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Kyobe Bosa H, Kamara N, Aragaw M, Wayengera M, Talisuna A, Bangura J, Mwebesa HG, Katoto PDMC, Agyarko RK, Ihekweazu C, Bousso A, Joshua O, Douno M, Fallah MP, Squire JS, Nyenswah TG, Nelson TV, Maeda J, Raji T, Traoré MS, Olu OO, Tegegn Woldemariam Y, Djoudalbaye B, Ngongo N, Kasolo FC, Mbala P, Fall IS, Ouma AO, Kaseya J, Aceng JR. The west Africa Ebola virus disease outbreak: 10 years on. Lancet Glob Health 2024:S2214-109X(24)00129-3. [PMID: 38527467 DOI: 10.1016/s2214-109x(24)00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Affiliation(s)
| | - Neema Kamara
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia.
| | - Merawi Aragaw
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | | | - Ambrose Talisuna
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - James Bangura
- Health and Development in Action, Freetown, Sierra Leone
| | | | | | | | | | | | | | - Moussa Douno
- Université Gamal Abdel de Conakry, Conakry, Guinea
| | - Mosoka P Fallah
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | | | | | | | - Justin Maeda
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | - Tajudeen Raji
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | | | | | | | - Benjamin Djoudalbaye
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | - Ngashi Ngongo
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | | | - Placide Mbala
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Ahmed Ogwell Ouma
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
| | - Jean Kaseya
- Africa Centres for Disease Control and Prevention, PO Box 3243, Addis Ababa, Ethiopia
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2
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Kirenga BJ, Mugenyi L, Sánchez-Rico M, Kyobe H, Muttamba W, Mugume R, Mwesigwa E, Kalimo E, Nyombi V, Segawa I, Namakula LO, Sekibira R, Kabweru W, Byanyima R, Aanyu H, Byakika-Kibwika P, Mwebesa HG, Hoertel N, Bazeyo W. Association of fluvoxamine with mortality and symptom resolution among inpatients with COVID-19 in Uganda: a prospective interventional open-label cohort study. Mol Psychiatry 2023; 28:5411-5418. [PMID: 36869228 PMCID: PMC9982784 DOI: 10.1038/s41380-023-02004-3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
Prior research suggests that fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) used for the treatment of obsessive-compulsive disorder and major depressive disorder, could be repurposed against COVID-19. We undertook a prospective interventional open-label cohort study to evaluate the efficacy and tolerability of fluvoxamine among inpatients with laboratory-confirmed COVID-19 in Uganda. The main outcome was all-cause mortality. Secondary outcomes were hospital discharge and complete symptom resolution. We included 316 patients, of whom 94 received fluvoxamine in addition to standard care [median age, 60 years (IQR = 37.0); women, 52.2%]. Fluvoxamine use was significantly associated with reduced mortality [AHR = 0.32; 95% CI = 0.19-0.53; p < 0.001, NNT = 4.46] and with increased complete symptom resolution [AOR = 2.56; 95% CI = 1.53-5.51; p < 0.001, NNT = 4.44]. Sensitivity analyses yielded similar results. These effects did not significantly differ by clinical characteristic, including vaccination status. Among the 161 survivors, fluvoxamine was not significantly associated with time to hospital discharge [AHR 0.81, 95% CI (0.54-1.23), p = 0.32]. There was a trend toward greater side effects with fluvoxamine (7.45% versus 3.15%; SMD = 0.21; χ2 = 3.46, p = 0.06), most of which were light or mild in severity and none of which were serious. One hundred mg of fluvoxamine prescribed twice daily for 10 days was well tolerated and significantly associated with reduced mortality and with increased complete symptom resolution, without a significant increase in time to hospital discharge, among inpatients with COVID-19. Large-scale randomized trials are urgently needed to confirm these findings, especially for low- and middle-income countries, where access to vaccines and approved treatments against COVID-19 is limited.
