Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-26 (of 26 Records) |
Query Trace: Kayiwa J [original query] |
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Rift valley fever outbreak in Sembabule District, Uganda, December 2020
Aceng FL , Kayiwa J , Elyanu P , Ojwang J , Nyakarahuka L , Balinandi S , Byakika-Tusiime J , Wejuli A , Harris JR , Opolot J . One Health Outlook 2023 5 (1) 16 BACKGROUND: Rift Valley Fever (RVF) is a viral zoonosis that can cause severe haemorrhagic fevers in humans and high mortality rates and abortions in livestock. On 10 December 2020, the Uganda Ministry of Health was notified of the death of a 25-year-old male who tested RVF-positive by reverse-transcription polymerase chain reaction (RT-PCR) at the Uganda Virus Research Institute. We investigated to determine the scope of the outbreak, identify exposure factors, and institute control measures. METHODS: A suspected case was acute-onset fever (or axillary temperature > 37.5 °C) and ≥ 2 of: headache, muscle or joint pain, unexpected bleeding, and any gastroenteritis symptom in a resident of Sembabule District from 1 November to 31 December 2020. A confirmed case was the detection of RVF virus nucleic acid by RT-PCR or serum IgM antibodies detected by enzyme-linked immunosorbent assay (ELISA). A suspected animal case was livestock (cattle, sheep, goats) with any history of abortion. A confirmed animal case was the detection of anti-RVF IgM antibodies by ELISA. We took blood samples from herdsmen who worked with the index case for RVF testing and conducted interviews to understand more about exposures and clinical characteristics. We reviewed medical records and conducted an active community search to identify additional suspects. Blood samples from animals on the index case's farm and two neighbouring farms were taken for RVF testing. RESULTS: The index case regularly drank raw cow milk. None of the seven herdsmen who worked with him nor his brother's wife had symptoms; however, a blood sample from one herdsman was positive for anti-RVF-specific IgM and IgG. Neither the index case nor the additional confirmed case-patient slaughtered or butchered any sick/dead animals nor handled abortus; however, some of the other herdsmen did report high-risk exposures to animal body fluids and drinking raw milk. Among 55 animal samples collected (2 males and 53 females), 29 (53%) were positive for anti-RVF-IgG. CONCLUSIONS: Two human RVF cases occurred in Sembabule District during December 2020, likely caused by close interaction between infected cattle and humans. A district-wide animal serosurvey, animal vaccination, and community education on infection prevention practices campaign could inform RVF exposures and reduce disease burden. |
Notes from the field: Rift valley fever outbreak - Mbarara District, Western Uganda, January-March 2023
Kabami Z , Ario AR , Migisha R , Naiga HN , Nankya AM , Ssebutinde P , Nahabwe C , Omia S , Mugabi F , Muwanguzi D , Muruta A , Kayiwa J , Gidudu S , Kadobera D , Nyakarahuka L , Baluku J , Balinandi S , Cossaboom CM , Harris JR . MMWR Morb Mortal Wkly Rep 2023 72 (23) 639-640 Rift Valley fever (RVF) is a zoonotic mosquito-borne viral hemorrhagic fever (VHF) caused by Rift Valley fever virus (RVFV). RVF is endemic throughout most of Africa and the Arabian Peninsula and causes considerable morbidity and mortality among domestic livestock (1,2). Human infection occurs through contact with infected animals or their products or through bites from infected mosquitoes, mainly Aedes and Culex spp. (3). Human infections are typically asymptomatic or mild, usually manifesting as acute influenza-like illnesses (2). Severe disease, including hemorrhagic signs, occurs in approximately 10% of cases, nearly 10%–20% of which are fatal (2). Because of its socioeconomic impact and epidemic potential, RVF is a priority zoonotic disease in Uganda (4). | | On February 4, 2023, the Uganda National Public Health Emergency Operations Center was notified of a suspected viral hemorrhagic fever case in a male abattoir worker and meat roaster aged 42 years from Mbarara City, the second largest city in Uganda. The patient was evaluated at a private health facility on January 30, at which time he reported a 2-day history of influenza-like illness. He received antimalarial medication and was discharged. On February 1, because of worsening signs and symptoms (fever, vomiting, diarrhea, fatigue, anorexia, difficulty breathing, and abdominal, chest, muscle, and joint pain), the patient sought treatment at Mbarara Regional Referral Hospital (MRRH). On February 3, he experienced nosebleed, gingival hemorrhage, hematuria, and bloody stools, and voluntarily left MRRH to seek care at a second, private facility. Suspecting a viral hemorrhagic fever, clinicians isolated him, provided supportive care, and referred him back to MRRH, where he died on February 4. A postmortem blood sample tested at the Uganda Virus Research Institute for any ebolavirus, marburgvirus, Crimean-Congo hemorrhagic fever virus, and RVFV, was positive on February 5 for RVFV by reverse transcription–polymerase chain reaction (RT-PCR) (5), and immunoglobulin M (IgM) and immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) (3). |
Phylogenomic analysis uncovers a 9-year variation of Uganda influenza type-A strains from the WHO-recommended vaccines and other Africa strains.
