Date: Mon 27 May 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/yellow-fever-outbreak-declared-uganda-69743/>

The Ugandan Ministry of Health declared a yellow fever outbreak earlier this month [May 2019] after laboratory confirmed cases were reported from Koboko [Northern region] and Masaka [Central region] districts (in the region of 600km [375 miles] apart). The patients are an 80 year old woman and a 10 year old girl. Neither had a history of yellow fever vaccination, nor exhibited symptoms of jaundice, however the older woman had haemorrhagic signs.

A district rapid response team was sent to the affected localities to conduct further investigation. The team sampled several households and found a substantial population of unvaccinated individuals due to immigration and missing the yellow fever reactive vaccination campaign, which was conducted in 2016. There were 7 suspected cases who met the case definition for yellow fever from whom additional samples were collected.

Yellow fever is a viral disease that is transmitted by mosquitoes belonging to the _Aedes_ species. Yellow fever can lead to serious illness and even death. Yellow fever vaccine is the best protection against yellow fever disease, which can be fatal.
==========================
[The prompt recognition of cases and timely mounting of the vaccination campaign in 2016 were key to successfully ending the outbreak before it got out-of-hand. That outbreak was due to spill-over of endemic sylvan (forest) transmission from monkeys via mosquitoes to people and this sylvan (forest) transmission may have been responsible for the 2 confirmed and 7 suspected cases mentioned above.

The virus doubtless has been circulating in the forests of Uganda, so the risk of new spill-over cases is real. One hopes that the rapid response team sent to the locality where the cases occurred can prevent further cases from occurring or the initiation of an urban transmission cycle. - ProMED Mod.TY]

[Maps of Uganda: <http://en.wikipedia.org/wiki/Districts_of_Uganda> and
<http://healthmap.org/promed/p/97>.]
Date: Fri 24 May 2019
Source: Daily Monitor [edited]
<https://www.monitor.co.ug/News/National/Strange-disease-Kagadi-blood-samples-Rift-Valley/688334-5129792-3jm16x/>

On Thursday [23 May 2019], 2 children died of a strange disease which presented symptoms similar to those of the Ebola virus [infection].  The victims of the strange disease are a 10-year-old girl and a boy who was 9 months old. They were children of a man, a resident of Kikonda village in Kiryanga Sub-county, Kagadi District. They were passing blood from the mouth and the nose, which symptoms are similar to those caused by the Ebola virus [infection].  Their death has caused fear among residents in a district that was hit by an outbreak of Ebola [virus disease] in 2012.

The Kagadi Ebola Task Force led by District Surveillance Officer Mr Selevano Thembo, went to the area to investigate the matter.  Wearing protective clothes, the team carried out the burial as one of the precautionary procedures in cases of suspected contagious diseases.  "When people see blood coming out of their sick relatives, they tend to take it as a serious disease, and our team went to investigate,'' Mr Thembo said.

He said that they got blood samples from the bodies, which will be taken to the Uganda Virus Research Institute for analysis.  "Our district is at risk because of the outbreak of the Ebola disease in DR Congo," Mr Thembo said. Diseases which present with signs and symptoms similar to those of Ebola include; Rift Valley fever (RVF), Crimean-Congo haemorrhagic fever (CCHF) and Marburg fever.  In 2018, Crimean-Congo haemorrhagic fever outbreak was confirmed in neighbouring Kakumiro District in Nkooko Sub-county. It claimed one person.

In late April 2019, the Ministry of Health gave Shs146 million [USD 39 000] to Kagadi District for Ebola preparedness activities. The activities include coordinating preparedness activities, strengthening surveillance, capacity building in contact tracing, laboratory diagnostics, infection prevention and control, clinical management of patients including psycho-social care. Other activities include safe and dignified burials, enhanced risk communication and community engagement, and cross-border surveillance are also part of the activities.

Kagadi is among the 22 high risk districts due to the cross-border movements between Ugandans and DR Congo citizens.

