Uganda - Yellow fever outbreak: 30 suspected cases and 11 deaths

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https://en.wikipedia.org/wiki/Masaka_District

1 APRIL 2016

The Monitor (Kampala)

Uganda: Experts Probe Suspected Ebola Outbreak

By Martins E. Ssekweyama

Masaka ? Health experts have opened investigations into the death of four people suspected to have succumbed to the contagious Ebola -like symptoms in Masaka District.

The first suspicious death was reported late last month from Kasaka parish in Buwunga Sub-county, after one person identified as Wilberforce Ssenkubuge died upon showing strange signs related to the deadly haemorrhagic fever- Ebola.

Ssenkubuge is reported to have died after suffering from advanced fever, accompanied by abnormal pain, immense vomiting, passing out bloody stool and yellow eyes, which are known symptoms of Ebola fever.

Dr Stuart Musisi, the Masaka District health officer, on Wednesday confirmed that three similar deaths have so far occurred within one month and continues to receive patients with the same symptoms, something that has called for specialised investigation into this strange illness that has scared the community.
...
He said they so far have four patients under watch by health experts at Masaka Regional Referral Hospital as they await results from blood samples ...

http://allafrica.com/stories/201604010835.html

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Two more succumb to strange illness in Masaka

Written by URN
Created: 02 April 2016

Two of the four patients that had been isolated at Masaka regional referral hospital over a strange illness have died.

The patients from the parishes of Kasaka and Mazinga in Buwunga sub-county, were admitted on Wednesday evening with signs akin to the deadly Ebola and Marburg fevers. They died last evening. The two succumbed to the unknown illness, bringing to six, the total deaths registered in a period of five weeks.

They had been kept in isolation while receiving expert treatment and analysis. But preliminary blood samples tested negative to Ebola, Marburg and Rift Valley Fever. A comprehensive sample testing was then undertaken by the Uganda Virus Research Institute to ascertain the infection that is currently ravaging the community.

Eleazar Mugisha, the Masaka hospital Principal Administrator confirms the deaths. He however hastens to add that the remaining patients are showing signs of improvement.

At the same time, another set of three patients was also admitted with similar symptoms and is equally receiving specialized medication by a team of experts from the Ministry of Health, World Health Organization and Makerere University School of Public Health.
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"We a meeting with the district and it was agreed that we send a team on the ground to sensitise local people and also alley the fears because some might think it is Ebola yet it is not?

On the other hand Mugisha also reveals that the nature of the infections which proved to be highly contagious...
...

http://observer.ug/news-headlines/43442-two-more-patients-succumb-to-strange-illness-in-masaka

[alert]

Negative for Ebola, Marburg, and RVF:

http://www.monitor.co.ug/News/Nation...b/-/index.html

Maybe test for yellow fever next?

Notably, there is some scattering of these case, and it doesn't appear that these cases form a contact chain, suggesting the method of spread might be something other than H2H.

[alert]

Typhoid fever confirmed:

http://www.newvision.co.ug/new_vision/news/1421321/rare-strain-typhoid-hits-masaka

[alert]

Or maybe not: Published Date: 2016-04-11 20:39:09
Subject: PRO/EDR> Yellow fever - Africa (36): Uganda (MQ)
Archive Number: 20160411.4153034
YELLOW FEVER - AFRICA (36): UGANDA (MASAKA)
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this report:
[1] 1st hand report
[2] Press report

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[1] 1st hand report
Date: 11 Apr 2016
From: Julius Lutwama [edited]


We have confirmed a yellow fever outbreak in Masaka. So far, we have 6 laboratory-confirmed cases with 3 deaths.

[The outbreak is in the rural part of] Masaka district, not in the town area. I will provide more information tomorrow [12 Apr 2016].

--
Julius Lutwama


[Masaka District is in Central Uganda. Its main town is Masaka, whose estimated population in 2011 was 74 100. It is on the western shore of Lake Victoria, 350 km (140 miles) from the edge of the Congo forest, home to the monkey reservoir of yellow fever.

