1
|
Lubwama M, Adams S, Muwonge C, Bwanga F, Kateete D, Nabiryo B, Kagwa P, Namubiru B, Orem J, Phipps W. 169. Multidrug-Resistant Bacteria Are Common Cause of Neutropenic Fever and Increase Mortality Among Patients with Hematologic Malignancies in Uganda. Open Forum Infect Dis 2019. [PMCID: PMC6810664 DOI: 10.1093/ofid/ofz360.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Cancer patients are at risk of developing severe infections. Empiric management of infections is complicated by emerging antimicrobial resistance and changing local epidemiology of organisms. We sought to determine predominant species causing bacteremia, their antimicrobial resistance profiles, and their contribution to mortality among hematologic cancer patients with febrile neutropenia at the Uganda Cancer Institute. Methods Blood drawn from participants during a febrile neutropenic episode (FNE; fever ≥37.5°C and neutrophil count ≤1,000 cells/µL) was cultured in the BACTEC 9120 blood culture system. Bacteria from positive cultures were identified biochemically. Antimicrobial susceptibility testing was performed with the disc diffusion method. Logistic regression and proportional hazards regression were applied to estimate associations between participant characteristics and FNE, bacteremia, and mortality. Results Of 246 participants, 74 (30%) had an FNE. During the first FNE, 6/21 (29%) participants with acute lymphocytic leukemia (ALL) developed bacteremia compared with 16/31 (52%) with acute myeloid leukemia (AML) (OR 2.22 (0.65, 7.4)). AML patients were specifically at higher risk of Gram-negative bacteremia (OR 4.59 (1.09, 19.3). Of the 41 aerobic bacteria isolated, 32 (78%) were Gram-negative, the most common being Klebsiella pneumoniae (11; 34%). Seventeen (53%) of the Gram-negative bacteria displayed the extended spectrum β lactamase phenotype and 5 (16%) were resistant to carbapenems. One of the eight Enterococcus species was vancomycin resistant. Overall survival among patients with FNE was 54% at 30 days and 19% at 100 days. Bacteremia was associated with higher mortality within 30 days (HR 2.1 (0.99, 4.45)) and 100 days (31% vs.10%; HR 2.23 (1.09, 4.59)). Conclusion Multidrug-resistant bacteria are the main cause of bacteremia and increase mortality in febrile neutropenic hematologic cancer patients at the UCI. Enhanced microbial surveillance, infection control and antimicrobial stewardship programs are needed to guide therapy and address emerging antimicrobial resistance at our institution. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Scott Adams
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Catherine Muwonge
- Hutchinson Centre Research Institute in Uganda, Kampala, Kampala, Uganda
| | | | | | - Barbara Nabiryo
- Hutchinson Centre Research Institute in Uganda, Kampala, Kampala, Uganda
| | - Paul Kagwa
- Hutchinson Centre Research Institute in Uganda, Kampala, Kampala, Uganda
| | - Betty Namubiru
- Hutchinson Centre Research Institute in Uganda, Kampala, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Kampala, Kampala, Uganda
| | - Warren Phipps
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| |
Collapse
|
2
|
Legason ID, Pfeiffer RM, Udquim KI, Bergen AW, Gouveia MH, Kirimunda S, Otim I, Karlins E, Kerchan P, Nabalende H, Bayanjargal A, Emmanuel B, Kagwa P, Talisuna AO, Bhatia K, Yeager M, Biggar RJ, Ayers LW, Reynolds SJ, Goedert JJ, Ogwang MD, Fraumeni JF, Prokunina-Olsson L, Mbulaiteye SM. Evaluating the Causal Link Between Malaria Infection and Endemic Burkitt Lymphoma in Northern Uganda: A Mendelian Randomization Study. EBioMedicine 2017; 25:58-65. [PMID: 29033373 PMCID: PMC5704046 DOI: 10.1016/j.ebiom.2017.09.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/16/2017] [Accepted: 09/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background Plasmodium falciparum (Pf) malaria infection is suspected to cause endemic Burkitt Lymphoma (eBL), but the evidence remains unsettled. An inverse relationship between sickle cell trait (SCT) and eBL, which supports that between malaria and eBL, has been reported before, but in small studies with low power. We investigated this hypothesis in children in a population-based study in northern Uganda using Mendelian Randomization. Methods Malaria-related polymorphisms (SCT, IL10, IL1A, CD36, SEMA3C, and IFNAR1) were genotyped in 202 eBL cases and 624 controls enrolled during 2010–2015. We modeled associations between genotypes and eBL or malaria using logistic regression. Findings SCT was associated with decreased risk of eBL (adjusted odds ratio [OR] 0·37, 95% CI 0·21–0·66; p = 0·0003). Decreased risk of eBL was associated with IL10 rs1800896-CT (OR 0·73, 95% CI 0·50–1·07) and -CC genotypes (OR 0·53, 95% CI 0·29–0·95, ptrend = 0·019); IL1A rs2856838-AG (OR 0·56, 95% CI 0·39–0·81) and -AA genotype (OR 0·50, 95% CI 0·28–1·01, ptrend = 0·0016); and SEMA3C rs4461841-CT or -CC genotypes (OR 0·57, 95% CI 0·35–0·93, p = 0·0193). SCT and IL10 rs1800896, IL1A rs2856838, but not SEMA3C rs4461841, polymorphisms were associated with decreased risk of malaria in the controls. Interpretation Our results support a causal effect of malaria infection on eBL. Mendelian randomization analysis was done to assess a causal relationship between malaria infection and endemic Burkitt lymphoma in Uganda Carriage of the sickle cell trait was associated with decreased risk of endemic Burkitt lymphoma Heterozygous or homozygous minor alleles of IL10 rs1800896, IL1A rs2856838, and SEMA3C rs4461841 were associated with decreased risk of endemic Burkitt lymphoma The inverse association between sickle cell trait and endemic Burkitt lymphoma supports a causal role of malaria in endemic Burkitt lymphoma
Collapse
Affiliation(s)
- Ismail D Legason
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| | - Krizia-Ivana Udquim
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Andrew W Bergen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA
| | - Mateus H Gouveia
- Instituto de Pesquisa Rene Rachou, Fundação Oswaldo Cruz, 30190-002 Belo Horizonte, Minas Gerais, Brazil
