epidemiological week 41 of 2014 [6th october 12th october ... · epidemiological week 41 of 2014...

Epidemiological week 41 of 2014 [6th

October– 12th

October 2014]

National Summary Completeness & Timeliness of Reporting

This week, 111 (99.12%) districts submitted their weekly reports as

opposed to 107 (95.53%) for the corresponding week of 2013. The mean

intra-district completeness this week is 59 [median 63.0%]; compared to

the mean intra-district completeness of 58 [median 63.0%] for the

corresponding week of 2013.

Only 31 (27.68%) of the districts that reported this week attained an

intra-district completeness of at least 80%, Compared to 32 (28.57%)

during the corresponding week of 2013. This week 111 districts

submitted their weekly reports [see annex 1].

Timeliness for week 41 reporting is 111 (99.12%) for the current week;

and 109 (97.32%) for the corresponding week of 2013.

The proportion of health facilities submitting weekly reports in each of

the reporting districts is way below the national target of 80%

in most of the districts. DHOs and district surveillance focal persons

(DSFPs) are urged to ensure their districts submit weekly reports and to

actively follow-up silent health facilities.

Public Health Emergencies/Disease Outbreaks

Polio Outbreak, Kamuli and Kween Districts: A suspected

AFP case was detected in Kween District between July and

September 2014. Stool samples from the suspected case and

5 contacts were collected on 15th

and 16th

September 2014.

While results were subsequently negative for the suspected case, one of the contacts tested positive. In Kamuli,

the AFP case was detected by the STOP team on 25th

September 2014 beyond 14 days of onset. The AFP case

was negative for polio but one the 4 contacts sampled, a sibling to the AFP case, was positive for polio. Detailed

field investigations into these cases have been conducted in both districts and the next steps will be determined

by the laboratory findings. Marburg Outbreak, Mpigi: On 3

rd October 2014, UVRI/CDC Viral Haemorrhagic Fever Reference Laboratory in Entebbe released

preliminary results of a sample that was obtained from a patient in a private Hospital in Kampala. Results of the repeat test were positive

for Marburg on 4th

October 2014. A Marburg outbreak was declared and response activities started in Kampala, Mpigi, and Kasese. 197

contacts were traced and followed for 21 days. None of them developed Marburg disease. The country will be declared Marburg free on

11th

November 2014, having finished 42 days without detecting any Marburg cases despite heightened surveillance

Cholera outbreak, Arua: There has been a Cholera epidemic in Arua District since 14th

July 2014. As of 2nd

October, 55 suspected

cases (4 confirmed) including two deaths had been reported. Two cases were still admitted at Omugo HC IV. The most affected sub

counties were River Olli, Adumi, Ayivumi and Rhino camp. The district reported on case during the current week. The cholera

outbreak in Moyo has been controlled. Overall, 29 cases were recorded between 17th

July and 26th

August. Affected Sub Counties were

Dufile (16 cases) and Metu (13 cases with 1 death). No additional cases have been recorded since though active surveillance is still

continuing.

Indicator Epidemiological week 41

2014 2013 Median

2008-2012

% of Districts reporting

99.12 98.21

% HU reporting 59 58

% Timely District

reports

99.12 97.32

AFP 0(0) 4(0)

Animal bites 390(0) 387(0)

Cholera 1(0) 2(0)

Dysentery 891(1) 1024(0)

Guinea Worm 0(0) 0(0)

Malaria 133431

(31)

170441

(43)

Measles 50(0) 43(0)

Meningitis 9(2) 3(1)

NNT 3(1) 1(0)

Plague 1(0) 0(0)

Typhoid 1437(0) 1396(0)

S/Sickness 0(0) 0(0)

Human Influenza 0(0) 0(0)

Nodding Syndrome 0(0) 0(0)

Yellow Fever 0(0) 0(0)

Viral Hemorrhagic

Fever

0(0) 0(0)

Maternal Deaths 5 5

Highlights of the Week

2

Available at http://health.go.ug/mohweb/?page_id=1294

Hepatitis E Virus [HEV] outbreak, Napak: The cumulative total of 1498 cases including 32 deaths being reported 18 of which are

pregnant mothers. The last maternal death attributable to Hepatitis E was registered in the 1st week of August. A comprehensive response

is underway using a strategy focused on improving access to safe drinking water, behavioral change communication to improve

sanitation and hygiene practices, targeting pregnant mothers for HEV prevention, enhanced HEV case surveillance at health facility and

community levels, and supportive care to admitted pregnant mothers and other cases with severe disease. (Annex 2 for details).

Human Influenza Surveillance - National: The National Influenza Centre in the Uganda Virus Institute [UVRI] &Makerere

University Walter Reed Project [MUWRP] maintain sentinel surveillance sites for ILI/SARI countrywide. As of 23rd

-Aug-2014; a total

of 914 specimens had been analyzed [by NIC & MUWRP] with 116 isolates (see page 8).

Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Heightened surveillance for Severe Acute Respiratory Infections

(SARI) is also ongoing after 206 cases & 86 deaths of MERS-CoV were reported largely from the Middle East. Healthcare workers

are urged to look out for cases of SARI or severe pneumonia requiring hospitalization especially among international travelers from the

Middle East. These cases should be isolated immediately and reported to NIC-UVRI [0752650251 or 0772477016] for immediate

investigation.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Algeria:

On May 31, 2014, the Ministry of health, Population and hospital reform of Algeria notified the World Health Organization of two cases

of MERS-COV. The two patients stayed in Saudi Arabia for the performance of Umrah. The date of onset of illness for both patients was

23 May 2013. The diagnosis and confirmation of the new coronavirus infection was established for both cases on May 30, 2014 by the

National Reference Laboratory of the Pasteur Institute of Algeria. This is the first laboratory confirmed human case of MERS-COV in

the WHO African Region. The following measures are being taken by national authorities: enhancement of surveillance particularly at

Points of Entry; strengthening of infection prevention and control; case management; and sensitization of the population and health care

workers on preventive and control measures that should be taken to prevent the spread of conoravirus infection.