Nabakooza G , Owuor DC , de Laurent ZR , Galiwango R , Owor N , Kayiwa JT , Jjingo D , Agoti CN , Nokes DJ , Kateete DP , Kitayimbwa JM , Frost SDW , Lutwama JJ . Sci Rep 2023 13 (1) 5516 Genetic characterisation of circulating influenza viruses directs annual vaccine strain selection and mitigation of infection spread. We used next-generation sequencing to locally generate whole genomes from 116 A(H1N1)pdm09 and 118 A(H3N2) positive patient swabs collected across Uganda between 2010 and 2018. We recovered sequences from 92% (215/234) of the swabs, 90% (193/215) of which were whole genomes. The newly-generated sequences were genetically and phylogenetically compared to the WHO-recommended vaccines and other Africa strains sampled since 1994. Uganda strain hemagglutinin (n = 206), neuraminidase (n = 207), and matrix protein (MP, n = 213) sequences had 95.23-99.65%, 95.31-99.79%, and 95.46-100% amino acid similarity to the 2010-2020 season vaccines, respectively, with several mutated hemagglutinin antigenic, receptor binding, and N-linked glycosylation sites. Uganda influenza type-A virus strains sequenced before 2016 clustered uniquely while later strains mixed with other Africa and global strains. We are the first to report novel A(H1N1)pdm09 subclades 6B.1A.3, 6B.1A.5(a,b), and 6B.1A.6 (± T120A) that circulated in Eastern, Western, and Southern Africa in 2017-2019. Africa forms part of the global influenza ecology with high viral genetic diversity, progressive antigenic drift, and local transmissions. For a continent with inadequate health resources and where social distancing is unsustainable, vaccination is the best option. Hence, African stakeholders should prioritise routine genome sequencing and analysis to direct vaccine selection and virus control. |
Uganda's experience in establishing an electronic compendium for public health emergencies
Ario AR , Aliddeki DM , Kadobera D , Bulage L , Kayiwa J , Wetaka MM , Kyazze S , Ocom F , Makumbi I , Mbaka P , Behumbiize P , Ayebazibwe I , Balinandi SK , Lutwama JJ , Crawley A , Divi N , Lule JR , Ojwang JC , Harris JR , Boore AL , Nelson LJ , Borchert J , Jarvis D . PLOS Glob Public Health 2023 3 (2) e0001402 Uganda has implemented several interventions that have contributed to prevention, early detection, and effective response to Public Health Emergencies (PHEs). However, there are gaps in collecting and documenting data on the overall response to these PHEs. We set out to establish a comprehensive electronic database of PHEs that occurred in Uganda since 2000. We constituted a core development team, developed a data dictionary, and worked with Health Information Systems Program (HISP)-Uganda to develop and customize a compendium of PHEs using the electronic Integrated Disease Surveillance and Response (eIDSR) module on the District Health Information Software version 2 (DHIS2) platform. We reviewed literature for retrospective data on PHEs for the compendium. Working with the Uganda Public Health Emergency Operations Center (PHEOC), we prospectively updated the compendium with real-time data on reported PHEs. We developed a user's guide to support future data entry teams. An operational compendium was developed within the eIDSR module of the DHIS2 platform. The variables for PHEs data collection include those that identify the type, location, nature and time to response of each PHE. The compendium has been updated with retrospective PHE data and real-time prospective data collection is ongoing. Data within this compendium is being used to generate information that can guide future outbreak response and management. The compendium development highlights the importance of documenting outbreak detection and response data in a central location for future reference. This data provides an opportunity to evaluate and inform improvements in PHEs response. |
Building national health security through a rapid self-assessment and annual operational plan in Uganda, May to September 2021
Nabatanzi M , Bakiika H , Nabukenya I , Lamorde M , Bukirwa J , Achan MI , Babigumira PA , Nakiire L , Lubanga T , Mbabazi E , Taremwa RB , Mayinja H , Nakinsige A , Makanga DK , Muruta A , Okware S , Komakech I , Makumbi I , Wetaka MM , Kayiwa J , Ocom F , Ario AR , Nabatanzi S , Ojwang J , Boore A , Yemanaberhan R , Lee CT , Obuku E , Stowell D . Health Secur 2023 21 (2) 130-140 Uganda established a National Action Plan for Health Security in 2019, following a Joint External Evaluation (JEE) of International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited capacity declined from 30% to 20%, and indicators with no capacity declined from 10% to 2%. More indicators had developed (47% vs 40%), demonstrated (29% vs 20%), and sustained (2% vs 0%) capacities in 2021 compared with 2017. Using the self-assessment JEE scores, 72 specific activities from the International Health Regulations (2005) benchmarks tool were selected for inclusion in a 1-year operational plan (2021-2022). In contrast to the 264 broad activities in the 5-year national action plan, the operational plan prioritized a small number of activities to enable sectors to focus limited resources on implementation. While certain capacities improved before and during implementation of the action plan, countries may benefit from using short-term operational planning to develop realistic and actionable health security plans to improve health security capacities. |
