 3.5-11.4) and age (OR, 2.3; 95% CI, 1.4-3.6) were associated significantly with RVFV seropositivity. This study could be important in developing risk-based surveillance for early outbreak detection to limit the spread of RVFV in both human and animal populations.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Carson Telford
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Whitesell
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Caitlin M. Cossaboom
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah L. Cannon
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M. Montgomery
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - John D. Klena
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Nyakarahuka L, Whitmer S, Klena J, Balinandi S, Talundzic E, Tumusiime A, Kyondo J, Mulei S, Patel K, Baluku J, Akurut G, Namanya D, Kamugisha K, Cossaboom C, Whitesell A, Telford C, Graziano J, Montgomery J, Nichol S, Lutwama J, Shoemaker T. Detection of Sporadic Outbreaks of Rift Valley Fever in Uganda through the National Viral Hemorrhagic Fever Surveillance System, 2017-2020. Am J Trop Med Hyg 2023; 108:995-1002. [PMID: 36913925 PMCID: PMC10160879 DOI: 10.4269/ajtmh.22-0410] [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: 06/20/2022] [Accepted: 11/22/2022] [Indexed: 03/15/2023] Open
Abstract
Rift Valley fever (RVF) is a zoonotic disease of public health and economic importance. Uganda has reported sporadic outbreaks of RVF in both humans and animals across the country, especially in the southwestern part of the "cattle corridor" through an established viral hemorrhagic fever surveillance system. We report 52 human cases of laboratory-confirmed RVF from 2017 to 2020. The case fatality rate was 42%. Among those infected, 92% were males and 90% were adults (≥ 18 years). Clinical symptoms were characterized by fever (69%), unexplained bleeding (69%), headache (51%), abdominal pain (49%), and nausea and vomiting (46%). Most of the cases (95%) originated from central and western districts that are part of the cattle corridor of Uganda, where the main risk factor was direct contact with livestock (P = 0.009). Other predictors of RVF positivity were determined to be male gender (P = 0.001) and being a butcher (P = 0.04). Next-generation sequencing identified the predominant Ugandan clade as Kenya-2, observed previously across East Africa. There is need for further investigation and research into the effect and spread of this neglected tropical disease in Uganda and the rest of Africa. Control measures such as promoting vaccination and limiting animal-human transmission could be explored to reduce the impact of RVF in Uganda and globally.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University, Kampala, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Klena
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Emir Talundzic
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Ketan Patel
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | | | - Caitlin Cossaboom
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Whitesell
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carson Telford
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Graziano
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel Montgomery
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stuart Nichol
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julius Lutwama
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Nyakarahuka L, Whitmer S, Kyondo J, Mulei S, Cossaboom CM, Telford CT, Tumusiime A, Akurut GG, Namanya D, Kamugisha K, Baluku J, Lutwama J, Balinandi S, Shoemaker T, Klena JD. Crimean-Congo Hemorrhagic Fever Outbreak in Refugee Settlement during COVID-19 Pandemic, Uganda, April 2021. Emerg Infect Dis 2022; 28:2326-2329. [PMID: 36198315 PMCID: PMC9622249 DOI: 10.3201/eid2811.220365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Crimean-Congo hemorrhagic fever (CCHF) was detected in 2 refugees living in a refugee settlement in Kikuube district, Uganda. Investigations revealed a CCHF IgG seroprevalence of 71.3% (37/52) in goats within the refugee settlement. This finding highlights the need for a multisectoral approach to controlling CCHF in humans and animals in Uganda.
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Cossaboom CM, Nyakarahuka L, Mulei S, Kyondo J, Tumusiime A, Baluku J, Akurut GG, Namanya D, Kamugisha K, Nansikombi HT, Nyabakira A, Mutesasira S, Whitmer S, Telford C, Lutwama J, Balinandi S, Montgomery J, Klena JD, Shoemaker T. Rift Valley Fever Outbreak during COVID-19 Surge, Uganda, 2021. Emerg Infect Dis 2022; 28:2290-2293. [PMID: 36150455 PMCID: PMC9622231 DOI: 10.3201/eid2811.220364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rift Valley fever, endemic or emerging throughout most of Africa, causes considerable risk to human and animal health. We report 7 confirmed Rift Valley fever cases, 1 fatal, in Kiruhura District, Uganda, during 2021. Our findings highlight the importance of continued viral hemorrhagic fever surveillance, despite challenges associated with the COVID-19 pandemic.