Based on the current information available for this event, WHO does not recommend that any travel or trade restrictions be applied to the

Republic of Algeria

Influenza A (H7N9): Surveillance for human cases of Influenza A (H7N9) continues globally after human cases emerge in China in

2013. So far, there is no evidence of human-to-human transmission. Health workers are urged to lookout for SARI cases among

international travellers from China or their associates. These cases should be isolated immediately and reported to NIC-UVRI

[0752650251 or 0772477016] for immediate investigation.

Ebola in West Africa (Nigeria, Guinea, Liberia, Senegal and Sierra Leone) and Democratic Republic of Congo: New cases and

deaths attributable to EVD continue to be reported by the Ministries of Health in the four West African countries of Guinea, Liberia, and

Sierra Leone. On 26th

August 2014, DR Congo announced that there was an outbreak of EVD in the country. As of 18th

September 2014,

71 cases and 40 deaths had been reported. There was confirmed human to human transmission and involvement of Health Workers. So

far 8 Health Workers have been infected in Congo and they have all died. The government of Senegal announced on 29th

August that a 20

year old male who had traveled from Guinea, and a contact to a confirmed EVD patient had tested positive for Ebola. No other cases of

EVD have been reported from Senegal. As of 3rd October 2014, the cumulative number of cases in Guinea, Liberia and Sierra Leone

attributed to EVD in the affected countries stands at 7,470, including 3,431 deaths (CFR =45.93%)(WHO Situation Update 3rd

October

2014). Other countries that have since registered cases include: Nigeria (20 cases and 8 deaths), Senegal (1 case and no death) and The

United States of America (1 case and no death).The World Health Organization (WHO) continues to closely monitor the evolving Ebola

virus disease (EVD) outbreak in these countries.

Uganda is on high alert for Ebola. Government has reinstated the country's National Task Force on Epidemics and Disease Surveillance

to watch out on any Ebola alerts throughout the country. The ministry has set up a screening desk at the country's Entebbe International

Airport to check travellers who have a travel history to West Africa in the last 21 days before coming to Uganda. The disease incubates

within 21 days. The country has stocked enough supplies in case of any outbreak. The ministry of health, with support from the partners,

has also assembled a team of experts to be on standby to be deployed in areas where suspected cases are reported. The ministry of health

also advised the public to limit their travels to any of the affected countries in West Africa until the situation is contained.

Border districts especially those that are close to DR Congo have been put on high alert. MOH plans to train health workers and other

essential personnel in selected districts such as Kisoro, Kabale, Kasese, Arua, Nebbi, Tororo and Busia, as part of preparedness for EVD.

3


Weekly Incidence for Selected Priority Diseases in the Country

This week; we present a concise profile of twelve (12) top priority diseases/conditions including AFP (suspect Polio), Cholera, Bloody

diarrhea, Malaria; Meningitis, Measles, Suspect Rabies, Typhoid Fever, Maternal deaths, Human Influenza, MDR-TB, & Acute viral

hepatitis] reported during the 35th

Epidemiological week of 2014.

AFP (Suspect Polio): No AFP cases were reported during this week. The Non-polio AFP rate is 1.94/100,000

children 0 – 14 years compared to Non-polio AFP rate of 1.89/100,000 children 0 – 14 years for the

corresponding week of 2013.

The adequate samples collection rate is 85.8% compared to 92% for the corresponding week of 2013. NPENT

rate is 17.2% compared to 12.0% for the corresponding week of 2013. 33 AFP cases were reported and

investigated. Cholera: One (1) case of Cholera was reported during this week from Arua District. The outbreak in Moyo District has subsided, with no

cases recorded after 30th August. The figure below shows the cholera trends for 2012/14 [see annex 2]. (Note: Threshold equals average

cases per week for 2012 and 2013, plus 1 standard deviation).

Dysentery (Bloody diarrhea): A total of 891 cases of bloody diarrhea with 1 death were reported from 93 districts during the current week.

This translates into a national weekly incidence of 2.62 cases of bloody diarrhea per 100,000. The top 10 districts [Kaamuli, Nebbi, Iganga,

Hoima, Bundibugyo, Bukwo, Wakiso, Gulu, Arua, Kotido] reported 19-179 cases this week. The figure below shows the number of bloody

diarrhea cases reported by week for 2012/14 [Annex 1 for district specific reports].

4


Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, 133,431 clinical malaria cases including 31 deaths were

reported from the 111 districts that submitted weekly reports. The figure below shows the number of clinical malaria cases reported to the MoH by

week for 2012/14 [annex 1 for district specific reports]. (Note: Threshold equals average cases per week for 2012 and 2013, plus 1 standard

deviation).

5


The figure below shows the proportion of clinical malaria cases that have been tested and confirmed by week during 2014 using malaria

laboratory data submitted through mTrac and DHIS2. During the current week [41st Epidemiological week], a total of 175,096 suspect

malaria cases were reported from the 112 districts that submitted laboratory-testing data [through mTrac or DHIS2]. 164,529 of the suspect

malaria cases were tested [RDT/microscopy] with 67,352 (40.90%) being confirmed to have malaria. Children under five years constituted

12.3 % (20,282) of the malaria confirmed cases. The graph below shows the trends for the proportions of clinical malaria cases tested and

confirmed during 2013/14.

6


Meningitis: This week, 9 cases of meningitis and 2 deaths were reported from Lira (3 cases and 2 deaths), Kamuli (2), Napak (2), Mbarara(1),

Nakaseke (1), . All meningitis epidemic prone districts [especially the ones hosting refugee populations in West Nile] are urged to enhance

surveillance for suspect cases. The figure below shows the number of meningitis cases reported by week for 2012, 2013 & 2014 [annex 1 for district

specific reports]. (Note: Threshold equals average cases per week for 2012 and 2013, plus 1 standard deviation).