Phylogenetic analysis of Wesselsbron virus isolated from field-captured mosquitoes during a Rift Valley fever outbreak in Kabale District, Uganda-2016
Kayiwa JT , Mayanja MN , Nakayiki TM , Senfuka F , Mugga J , Koehler JW , Mossel EC , Lutwama JJ . Am J Trop Med Hyg 2022 108 (1) 161-164 After confirmation of two human cases of Rift Valley fever (RVF) in March 2016 in the Kabale district of Uganda, an entomological investigation was conducted with a focus on mosquito species composition and abundance of known and potential mosquito vector species, and virus testing to identify species most likely involved in Rift Valley fever virus transmission. This information could be used to forecast risk and facilitate improvement of prevention and response tools for use in preventing or controlling future outbreaks. From these collections, two virus isolates were obtained, one each from a pool of Aedes tricholabis and Ae. gibbinsi. Next-generation sequencing identified both isolates as Wesselsbron virus, family Flaviviridae, a neglected arbovirus of economic importance. These are the first reported Wesselsbron virus isolates from Uganda since 1966. |
Notes from the Field: Outbreak of ebola virus disease caused by sudan ebolavirus - Uganda, August-October 2022
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 . MMWR Morb Mortal Wkly Rep 2022 71 (45) 1457-1459 Ebola virus disease (EVD) is a rare and often deadly viral hemorrhagic fever (VHF); four species of Ebola virus (Zaire ebolavirus, Sudan ebolavirus, Taï Forest ebolavirus, and Bundibugyo ebolavirus) cause occasional outbreaks among humans and nonhuman primates* (1). Infection is transmitted through direct contact with infectious blood, body fluids, and animal tissues. Symptoms include fever, abdominal pain, diarrhea, vomiting, generalized body weakness, and hemorrhage. Since 2000, four outbreaks of EVD caused by Sudan ebolavirus have been identified in Uganda; the largest outbreak (in 2000) resulted in 425 cases and 224 (53%) deaths (2,3). No vaccine is available to prevent Sudan ebolavirus infection, and treatment is supportive. The estimated case fatality rate is 55% (4). |
Complete Genome Sequence of O'nyong Nyong Virus Isolated from a Febrile Patient in 2017 in Uganda.
Ledermann JP , Kayiwa JT , Perinet LC , Apangu T , Acayo S , Lutwama JJ , Powers AM , Mossel EC . Microbiol Resour Announc 2022 11 (12) e0069222 Despite causing numerous large outbreaks in the 20th century, few isolates of o'nyong nyong virus (ONNV) have been fully sequenced. Here, we report the complete genome sequence of an isolate of ONNV obtained from a febrile patient in northwest Uganda in 2017, designated ONNV UVRI0804. |
Establishing a public health emergency operations center in an outbreak-prone country: Lessons learned in Uganda, January 2014 to December 2021
Kayiwa J , Homsy J , Nelson LJ , Ocom F , Kasule JN , Wetaka MM , Kyazze S , Mwanje W , Kisakye A , Nabunya D , Nyirabakunzi M , Aliddeki DM , Ojwang J , Boore A , Kasozi S , Borchert J , Shoemaker T , Nabatanzi S , Dahlke M , Brown V , Downing R , Makumbi I . Health Secur 2022 20 (5) 394-407 Uganda is highly vulnerable to public health emergencies (PHEs) due to its geographic location next to the Congo Basin epidemic hot spot, placement within multiple epidemic belts, high population growth rates, and refugee influx. In view of this, Uganda's Ministry of Health established the Public Health Emergency Operations Center (PHEOC) in September 2013, as a central coordination unit for all PHEs in the country. Uganda followed the World Health Organization's framework to establish the PHEOC, including establishing a steering committee, acquiring legal authority, developing emergency response plans, and developing a concept of operations. The same framework governs the PHEOC's daily activities. Between January 2014 and December 2021, Uganda's PHEOC coordinated response to 271 PHEs, hosted 207 emergency coordination meetings, trained all core staff in public health emergency management principles, participated in 21 simulation exercises, coordinated Uganda's Global Health Security Agenda activities, established 6 subnational PHEOCs, and strengthened the capacity of 7 countries in public health emergency management. In this article, we discuss the following lessons learned: PHEOCs are key in PHE coordination and thus mitigate the associated adverse impacts; although the functions of a PHEOC may be legalized by the existence of a National Institute of Public Health, their establishment may precede formally securing the legal framework; staff may learn public health emergency management principles on the job; involvement of leaders and health partners is crucial to the success of a public health emergency management program; subnational PHEOCs are resourceful in mounting regional responses to PHEs; and service on the PHE Strategic Committee may be voluntary. |
Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019.