Julius took over from me as medical entomologist/virologist at the Entebbe virus lab, now the Uganda Virus Research Institute, when I left it in 1965. I have asked him whether there is any epidemiological connection with Angola. Their capitals, Kampala and Luanda, are 2370 km (1470 miles) across the Congo rain forest by the great circle route. I also asked whether Uganda has any vaccine in stock. - Mod.JW



******
[2] Press report:
Date: Mon 11 Apr 2016
Source: ETN [edited]
http://www.eturbonews.com/70266/trav...culation-certi


Usually reliable sources have confirmed what a statement by the Ugandan Ministry of Health said yesterday afternoon already [10 Apr 2016], that at least 5 cases of yellow fever have been detected in the area around Masaka. Masaka is a town in Central Uganda, lying west of Lake Victoria. It is the chief town of Masaka.

Several other patients have been tested, and the results are awaited now.

It was the Uganda Virus Institute in Entebbe which carried out the tests and confirmed the presence of yellow fever, though samples have reportedly also been sent to the CDC in Atlanta.

It now also appears that the 1st cases date back to mid March [2016] already, raising questions of why the information took so long to be made public, almost a month since the 1st patient fell seriously ill before dying.

The outbreak comes at a bad time for the Ugandan public, as the rainy season has set in at full force, often making access to remote rural areas difficult when roads become impassable.

Tourism stakeholders have begun to inform their clients that a valid yellow fever inoculation certificate is now mandatory and absolutely required, taking into account that after receiving the shot, it takes 10 days to become immune to the disease [virus].

As an outbreak country (presently, the largest outbreak in Africa is raging across Angola), will passengers traveling from Uganda to 3rd countries now also be required to carry the inoculation certificates or else risk being singled out on arrival, inoculated at the airport, and, in a worst case scenario, be kept in quarantine?

It should be stressed that the outbreak area is already sealed off by Ugandan health authorities and that tourists are most unlikely to come into any contact with infected patients, but due caution is nevertheless advised for visitors to the country.

Relevant statements can be sourced from the website of the Ugandan Ministry of Health, while additional information from the Ministry of Tourism and the Uganda Tourism Board are still awaited at this stage.

[Byline: Prof. Dr. Wolfgang H Thome]

--
Communicated by:
ProMED-mail


[This report provides some additional information. Apparently, all these cases are locally acquired, indicating ongoing transmission, but it is not clear whether it is still going on.

Exclusion of tourists, vaccinated or not, from the Masaka area is wise. No mention is made of whether any vector control measures are being carried out. Perhaps information coming from the Ministry of Health will provide clarity and additional reports of dates of occurrence of the cases after the index case in March 2016. - Mod.TY

It is worrying that there is no mention of vaccination on the area. - Mod.JW.

[alert]

Published Date: 2016-04-13 13:58:07
Subject: PRO/EDR> Yellow fever - Africa (39): Uganda (MQ)
Archive Number: 20160413.4157158
YELLOW FEVER - AFRICA (39): UGANDA (MASAKA)
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Wed 13 Apr 2016
Source: Africa.news.cn, Xinhua report [edited]

http://news.xinhuanet.com/english/2016-04/13/c_135275928.htm

Uganda has confirmed 7 cases of yellow fever [YF] since the disease broke out in its central region [Masaka] last week.

Sarah Opendi, Minister for Primary Healthcare, on [Wed 13 Apr 2016] told Xinhua by phone that out of the samples so far taken from suspected cases, 7 tested positive. The confirmed and suspected cases have been admitted to Masaka Regional Referral Hospital for treatment. Opendi said the ministry on [Tuesday 12 Apr 2016] dispatched a team of 9 epidemiologists to the central region to help assess and contain the fever outbreak. She said in a week's time, the ministry will carry out yellow fever vaccination of "all people at risk" in the central region.

The outbreak in Uganda comes as Angola and the Democratic Republic of Congo are battling the epidemic. Yellow fever is an acute viral disease. In most cases, symptoms include fever, jaundice, and bleeding.