Measles: This week, a total of 50 suspect measles cases were reported from 14 districts. The top 10 districts included [[Wakiso, Kiryandongo,

Buvuma,, Kisoro, Luweero, Mbarara, Rakai,Kibaale,Masindi, Kampala]], which reported 2-11 cases each.

7


Measles outbreaks have been confirmed in Adjumani, Arua, Hoima, Kibaale Ntungamo and Mubende. The outbreaks in Ajumani and Arua have

been reported in camps hosting refugees from South Sudan while the cases in Hoima originated from Kyangwali sub county IDP camp and

then spread to the neighboring sub counties. Measles vaccinations have been undertaken in the affected refugee populations targeting

children less than five years of age while accelerated routine immunization has been implemented in the other affected areas.

At the close of 2013, a total of 101 (90.18%) districts had investigated at least one suspect measles case. Consequently, the annualized rate

for suspect measles cases investigated was 3.22/100,000 (national target 2/100,000). Also, 8% of investigated suspect measles cases had

tested measles IgM positive [measles cases have been confirmed from 27districts]. The current trends are generally far below the cases

reported for the corresponding period of 2012 & 2013. The figure below shows the number of suspect measles cases reported by week for

2012/14 [annex 1 for district specific reports]. (Note: Threshold equals average cases per week for 2012 and 2013, plus 1 standard

deviation).

Animal bites (Suspect human rabies): A total of 390 cases of suspect rabies were reported from 75 districts during the current week. This

translates into a national weekly incidence of 1.15 suspect rabies cases per 100,000. The top 10 districts [Kotido, Oyam, Tororo, Mbale,

Hoima, Masindi, Nebbi, Kabarole, Kampala, Yumbe] reported 11-24 cases this week. Below is a trend graph for suspect, rabies during

2012/14. (Note: Threshold equals average cases per week for 2012 and 2013, plus 1 standard deviation).

8


Typhoid Fever: A total of 1,437 cases of suspect typhoid fever were reported from 83 districts during the current week. This translates into

a national weekly incidence of 4.23 cases per 100,000. The top 10 districts [Bukwo, Kibaale, Busia, Mbarara, Kween, Kotido, Isingiro,

Kanungu, Arua, Wakiso] reported 43-71 cases this week. The figure below shows the number of Typhoid fever cases reported by week for

2012, 2013 & 2014 with the cases reported since the beginning of 2014 exceeding those from the corresponding period of 2012/13 [annex 1

for district specific reports]. (Note: Threshold equals average cases per week for 2012 and 2013, plus 1 standard deviation).

9


Maternal deaths: Maternal mortality trends are a national priority and consequently, these data are now submitted on a weekly basis by the

health facilities where these events are detected.

This week a total of 5 maternal deaths were reported from Five (5) districts as shown in the table below. It is worth noting that 4 of the five

districts are located in the West Nile region.

Epi Wk District Facility Deaths

41 Yumbe Yumbe General Hospital 1

41 Hoima Hoima RR Hospital 1

41 Adjumani Adjumani General Hospital 1

41 Nebbi Angal St. Luke HOSPITAL 1

41 Koboko Koboko HC IV 1

Total 5

Human Influenza: The National Influenza Centre in the Uganda Virus Institute [UVRI] & Makerere University Walter Reed

Project [MUWRP] maintain sentinel surveillance sites for ILI/SARI countrywide. As of 12th-October-2014; a total of 1022 specimens had

been analyzed [by NIC & MUWRP] with 122 isolates. The graph below shows the isolate trends from the NIC by epidemiological week

with pandemic A (HINI) and Influenza type A (H3) being the common isolate since the year started.

10


Makerere University Walter Reed Project [MUWRP] is implements a complementary Influenza surveillance program with sites in

Gulu RRH, Jinja RRH, & Mulago NRH. By the end of the 34th epidemiological week of 2014 a total of 914 human samples

[included in the NIC total above] had been analyzed by MUWRP with 116 isolates. The isolate trends are shown in the figure below.

Acute Viral Hepatitis [Hepatitis E Virus - HEV]: This outbreak rages on with a total of 1498 cases including 32 deaths being reported

18 of which are pregnant mothers. The last maternal death attributable to HEV was reported in the first week of August. The most

affected sub-counties in Napak are Iriiri, Lokopo, Lorengechora, Matany, & Lopee. Overall, the outbreak has waned down though

some scattered cases are still being reported in Irriri and Tepeth Parishes (Irriri Sub County), Lokwat Parish (Matany Sub County), and

Lokoreto Parish (Ngoreriet Sub County). Latrine coverage in Napak district is 18.6% and safe water coverage is 62% though 44% of

the safe water sources are non-functional. A comprehensive response is underway using a strategy focused on improving access to safe

drinking water, behavioral change communication to improve sanitation and hygiene practices, targeting pregnant mothers for HEV

prevention, enhanced HEV case surveillance at health facility and community levels, and supportive care to admitted pregnant mothers

and other cases with severe disease.

Multi-Drug Resistant Tuberculosis [MDR-TB]: A total of 570 MDR-TB cases have been detected between January 2008 and June 2014.

During this period, MDR-TB case detection has increased from 30 cases in 2008 to 86 cases in 2010; 125 cases in 2012; 129 cases by

September 30, 2013, and 79 cases between October 2013 and June 2014. MDR-TB case detection is higher in districts close to the

designated regional MDR-TB treatment centers in Kampala, Wakiso, Arua, Gulu, Kitgum, and Mpigi.

Cumulative patient enrollment on second line TB treatment reached 310 by March 2014. 73, 68, 40, 38 patients were enrolled on treatment

in Jul-Sep, Oct-Dec 2013 and Jan-Mar, April-June 2014 respectively.