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 . PLoS Negl Trop Dis 2021 15 (12) e0009967 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. |
Laboratory capacity assessments in 25 African countries at high risk of yellow fever, August-December 2018
Johnson BW , Demanou M , Fall G , Betoulle JL , Obiekea C , Basile AJ , Domingo C , Goodman C , Mossel E , Reusken C , Staples E , de Morais JFM , Neto Z , Paixao P , Denon YE , Glitho M , Mahinou J , Kagone T , Nakoune E , Gamougam K , Simbu EP , Ahuka S , Mombouli JV , Goma-Nkoua C , Adjogoua EV , Tayachew A , Beyene B , Sanneh B , Jarju ML , Mendy A , Amelor DK , Ofosu-Appiah L , Opare D , Antwi L , Adade R , Magassouba N , Gomes SF , Limbaso S , Lutomiah J , Gbelee B , Dogba J , Cisse I , Idde Z , Ihekweazu C , Mba N , Faye O , Sall AA , Koroma Z , Juma MA , Maror JA , Eldigail M , Elduma AH , Elageb R , Badziklou K , Komla KA , Kayiwa J , Lutwama JJ , Hampton L , Mulders MN . Pan Afr Med J 2021 38 402 Introduction: accurate and timely laboratory diagnosis of yellow fever (YF) is critical to the Eliminate Yellow Fever Epidemics (EYE) strategy. Gavi, the Vaccine Alliance recognized the need to support and build capacity in the national and regional laboratories in the Global YF Laboratory Network (GYFLN) as part of this strategy. Method(s): to better understand current capacity, gaps and needs of the GYFLN laboratories in Africa, assessments were carried out in national and regional reference laboratories in the 25 African countries at high risk for YF outbreaks that were eligible for new financial support from Gavi. Result(s): the assessments found that the GYFLN in Africa has high capacity but 21% of specimens were not tested due to lack of testing kits or reagents and approximately 50% of presumptive YF cases were not confirmed at the regional reference laboratory due to problems with shipping. Conclusion(s): the laboratory assessments helped to document the baseline capacities of these laboratories prior to Gavi funding to support strengthening YF laboratories. Copyright © Barbara Wilmot Johnson et al. |
Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches - March-April 2020.
Migisha R , Kwesiga B , Mirembe BB , Amanya G , Kabwama SN , Kadobera D , Bulage L , Nsereko G , Wadunde I , Tindyebwa T , Lubwama B , Kagirita AA , Kayiwa JT , Lutwama JJ , Boore AL , Harris JR , Bosa HK , Ario AR . Global Health 2020 16 (1) 114 BACKGROUND: On March 13, 2020, Uganda instituted COVID-19 symptom screening at its international airport, isolation and SARS-CoV-2 testing for symptomatic persons, and mandatory 14-day quarantine and testing of persons traveling through or from high-risk countries. On March 21, 2020, Uganda reported its first SARS-CoV-2 infection in a symptomatic traveler from Dubai. By April 12, 2020, 54 cases and 1257 contacts were identified. We describe the epidemiological, clinical, and transmission characteristics of these cases. METHODS: A confirmed case was laboratory-confirmed SARS-CoV-2 infection during March 21-April 12, 2020 in a resident of or traveler to Uganda. We reviewed case-person files and interviewed case-persons at isolation centers. We identified infected contacts from contact tracing records. RESULTS: Mean case-person age was 35 (±16) years; 34 (63%) were male. Forty-five (83%) had recently traveled internationally ('imported cases'), five (9.3%) were known contacts of travelers, and four (7.4%) were community cases. Of the 45 imported cases, only one (2.2%) was symptomatic at entry. Among all case-persons, 29 (54%) were symptomatic at testing and five (9.3%) were pre-symptomatic. Among the 34 (63%) case-persons who were ever symptomatic, all had mild disease: 16 (47%) had fever, 13 (38%) reported headache, and 10 (29%) reported cough. Fifteen (28%) case-persons had underlying conditions, including three persons with HIV. An average of 31 contacts (range, 4-130) were identified per case-person. Five (10%) case-persons, all symptomatic, infected one contact each. CONCLUSION: The first 54 case-persons with SARS-CoV-2 infection in Uganda primarily comprised incoming air travelers with asymptomatic or mild disease. Disease would likely not have been detected in these persons without the targeted testing interventions implemented in Uganda. Transmission was low among symptomatic persons and nonexistent from asymptomatic persons. Routine, systematic screening of travelers and at-risk persons, and thorough contact tracing will be needed for Uganda to maintain epidemic control. |
Ebola virus disease preparedness assessment and risk mapping in Uganda, August-September 2018