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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] [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: 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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8
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Schuh AJ, Kyondo J, Graziano J, Balinandi S, Kainulainen MH, Tumusiime A, Nyakarahuka L, Mulei S, Baluku J, Lonergan W, Mayer O, Masereka R, Masereka F, Businge E, Gatare A, Kabyanga L, Muhindo S, Mugabe R, Makumbi I, Kayiwa J, Wetaka MM, Brown V, Ojwang J, Nelson L, Millard M, Nichol ST, Montgomery JM, Taboy CH, Lutwama JJ, Klena JD. Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019. PLoS Negl Trop Dis 2021; 15:e0009967. [PMID: 34860831 PMCID: PMC8673597 DOI: 10.1371/journal.pntd.0009967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/08/2021] [Revised: 12/15/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda. Following an imported outbreak of Ebola virus disease in Uganda’s western Kasese District, the Uganda Virus Research Institute and the United States Centers for Disease Control and Prevention jointly established a frontline field laboratory to test specimens collected from alert and suspect cases for Ebola virus disease. Using a single room equipped with a rapid containment kit to safely inactivate patient specimens and a GeneXpert to perform the Xpert Ebola Assay, the field laboratory rapidly ruled-out Ebola virus disease as the cause of illness in 76 patients during its 46 operational days. All specimens were also referred to Uganda Virus Research Institute (Entebbe) for confirmatory Ebola virus testing and testing against a panel of viruses known to cause hemorrhagic fever in Uganda, in line with the National Viral Hemorrhagic Fever Program’s testing protocol and mandate. The Ebola field laboratory served as a valuable asset in the outbreak response by supporting patient management and epidemiological surveillance.
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Affiliation(s)
- Amy J. 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
- United States Public Health Service Commissioned Corps, Rockville, Maryland, United States of America
- * E-mail: (AJS); (JDK)
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - James Graziano
- 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 Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Markus H. Kainulainen
- 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
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Luke Nyakarahuka
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - William Lonergan
- 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
| | - Oren Mayer
- 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
- United States Public Health Service Commissioned Corps, Rockville, Maryland, United States of America
| | | | | | | | | | | | | | - Raymond Mugabe
- Uganda Central Public Health Laboratories, Kampala, Uganda
| | - Issa Makumbi
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Joshua Kayiwa
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | | | - Vance Brown
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Joseph Ojwang
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa Nelson
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Stuart T. Nichol
- 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
| | - 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
- United States Public Health Service Commissioned Corps, Rockville, Maryland, United States of America
| | - Celine H. Taboy
- 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
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Reemerging 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
- * E-mail: (AJS); (JDK)
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Balinandi S, Whitmer S, Mulei S, Nyakarahuka L, Tumusiime A, Kyondo J, Baluku J, Mutyaba J, Mugisha L, Malmberg M, Lutwama J, Shoemaker T, Klena J. Clinical and Molecular Epidemiology of Crimean-Congo Hemorrhagic Fever in Humans in Uganda, 2013-2019. Am J Trop Med Hyg 2021; 106:88-98. [PMID: 34662872 PMCID: PMC8733546 DOI: 10.4269/ajtmh.21-0685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 06/16/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022] Open
Abstract
Crimean-Congo Hemorrhagic Fever (CCHF) is endemic in Uganda, yet its epidemiology remains largely uncharacterized. To better understand its occurrence within Uganda, case reports of patients hospitalized with CCHF between 2013 and 2019 were reviewed. Further, genome sequences of CCHF-positive RNA obtained during this period were determined for phylogenetic comparisons. We found that a total of 32 cases (75% males; CFR, 31.2%), aged between 9 to 68 years, were reported during the study period. Most cases were detected during July to December of each outbreak year (81.2%; P < 0.01) and were located along the "cattle corridor" (68.7%, P = 0.03). The most common presenting symptoms were fever (93.8%), hemorrhage (81.3%), headache (78.1%), fatigue (68.8%), vomiting (68.8%), and myalgia (65.6%). In five patients for whom hematological data were available, varied abnormalities were observed including thrombocytopenia, leukopenia, anemia, lymphopenia, lymphocytosis, polycythemia, and microcytosis. About 56.3% (P = 0.47) of patients reported tick bites or exposure to livestock as their potential source of infection. Person-to-person transmission was suspected for two cases. Using unbiased metagenomics, we found that the viral S- and L- segments have remained conserved in Africa 2 clade since the 1950s. In contrast, the M segment split into two geographically interspersed clades; one that belongs to Africa 2 and another that is ancestral to Africa 1 and 2. Overall, this data summarizes information on the history and clinical presentation of human CCHF in Uganda. Importantly, it identifies vulnerable populations as well as temporal and geographic regions in Uganda where surveillance and control interventions could be focused.