| | - Samuel Kirimunda
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Isaac Otim
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda
| | - Eric Karlins
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| | - Patrick Kerchan
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda
| | - Hadijah Nabalende
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda
| | - Ariunaa Bayanjargal
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin Emmanuel
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda; Benjamin Emmanuel, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Paul Kagwa
- EMBLEM Study, African Field Epidemiology Network, P.O. Box 12874, Kampala, Uganda
| | - Ambrose O Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| | - Robert J Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA
| | - Leona W Ayers
- Department of Pathology, The Ohio State University, Columbus, OH, USA.
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA
| | - Martin D Ogwang
- EMBLEM Study, St. Mary's Hospital, Lacor, P.O. Box 180, Gulu, Uganda.
| | - Joseph F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| | - Ludmila Prokunina-Olsson
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Ctr Dr, Bethesda 20892, MD, USA.
| |
Collapse
|
3
|
Maziarz M, Kinyera T, Otim I, Kagwa P, Nabalende H, Legason ID, Ogwang MD, Kirimunda S, Emmanuel B, Reynolds SJ, Kerchan P, Joloba MM, Bergen AW, Bhatia K, Talisuna AO, Biggar RJ, Goedert JJ, Pfeiffer RM, Mbulaiteye SM. Age and geographic patterns of Plasmodium falciparum malaria infection in a representative sample of children living in Burkitt lymphoma-endemic areas of northern Uganda. Malar J 2017; 16:124. [PMID: 28320389 PMCID: PMC5360076 DOI: 10.1186/s12936-017-1778-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Falciparum malaria is an important risk factor for African Burkitt lymphoma (BL), but few studies have evaluated malaria patterns in healthy BL-age children in populations where both diseases are endemic. To obtain accurate current data, patterns of asymptomatic malaria were investigated in northern Uganda, where BL is endemic. Methods Between 2011 and 2015, 1150 apparently healthy children under 15 years old were sampled from 100 villages in northern Uganda using a stratified, multi-stage, cluster survey design. Falciparum malaria prevalence (pfPR) was assessed by questionnaire, rapid diagnostic test (RDT) and thick film microscopy (TFM). Weighted pfPR and unadjusted and adjusted associations of prevalence with covariates were calculated using logistic models and survey methods. Results Based on 1143 children successfully tested, weighted pfPR was 54.8% by RDT and 43.4% by TFM. RDT sensitivity and specificity were 97.5 and 77.8%, respectively, as compared to TFM, because RDT detect malaria antigens, which persist in peripheral blood after clinical malaria, thus results based on RDT are reported. Weighted pfPR increased from 40% in children aged under 2 years to 61.8% in children aged 6–8 years (odds ratio 2.42, 95% confidence interval (CI) 1.26–4.65), then fell slightly to 49% in those aged 12–15 years. Geometric mean parasite density was 1805.5 parasites/µL (95% CI 1344.6–2424.3) among TFM-positive participants, and it was higher in children aged <5 years at 5092.9/µL (95% CI 2892.7–8966.8) and lower in those aged ≥10 years at 983.8/µL (95% CI 472.7–2047.4; P = 0.001). Weighted pfPR was lower in children residing in sub-regions employing indoor residual spraying (IRS) than in those residing in non-IRS sub-regions (32.8 versus 65.7%; OR 0.26, 95% CI 0.14, 0.46). However, pfPR varied both within IRS (3.2–55.3%) and non-IRS sub-regions (29.8–75.8%; Pheterogeneity <0.001). pfPR was inversely correlated with a child’s mother’s income (P = 0.011) and positively correlated with being enrolled in the wet season (P = 0.076), but sex was irrelevant. Conclusions The study observed high but geographically and demographically heterogenous patterns of asymptomatic malaria prevalence among children living in northern Uganda. These results provide important baseline data that will enable precise evaluation of associations between malaria and BL. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1778-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marlena Maziarz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tobias Kinyera
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Isaac Otim
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Paul Kagwa
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Hadijah Nabalende
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Ismail D Legason
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Martin D Ogwang
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Samuel Kirimunda
- Department of Medical Microbiology, Makerere Medical School, Kampala, Uganda
| | - Benjamin Emmanuel
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,University of Maryland, Baltimore, MD, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Patrick Kerchan
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.,Kuluva Hospital, Kuluva, Arua, Uganda
| | - Moses M Joloba
- Department of Medical Microbiology, Makerere Medical School, Kampala, Uganda
| | - Andrew W Bergen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ambrose O Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Robert J Biggar
- Institute of Health and Biotechnical Innovation, Queensland University of Technology, Brisbane, Australia
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
4
|
Okware SI, Omaswa F, Talisuna A, Amandua J, Amone J, Onek P, Opio A, Wamala J, Lubwama J, Luswa L, Kagwa P, Tylleskar T. Managing Ebola from rural to urban slum settings: experiences from Uganda. Afr Health Sci 2015; 15:312-21. [PMID: 25834568 DOI: 10.4314/ahs.v15i1.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. METHODS Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. RESULTS Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. CONCLUSION Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.