Nanziri C , Ario AR , Ntono V , Monje F , Aliddeki DM , Bainomugisha K , Kadobera D , Bulage L , Nsereko G , Kayiwa J , Nakiire L , Walwema R , Tusiime PK , Mabumba E , Makumbi I , Ocom F , Lamorde M , Kasule JN , Ward SE , Merrill RD . Health Secur 2020 18 (2) 105-113 Uganda's proximity to the tenth Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) presents a high risk of cross-border EVD transmission. Uganda conducted preparedness and risk-mapping activities to strengthen capacity to prevent EVD importation and spread from cross-border transmission. We adapted the World Health Organization (WHO) EVD Consolidated Preparedness Checklist to assess preparedness in 11 International Health Regulations domains at the district level, health facilities, and points of entry; the US Centers for Disease Control and Prevention (CDC) Border Health Capacity Discussion Guide to describe public health capacity; and the CDC Population Connectivity Across Borders tool kit to characterize movement and connectivity patterns. We identified 40 ground crossings (13 official, 27 unofficial), 80 health facilities, and more than 500 locations in 12 high-risk districts along the DRC border with increased connectivity to the EVD epicenter. The team also identified routes and congregation hubs, including origins and destinations for cross-border travelers to specified locations. Ten of the 12 districts scored less than 50% on the preparedness assessment. Using these results, Uganda developed a national EVD preparedness and response plan, including tailored interventions to enhance EVD surveillance, laboratory capacity, healthcare professional capacity, provision of supplies to priority locations, building treatment units in strategic locations, and enhancing EVD risk communication. We identified priority interventions to address risk of EVD importation and spread into Uganda. Lessons learned from this process will inform strategies to strengthen public health emergency systems in their response to public health events in similar settings. |
Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019
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 . Global Health 2020 16 (1) 24 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. |
Intervention to stop transmission of imported pneumonic plague - Uganda, 2019
Apangu T , Acayo S , Atiku LA , Apio H , Candini G , Okoth F , Basabose JK , Ojosia L , Ajoga S , Mongiba G , Wetaka MM , Kayiwa J , Balinandi S , Schwartz A , Yockey B , Sexton C , Dietrich EA , Pappert R , Petersen JM , Mead PS , Lutwama JJ , Kugeler KJ . MMWR Morb Mortal Wkly Rep 2020 69 (9) 241-244 Plague, an acute zoonosis caused by Yersinia pestis, is endemic in the West Nile region of northwestern Uganda and neighboring northeastern Democratic Republic of the Congo (DRC) (1-4). The illness manifests in multiple clinical forms, including bubonic and pneumonic plague. Pneumonic plague is rare, rapidly fatal, and transmissible from person to person via respiratory droplets. On March 4, 2019, a patient with suspected pneumonic plague was hospitalized in West Nile, Uganda, 4 days after caring for her sister, who had come to Uganda from DRC and died shortly thereafter, and 2 days after area officials received a message from a clinic in DRC warning of possible plague. The West Nile-based Uganda Virus Research Institute (UVRI) plague program, together with local health officials, commenced a multipronged response to suspected person-to-person transmission of pneumonic plague, including contact tracing, prophylaxis, and education. Plague was laboratory-confirmed, and no additional transmission occurred in Uganda. This event transpired in the context of heightened awareness of cross-border disease spread caused by ongoing Ebola virus disease transmission in DRC, approximately 400 km to the south. Building expertise in areas of plague endemicity can provide the rapid detection and effective response needed to mitigate epidemic spread and minimize mortality. Cross-border agreements can improve ability to respond effectively. |
Dengue fever and chikungunya virus infections: identification in travelers in Uganda - 2017
Kayiwa JT , Nankya AM , Ataliba I , Nassuna CA , Omara IE , Koehler JW , Dye JM , Mossel EC , Lutwama JJ . Trop Dis Travel Med Vaccines 2019 5 21 Arboviruses are (re-) emerging viruses that cause significant morbidity globally. Clinical manifestations usually consist of a non-specific febrile illness that may be accompanied by rash, arthralgia and arthritis and/or with neurological or hemorrhagic syndromes. The broad range of differential diagnoses of other infectious and non-infectious etiologies presents a challenge for clinicians. While knowledge of the geographic distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the non-specific and variable clinical presentation can delay final diagnosis. This case report summarizes the laboratory-based findings of three travel-related cases of arbovirus infections in Uganda. These include a patient from Bangladesh with chikungunya virus infection and two cases of dengue fever from Ethiopia. Early detection of travel-imported cases by public health laboratories is important to reduce the risk of localized outbreaks of arboviruses such as dengue virus and chikungunya virus. Because of the global public health importance and the continued risk of (re-) emerging arbovirus infections, specific recommendations following diagnosis by clinicians should include obtaining travel histories from persons with arbovirus-compatible illness and include differential diagnoses when appropriate. |