11


During 2013, the new MDR-TB cases for the months of June, August, & September exceeded the median number of cases for the

corresponding months during 2008-2012. Similarly, the new MDR-TB cases during June, August, & September of 2013 exceeded the

number of new cases for the corresponding months of 2012 (see figure below with MDR-TB trends for 2008-2013).

The National TB & Leprosy Program (NTLP) is currently using the hospitalization & ambulatory (mixed) model for management of

MDR-TB cases. This model entails initiation of MDR-TB patients on treatment at accredited facilities; with the subsequent daily follow-up

being undertaken at the health facility nearest to the patient’s home. The initiation facilities also orient staff at follow up facilities; supply

infection control materials; and provide periodic mentorships. The Initiation facility and the follow up facility staff should visit the home of

the patient as a requirement to educate the family of their role in supporting this patient during treatment; and also do contact examination.

The number of treatment initiation centers has increased from 9 to 14 (Lira RRH, Soroti RRH, Hoima RRH, Mubende RRH, and Kabale

RRH ,Mulago NRH, Mbarara RRH, Mbale RRH, Arua RRH, Masaka RRH, Fort portal RRH, Gulu RRH, Kitgum Hospital, and Iganga

Hospital]. New sites are Lira, Soroti, Hoima, Mubende, and Kabale. Due to the lack of specialized isolation wards at RRH, all close-to-

home facilities are used as follow up facilities for convenient management of MDR-TB patients.

12


These data show that the prevention and control of TB and MDR-TB is fast becoming a national emergency that requires multi-sectoral

response with adequate resources to: enhance treatment support for drug susceptible TB cases; secure food for MDR-TB cases;

enhance utilization of the 46 gene xpert machines by screening more HIV cases for TB & screening suspect MDR-TB cases; monthly

sputum testing at the NTRL for all MDR-TB cases; and register, initiate treatment, and educate new TB cases on TB treatment

compliance.

For comments please contact:

The Epidemiological Surveillance Division- M.O.H

P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108

Email: [email protected]

Editorial: Dr. Robert Musoke, Dr. Joseph F. Wamala, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson

Katushabe, Dr. Immaculate Nabukenya, Mr. Luswa Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr.

Issa Makumbi

Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero Dr. N. Ndayimirigye

Mr. L. Luswa Dr. N. Bakyaita, Mr. M. Mugagga

Annex to the Weekly Epidemiological Bulletin for Uganda


Annex 1: Summary of District Reports for Epidemiological week 37 of 2014 [8th

Aug–14th

Sept 2014] (Numbers in brackets indicate deaths)

HU= Health Units, NR = Not reported, CP = Chicken Pox, KZ = Kalazar, Sch = Schistosomiasis, MP= Malaria in pregnancy; Nodding Syndrome

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Lyantonde NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Nebbi 100 T 0 12 0 42 0 4055(1) 0 0 0 0 38 0

Bukwo 100 T 0 9 0 23 0 646 0 0 0 0 71 0

Butambala 100 T 0 3 0 4 0 979 0 0 0 0 20 0

Moyo 100 T 0 1 0 13 0 3173 0 0 0 0 19 0

Bududa 100 T 0 1 0 4 0 847 0 0 0 0 18 0

Bundibugyo 100 T 0 5 0 25 0 2184 1 0 0 0 16 0

Maracha 100 T 0 8 0 5 0 1363 0 0 0 0 11 0

Zombo 100 T 0 3 0 7 0 623 0 0 0 1 3 0

Dokolo 100 T 0 1 0 1 0 1305(1) 0 0 0 0 2 0

Nwoya 100 T 0 1 0 1 0 266 0 0 0 0 1 0

Koboko 100 T 0 2 0 9 0 1520 0 0 0 0 0 0

Buvuma 100 T 0 0 0 3 0 225 5 0 0 0 0 0

Otuke 100 T 0 0 0 2 0 543 0 0 0 0 0 0

Kisoro 95 T 0 3 0 0 0 250 5 0 0 0 6 0

Rubirizi 94 T 0 0 0 0 0 570 0 0 0 0 11 0

Amolatar 92 T 0 0 0 1 0 1017 0 0 0 0 5 0

Mbarara 91 T 0 4 0 19 0 1454 2 1 0 0 65 0

Kween 88 T 0 1 0 2 0 740 0 0 0 0 62 0

Color codes for Completeness of reporting: Dark Yellow; (80-100%); & Light Brown (0-79%); Red (No Report)