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Affiliation(s)
- Stephen Balinandi
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda.,School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda.,School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jimmy Baluku
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Mutyaba
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Lawrence Mugisha
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,EcoHealth Research Group, Conservation & Ecosystem Health Alliance (CEHA), Kampala, Uganda
| | - Maja Malmberg
- Section of Virology, Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden.,SLU Global Bioinformatics Centre, Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Julius Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Balinandi S, von Brömssen C, Tumusiime A, Kyondo J, Kwon H, Monteil VM, Mirazimi A, Lutwama J, Mugisha L, Malmberg M. Serological and molecular study of Crimean-Congo Hemorrhagic Fever Virus in cattle from selected districts in Uganda. J Virol Methods 2021; 290:114075. [PMID: 33515661 DOI: 10.1016/j.jviromet.2021.114075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Crimean-Congo Hemorrhagic Fever (CCHF) is a severe tick-borne viral hemorrhagic disease caused by Crimean-Congo Hemorrhagic Fever Virus (CCHFV) that poses serious public health challenges in many parts of Africa, Europe and Asia. METHODS We examined 500 cattle sera samples from five districts for CCHFV antibodies using in-house and commercially available (IDVet) ELISA, Immunofluorescent assay (IFA) and Real-time polymerase chain reaction (RT-PCR). RESULTS 500 cattle (73.8 % females) were analyzed; CCHFV seropositivity was 12.6 % (n = 63) and 75.0 % (n = 375) with the in-house and IDVet ELISAs, respectively. Seropositivity was associated with geographical location, increasing age, being female, and having a higher tick burden. Twenty four out of the 37 (64.8 %) were seropositive for CCHFV using IFA and all were negative for virus on RT-PCR. The IFA results were more comparable to IDVet (κcoefficient = 0.88, p = <0.01) than to in-house (κcoefficient = 0.32, p = 0.02). CONCLUSIONS Our study confirmed the presence and high prevalence of anti-CCHF antibodies in cattle based on three methods from all the five study districts, confirming presence and exposure of CCHFV. Given the zoonotic potential for CCHFV, we recommend a multidisciplinary public health surveillance and epidemiology of CCHFV in both animals and humans throughout the country.
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Affiliation(s)
- Stephen Balinandi
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda; College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Claudia von Brömssen
- Division of Applied Statistics and Mathematics, Department of Engergy and Technology, Swedish University of Agricultural Sciences, Box 7013, Uppsala, 750 07, Sweden.
| | - Alex Tumusiime
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
| | - Jackson Kyondo
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
| | - Hyesoo Kwon
- National Veterinary Institute, Uppsala, 751 89, Sweden.
| | - Vanessa M Monteil
- Department of Laboratory Medicine, Karolinska Institute and Karolinska Hospital University, Stockholm, 171 77, Sweden.
| | - Ali Mirazimi
- National Veterinary Institute, Uppsala, 751 89, Sweden; Department of Laboratory Medicine, Karolinska Institute and Karolinska Hospital University, Stockholm, 171 77, Sweden; Public Health Agency of Sweden, Stockholm, 171 82, Sweden.
| | - Julius Lutwama
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda; Ecohealth Research Group, Conservation & Ecosystem Health Alliance (CEHA), Box 34153, Kampala, Uganda.
| | - Maja Malmberg
- Section of Virology, Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Box 7028, Uppsala, 750 07, Sweden; SLU Global Bioinformatics Centre, Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Box 7023, Uppsala, 750 07, Sweden.
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11
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Masereka EM, Naturinda A, Tumusiime A, Munguiko C. Implementation of the Perinatal Death Surveillance and Response guidelines: Lessons from annual health system strengthening interventions in the Rwenzori Sub-Region, Western Uganda. Nurs Open 2020; 7:1497-1505. [PMID: 32802370 PMCID: PMC7424478 DOI: 10.1002/nop2.524] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
Aim To determine the health facility-based perinatal mortality rate, its causes and avoidable factors using the perinatal mortality surveillance and response guidelines. Design This was an action study conducted in one of the districts in Western Uganda from 1 January-31 December 2019. Methods A total of 20 perinatal death cases were recruited consecutively. Data were collected using a Ministry of Health Perinatal Death Surveillance and Response (PDSR) questionnaire containing questions on pregnancy, delivery and immediate postnatal care. We used descriptive statistics to describe key data elements. Results We found a health facility-based perinatal mortality rate of 17.3 deaths per 1,000 live births. Birth asphyxia was the most common cause of perinatal deaths. Seven, three and ten mothers delayed seeking, reaching and receiving appropriate health care, respectively.