The logic model for Uganda's health sector preparedness for public health threats and emergencies
Ario AR , Makumbi I , Bulage L , Kyazze S , Kayiwa J , Wetaka MM , Kasule JN , Ocom F . Glob Health Action 2019 12 (1) 1664103 Background: Uganda is an ecological hot-spot with infectious disease transmission belts which exacerbates its vulnerability to epidemics. Its proximity to the Congo Basin, climate change pressure on eco-systems, increased international travel and globalization, and influx of refugees due to porous borders, has compounded the problem. Public Health Events are a major challenge in the region with significant impact on Global Health Security. Objective: The country developed a multi-hazard plan with the purpose of harmonizing processes and guiding stakeholders on strengthening emergency preparedness and response. Method: Comprehensive risk profiling, identification of preparedness gaps and capacities were developed using a preparedness logic model, which is a step by step process. A multidisciplinary team was constituted; the Strategic Tool for Analysis of Risks was used for risk profiling and identification of hazards; a desk review of relevant documents informed the process and finally, approval was sought from the National Task Force for public health emergencies. Results: Target users and key public health preparedness and response functions of the multi-hazard plan were identified. The key capabilities identified were: coordination; epidemiology and surveillance; laboratory; risk communication and social mobilization. In each of these capabilities, key players were identified. Risk profiling classified road traffic accident, cholera, malaria and typhoid as very high risk. Meningitis, VHF, drought, industrial accidents, terrorism, floods and landslides were high risk. Hepatitis E, avian influenza and measles were low risk and the only plague fell into the category of very low risk. Risk profiling using STAR yielded good results. All risk categories required additional preparedness activities, and very high and high-risk categories required improved operational response capacity and risk mitigation measures. Conclusion: Uganda successfully developed a national multi-hazard emergency preparedness and response plan using the preparedness logic model. The plan is now ready for implementation by the Uganda MoH and partners. |
Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016
Emukule GO , Namagambo B , Owor N , Bakamutumaho B , Kayiwa JT , Namulondo J , Byaruhanga T , Tempia S , Chaves SS , Lutwama JJ . PLoS One 2019 14 (7) e0219012 BACKGROUND: Influenza is an important contributor to acute respiratory illness, including pneumonia, and results in substantial morbidity and mortality globally. Understanding the local burden of influenza-associated severe disease can inform decisions on allocation of resources toward influenza control programs. Currently, there is no national influenza vaccination program in Uganda. METHODS: In this study, we used data on pneumonia hospitalizations that were collected and reported through the Health Management Information System (HMIS) of the Ministry of Health, Uganda, and the laboratory-confirmed influenza positivity data from severe acute respiratory illness (SARI) surveillance in three districts (Wakiso, Mbarara, and Tororo) to estimate the age-specific incidence of influenza-associated pneumonia hospitalizations from January 2013 through December 2016. RESULTS: The overall estimated mean annual rate of pneumonia hospitalizations in the three districts was 371 (95% confidence interval [CI] 323-434) per 100,000 persons, and was highest among children aged <5 years (1,524 [95% CI 1,286-1,849]) compared to persons aged >/=5 years (123 [95% CI 105-144]) per 100,000 persons. The estimated mean annual rate of influenza-associated pneumonia hospitalization was 34 (95% CI 23-48) per 100,000 persons (116 [95% CI 78-165] and 16 [95% CI 6-28] per 100,000 persons among children aged <5 years and those >/=5 years, respectively). Among children aged <5 years, the rate of hospitalized influenza-associated pneumonia was highest among those who were <2 years old (178 [95% CI 109-265] per 100,000 persons). Over the period of analysis, the estimated mean annual number of hospitalized influenza-associated pneumonia cases in the three districts ranged between 672 and 1,436, of which over 70% represent children aged <5 years. CONCLUSIONS: The burden of influenza-associated pneumonia hospitalizations was substantial in Uganda, and was highest among young children aged <5 years. Influenza vaccination may be considered, especially for very young children. |
Conducting the Joint External Evaluation in Uganda: The Process and Lessons Learned