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Affiliation(s)
- Bruce J Kirenga
- Department of Internal Medicine, Makerere University, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Kampala, Uganda
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Entebbe Unit, Entebbe, Uganda
| | - Marina Sánchez-Rico
- Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, F-92130, Issy-les-Moulineaux, France
| | | | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Eliya Mwesigwa
- Makerere University Lung Institute, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | - Ezra Kalimo
- Mulago National Referral Hospital, Kampala, Uganda
| | - Vicky Nyombi
- Mulago National Referral Hospital, Kampala, Uganda
| | - Ivan Segawa
- Makerere University Lung Institute, Kampala, Uganda
| | - Loryndah Olive Namakula
- Makerere University Lung Institute, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | - Hellen Aanyu
- Mulago National Referral Hospital, Kampala, Uganda
| | | | | | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, F-92130, Issy-les-Moulineaux, France
- Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neuroscience de Paris, Paris, France
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3
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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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4
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Bwire G, Sack DA, Lunkuse SM, Ongole F, Ngwa MC, Namanya DB, Nsungwa J, Aceng Ocero JR, Mwebesa HG, Muruta A, Nakinsige A, Kisakye A, Kalyebi P, Kemirembe J, Makumbi I, Kagirita A, Ampeire I, Mutegeki D, Matseketse D, Debes AK, Orach CG. Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda. Am J Trop Med Hyg 2023; 108:954-962. [PMID: 37037429 PMCID: PMC10160876 DOI: 10.4269/ajtmh.23-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023] Open
Abstract
In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then "relapsed." These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed "eliminated" from four of these 18 districts but then "relapsed." The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.
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Affiliation(s)
- Godfrey Bwire
- Department of Community Health, Ministry of Health Uganda, Kampala, Uganda
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stella M. Lunkuse
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Francis Ongole
- Department of National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Moise Chi Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jesca Nsungwa
- Department of Maternal and Child Health, Ministry of Health, Kampala, Uganda
| | | | - Henry G. Mwebesa
- Office of the Director General Health Service, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | - Anne Nakinsige
- Division of Public Health Emergency Preparedness and Response, Ministry of Health, Kampala, Uganda
| | | | - Peter Kalyebi
- Department of Environmental Health, Ministry of Health, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Atek Kagirita
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Immaculate Ampeire
- Uganda National Immunization Programme, Ministry of Health, Kampala, Uganda
| | - David Mutegeki
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | | | - Amanda Kay Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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5
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Achan MI, Nabukenya I, Mitanda S, Nakacwa J, Bakiika H, Nabatanzi M, Bukirwa J, Nakanwagi A, Nakiire L, Aperce C, Schwid A, Okware S, Obuku EA, Lamorde M, Luswata B, Makumbi I, Muruta A, Mwebesa HG, Aceng Ocero JR. COVID-19 and the law in Uganda: a case study on development and application of the public health act from 2020 to 2021. BMC Public Health 2023; 23:761. [PMID: 37098568 PMCID: PMC10126532 DOI: 10.1186/s12889-023-15555-5] [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: 04/13/2022] [Accepted: 03/29/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda. METHODS This is a case study of Uganda's experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis. RESULTS Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions. CONCLUSIONS Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.
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Affiliation(s)
| | - Immaculate Nabukenya
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Sarah Mitanda
- Ministry of Justice and Constitutional Affairs, P.O Box 7183, Kampala, Uganda
| | - Joanita Nakacwa
- Ministry of Justice and Constitutional Affairs, P.O Box 7183, Kampala, Uganda
| | - Herbert Bakiika
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Maureen Nabatanzi
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Justine Bukirwa
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Aisha Nakanwagi
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Lydia Nakiire
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Cedric Aperce
- Resolve to Save Lives, New York 100 Broadway, 4th Floor, New York, NY 10005 USA
| | - Aaron Schwid
- Vital Strategies, New York 100 Broadway, 4th Floor, New York, NY 10005 USA
| | - Solome Okware
- World Health Organization, Uganda Country Office, P. O. Box 24578, Kampala, Uganda
| | - Ekwaro A. Obuku
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | | | - Issa Makumbi
- Ministry of Health, P.O. Box 7272, Kampala, Uganda
| | - Allan Muruta
- Ministry of Health, P.O. Box 7272, Kampala, Uganda
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6
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Harris JR, Kadobera D, Kwesiga B, Kabwama SN, Bulage L, Kyobe HB, Kagirita AA, Mwebesa HG, Wanyenze RK, Nelson LJ, Boore AL, Ario AR. Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda. BMC Health Serv Res 2022; 22:1532. [PMID: 36526999 PMCID: PMC9756722 DOI: 10.1186/s12913-022-08781-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda. METHODS We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs. RESULTS Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners. CONCLUSION Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.