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Affiliation(s)
- Enos Mirembe Masereka
- Department of Nursing and MidwiferySchool of MedicineKabale UniversityKabaleUganda
- Department of Nursing and MidwiferySchool of Health SciencesMountains of the Moon UniversityFort PortalUganda
| | - Amelia Naturinda
- Infectious Diseases InstituteSchool of MedicineCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Alex Tumusiime
- Department of Nursing and MidwiferySchool of MedicineKabale UniversityKabaleUganda
| | - Clement Munguiko
- Department of Nursing and MidwiferySchool of Health SciencesMountains of the Moon UniversityFort PortalUganda
- Department of NursingSchool of Health SciencesSoroti UniversitySorotiUganda
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12
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Nyakarahuka L, Schafer IJ, Balinandi S, Mulei S, Tumusiime A, Kyondo J, Knust B, Lutwama J, Rollin P, Nichol S, Shoemaker T. A retrospective cohort investigation of seroprevalence of Marburg virus and ebolaviruses in two different ecological zones in Uganda. BMC Infect Dis 2020; 20:461. [PMID: 32611400 PMCID: PMC7329513 DOI: 10.1186/s12879-020-05187-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/06/2020] [Accepted: 06/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Uganda has experienced seven Ebola Virus Disease (EVD) outbreaks and four Marburg Virus Disease (MVD) outbreaks between 2000 and 2019. We investigated the seroprevalence and risk factors for Marburg virus and ebolaviruses in gold mining communities around Kitaka gold mine in Western Uganda and compared them to non-mining communities in Central Uganda. METHODS A questionnaire was administered and human blood samples were collected from three exposure groups in Western Uganda (gold miners, household members of miners, non-miners living within 50 km of Kitaka mine). The unexposed controls group sampled was community members in Central Uganda far away from any gold mining activity which we considered as low-risk for filovirus infection. ELISA serology was used to analyse samples, detecting IgG antibodies against Marburg virus and ebolaviruses (filoviruses). Data were analysed in STATA software using risk ratios and odds ratios. RESULTS Miners in western Uganda were 5.4 times more likely to be filovirus seropositive compared to the control group in central Uganda (RR = 5.4; 95% CI 1.5-19.7) whereas people living in high-risk areas in Ibanda and Kamwenge districts were 3.6 more likely to be seropositive compared to control group in Luweeero district (RR = 3.6; 95% CI 1.1-12.2). Among all participants, filovirus seropositivity was 2.6% (19/724) of which 2.3% (17/724) were reactive to Sudan virus only and 0.1% (1/724) to Marburg virus. One individual seropositive for Sudan virus also had IgG antibodies reactive to Bundibugyo virus. The risk factors for filovirus seropositivity identified included mining (AOR = 3.4; 95% CI 1.3-8.5), male sex (AOR = 3.1; 95% CI 1.01-9.5), going inside mines (AOR = 3.1; 95% CI 1.2-8.2), cleaning corpses (AOR = 3.1; 95% CI 1.04-9.1) and contact with suspect filovirus cases (AOR = 3.9, 95% CI 1.04-14.5). CONCLUSIONS These findings indicate that filovirus outbreaks may go undetected in Uganda and people involved in artisan gold mining are more likely to be exposed to infection with either Marburg virus or ebolaviruses, likely due to increased risk of exposure to bats. This calls for active surveillance in known high-risk areas for early detection and response to prevent filovirus epidemics.
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Affiliation(s)
- Luke Nyakarahuka
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Stephen Balinandi
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Sophia Mulei
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Alex Tumusiime
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Jackson Kyondo
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Barbara Knust
- Centres for Disease Control and Prevention, Atlanta, USA
| | - Julius Lutwama
- Arbovirology, Emerging and Re-emerging Diseases, Uganda Virus Research Institute , Entebbe, Uganda
| | - Pierre Rollin
- Centres for Disease Control and Prevention, Atlanta, USA
| | - Stuart Nichol
- Centres for Disease Control and Prevention, Atlanta, USA
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13
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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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Shoemaker TR, Nyakarahuka L, Balinandi S, Ojwang J, Tumusiime A, Mulei S, Kyondo J, Lubwama B, Sekamatte M, Namutebi A, Tusiime P, Monje F, Mayanja M, Ssendagire S, Dahlke M, Kyazze S, Wetaka M, Makumbi I, Borchert J, Zufan S, Patel K, Whitmer S, Brown S, Davis WG, Klena JD, Nichol ST, Rollin PE, Lutwama J. First Laboratory-Confirmed Outbreak of Human and Animal Rift Valley Fever Virus in Uganda in 48 Years. Am J Trop Med Hyg 2020; 100:659-671. [PMID: 30675833 PMCID: PMC6402942 DOI: 10.4269/ajtmh.18-0732] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/23/2022] Open
Abstract
In March 2016, an outbreak of Rift Valley fever (RVF) was identified in Kabale district, southwestern Uganda. A comprehensive outbreak investigation was initiated, including human, livestock, and mosquito vector investigations. Overall, four cases of acute, nonfatal human disease were identified, three by RVF virus (RVFV) reverse transcriptase polymerase chain reaction (RT-PCR), and one by IgM and IgG serology. Investigations of cattle, sheep, and goat samples from homes and villages of confirmed and probable RVF cases and the Kabale central abattoir found that eight of 83 (10%) animals were positive for RVFV by IgG serology; one goat from the home of a confirmed case tested positive by RT-PCR. Whole genome sequencing from three clinical specimens was performed and phylogenetic analysis inferred the relatedness of 2016 RVFV with the 2006–2007 Kenya-2 clade, suggesting previous introduction of RVFV into southwestern Uganda. An entomological survey identified three of 298 pools (1%) of Aedes and Coquillettidia species that were RVFV positive by RT-PCR. This was the first identification of RVFV in Uganda in 48 years and the 10th independent viral hemorrhagic fever outbreak to be confirmed in Uganda since 2010.