Collapse
Affiliation(s)
- Sam I Okware
- Uganda National Health Research Organisation, Entebbe, Uganda
| | - Francis Omaswa
- African Centre for Health and Social Transformation, Kampala
| | - Ambrose Talisuna
- Public Health and Health Systems Research, University of Oxford- KEMRI Welcome Trust Program, Nairobi, Kenya
| | | | - Jackson Amone
- Curative Services, Ministry of Health,, Kampala, Uganda
| | - Paul Onek
- District Director Health Services, Gulu district, Uganda
| | - Alex Opio
- Department disease Control, Ministry of Health, Kampala, Uganda
| | - Joseph Wamala
- Division of Epidemiology and Disease Control, Ministry of Health, Uganda
| | | | - Lukwago Luswa
- Division of Epidemiology and Disease Control, Ministry of Health, Uganda
| | - Paul Kagwa
- Health Education Division, Ministry of Health, Uganda
| | | |
Collapse
|
5
|
Talisuna AO, Daumerie PG, Balyeku A, Egan T, Piot B, Coghlan R, Lugand M, Bwire G, Rwakimari JB, Ndyomugyenyi R, Kato F, Byangire M, Kagwa P, Sebisubi F, Nahamya D, Bonabana A, Mpanga-Mukasa S, Buyungo P, Lukwago J, Batte A, Nakanwagi G, Tibenderana J, Nayer K, Reddy K, Dokwal N, Rugumambaju S, Kidde S, Banerji J, Jagoe G. Closing the access barrier for effective anti-malarials in the private sector in rural Uganda: consortium for ACT private sector subsidy (CAPSS) pilot study. Malar J 2012; 11:356. [PMID: 23107021 PMCID: PMC3523984 DOI: 10.1186/1475-2875-11-356] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/25/2012] [Indexed: 11/27/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy. Methods Four intervention districts were purposefully selected to receive branded subsidized medicines - “ACT with a leaf”, while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention’s impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial. Results At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, “ACT with a leaf” accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had “ACT with a leaf” purchased for them more often than those aged above five years. There was no evidence of price gouging. Conclusions These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda.
Collapse
Affiliation(s)
- Ambrose O Talisuna
- Medicines for Malaria Venture-MMV, PO Box 1826 20, rte de Pré-Bois, Geneva 15, 1215, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Talisuna AO, Grevval P, Balyeku A, Egan T, Bwire G, Piot B, Coghlan R, Lugand M, Rwakimari JB, Ndyomugyenyi R, Kato F, Byangire M, Kagwa P, Sebisubi F, Nahamya D, Bonabana A, Mpanga-Mukasa S, Buyungo P, Lukwago J, Batte A, Nakanwagi G, Tibenderana J, Nayer K, Reddy K, Dokvval N, Rugumambaju S, Kidde S, Banerji J, Jagoe G. Overcoming the affordability barrier for effective and high quality life saving malaria medicines in the private sector in rural Uganda: the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study. Malar J 2012. [PMCID: PMC3472303 DOI: 10.1186/1475-2875-11-s1-o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
Abstract
An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterized by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot-Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts. Response measures included surveillance, community mobilization, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism and international relations. The international response was coordinated by the World Health Organization (WHO) under the umbrella organization of the Global Outbreak and Alert Response Network. A WHO/CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the 'alert', 'suspected', 'probable' and 'confirmed cases'. Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC). For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2.5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community-based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably.
Collapse
Affiliation(s)
- S I Okware
- Uganda Ministry of Health, Kampala, Uganda
| | | | | | | | | | | | | | | | | |
Collapse
|