Kayiwa J , Kasule JN , Ario AR , Sendagire S , Homsy J , Lubwama B , Aliddeki D , Kagirita A , Komakech I , Brown V , Wetaka MM , Zhu BP , Opar B , Kyazze S , Okware P , Okot P , Matseketse D , Tusiime P , Mwebesa H , Makumbi I . Health Secur 2019 17 (3) 174-180 Uganda is currently implementing the Global Health Security Agenda (GHSA), aiming at accelerating compliance to the International Health Regulations (IHR) (2005). To assess progress toward compliance, a Joint External Evaluation (JEE) was conducted by the World Health Organization (WHO). Based on this evaluation, we present the process and lessons learned. Uganda's methodological approach to the JEE followed the WHO recommendations, including conducting a whole-of-government in-country self-assessment prior to the final assessment, using the same tool at both assessments, and generating consensus scores during the final assessment. The in-country self-assessment process began on March 24, 2017, with a multisectoral representation of 203 subject matter experts from 81 institutions. The final assessment was conducted between June 26 and 30, 2017, by 15 external evaluators. Discrepancies between the in-country and final scores occurred in 27 of 50 indicators. Prioritized gaps from the JEE formed the basis of the National Action Plan for Health Security. We learned 4 major lessons from this process: subject matter experts should be adequately oriented on the scoring requirements of the JEE tool; whole-of-government representation should be ensured during the entire JEE process; equitable multisectoral implementation of IHR activities must be ensured; and over-reliance on external support is a threat to sustainability of GHSA gains. |
Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings
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 . PLoS Negl Trop Dis 2019 13 (3) e0007257 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. |
A cross-cutting approach to surveillance and laboratory capacity as a platform to improve health security in Uganda
Lamorde M , Mpimbaza A , Walwema R , Kamya M , Kapisi J , Kajumbula H , Sserwanga A , Namuganga JF , Kusemererwa A , Tasimwa H , Makumbi I , Kayiwa J , Lutwama J , Behumbiize P , Tagoola A , Nanteza JF , Aniku G , Workneh M , Manabe Y , Borchert JN , Brown V , Appiah GD , Mintz ED , Homsy J , Odongo GS , Ransom RL , Freeman MM , Stoddard RA , Galloway R , Mikoleit M , Kato C , Rosenberg R , Mossel EC , Mead PS , Kugeler KJ . Health Secur 2018 16 S76-s86 Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda. |
Outbreak of yellow fever in central and southwestern Uganda, February-May 2016
Kwagonza L , Masiira B , Kyobe-Bosa H , Kadobera D , Atuheire EB , Lubwama B , Kagirita A , Katushabe E , Kayiwa JT , Lutwama JJ , Ojwang JC , Makumbi I , Ario AR , Borchert J , Zhu BP . BMC Infect Dis 2018 18 (1) 548 BACKGROUND: On 28 March, 2016, the Ministry of Health received a report on three deaths from an unknown disease characterized by fever, jaundice, and hemorrhage which occurred within a one-month period in the same family in central Uganda. We started an investigation to determine its nature and scope, identify risk factors, and to recommend eventually control measures for future prevention. METHODS: We defined a probable case as onset of unexplained fever plus >/=1 of the following unexplained symptoms: jaundice, unexplained bleeding, or liver function abnormalities. A confirmed case was a probable case with IgM or PCR positivity for yellow fever. We reviewed medical records and conducted active community case-finding. In a case-control study, we compared risk factors between case-patients and asymptomatic control-persons, frequency-matched by age, sex, and village. We used multivariate conditional logistic regression to evaluate risk factors. We also conducted entomological studies and environmental assessments. RESULTS: From February to May, we identified 42 case-persons (35 probable and seven confirmed), of whom 14 (33%) died. The attack rate (AR) was 2.6/100,000 for all affected districts, and highest in Masaka District (AR = 6.0/100,000). Men (AR = 4.0/100,000) were more affected than women (AR = 1.1/100,000) (p = 0.00016). Persons aged 30-39 years (AR = 14/100,000) were the most affected. Only 32 case-patients and 128 controls were used in the case control study. Twenty three case-persons (72%) and 32 control-persons (25%) farmed in swampy areas (ORadj = 7.5; 95%CI = 2.3-24); 20 case-patients (63%) and 32 control-persons (25%) who farmed reported presence of monkeys in agriculture fields (ORadj = 3.1, 95%CI = 1.1-8.6); and 20 case-patients (63%) and 35 control-persons (27%) farmed in forest areas (ORadj = 3.2; 95%CI = 0.93-11). No study participants reported yellow fever vaccination. Sylvatic monkeys and Aedes mosquitoes were identified in the nearby forest areas. CONCLUSION: This yellow fever outbreak was likely sylvatic and transmitted to a susceptible population probably by mosquito bites during farming in forest and swampy areas. A reactive vaccination campaign was conducted in the affected districts after the outbreak. We recommended introduction of yellow fever vaccine into the routine Uganda National Expanded Program on Immunization and enhanced yellow fever surveillance. |
Phylogeny of Yellow Fever Virus, Uganda, 2016.