Yumbe 88 T 0 11 0 19 0 2429(2) 0 0 0 0 21 0

Kayunga 88 T 0 3 0 17 0 2127 0 0 0 0 4 0

Buhweju 87 T 0 0 0 0 0 200 0 0 0 0 3 0

Agago 85 T 0 11 0 10 0 530 0 0 0 0 0 0

Kabale 85 T 0 6 0 1 0 252 0 0 0 0 0 0

Lamwo 85 T 0 0 0 1 0 208(1) 0 0 0 0 0 0

Masaka 84 T 0 0 0 2 0 694(1) 1 0 0 0 6 0

Isingiro 81 T 0 7 0 11 0 1536(1) 0 0 0 0 57 0

Kabarole 80 T 0 12 0 6 0 1921(1) 0 0 0 0 27 0

Amudat 80 T 0 0 0 8 0 339 0 0 0 0 7 0

Buliisa 80 T 0 0 0 8 0 732(1) 0 0 0 0 1 0

Bulambuli 80 T 0 0 0 0 0 1261 0 0 0 0 0 0

Kiruhura 79 T 0 0 0 2 0 2611 0 0 0 0 1 0

Mbale 78 T 0 14 0 4 0 1461 0 0 0 0 3 0

Ntoroko 78 T 0 0 0 9 0 241 0 0 0 0 1 0

Kamwenge 78 T 0 10 0 5 0 1465(2) 0 0 0 0 0 0

Serere 77 T 0 1 0 4 0 2035(1) 0 0 0 0 0 0

Kanungu 76 T 0 2 0 0 0 1026 0 0 0 0 48 0

Butaleja 75 T 0 2 0 11 0 2610(1) 0 0 0 0 6 0

Hoima 74 T 0 12 0 32 0 1438(1) 2 0 0 0 39 0

Manafwa 74 T 0 2 0 7 0 1536(1) 0 0 0 0 28 0

Tororo 74 T 0 19 0 11 0 4692 0 0 0 0 19 0

Nakaseke 74 T 0 1 0 5 0 885 0 1 0 0 14 0

Adjumani 74 T 0 2 0 17 0 2329 0 0 0 0 3 0

Gulu 71 T 0 5 0 21 0 1130 0 0 0 0 36 0

Kiboga 71 T 0 0 0 0 0 378 1 0 0 0 13 0

Bukomansimbi 71 T 0 0 0 3 0 275 0 0 0 0 1 0

Alebtong 71 T 0 0 0 1 0 529 0 0 0 0 0 0



Ibanda 70 T 0 5 0 2 0 1855 0 0 0 0 1 0

Sironko 69 T 0 0 0 1 0 1753 0 0 0 0 0 0

Oyam 68 T 0 22 0 1 0 220(1) 0 0 0 0 7 0

Abim 68 T 0 1 0 12 0 1103 1 0 0 0 0 0

Masindi 67 T 0 12 0 8 0 932(1) 2 0 0 0 12 0

Kitgum 67 T 0 4 0 10 0 519 0 0 0 0 8 0

Kyegegwa 67 T 0 1 0 0 0 1029 0 0 0 0 4 0

Napak 67 T 0 6 0 3 0 721 0 2 0 0 0 0

Nakapiripirit 65 T 0 1 0 9 0 838 0 0 0 0 0 0

Pallisa 63 T 0 4 0 7(1) 0 2876(1) 0 0 0 0 25 0

Kamuli 62 T 0 6 0 179 0 4526(1) 0 2 1 0 4 0

Budaka 62 T 0 4 0 1 0 1618 0 0 0 0 3 0

Kibuku 62 T 0 0 0 1 0 641 0 0 0 0 0 0

Kumi 60 T 0 3 0 1 0 1760 0 0 0 0 37 0

Rukungiri 60 T 0 0 0 1 0 1232 0 0 0 0 13 0

National 59 0(0) 390(0) 1(0) 891(1) 0(0) 133431(31) 50(0) 9(2) 3(1) 1(0) 1437(0) 0(0)