--
Communicated by:
ProMED-mail


[The previous report indicated that the 6 YF infections mentioned are apparently locally acquired, indicating ongoing transmission. The occurrence of an additional case could indicate that the transmission is still going on. It is good to see that a vaccination effort in the area of risk is moving forward. A prompt response to the outbreak is essential to prevent its spread, especially at the current time, when stocks of YF vaccine are very limited.

The earlier report stated that there would be exclusion of tourists, vaccinated or not, from the Masaka area. No mention is made of whether any vector control measures are being carried out there. - Mod.TY

[Ronan Kelly]

Yellow fever kills 3 more in Masaka
By Dismus Buregyeya
Added 14th April 2016 01:11 PM


Three people from Bukakata sub-county in Masaka district have died of suspected yellow fever.

The death toll has risen to 10 within a period of two weeks.

The Masaka District Health Officer, Stuart Musisi told the press that Ministry of Health, World Health Organizations (WHO) and the Centre for Disease Control team has been deployed in the area to make further investigations into the causes of the deaths.

?We have sent a team of experts to Bukakata to verify whether the causes of deaths is related to yellow fever,? he said.
...
- See more at: http://www.newvision.co.ug/new_visio....QMLjdcpb.dpuf

[alert]

Maybe both illnesses?

Published Date: 2016-04-14 14:08:46
Subject: PRO/EDR> Yellow fever - Africa (40): Uganda (MQ) susp, RFI
Archive Number: 20160414.4159929
YELLOW FEVER - AFRICA (40): UGANDA (MASAKA) SUSPECTED, REQUEST FOR INFORMATION
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Thu 14 Apr 2016
Source: New Vision [edited]

http://www.newvision.co.ug/new_vision/news/1422135/yellow-fever-kills-masaka

With 3 people, all residents of Bukakata in Masaka district, having died of suspected yellow fever [YF], the death toll has risen to 10 in a period of 2 weeks.

The Masaka District Health Officer, Stuart Musisi told the press that the Ministry of Health, the World Health Organizations (WHO) and the Centre for Disease Control team has been deployed in the area to make further investigations into the causes of the deaths. "We have sent a team of experts to Bukakata to verify whether the cause of [the] deaths is related to yellow fever," he said.

Dr Musisi said some sources in Bukakata had informed the health authorities that the deceased persons had also died on [Wed 13 Apr 2016] with symptoms related to the disease outbreak. He said laboratory tests confirmed yellow fever as the cause of the death of the 6 people who died earlier in Buwunga sub-county. "The victims suffered multiple infections connected to Typhoid and yellow fever," he said.

He also said a total of 13 suspected cases were initially reported in Masaka and that the most affected areas are those with forests. The victims were connected to charcoal burning activities. Dr Musisi said yellow fever outbreak is transmitted by mosquitoes which originate from the forests where there are monkeys. He said the mosquitoes bite during day time.

He warned the people operating in Mazinga, Kasaka in Mukungwe and Buwunga , Bukakata sub-counties to be cautious. Dr Musisi said the deceased developed symptoms which include yellow eyes, severe abdominal pains, headache, and that they fail to respond to malaria treatment. He said the health team has opened an alert desk to receive information on the yellow fever outbreak.

The district has also set up a task force led by the Masaka RDC [Resident District Commissioner], CAO [Chief Administrative Officer] and heads of departments to support the fight against yellow fever. An official from the Ministry of Health, Ahimbisibwe strongly advised the people in Masaka to sleep under mosquito nets. He said the mosquito which spreads yellow fever comes from the forest jungles and spreads it from animals to humans or humans to humans. Ahimbisibwe also said the Ministry of Health is organizing a mass vaccination campaign against yellow fever in Masaka region.

[Byline: Dismus Buregyeya]

--
Communicated by:
ProMED-mail


[This report adds some confusion about the etiology of the diseases that have occurred. The District Health officer indicated that the earlier 6 cases were laboratory confirmed as YF infections, and then stated that they "suffered multiple infections connected to typhoid and yellow fever."