Hughes HR , Kayiwa J , Mossel EC , Lutwama J , Staples JE , Lambert AJ . Emerg Infect Dis 2018 24 (8) 1598-9 In April 2016, a yellow fever outbreak was detected in Uganda. Removal of contaminating ribosomal RNA in a clinical sample improved the sensitivity of next-generation sequencing. Molecular analyses determined the Uganda yellow fever outbreak was distinct from the concurrent yellow fever outbreak in Angola, improving our understanding of yellow fever epidemiology. |
Confirmation of Zika virus infection through hospital-based sentinel surveillance of acute febrile illness in Uganda, 2014-2017
Kayiwa JT , Nankya AM , Ataliba IJ , Mossel EC , Crabtree MB , Lutwama JJ . J Gen Virol 2018 99 (9) 1248-1252 Zika virus (ZIKV), transmitted by Aedes species mosquitoes, was first isolated in Uganda in 1947. From February 2014 to October 2017, the Uganda Virus Research Institute, in collaboration with the US Centers for Diseases Control and Prevention, conducted arbovirus surveillance in acute febrile illness (AFI) patients at St Francis hospital in Nkonkonjeru. Three hundred and eighty-four serum samples were collected and tested for IgM antibodies to yellow fever virus (YFV), West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV) and ZIKV. Of the 384 samples, 5 were positive for ZIKV IgM. Of these five, three were confirmed by plaque reduction neutralization test (PRNT) to be ZIKV infections. Of the remaining two, one was determined to be a non-specific flavivirus infection and one was confirmed to be alphavirus-positive by reverse transcriptase polymerase chain reaction (RT-PCR). This study provides the first evidence of laboratory-confirmed ZIKV infection in Uganda in five decades, and emphasizes the need to enhance sentinel surveillance. |
Development of a real-time RT-PCR assay for the global differentiation of yellow fever virus vaccine adverse events from natural infections.
Hughes HR , Russell BJ , Mossel EC , Kayiwa J , Lutwama J , Lambert AJ . J Clin Microbiol 2018 56 (6) Yellow fever (YF) is a reemerging public health threat with frequent outbreaks prompting large vaccination campaigns in endemic regions of Africa and South America. Specific detection of vaccine-related adverse events is resource-intensive, time-consuming and difficult to achieve during an outbreak. To address this, we have developed a highly transferable, rapid yellow fever virus (YFV) vaccine-specific real-time RT-PCR assay that distinguishes vaccine from wild-type lineages. The assay utilizes a specific hydrolysis probe that includes locked nucleic acids to enhance specific discrimination of the YFV 17D vaccine strain genome. Promisingly, sensitivity and specificity analyses reveal this assay to be highly specific to vaccine strain(s) when tested on clinical samples and YFV cell culture isolates of global origin. Taken together, our data suggest the utility of this assay for use in laboratories of varied capacity for the identification and differentiation of vaccine-related adverse events from wild-type infections of both African and South American origin. |
Isolation of genetically diverse Marburg viruses from Egyptian fruit bats
Towner JS , Amman BR , Sealy TK , Carroll SA , Comer JA , Kemp A , Swanepoel R , Paddock CD , Balinandi S , Khristova ML , Formenty PB , Albarino CG , Miller DM , Reed ZD , Kayiwa JT , Mills JN , Cannon DL , Greer PW , Byaruhanga E , Farnon EC , Atimnedi P , Okware S , Katongole-Mbidde E , Downing R , Tappero JW , Zaki SR , Ksiazek TG , Nichol ST , Rollin PE . PLoS Pathog 2009 5 (7) e1000536 In July and September 2007, miners working in Kitaka Cave, Uganda, were diagnosed with Marburg hemorrhagic fever. The likely source of infection in the cave was Egyptian fruit bats (Rousettus aegyptiacus) based on detection of Marburg virus RNA in 31/611 (5.1%) bats, virus-specific antibody in bat sera, and isolation of genetically diverse virus from bat tissues. The virus isolates were collected nine months apart, demonstrating long-term virus circulation. The bat colony was estimated to be over 100,000 animals using mark and re-capture methods, predicting the presence of over 5,000 virus-infected bats. The genetically diverse virus genome sequences from bats and miners closely matched. These data indicate common Egyptian fruit bats can represent a major natural reservoir and source of Marburg virus with potential for spillover into humans. |
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