Wakiso 59 T 0 4 0 23 0 3584(1) 11 0 0 0 43 0

Kyenjojo 58 T 0 2 0 6 0 246 0 0 0 0 3 0

Amuru 58 T 0 1 0 11 0 387 0 0 0 0 0 0

Kole 58 T 0 1 0 0 0 114 0 0 0 0 0 0

Lwengo 57 T 0 0 0 3 0 239 0 0 0 0 14 0

Bushenyi 57 T 0 1 0 1 0 1063 0 0 0 0 8 0

Iganga 57 T 0 3 0 5 0 3717 0 0 0 0 1 0

Ntungamo 56 T 0 7 0 0 0 509 0 0 0 0 7 0

Kiryandongo 56 T 0 2 0 8 0 885 5 0 0 0 4 0

Apac 56 T 0 0 0 0 0 391 0 0 0 0 0 0

Buyende 55 T 0 3 0 6 0 661 0 0 0 0 0 0



Busia 54 T 0 6 0 11 0 2536 0 0 0 0 65 0

Ssembabule 54 T 0 5 0 5 0 831 0 0 0 0 10 0

Luweero 53 T 0 4 0 13 0 1400 3 0 0 0 42 0

Soroti 52 T 0 6 0 5 0 2660(1) 1 0 0 0 32 0

Mpigi 50 T 0 0 0 3 0 707 0 0 0 0 20 0

Kaliro 50 T 0 0 0 0 0 1584 0 0 0 0 8 0

Gomba 50 T 0 1 0 3 0 307 0 0 0 0 5 0

Kyankwanzi 50 T 0 0 0 1 0 297 0 0 0 0 3 0

Luuka 50 T 0 0 0 2 0 1588 0 0 0 0 0 0

Buikwe 48 T 0 4 0 9 0 997 0 0 0 0 22 0

Lira 48 T 0 3 0 9 0 1110(3) 0 3(2) 0 0 21 0

Rakai 46 T 0 2 0 12 0 1618 2 0 0 0 14 0

Jinja 45 T 0 11 0 10 0 2516(3) 0 0 0 0 9 0

Mityana 45 T 0 8 0 3 0 1096 2 0 0 0 0 0

Katakwi 45 T 0 2 0 1 0 2269 0 0 0 0 0 0

Kibaale 44 T 0 1 0 9 0 936 2 0 0 0 70 0

Amuria 44 T 0 0 0 1 0 1882 0 0 0 0 6 0

Moroto 43 T 0 1 0 3 0 693 0 0 0 0 1 0

Nakasongola 42 T 0 2 0 9 0 980 1 0 0 0 7 0

Ngora 42 T 0 0 0 4 0 696 0 0 0 0 1 0

Kotido 41 T 0 24 0 19 0 1167 0 0 0 0 57 0

Kaabong 41 T 0 2 0 11 0 1033 0 0 0 0 9 0

Mukono 40 T 0 2 0 6 0 652 0 0 0 0 7 0

Kasese 38 T 0 2 0 7 0 1347(2) 0 0 0 0 24 0

Arua 36 T 0 8 1 20 0 2022(2) 1 0 0 0 44 0

Bukedea 36 T 0 0 0 1 0 542 0 0 0 0 9 0

Kalangala 36 T 0 0 0 9 0 118 0 0 0 0 0 0



Kalungu 35 T 0 0 0 0 0 81 0 0 1(1) 0 8 0

Namayingo 34 T 0 2 0 9 0 1901 0 0 0 0 12 0

Mayuge 33 T 0 0 0 7 0 1273 0 0 0 0 1 0

Kaberamaido 29 T 0 0 0 0 0 1031 0 0 0 0 1 0

Kapchorwa 29 T 0 6 0 0 0 350 0 0 0 0 0 0

Mubende 22 T 0 9 0 3 0 606 0 0 1 0 32 0

Namutumba 21 T 0 0 0 5 0 837 0 0 0 0 3 0

Bugiri 12 T 0 0 0 0 0 377 0 0 0 0 0 0

Pader 9 T 0 1 0 1 0 83 0 0 0 0 0 0

Kampala 7 T 0 11 0 5 0 1205 2 0 0 0 14 0

Mitooma 4 T 0 0 0 0 0 16 0 0 0 0 0 0

Sheema 3 T 0 0 0 0 0 38 0 0 0 0 0 0



Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 41 of 2014 [6th

October – 12th

October 2014] Condition Affected

districts New cases

(deaths)

Cumulative Cases

Cumulative Deaths

Ebola Screening Exercise

Entebbe 0 0 1. No new alerts have been registered this week. 2. The screening exercise is going on well. Training of Health Workers in Infection Control and Case

Management is ongoing.

Ebola Screening Exercise

Entebbe 5 Alerts 0 1. Government has reinstated the country's National Task Force on Epidemics and Disease Surveillance to watch out on any Ebola alerts throughout the country.

2. The ministry has set up a screening desk at the country's Entebbe International Airport to check travellers who have a travel history to West Africa in the last 21 days before coming to Uganda. The.

3. The country has stocked enough supplies in case of any outbreak. 4. The ministry of health has also assembled a team of experts to be on standby to be deployed in areas where

suspected cases are reported. 5. Ministry of health also advised the public to limit their travels to any of the affected countries in West Africa until the

situation is contained.

Cholera outbreak

Arua, 63 2 1. On 14th July 2014, suspected cases of Cholera were reported from Arua district 2. 4 Samples so far sent to CPHL tested positive for Cholera 3. Cumulative cases now 63 including 2 deaths 4. One patient still admitted as of 25th September 5. Affected sub counties include River Olli, Adumi, Ayivumi and Rhino camp 6. According to the district the situation is under control, 7. Response activities are ongoing with weekly task force meetings, health education, contact tracing and referral,

case management and distribution of jerricans and tablets for water chlorination.

Cholera Outbreak

Moyo 29 1 1. Index case registered on 17th July 2014 2. No cases registered after 30th August despite active surveillance 3. Affected sub counties include Dufile, which registered 16 cases and Metu, which had 13 cases and 1 death.

Cholera outbreak

Namayingo 88 2 1. On the 21st May 2014, a suspected Cholera outbreak was reported in Mutumba sub County Namayingo district. 2. Cases presented with symptoms of diarrhea and vomiting. 3. Sample tested at CPHL was positive for Vibrio holera. 4. So far 88 cases have been reported including two (2) deaths 5. A team of experts from the ministry of health was sent to the district to support the district in management for the

outbreak. 8. Interventions to control the outbreak are ongoing.

Cholera outbreak

Moyo 117 4 1. On the 25th/04/2014 a suspected Cholera outbreak was reported in Obongi county Moyo district. 2. The patients presented with symptoms of diarrhea, vomiting and fever 3. On the 30/04/2014 culture results from CPHL showed 3 sample positive for Vibrio cholera 01 Inaba 4. Blood sample from UVRI tested negative for VHF 5. On the 1st/05/2014 MOH confirmed a Cholera outbreak in Moyo District. 6. Cumulative number of cases is now 117 including 4 deaths. 7. Cases are being treated at Obongi H/C IV on IV fluids and antibiotics.



Condition Affected districts

New cases (deaths)

Cumulative Cases

Cumulative Deaths

8. A team from MOH that had been in the district to support the outbreak management reported that the situation is under control

9. There are no new cases, all the patients admitted have been discharged 10. Social mobilization and surveillance activities in the district have been intensified. 11. Samples from the water sources have been collected for testing at CPHL

Strange disease

Kasese 6 0 1. On the 05/05/2014 the DHO of Kasese district reported a strange disease. Patients presented with painful knee joints with associated inability to walk properly. There was no history of swelling of the joints or paralysis of the lower limbs, no fever, and no diarrhea. Six (6) patients with in the age group 14 to 16 had been reported from Bwera Hospital. Stool and blood Samples sent to UVRI are negative for both polio and other suspected viral and bacterial infections however tests to rule out oyongnyong and kikungunya virus are still running in the arbor virology lab at UVRI. All the patients have fully recovered and the last one was discharged on the 15th May 2014.

Rare disease, Mubende, Mityana

21 1 1. On12th March 2014, the district rapid response team of Mubende reported a strange disease (that causes a skin rash in patterns corresponding to numbers) in Mugolola Parish, Kiganda Sub County. Another cluster of 17 cases with similar symptoms were reported from two sub counties in Mityana district starting April 4, 2014. Samples collected and sent to UVRI for testing were negative for any suspected viral and bacterial infections. A team of experts including a dermatologist sent to investigate the disease reported that there were no more active cases, giving a possible diagnosis of contact dermatitis.

Strange disease

Maracha 1 1 On 28th August 2014, a female adult died from a disease associated with bleeding, after collapsing in the market. Efforts to attain a blood sample were futile but the DHO, with support from the police and RDC engaged the community and limited physical contact. Active surveillance for similar cases in the community has been ongoing especially in view of the EVD outbreak in DR Congo but nothing has been found to date.

Suspect Bubonic plague

Zombo 1 0 1. On 28-Mar-2014, the plague program in Arua reported a suspect plague case from Karombo Village, Abira West, Zombo Town Council.

2. Preliminary tests on her samples were negative for plague though she reported six rat deaths prior to the onset of her illness. Two of the rat carcasses picked from her hole tested positive for plague by DFA.

