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Outbreaks and Emergencies Bulletin, Week 22 : 26 May - 01 June 2018
Undiagnosed disease Uganda
19
Cases
6
Deaths
31.6%
CFR
EVENT DESCRIPTION
The Uganda Ministry of Health has reported a cluster of an undiagnosed
disease with a high death rate in Manafwa District in the eastern region.
The event was initially detected on 23 May 2018 through an informal
surveillance report indicating that 14 children had been affected, eight of
whom had died and six were hospitalized. The illness was (reportedly)
characterised by a high fever and passing of dark-coloured urine.
A preliminary outbreak investigation (carried out by the national rapid
response team) identified and line-listed 19 cases, including six deaths
(case fatality rate 31.6%), as of 26 May 2018. The current event started
on 19 May 2018 when the first case in the cluster became ill, and most
of the cases (11) occurred between 18 and 25 May 2018. The casepatients,
all children 10 years and below, commonly presented with
high fever, abdominal pain, haematuria, signs of anaemia, jaundice, and
other constitutional symptoms. This condition ? usually responsive to
antimalarial and antibiotic treatment ? has (reportedly) been recurrent
in all the case-patients, with 37% (7/19) getting episodes since 2016.
The age of case-patients ranged from 1 to 10 years, with a mean of
4 years and median of 5 years. Most of the case-patients (79%, 15)
started getting ill between 1 and 2 years, with one case-patient catching
the disease at 5 months of age. Most, 74% (14/19), of the case persons
are males.
Three out of 10 sub-counties in Manafwa District have been affected:
Bugobero (8 cases), Busukuya (8) and Bukusu (3).
Of the 11 blood specimens obtained and analysed, nine tested positive
for malaria (Plasmodium falciparum) on rapid diagnostic test (RDT),
while two were negative. All the six deceased cases had positive malaria
RDT test results.
PUBLIC HEALTH ACTIONS
The Ministry of Health has deployed a national rapid response
team to conduct outbreak investigation of the public health event
in Manafwa District.
Laboratory specimens (blood and urine) have been collected
from the case-patients and shipped to the Central Public Health
Laboratory (CPHL) for further analysis.
Based on the working diagnosis, the National Malaria Control
Program, in collaboration with the Epidemiology and Surveillance
Division of the Ministry of Health, has developed an emergency response plan to guide initial interventions to the public health event.
Active surveillance has been enhanced in the district, including active case search in the community and health facilities.
The case-patients are being managed at the local health facilities.
SITUATION INTERPRETATION
Manafwa District in the eastern region of Uganda is experiencing a cluster of cases of an undiagnosed illness with high fatality. The disease, commonly affecting
children, appears to be chronic with frequent recurrence. The preliminary investigation made a working diagnosis of black water fever, a complication of Plasmodium
falciparum infection leading to massive rupture (haemolysis) of red blood cells, releasing haemoglobin directly into the blood vessels and in urine, and frequently
leading to kidney failure.
While malaria is endemic in the affected district (and in 95% of Uganda), clinicians need to be open-minded while investigating this public health event. There is a need
to conduct a wide range of diagnostic and clinical investigations in order to obtain a better understanding of the condition. Meanwhile, active surveillance needs to be
enhanced as well as improved symptomatic clinical management of the cases.
Undiagnosed disease Uganda
19
Cases
6
Deaths
31.6%
CFR
EVENT DESCRIPTION
The Uganda Ministry of Health has reported a cluster of an undiagnosed
disease with a high death rate in Manafwa District in the eastern region.
The event was initially detected on 23 May 2018 through an informal
surveillance report indicating that 14 children had been affected, eight of
whom had died and six were hospitalized. The illness was (reportedly)
characterised by a high fever and passing of dark-coloured urine.
A preliminary outbreak investigation (carried out by the national rapid
response team) identified and line-listed 19 cases, including six deaths
(case fatality rate 31.6%), as of 26 May 2018. The current event started
on 19 May 2018 when the first case in the cluster became ill, and most
of the cases (11) occurred between 18 and 25 May 2018. The casepatients,
all children 10 years and below, commonly presented with
high fever, abdominal pain, haematuria, signs of anaemia, jaundice, and
other constitutional symptoms. This condition ? usually responsive to
antimalarial and antibiotic treatment ? has (reportedly) been recurrent
in all the case-patients, with 37% (7/19) getting episodes since 2016.
The age of case-patients ranged from 1 to 10 years, with a mean of
4 years and median of 5 years. Most of the case-patients (79%, 15)
started getting ill between 1 and 2 years, with one case-patient catching
the disease at 5 months of age. Most, 74% (14/19), of the case persons
are males.
Three out of 10 sub-counties in Manafwa District have been affected:
Bugobero (8 cases), Busukuya (8) and Bukusu (3).
Of the 11 blood specimens obtained and analysed, nine tested positive
for malaria (Plasmodium falciparum) on rapid diagnostic test (RDT),
while two were negative. All the six deceased cases had positive malaria
RDT test results.
PUBLIC HEALTH ACTIONS
The Ministry of Health has deployed a national rapid response
team to conduct outbreak investigation of the public health event
in Manafwa District.
Laboratory specimens (blood and urine) have been collected
from the case-patients and shipped to the Central Public Health
Laboratory (CPHL) for further analysis.
Based on the working diagnosis, the National Malaria Control
Program, in collaboration with the Epidemiology and Surveillance
Division of the Ministry of Health, has developed an emergency response plan to guide initial interventions to the public health event.
Active surveillance has been enhanced in the district, including active case search in the community and health facilities.
The case-patients are being managed at the local health facilities.
SITUATION INTERPRETATION
Manafwa District in the eastern region of Uganda is experiencing a cluster of cases of an undiagnosed illness with high fatality. The disease, commonly affecting
children, appears to be chronic with frequent recurrence. The preliminary investigation made a working diagnosis of black water fever, a complication of Plasmodium
falciparum infection leading to massive rupture (haemolysis) of red blood cells, releasing haemoglobin directly into the blood vessels and in urine, and frequently
leading to kidney failure.
While malaria is endemic in the affected district (and in 95% of Uganda), clinicians need to be open-minded while investigating this public health event. There is a need
to conduct a wide range of diagnostic and clinical investigations in order to obtain a better understanding of the condition. Meanwhile, active surveillance needs to be
enhanced as well as improved symptomatic clinical management of the cases.
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