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Affiliation(s)
- Julie R. Harris
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Steven N. Kabwama
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Henry B. Kyobe
- grid.4991.50000 0004 1936 8948University of Oxford, Kellogg College, Oxford, UK ,grid.415705.2Ministry of Health, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lisa J. Nelson
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda ,grid.415705.2Ministry of Health, Kampala, Uganda
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7
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Kiggundu T, Ario AR, Kadobera D, Kwesiga B, Migisha R, Makumbi I, Eurien D, Kabami Z, Kayiwa J, Lubwama B, Okethwangu D, Nabadda S, Bwire G, Mulei S, Harris JR, Dirlikov E, Fitzmaurice AG, Nabatanzi S, Tegegn Y, Muruta AN, Kyabayinze D, Boore AL, Kagirita A, Kyobe-Bosa H, Mwebesa HG, Atwine D, Aceng Ocero JR. Notes from the Field: Outbreak of Ebola Virus Disease Caused by Sudan ebolavirus - Uganda, August-October 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1457-1459. [PMID: 36355610 PMCID: PMC9707349 DOI: 10.15585/mmwr.mm7145a5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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8
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Ario AR, Makumbi I, Kadobera D, Bulage L, Ocom F, Kwesiga B, Jarvis DF, Nabatanzi S, Homsy J, Banage F, Brown V, Harris JR, Boore AL, Nelson LJ, Binder S, Mwebesa HG, Aceng JR. Uganda National Institute of Public Health: Establishment and Experiences, 2013–2021. Glob Health Sci Pract 2022; 10:GHSP-D-21-00784. [PMID: 36041845 PMCID: PMC9426990 DOI: 10.9745/ghsp-d-21-00784] [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] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
Since 2013, the Uganda National Institute of Public Health (UNIPH) has successfully collaborated with partners and secured donor funding as it works toward legal establishment as an autonomous entity eligible for government funding. Countries in Africa and beyond can learn from the process Uganda undertook to develop the UNIPH. Uganda is an ecological hot spot with porous borders that lies in several infectious disease transmission belts, making it prone to disease outbreaks. To prepare and respond to these public health threats and emergencies in a coordinated manner, Uganda established the Uganda National Institute of Public Health (UNIPH) in 2013. Using a step-by-step process, Uganda’s Ministry of Health (MOH) crafted a strategy with a vision, mission, goal, and strategic objectives, and identified value additions and key enablers for success. A regulatory impact assessment was then conducted to inform the drafting of principles of the bill for legislation on the Institute. Despite not yet attaining legal status, the UNIPH has already achieved faster, smarter, and more efficient and effective prevention, detection, and response to public health emergencies. Successes include a more coordinated multisectoral, disciplined, and organized response to emergencies; appropriate, timely, and complete information receipt and sharing; a functional national lab sample and results transportation network that has enabled detection and confirmation of public health events within 48 hours of alert; appropriate response to a confirmed public health event in 24–48 hours; and real-time surveillance of endemic- and epidemic-prone diseases. In this article, we document success stories, lessons learned, and challenges encountered during the unique staged process used to develop the components of the UNIPH. The creation of an integrated disease control center has proven to yield better collaboration and synergies between different arms of epidemic preparedness and response.