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Affiliation(s)
- Trevor R Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.,Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Luke Nyakarahuka
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Stephen Balinandi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Joseph Ojwang
- Global Health Security Unit, Centers for Disease Control and Prevention-Uganda, Kampala, Uganda
| | - Alex Tumusiime
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Jackson Kyondo
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | | | | | - Fred Monje
- Ministry of Agriculture, Animal Industry and Fisheries, Kampala, Uganda
| | - Martin Mayanja
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Melissa Dahlke
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Jeff Borchert
- Global Health Security Unit, Centers for Disease Control and Prevention-Uganda, Kampala, Uganda
| | - Sara Zufan
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ketan Patel
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Whitmer
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley Brown
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William G Davis
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John D Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stuart T Nichol
- 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
| | - Julius Lutwama
- Department of Arbovirology, Emerging and Reemerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
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Nyakarahuka L, Shoemaker TR, Balinandi S, Chemos G, Kwesiga B, Mulei S, Kyondo J, Tumusiime A, Kofman A, Masiira B, Whitmer S, Brown S, Cannon D, Chiang CF, Graziano J, Morales-Betoulle M, Patel K, Zufan S, Komakech I, Natseri N, Chepkwurui PM, Lubwama B, Okiria J, Kayiwa J, Nkonwa IH, Eyu P, Nakiire L, Okarikod EC, Cheptoyek L, Wangila BE, Wanje M, Tusiime P, Bulage L, Mwebesa HG, Ario AR, Makumbi I, Nakinsige A, Muruta A, Nanyunja M, Homsy J, Zhu BP, Nelson L, Kaleebu P, Rollin PE, Nichol ST, Klena JD, Lutwama JJ. Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings. PLoS Negl Trop Dis 2019; 13:e0007257. [PMID: 30883555 PMCID: PMC6438581 DOI: 10.1371/journal.pntd.0007257] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 09/30/2018] [Revised: 03/28/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations. METHODS A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus. RESULTS Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda. CONCLUSION This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.
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Affiliation(s)
- Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
- Department of Biosecurity, Ecosystems, and Veterinary Public Health, Collage of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala Uganda
| | - Trevor R. Shoemaker
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Stephen Balinandi
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Godfrey Chemos
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Alex Tumusiime
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Aaron Kofman
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Ben Masiira
- African Field Epidemiology Network, Kampala, Uganda
| | - Shannon Whitmer
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Shelley Brown
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Debi Cannon
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Cheng-Feng Chiang
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - James Graziano
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Maria Morales-Betoulle
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Ketan Patel
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Sara Zufan
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | | | - Nasan Natseri
- World Health Organization – Country Office, Kampala, Uganda
| | | | | | | | - Joshua Kayiwa
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Innocent H. Nkonwa
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Patricia Eyu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lydia Nakiire
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | - Leonard Cheptoyek
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | | | - Michael Wanje
- Kween District Health Team, Kween District Local Government, Kween, Uganda
| | | | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | - Alex R. Ario
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | | | - Jaco Homsy
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Bao-Ping Zhu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Lisa Nelson
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Pontiano Kaleebu
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
| | - Pierre E. Rollin
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - John D. Klena
- Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC), Atlanta, GA United States of America
| | - Julius J. Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infections, Uganda Virus Research Institute (UVRI), Entebbe Uganda
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Nyakarahuka L, Balinandi S, Mulei S, Kyondo J, Tumusiime A, Klena J, Lutwama J, Shoemaker T. Ten outbreaks of rift valley fever in Uganda 2016-2018: epidemiological and laboratory findings. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.029] [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: 10/27/2022] Open
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Kizito S, Okello PE, Kwesiga B, Nyakarahuka L, Balinandi S, Mulei S, Kyondo J, Tumusiime A, Lutwama J, Ario AR, Ojwang J, Zhu BP. Notes from the Field: Crimean-Congo Hemorrhagic Fever Outbreak - Central Uganda, August-September 2017. MMWR Morb Mortal Wkly Rep 2018; 67:646-647. [PMID: 29879093 PMCID: PMC5991810 DOI: 10.15585/mmwr.mm6722a6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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de St. Maurice A, Harmon J, Nyakarahuka L, Balinandi S, Tumusiime A, Kyondo J, Mulei S, Namutebi A, Knust B, Shoemaker T, Nichol ST, McElroy AK, Spiropoulou CF. Rift valley fever viral load correlates with the human inflammatory response and coagulation pathway abnormalities in humans with hemorrhagic manifestations. PLoS Negl Trop Dis 2018; 12:e0006460. [PMID: 29727450 PMCID: PMC5955566 DOI: 10.1371/journal.pntd.0006460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/22/2017] [Revised: 05/16/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022] Open
Abstract
Rift Valley fever virus is an arbovirus that affects both livestock and humans throughout Africa and in the Middle East. Despite its endemicity throughout Africa, it is a rare event to identify an infected individual during the acute phase of the disease and an even rarer event to collect serial blood samples from the affected patient. Severely affected patients can present with hemorrhagic manifestations of disease. In this study we identified three Ugandan men with RVFV disease that was accompanied by hemorrhagic manifestations. Serial blood samples from these men were analyzed for a series of biomarkers specific for various aspects of human pathophysiology including inflammation, endothelial function and coagulopathy. There were significant differences between biomarker levels in controls and cases both early during the illness and after clearance of viremia. Positive correlation of viral load with markers of inflammation (IP-10, CRP, Eotaxin, MCP-2 and Granzyme B), markers of fibrinolysis (tPA and D-dimer), and markers of endothelial function (sICAM-1) were all noted. However, and perhaps most interesting given the fact that these individuals exhibited hemorrhagic manifestations of disease, was the finding of a negative correlation between viral load and P-selectin, ADAMTS13, and fibrinogen all of which are associated with coagulation pathways occurring on the endothelial surface.