The district shares a border with DR Congo, where the disease has claimed more than 1000 people in North Kivu province.
====================
[Unfortunately, this above report does not provide information sufficient to confirm Ebola virus infections or other possible pathogens such as cases of Marburg, Rift Valley fever, yellow fever and Crimean-Congo hemorrhagic fever virus infections, all of which have occurred in Uganda in the past. One hopes that samples that were taken from the 2 unfortunate cases will be tested promptly in the laboratory. Since Ebola virus is suspected, it seems possible but unlikely that it is the result of spill-over from the outbreak going on in northeastern DR Congo. Kagadi district is approximately 50 km (31 miles) directly east of the DR Congo border across Lake Albert but approximately 140 km (87 miles) distant by road.

ProMED-mail would appreciate receiving any additional information about these cases, including additional symptoms, autopsy findings and other clinical signs, as well as laboratory results. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Uganda: <http://healthmap.org/promed/p/97>]
Date: Thu 2 May 2019
Source: Daily Monitor [edited]
<https://www.monitor.co.ug/News/National/Dealers-defy-quarantine-cattle-Kapchorwa-/688334-5096414-vn4pfs/index.html>

Cattle dealers in Kapchorwa District have defied a directive from authorities imposing quarantine on the movement of the animals, slaughter of meat and sale following the outbreak of anthrax in the area. Some cattle dealers are selling meat and its products on the black market.

Mr. Sande Cherop, the district veterinary officer, said the dealers smuggle cattle and meat from neighbouring Bulambuli, Kween and Amudat districts. "They take advantage of laxity of our agencies and the fact that we do not have checkpoints to smuggle in meat at night," he said, adding that they are proposing to establish effective checkpoints. Mr. Cherop, however, said they have not received any new cases of anthrax and vaccination is still ongoing. "We are summing up with vaccination of cattle and coverage is now at 75%. We believe we will soon finish with vaccination and the ban will be lifted," he said. Mr. Cherop said samples that were taken to Uganda Virus Research Institute turned out negative, but they had to sustain the ban as a precaution.

Mr. Isaac Cherista, the district health officer, said they are organising meetings to sensitise the community to prevent further spread of the disease. "We are conducting health education in communities, especially where the suspect died from," he said. Mr. Stephen Batya, the municipality mayor, said people should be alert and desist from consuming meat until the ban is lifted. "We urge people to report any incidents suspected to be anthrax disease," he added.

However, a cattle dealer, who preferred anonymity, said they have been affected by the quarantine. "This is our business, where we earn a living to sustain our families. We ask the district officials to lift the ban because it has overstayed," he said.

The World Health Organisation says humans acquire the disease directly or indirectly from infected animals or occupational exposure to infected or contaminated animal products.

Anthrax was 1st reported early last month [April 2019] in Kokwomurya ward, Central Division in Kapchorwa municipality. One person reportedly died and 4 others were admitted to Kapchorwa Hospital.  [Byline: Micheal Woniala]
===========================
[And we thought we had problems persuading parents to vaccinate their children against measles! Both are killing diseases, but anthrax kills more folk and faster. Mr. Sande Cherop and his veterinary officers and assistants are to be congratulated on getting 75% of their district's cattle vaccinated so quickly. I am sure that they will reach their target level soon. Anthrax is a livestock disease that kills humans. Therefore, the most efficient control procedure is to proactively vaccinate cattle. This prevents the livestock deaths and the far more expensive human cases and deaths.

Kapchorwa is on the northeast border of Uganda with Kenya; see
<http://fallingrain.com/world/UG/A5/Kapchorwa.html>. For a description
of the district, see
<https://en.wikipedia.org/wiki/Kapchorwa_District>. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map:
Kapchorwa District, Uganda: <http://healthmap.org/promed/p/2196>]
Date: Mon 22 Apr 2019
Source: Monitor [edited]
<https://www.monitor.co.ug/News/National/Jinja-declared-free-of-Crimean-Congo-fever/688334-5082202-yf2n46z/index.html>

The Ministry of Health has confirmed that all the suspected Crimean-Congo haemorrhagic fever [CCHF] cases in Jinja district tested negative.