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Affiliation(s)
- Alex Riolexus Ario
- Uganda National Institute of Public Health, Kampala, Uganda.
- Ministry of Health, Kampala, Uganda
| | - Issa Makumbi
- Uganda National Institute of Public Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | - Lilian Bulage
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Dennis F Jarvis
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra Nabatanzi
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jaco Homsy
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Flora Banage
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Vance Brown
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Julie R Harris
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L Boore
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa J Nelson
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Sue Binder
- International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, GA, USA
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Byakika-Kibwika P, Sekaggya-Wiltshire C, Semakula JR, Nakibuuka J, Musaazi J, Kayima J, Sendagire C, Meya D, Kirenga B, Nanzigu S, Kwizera A, Nakwagala F, Kisuule I, Wayengera M, Mwebesa HG, Kamya MR, Bazeyo W. Safety and efficacy of hydroxychloroquine for treatment of non-severe COVID-19 among adults in Uganda: a randomized open label phase II clinical trial. BMC Infect Dis 2021; 21:1218. [PMID: 34872511 PMCID: PMC8647506 DOI: 10.1186/s12879-021-06897-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Several repurposed drugs such as hydroxychloroquine (HCQ) have been investigated for treatment of COVID-19, but none was confirmed to be efficacious. While in vitro studies have demonstrated antiviral properties of HCQ, data from clinical trials were conflicting regarding its benefit for COVID-19 treatment. Drugs that limit viral replication may be beneficial in the earlier course of the disease thus slowing progression to severe and critical illness. Design We conducted a randomized open label Phase II clinical trial from October–December 2020. Methods Patients diagnosed with COVID-19 using RT-PCR were included in the study if they were 18 years and above and had a diagnosis of COVID-19 made in the last 3 days. Patients were randomized in blocks, to receive either HCQ 400 mg twice a day for the first day followed by 200 mg twice daily for the next 4 days plus standard of care (SOC) treatment or SOC treatment alone. SARS COV-2 viral load (CT values) from RT-PCR testing of samples collected using nasal/orapharyngeal swabs was performed at baseline, day 2, 4, 6, 8 and 10. The primary outcome was median time from randomization to SARS COV-2 viral clearance by day 6. Results Of the 105 participants enrolled, 55 were assigned to the intervention group (HCQ plus SOC) and 50 to the control group (SOC only). Baseline characteristics were similar across treatment arms. Viral clearance did not differ by treatment arm, 20 and 19 participants respectively had SARS COV-2 viral load clearance by day 6 with no significant difference, median (IQR) number of days to viral load clearance between the two groups was 4(3–4) vs 4(2–4): p = 0.457. There were no significant differences in secondary outcomes (symptom resolution and adverse events) between the intervention group and the control group. There were no significant differences in specific adverse events such as elevated alkaline phosphatase, prolonged QTc interval on ECG, among patients in the intervention group as compared to the control group. Conclusion Our results show that HCQ 400 mg twice a day for the first day followed by 200 mg twice daily for the next 4 days was safe but not associated with reduction in viral clearance or symptom resolution among adults with COVID-19 in Uganda. Trial registration: NCT04860284.
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Affiliation(s)
- Pauline Byakika-Kibwika
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Christine Sekaggya-Wiltshire
- Mulago National Referral Hospital, Kampala, Uganda.,Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - James Kayima
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - David Meya
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Bruce Kirenga
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.,Makerere University Lung Institute, Kampala, Uganda
| | - Sarah Nanzigu
- Department of Pharmacology, Makerere University, Kampala, Uganda
| | - Arthur Kwizera
- Department of Anesthesia, Makerere University, Kampala, Uganda
| | | | - Ivan Kisuule
- Mulago National Referral Hospital, Kampala, Uganda
| | - Misaki Wayengera
- Department of Microbiology, Makerere University, Kampala, Uganda
| | | | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - William Bazeyo
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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10
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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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11
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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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