​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

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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.

http://apps.who.int/iris/bitstream/handle/10665/272749/OEW22-260501062018.pdf

http://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates

 

[Ronan Kelly]

Mystery illness kills eight in Uganda

Anne Gulland, global health security correspondent
5 JUNE 2018 ? 4:58PM
A mystery illness which has killed eight children has been reported in Uganda, the World Health Organization (WHO) has said.

Nineteen children, all under the age of 10, have caught the disease, which is thought to be black water fever, a complication of malaria.

The illness is characterised by a high fever and dark black urine. The children also presented with stomach pain, signs of anaemia and other symptoms. The children were all under the age of 10, with the majority having had several episodes of the illness over the past two years.

The undiagnosed illness was first reported on May 23, when 14 children were initially thought to have contracted the disease. The government then dispatched a rapid response team to the area - the Manafwa District in the east of the country - which then identified 19 cases in total.
...
https://www.telegraph.co.uk/news/2018/06/05/mystery-illness-kills-eight-uganda/

 

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TUESDAY JUNE 12 2018

Strange disease kills dozens in Manafwa
...
By FRED WAMBEDE

A strange epidemic has struck Manafwa and Namisindwa districts, claiming unspecified number of lives and left dozens admitted to various hospitals

The disease, which mainly attacks children aged one and 10 with severe symptoms, including passing out bloody urine, was first reported in Bugobero Sub-county about three weeks ago but it spread to other sub-counties of Butiru, Sisuni, Khabutoola, Busukuya in Manafwa and to Namisindwa District. More than 40 children are reported to be admitted to different health centres but the actual number is yet to be confirmed.

District health officials, who preferred anonymity, said more than 14 children have died at community level but this could not be officially verified.
...
However, the district health officer, Dr Gideon Wamasebu, said a team of experts from the Ministry of Health visited the area and found the symptoms were associated with malaria.

?It is not a strange disease but complicated malaria. We have, as a result, strengthened their capacity to handle it,? he said.

The ministry public relations officer, Ms Vivian Serwanja, said their analysis suggests the disease is black water fever.
...
Blackwater fever is a complicated malaria infection in which red blood cells burst in the bloodstream, releasing haemoglobin directly into the blood vessels and into the urine, usually leading to kidney failure.
...

http://www.monitor.co.ug/News/Natio...zens-Manafwa/688334-4606956-9hunhw/index.html

 

[Pathfinder]

Manafwa Registers More Black Water Fever Patients

2 Aug 2018, 10:40 0
...
Bugobero Health Center IV in Manafwa district has received more than 120 children affected by the black water fever since June this year.

The health Center in Charge, Dr. Emma Gahima, says between 3 to 5 children are admitted in the emergency ward on average each day.

Most of the patients are from Bugobero, Butiru, Sisuni, Khabutoola, Busukuya sub counties in Manafwa and parts of Namisindwa District.
...
Gideon Lubaale, a Nursing Officer in the emergency unit Bugobero Health Center IV, says they have registered more than 20 deaths in the last three months.

She however, notes that many cases go unregistered as some children die along the way as they are being rushed to Mbale Regional Referral Hospital for blood transfusion and parents don't report back to the Health Center.
...

https://ugandaradionetwork.com/story/manafwa-registers-more-black-water-fever-patients