ProMED would appreciate additional information clarifying the etiologies of these cases, as well any results of laboratory tests of the 3 new cases. If these 3 new cases are, indeed, YF, then virus transmission is continuing in the area. The vaccination effort in the area of risk should move forward and is urgent. A prompt response to the outbreak is essential to prevent its spread, especially at the current time, when stocks of YF vaccine are very limited.

No mention is made of whether any vector control measures are being carried out there. If this is a forest (sylvan) cycle of transmission, it is important to reduce the risk of spill-over into an urban cycle by reduction of _Aedes aegypti_ that might be present.

[Shiloh]

Source: http://www.theafricareport.com/East-...-10-lives.html


Posted on Tuesday, 19 April 2016 14:49
Uganda: Yellow fever claims 10 lives
By Godfrey Olukya

At least 10 people have died from yellow fever in central Uganda's Masaka district, 120 kilometres west of the capital, Kampala, since the outbreak of the disease six weeks ago.

As news of deaths continue to spread, a number of panic-stricken Ugandans in rural areas across Masaka district are reportedly refusing to leave their homes for fear of catching the virus...

[Pathfinder]

Hundreds stuck at Busia over yellow fever

Written by URN
Created: 27 April 2016

The population of stranded travellers without yellow fever vaccination certificates continues to soar at the Busia border post in eastern Uganda as Kenyan and Uganda authorities continue to turn away people without proof of vaccination.
...
Dr Jane Aceng, the director general of Health Services, has since rushed to the Busia border post. She has held meetings with immigration officials from both countries.

She said government is set to roll out mass yellow fever vaccinations in areas where the outbreak has been confirmed.

http://observer.ug/news-headlines/43908-hundreds-stuck-at-busia-over-yellow-fever

[Shiloh]

Source: http://www.who.int/csr/don/02-may-20...ver-uganda/en/
Yellow fever ? Uganda

Disease Outbreak News
2 May 2016

On 8 April 2016, the National IHR Focal Point of Uganda notified WHO of an outbreak of Yellow Fever (YF) in Masaka district, south of Kampala.
An alert concerning a suspected outbreak of viral haemorrhagic fever in Kaloddo village, Masaka district was initially sent on 26 March. A cluster of three cases from a single family was reported after patients presented with high-grade fever, were non-responsive to anti-malarial treatment with haemorrhaging signs and acute neurological signs (convulsions and unconsciousness).
From 28 March to 1 April, a rapid response team (RRT) was deployed to carry out investigation and response activities. The RRT confirmed the deaths, activated the district task force, set up a treatment facility in Masaka, and collected and referred samples to the Uganda Virus Research Institute (UVRI) for laboratory testing. In addition, the team used a case definition for haemorrhagic fevers and proceeded to carry out active case search to identify additional suspected cases.
On 29 and 30 March, 6 samples were sent to the UVRI and tested negative for all Ebola virus disease, Marburg virus disease, Crimean-Congo haemorrhagic fever, Rift Valley fever by polymerase chain reaction (PCR). On 8 April, Yellow Fever was confirmed on three samples by PCR, two blood samples tested positive for salmonella non-typhi and one tested positive for malaria. On 21 April, at least four samples were re-confirmed positive by PCR at CDC Fort Collins (WHO Collaborative Center for Yellow Fever).
From 26 March to 18 April, 30 cumulative suspected cases, including 7 deaths, were reported from Masaka, Rukungiri, Ntungamo, Bukumansimbi, Kalungu, Lyantonde, and Rakai. Of these, 6 cases and 2 deaths were confirmed in Masaka district (5 cases), and Rukungiri district (1 case). The mean age of the cases is 23 years old. The majority of cases are male. The cases do not have any history of travel outside of Uganda.
Public health response