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Affiliation(s)
- Annabelle de St. Maurice
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
- University of California Los Angeles, Division of Pediatric Infectious Disease, Los Angeles, CA, United States of America
| | - Jessica Harmon
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | | | | | | | | | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Barbara Knust
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Trevor Shoemaker
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Stuart T. Nichol
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
| | - Anita K. McElroy
- Viral Special Pathogens Branch, US CDC, Atlanta, GA, United States of America
- Emory University, Division of Pediatric Infectious Disease, Atlanta, GA, United States of America
- University of Pittsburgh, Division of Pediatric Infectious Disease, Pittsburgh, PA, United States of America
- * E-mail:
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Nyakarahuka L, de St. Maurice A, Purpura L, Ervin E, Balinandi S, Tumusiime A, Kyondo J, Mulei S, Tusiime P, Lutwama J, Klena JD, Brown S, Knust B, Rollin PE, Nichol ST, Shoemaker TR. Prevalence and risk factors of Rift Valley fever in humans and animals from Kabale district in Southwestern Uganda, 2016. PLoS Negl Trop Dis 2018; 12:e0006412. [PMID: 29723189 PMCID: PMC5953497 DOI: 10.1371/journal.pntd.0006412] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 12/07/2017] [Revised: 05/15/2018] [Accepted: 03/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background Rift Valley fever (RVF) is a zoonotic disease caused by Rift Valley fever virus (RVFV) found in Africa and the Middle East. Outbreaks can cause extensive morbidity and mortality in humans and livestock. Following the diagnosis of two acute human RVF cases in Kabale district, Uganda, we conducted a serosurvey to estimate RVFV seroprevalence in humans and livestock and to identify associated risk factors. Methods Humans and animals at abattoirs and villages in Kabale district were sampled. Persons were interviewed about RVFV exposure risk factors. Human blood was tested for anti-RVFV IgM and IgG, and animal blood for anti-RVFV IgG. Principal findings 655 human and 1051 animal blood samples were collected. Anti-RVFV IgG was detected in 78 (12%) human samples; 3 human samples (0.5%) had detectable IgM only, and 7 (1%) had both IgM and IgG. Of the 10 IgM-positive persons, 2 samples were positive for RVFV by PCR, confirming recent infection. Odds of RVFV seropositivity were greater in participants who were butchers (odds ratio [OR] 5.1; 95% confidence interval [95% CI]: 1.7–15.1) and those who reported handling raw meat (OR 3.4; 95% CI 1.2–9.8). No persons under age 20 were RVFV seropositive. The overall animal seropositivity was 13%, with 27% of cattle, 7% of goats, and 4% of sheep seropositive. In a multivariate logistic regression, cattle species (OR 9.1; 95% CI 4.1–20.5), adult age (OR 3.0; 95% CI 1.6–5.6), and female sex (OR 2.1; 95%CI 1.0–4.3) were significantly associated with animal seropositivity. Individual human seropositivity was significantly associated with animal seropositivity by subcounty after adjusting for sex, age, and occupation (p < 0.05). Conclusions Although no RVF cases had been detected in Uganda from 1968 to March 2016, our study suggests that RVFV has been circulating undetected in both humans and animals living in and around Kabale district. RVFV seropositivity in humans was associated with occupation, suggesting that the primary mode of RVFV transmission to humans in Kabale district could be through contact with animal blood or body fluids. Viral hemorrhagic fevers are known to cause high morbidity and mortality and pose a serious threat to human and animal populations in endemic countries. An outbreak of Rift Valley fever was detected in Kabale district in March, 2016 and identified the first human cases in Uganda since 1968. There was a need to perform a rapid assessment of the burden of Rift valley fever in Kabale district, identify undetected acute cases, identify risk factors associated with human disease, identify areas at high-risk or future infections, and to determine if this was a newly emerging infection or an endemic disease. Our study found the seroprevalence to be as high as 28% in humans and 36% in animals within some subcounties of Kabale district. Human seropositivity correlated with animal seropositivity, suggesting that animal to human transmission may be the predominant mode of virus spread. Our findings also suggest that this virus may have been endemic for many years prior to these human cases being identified.