3. IRS for all the households in the affected village is scheduled for 1-April-2014 and will be supported by the DLG and CDC/UVRI plague program in Arua.

Epidemic meningitis [suspect]

Nakaseke 5 2 1. On 6-Mar-2014, the DHO-Nakaseke reported a cluster of suspect meningitis cases in Ngoma sub-county. A total of ten (10) suspect cases including five (5) deaths were reported initially. However, following investigations conducted by the national rapid response team only five (5) cases including 2 deaths had a clinical presentation consistent with meningococcalmeningitis. All the five (5) cases were identified through retrospective investigation, lacked laboratory test results, and occurred without clustering in space and time

Foodborne illness [suspect]

Kibaale 25 0 1. On 12-Mar-2014, the DHO Kibaale reported a suspect outbreak of Foodborne illness involving 25 boarding school students from Bishop Rwakaikara Primary School. The outbreak started on 10-Mar-2014 and followed a parents’ visitation day on 9-Mar-2014. The affected students were treated and discharged from Kagadi hospital after they improved on supportive treatment. No bacteria were isolated following tests done at CPHL




New cases (deaths)

Cumulative Cases

Cumulative Deaths

Cholera [suspect]

Ntoroko 2 0 1. Two new suspect cases have been reported from Ntoroko district. Investigations are underway to identify the etiology and risk factors.

Hepatitis E Virus (HEV)

Napak 1498 32 1. HEV cases have been reported from all the seven sub-counties but the majority of the cases have been reported from the sub-counties of Lokopo, Lorengechora, and Matany.

2. Most of the fatal cases have occurred in pregnant women 3. Isolated cases have been reported from neighbouring districts of Moroto, Nakapiripirit, Katakwi, Kotido, Abim, &

Amuria. 4. Latrine coverage in the district is 18.6% and safe water coverage is 62% though 44% of the safe water sources are

non-functional. 5. The current response efforts are coordinated by the National and district taskforce committees 6. Following an assessment undertaken by the national rapid response team; a response plan has been developed

and is currently being reviewed by the national task force. 7. Otherwise, response in the affected district has stalled due to the absence of resources to support the planned

activities.

Epidemic meningitis [confirmed]

Adjumani 80 1 1. District authorities in Adjumani district, West Nile sub- region, reported a suspected meningitis epidemic on the 2nd February 2014. The index case was reported to have occurred on 31st January 2014.

2. A Ministry of Health team confirmed the outbreak using a combination of Latex agglutination (Pastorex kit) testing and microbiological culturing as due to Neisseria meningitidis serotype W135.

3. Eight (8) samples collected in Adjumani have tested positive for Neisseria meningitidis serotype W135. 4. Two sub-counties [Dzaipi & Adropi] in Adjumani surpassed the epidemic and alert thresholds respectively during

the 6th epidemiological week are slated for vaccination during the 12th epidemiological week. 5. A total of 6680 doses of the Trivalent AC W135 vaccine, procured with support from Government, UNICEF, &

WHO, are already in the country to facilitate the vaccination campaign

6. A meningitis vaccination campaign was conducted in Adropi and Dzaipi sub-counties in Adjumani district during March 21-24, 2014. Only 47% of the targeted 58,120 population in Adropi and Dzaipi sub-counties were vaccinated.

Epidemic meningitis [probable]

Arua 67 3 1. In Arua, 65 suspect cases have been reported but only one case has been confirmed to have Neisseria meningi-tidis serogroup W135 BUT cases continue to occur without clustering in time and space.

Suspect VHF (ruled out)

Hoima 7 5 2. On 14 Jan. 2014, the DHO Hoima received reports of a cluster of five deaths in Kiyora village, Bugambe sub-county, Hoima district.

3. The cases presented with bloody diarrhea, vomiting, abdominal pains, headache, and low grade fevers. The cases were reported among immigrants from Kabale district that had just recently settled in an area with poor access to safe water and sanitation facilities.

4. All the initial five cases never sought healthcare and eventually died from their illness in the community. 5. During the ensuing investigations, the district rapid response team identified two additional cases. These cases

were investigated and promptly initiated on treatment using broad-spectrum antibiotics. 6. These two cases tested negative for cholera using the rapid cholera kits; and no pathogens were isolated from the

national reference laboratory following stool cultures. The two cases have since recovered from their illness and no




New cases (deaths)

Cumulative Cases

Cumulative Deaths

additional cases have been reported from the area in the last two weeks after the rapid response team sensitized the locals on good sanitation, hygiene, and health seeking behaviors.

7. Surveillance has been intensified in this area to detect any additional cases.

Suspect VHF (ruled out)

Kyegegwa 4 2 1. On 28 Jan 2014; the Ministry of Health received a report of suspect viral hemorrhagic fever cases in Mpara sub-county, Kyegegwa district.

2. A drug shop owner who attended to the four cases relayed the report to MoH using mTrac. 3. The DHO Kyegegwa was alerted and he promptly constituted a team to verify the reports on 29 Jan. 2014. 4. A total of 4 cases (including 2 deaths) aged 4, 3, 3.5, & 13 years; all from different villages in Mpara sub-county and

with no epidemiological link were seen at the drug shop during 28/12/2013 and 28/1/2014. 5. The presentation of the cases was consistent with severe malaria complicated by severe anaemia requiring

transfusion. The two survivors were transfused and eventually recovered after receiving treatment for severe malaria.

6. Two blood samples were obtained from the survivors for testing at UVRI. They both tested negative for Ebola, Marburg, & CCHF. No additional cases were identified and surveillance has been enhanced in the sub-county.