Speaking to Daily Monitor on [Sat 20 Apr 2019], the ministry's senior public relations officer, Mr Emmanuel Ainebyoona, confirmed that the results that were tested at Uganda Virus Research Institute in Entebbe were negative.

"The samples of the relatives of the man who died at Entebbe General Hospital after he tested positive to the disease were taken to Entebbe but all have been found negative,'' he said.

Last [Tue 16 Apr 2019], the Jinja District health officer, Dr Dyogo Nantamu, confirmed that 13 people were admitted to Butagaya Health Centre III, in Butagaya Sub-county in Jinja District after they suspected them of having the disease.

Dr Dyogo, said these patients, who had signs of CCHF including general body weakness, bloody diarrhoea, severe pain in limbs and headache, were being treated in an isolated ward to prevent the disease from spreading to other people.

Dr Dyogo said the isolation ward that was created has since been left open for any new suspected cases. On [Mon 22 Apr 2019], the Ministry of Health, confirmed an outbreak of CCHF in Uganda.

According to World Health Organisation, the disease is caused by tick-borne virus. It is transmitted by tick bites and contact with infected animal blood or tissues.  [Byline: Tausi Nakato]
==========================
[Confirmation of the end of an outbreak as above is important as it helps evaluate the impact of response activities. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Uganda:
<http://healthmap.org/promed/p/2806>]
Date: Mon 15 Apr 2019
Source: The Observer [edited]
<https://observer.ug/news/headlines/60419-crimean-congo-fever-confirmed-in-jinja>

The ministry of Health has confirmed a case of Crimean-Congo haemorrhagic fever and warned of a possible outbreak in the eastern district of Jinja.  "A 32-year-old male, who passed on at Entebbe General Hospital in Wakiso, tested positive with Crimean-Congo haemorrhagic fever. He was buried in Jinja," said ministry of Health spokesperson Emmanuel Ainebyoona.

The deceased was a builder and was staying in Bendegere village, Kasenyi parish-Katabi sub county in Wakiso district. His body was transported by relatives from Entebbe hospital and buried in Butagaya, Nakakulwe village, in Jinja on [12 Apr 2019].  "This is to alert the general public of Jinja that; there is a suspected outbreak of Crimean-Congo haemorrhagic fever disease following a death of the confirmed case with the disease," read a statement issued by Jinja district health officer.

Jinja district chairman Titus Kisambira said that 11 suspected cases have been quarantined in their homes in Nakakulwe village, LC 1B. "We have quarantined 11 people who have shown signs and symptoms of the disease. Some are relatives of the man who died and others participated in his burial," said Kisambira.

Ainebyoona, said medical officers are on the ground are investigating other suspected cases. "But the public should remain calm as we investigate the illness and report any person with symptoms to the nearest health facility."

According to WHO, the disease is caused by a bunyavirus. It is transmitted by tick bites, contact with infected animal blood or tissues, and person-to person transmission via blood, body fluids, and semen.

The symptoms are sudden onset of fever, general body weakness, headache, severe pain in limbs, bloody diarrhoea, and bleeding from body openings. In 2017, an outbreak of the fever was confirmed in the districts of Nakaseke and Luwero, and in 2018, an outbreak was confirmed in Kabarole district where it killed one person.
=======================
[The report above does not highlight possible exposure/risk factors in the index case; the measures of contact tracing and monitoring with public communication are appropriate.

As mentioned above, sexual contact has been mentioned as a possible risk of CCHF transmission, even if the patient only experiences mild symptoms
(<https://www.sciencedirect.com/science/article/pii/S1201971216309924>). - ProMED Mod.UBA]

[Maps of Uganda: <http://en.wikipedia.org/wiki/Districts_of_Uganda> and
<http://healthmap.org/promed/p/2806>]
More ...