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Affiliation(s)
- Luke Nyakarahuka
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - Annabelle de St. Maurice
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
- University of California Los Angeles, Division of Pediatric Infectious Disease, Los Angeles, CA
| | - Lawrence Purpura
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Elizabeth Ervin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Stephen Balinandi
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
| | - Alex Tumusiime
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
| | - Jackson Kyondo
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - Sophia Mulei
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | | | - Julius Lutwama
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging Infections, Entebbe, Uganda
| | - John D. Klena
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Shelley Brown
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Barbara Knust
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Trevor R. Shoemaker
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Entebbe, Uganda
- * E-mail:
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de St. Maurice A, Nyakarahuka L, Purpura L, Ervin E, Tumusiime A, Balinandi S, Kyondo J, Mulei S, Tusiime P, Manning C, Rollin PE, Knust B, Shoemaker T. Rift Valley Fever: A survey of knowledge, attitudes, and practice of slaughterhouse workers and community members in Kabale District, Uganda. PLoS Negl Trop Dis 2018; 12:e0006175. [PMID: 29505579 PMCID: PMC5860784 DOI: 10.1371/journal.pntd.0006175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 03/20/2018] [Accepted: 12/19/2017] [Indexed: 01/15/2023] Open
Abstract
Background Rift Valley Fever virus (RVF) is a zoonotic virus in the Phenuiviridae family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF. Methodology/Principal findings A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering. Conclusions Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations. Rift Valley Fever (RVF) virus is transmitted to humans from contact with infected livestock and through mosquito bites. Several human cases of RVF were diagnosed in Kabale District, Uganda in March 2016, over 40 years after the last RVF case was identified in Uganda. We administered a knowledge, attitudes, and practice survey to people living in Kabale District, near where the cases occurred. Survey results demonstrated that knowledge, attitudes and practice surrounding RVF could be improved within the community.
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Affiliation(s)
- Annabelle de St. Maurice
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
- * E-mail:
| | - Luke Nyakarahuka
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
- Makerere University, College of Veterinary Medicine, Animal Resources and Biosecurity, Department of Biosecurity, Ecosystems and Veterinary Public Health, Kampala, Uganda
| | - Lawrence Purpura
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Elizabeth Ervin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Alex Tumusiime
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Stephen Balinandi
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Jackson Kyondo
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
| | - Sophia Mulei
- Department of Arbovirology, Emerging and Re-emerging Disease, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Craig Manning
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Pierre E. Rollin
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Barbara Knust
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
| | - Trevor Shoemaker
- Centers for Disease Control and Prevention, Division of High Consequence Pathogens and Pathology, Viral Special Pathogens Branch, Atlanta, GA, United States of America
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Nyakarahuka L, Ojwang J, Tumusiime A, Balinandi S, Whitmer S, Kyazze S, Kasozi S, Wetaka M, Makumbi I, Dahlke M, Borchert J, Lutwama J, Ströher U, Rollin PE, Nichol ST, Shoemaker TR. Isolated Case of Marburg Virus Disease, Kampala, Uganda, 2014. Emerg Infect Dis 2018; 23:1001-1004. [PMID: 28518032 PMCID: PMC5443453 DOI: 10.3201/eid2306.170047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In September 2014, a single fatal case of Marburg virus was identified in a healthcare worker in Kampala, Uganda. The source of infection was not identified, and no secondary cases were identified. We describe the rapid identification, laboratory diagnosis, and case investigation of the third Marburg virus outbreak in Uganda.
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Balinandi S, Patel K, Ojwang J, Kyondo J, Mulei S, Tumusiime A, Lubwama B, Nyakarahuka L, Klena JD, Lutwama J, Strӧher U, Nichol ST, Shoemaker TR. Investigation of an isolated case of human Crimean-Congo hemorrhagic fever in Central Uganda, 2015. Int J Infect Dis 2018; 68:88-93. [PMID: 29382607 PMCID: PMC5893389 DOI: 10.1016/j.ijid.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/29/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Research Institute received an alert for a suspect VHF case in a 33-year-old male who presented with VHF compatible signs and symptoms at Mengo Hospital in Kampala. METHODS A blood sample from the suspect patient was tested by RT-PCR for CCHF and found positive. Serological testing on sequential blood specimens collected from this patient showed increasing anti-CCHFV IgM antibody titers, confirming recent infection. Repeat sampling of the confirmed case post recovery showed high titers for anti-CCHFV-specific IgG. An epidemiological outbreak investigation was initiated following the initial RT-PCR positive detection to identify any additional suspect cases. RESULTS Only a single acute case of CCHF was detected from this outbreak. No additional acute CCHF cases were identified following field investigations. Environmental investigations collected 53 tick samples, with only 1, a Boophilus decoloratus, having detectable CCHFV RNA by RT-PCR. Full-length genomic sequencing on a viral isolate from the index human case showed the virus to be related to the DRC (Africa 2) lineage. CONCLUSIONS This is the fourth confirmed CCHF outbreak in Uganda within 2 years after more than 50 years of no reported human CCHF cases in this country. Our investigations reaffirm the endemicity of CCHFV in Uganda, and show that exposure to ticks poses a significant risk for human infection. These findings also reflect the importance of having an established national VHF surveillance system and diagnostic capacity in a developing country like Uganda, in order to identify the first cases of VHF outbreaks and rapidly respond to reduce secondary cases. Additional efforts should focus on implementing effective tick control methods and investigating the circulation of CCHFV throughout the country.