The Ministry of Health of Uganda, with the support of WHO, Centers for Disease Control, M?decins Sans Fronti?res and other partners are supporting the response to the outbreak. WHO AFRO shared relevant guiding documents with the country for conducting risk assessment, vector control and outbreak management. The district task force which coordinates the response at district level developed a response plan and meets regularly. A multidisciplinary investigation team (physicians, laboratory experts, communication specialists, an epidemiologist and an entomologist) was sent to the affected district to conduct in-depth investigations and provide technical support to the District Task Force. Active surveillance has been enhanced through the activation of the alert desk and provision of alert free lines to the public. Case management, social mobilization, reactive vaccination and a rapid YF risk assessment are ongoing. A YF management centre was established in Masaka and Yellow Fever vaccine has already been requested from the International Coordinating Group on Vaccine Provision for reactive vaccination.
WHO risk assessment

The current outbreak in Uganda is occurring in the context of international export of YF cases from Angola to China, the Democratic Republic of the Congo, and Kenya. Uganda is situated in the ?Yellow Fever belt? of Africa and is considered a country at risk of Yellow Fever virus transmission. Last outbreak of Yellow Fever was reported in December 2011. The affected districts are in south-western Uganda close to Democratic Republic of Congo, Rwanda and Tanzania. As the borders are porous with substantial cross border social and economic activities, further transmission cannot be excluded. WHO continues to monitor the epidemiological situation and conduct risk assessment based on the latest available information.
WHO advice

WHO urges Members States especially those where the establishment of a local cycle of transmission is possible (i.e., where the Aedes spp mosquitoes are present) to strengthen the control of immunization status of travellers to all potentially endemic areas and the surveillance of potential YF cases.
WHO does not recommend any restriction of travel and trade to Uganda based on the current information available.

[Ronan Kelly]

Worth following the link to read in full - Ro

Masaka’s ‘mystery illness’ unmasked

By MARTINS E. SSEKWEYAMA

The patients complained of advanced fever, accompanied by symptoms that included abnormal pain, vomiting, bloody stool, yellow eyes and dizziness. They associated it with witchcraft and sought services of traditional healers. In the end, families that had lost loved ones were left isolated.
...
further laboratory testing later established rare strain of typhoid fever in some of the blood samples and a general outbreak of yellow fever; an infectious viral disease. This implies that some patients had multiple infections which experts say is possible and common.
The last results came in after 10 people had already succumbed to what had earlier been described as a strange disease.
...
About this type of typhoid fever.

Francis Ssenyonjo Mbaziira, says this type of typhoid is caused by bacteria known called; “salmonella Typhi”. Its symptoms include: fever, abdominal pain, cough, joint pains, general malaise and dizziness. He says infection is caused by consumption of food and water containing human faecal matter.
Dr Florence Tugumisirize, the Masaka Hospital Superintendent, a consultant pediatrician, says typhoid has a direct linkage with the consumption of human waste (including that of little children), which is often common in people who ignore washing their hands after visiting the toilet and before having their meals.
...
http://mobile.monitor.co.ug/Masaka-s...z/-/index.html

[Pathfinder]

Monday, May 16, 2016

Uganda receives doses of yellow fever vaccine

Kampala, UGANDA - Uganda has received 714,579 doses of yellow fever vaccine, worth 643,765 US dollars (over shs 2 billion), for an emergency reactive mass vaccination campaign in Masaka and Rukungiri districts.

Since January 2016, Uganda has been experiencing a yellow fever outbreak in Masaka and Rukungiri districts, with 30 suspected cases and 11 deaths. The last reported yellow fever outbreak in Uganda was in 2010 that affected five districts in the northern part of the country.

The GAVI Alliance is paying for the vaccines after a request from the Government of Uganda was approved through the International Coordination Group on vaccines. The group comprises of United Nations Children?s Fund (UNICEF), World Health Organization (WHO), M?decins Sans Fronti?res (MSF), and the International Federation of Red Cross and Red Crescent Societies (IFRC).
...

http://www.busiweek.com/index1.php?Ctp=2&pI=5155&pLv=3&srI=68&spI=107