Confirmed Measles outbreaks,

Hoima, Arua, Kibaale, & Adjumani

219 6 1. Measles outbreaks have been confirmed in Adjumani, Arua, Hoima, Kibaale and Ntungamo. The cases in Ntungamo have been reported from Nyakyera, Itojo, and Kahunga sub counties from where a total of 6 cases were confirmed to have measles following tests conducted in the measles laboratory at UVRI on the 11th March 2014. The outbreaks in Adjumani and Arua have been reported in camps hosting refugees from South Sudan while the cases in Hoima originated from Kyangwali sub county IDP camp and then spread to the neighboring sub counties. Measles vaccinations have been undertaken in the affected refugee populations targeting children less than five years of age while accelerated routine immunization has been implemented in the other affected areas.

Plague Alert (rodent cases)

Zombo 3 2 1. As part of the ongoing CDC Rat-fall surveillance program in the plague endemic sub-counties of Arua and Zombo districts, two rodents [Rattus rattus species] from Surusoni village, Jiki parish and Andruvu village, Anyavu parish in Logiri sub-county, Arua district tested positive for plague by DFA-test and the corresponding cultures have been initiated.

2. Indoor residual spraying is therefore recommend to protect the inhabitants of the two affected villages 3. Though insecticides, protective wear, and spray pumps are available under the CDC/UVRI program; the districts

lack operational funds to conduct the IRS. 4. Several villages in Arua & Zombo therefore remain unsprayed despite confirmation of rodent and/or human plague

cases in the recent months.

Cholera (suspect)

Arua 91 4 1. A Cholera outbreak has been reported in Arua district. Since the 21/04/2014, 91 cases including 4 deaths have so far been reported from Rigbo and Pawor subcounties, 2 samples that were collected and sent to CPHL earlier showed no growth, more samples have however been sent to CPHL for confirmation of the outbreak

2. District task force meeting have been convened 3. Cases are being managed at Pawor H/C III, Rhino camp H/CIV and Olujobo H/C III

Cholera (confirmed)

Nebbi 44 0

1. Sporadic cholera cases continue to be reported in Panyimur, Nebbi district where transmission has been ongoing since 16 Jan. 2013.

2. This indicates a sub-optimal response and failure to address the underlying risk factors – inadequate access to safe water; & poor sanitation and hygiene.




New cases (deaths)

Cumulative Cases

Cumulative Deaths

3. A thorough evaluation of the outbreak trends and response is warranted to ensure that sustainable interventions are initiated to curtail the current transmission.

Cholera (suspect)

Arua 1 1 1. During week 13,a suspect cholera case was reported from Arua and nine (9) satellite cases in Maracha district. The outbreak in Maracha was linked to a suspect cholera death in Rhino camp, Arua that was eventually buried in Maracha district.

2. The outbreak in Maracha started on 28th March 2014 with the index case being 55-year-old female from Okaa village, Oluffe sub-county. She was admitted to Maracha hospital and following a positive rapid test for cholera; she underwent treatment from 30th March to 4th April 2014.

3. Samples have not been sent to CPHL for confirmatory testing. 4. Adequate supplies are available in the districts to manage cases.

Cholera (suspect)

Maracha 9 0

Nodding Syndrome

Kitgum OPD – 2,034 IPD – 162

5 1. Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalized in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from cases seen at NS treatment centre – Kitgum hosp. & outreaches.

Lamwo OPD - 349 IPD – 39

1. Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalized in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from patients seen at NS treatment centres – Padibe HCIV & the 12 outreaches

conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili &Lokung sub-counties. 4. Aerial spraying along rivers Pager &Aswa finalized in November/December 2012. 5. Food received from OPM was distributed to the affected families on [3/02/13].

Pader OPD – 1,210 IPD – 108

15 1. Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalized in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from patients seen at NS treatment centres – Atanga HCIII & outreaches.

Gulu 330 1 1. Case management ongoing at the treatment centre and outreach posts. 2. One death was reported from Aromowanglobo; after he missed a scheduled refill visit and fitted while alone at

home. 3. A total of 15 HCW trained in NS case management; & they subsequently conducted verification in Omel&Cwero

Parishes in Paicho sub-county; &Paibona parish in Awac sub-county. 4. NS treatment centres set up in Odek HCIII; Aromowanglobo HCII; Cwero HCII; &Labworomo HCIII. 5. Food donations from WVU have been distributed to affected families. & Additional funds have been provided by

WVU to train more HCW on NS case management.

Lira 13 1. A total of 13 NS cases registered but only three are attending care at Aromo HC while the rest are attending care in Aromowanglobo in Gulu. No admissions to date.

Amuru 61 1. No new cases recorded; cases are getting care from the treatment centre in Atiak HCIV and at the four (4) outreach sites [Ogomraa Community School; Okidi HCII; Pacilo HCII; &Gunya Community School].

2. A total of 10 HCW trained in NS case management. 3. Mass treatment for onchocerciasis with ivermectin conducted in October 2012.

Epilepsy Kitgum OPD – 1,321 IPD – 25

Data derived from cases seen at NS treatment centre – Kitgum hosp. & outreaches.




New cases (deaths)

Cumulative Cases

Cumulative Deaths

Lamwo OPD – 122 IPD – 0

The data presented here is derived from patients seen at the NS treatment centres – Padibe HCIV & the 12 outreaches conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili &Lokung sub-counties.

Pader OPD – 1,251 IPD – 41

The data presented here is derived from patients seen at NS treatment centres – Atanga HCIII & outreaches.

Gulu 268 Data derived from Nodding Syndrome treatment centres.

Lira 344 Current data derived from cases seeking care from the treatment centre in Aromo HC

Amuru 62 Data derived from Nodding Syndrome treatment centres.

For comments, please contact:

The Epidemiological Surveillance Division- M.O.H

P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108

Email: [email protected]

Editorial:, Dr. Robert Musoke, Dr. Joseph F. Wamala, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, Dr. ImmaculateNabukenya, Mr. Luswa

Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr. Issa Makumbi

Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero, Dr. N. Ndayimirigye, Mr. L. Luswa, Dr. N. Bakyaita, Mr. M.

Mugagga

mailto:[email protected]

epidemiological week 41 of 2014 [6th october 12th october ... · epidemiological week 41 of 2014...

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