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Affiliation(s)
- Stephen Balinandi
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, Uganda
| | - Ketan Patel
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Joseph Ojwang
- Global Health Security Unit, Centers for Disease Control and Prevention-Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, Uganda
| | - Jackson Kyondo
- Department of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Sophia Mulei
- Department of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Alex Tumusiime
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, Uganda
| | - Bernard Lubwama
- Epidemiological Surveillance Division, Ministry of Health, Plot 6, Lourdel Road, P.O. Box 7272, Kampala, Uganda
| | - Luke Nyakarahuka
- Department of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - John D Klena
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Julius Lutwama
- Department of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Ute Strӧher
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Stuart T Nichol
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA
| | - Trevor R Shoemaker
- Viral Special Pathogens Branch, Centers for Disease Control and Prevention-Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, Uganda; Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA.
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23
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de St Maurice A, Nyakarahuka L, Purpura L, Ervin E, Tumusiime A, Balinandi S, Kayondo J, Mulei S, Namutebi AM, Tusiime P, Wiersma S, Nichol S, Rollin P, Klena J, Knust B, Shoemaker T. Notes from the Field: Rift Valley Fever Response - Kabale District, Uganda, March 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1200-1201. [PMID: 27811840 DOI: 10.15585/mmwr.mm6543a5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On March 9, 2016, a male butcher from Kabale District, Uganda, aged 45 years, reported to the Kabale Regional Referral Hospital with fever, fatigue, and headache associated with black tarry stools and bleeding from the nose. One day later, a student aged 16 years from a different sub-county in Kabale District developed similar symptoms and was admitted to the same hospital. The student also had a history of contact with livestock. Blood specimens collected from both patients were sent for testing for Marburg virus disease, Ebola virus disease, Rift Valley fever (RVF), and Crimean Congo Hemorrhagic fever at the Uganda Virus Research Institute, as part of the viral hemorrhagic fevers surveillance program. The Uganda Virus Research Institute serves as the national viral hemorrhagic fever reference laboratory and hosts the national surveillance program for viral hemorrhagic fevers, in collaboration with the CDC Viral Special Pathogens Branch and the Uganda Ministry of Health.
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24
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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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25
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Albariño CG, Shoemaker T, Khristova ML, Wamala JF, Muyembe JJ, Balinandi S, Tumusiime A, Campbell S, Cannon D, Gibbons A, Bergeron E, Bird B, Dodd K, Spiropoulou C, Erickson BR, Guerrero L, Knust B, Nichol ST, Rollin PE, Ströher U. Genomic analysis of filoviruses associated with four viral hemorrhagic fever outbreaks in Uganda and the Democratic Republic of the Congo in 2012. Virology 2013; 442:97-100. [PMID: 23711383 DOI: 10.1016/j.virol.2013.04.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/07/2013] [Accepted: 04/18/2013] [Indexed: 11/28/2022]
Abstract
In 2012, an unprecedented number of four distinct, partially overlapping filovirus-associated viral hemorrhagic fever outbreaks were detected in equatorial Africa. Analysis of complete virus genome sequences confirmed the reemergence of Sudan virus and Marburg virus in Uganda, and the first emergence of Bundibugyo virus in the Democratic Republic of the Congo.
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Affiliation(s)
- C G Albariño
- Centers for Disease Control and Prevention, Atlanta, USA
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Mpairwe H, Muhangi L, Namujju PB, Kisitu A, Tumusiime A, Muwanga M, Whitworth JAG, Onyango S, Biryahwaho B, Elliott AM. HIV Risk Perception and Prevalence in a Program for Prevention of Mother-to-Child HIV Transmission. J Acquir Immune Defic Syndr 2005; 39:354-8. [PMID: 15980698 DOI: 10.1097/01.qai.0000148081.38331.92] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. METHODS Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously. RESULTS Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001). CONCLUSION There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.
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Affiliation(s)
- Harriet Mpairwe
- Uganda Virus Research Institute and Entebbe General Hospital, Entebbe, Uganda
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