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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917783

RESUMO

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Vigilância em Saúde Pública/métodos , República Democrática do Congo/epidemiologia , Humanos , Ruanda/epidemiologia , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
2.
Emerg Infect Dis ; 26(1): 70-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855140

RESUMO

Crimean-Congo hemorrhagic fever (CCHF), Q fever, and Lyme disease are endemic to southern Kazakhstan, but population-based serosurveys are lacking. We assessed risk factors and seroprevalence of these zoonoses and conducted surveys for CCHF-related knowledge, attitudes, and practices in the Zhambyl region of Kazakhstan. Weighted seroprevalence for CCHF among all participants was 1.2%, increasing to 3.4% in villages with a known history of CCHF circulation. Weighted seroprevalence was 2.4% for Lyme disease and 1.3% for Q fever. We found evidence of CCHF virus circulation in areas not known to harbor the virus. We noted that activities that put persons at high risk for zoonotic or tickborne disease also were risk factors for seropositivity. However, recognition of the role of livestock in disease transmission and use of personal protective equipment when performing high-risk activities were low among participants.

3.
PLoS Negl Trop Dis ; 13(3): e0007257, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30883555

RESUMO

INTRODUCTION: In October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations. METHODS: A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus. RESULTS: Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda. CONCLUSION: This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.


Assuntos
Técnicas de Laboratório Clínico/métodos , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças , Doença do Vírus de Marburg/epidemiologia , Doença do Vírus de Marburg/patologia , Marburgvirus/isolamento & purificação , Adulto , Animais , Análise por Conglomerados , Transmissão de Doença Infecciosa/prevenção & controle , Saúde da Família , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Doença do Vírus de Marburg/mortalidade , Pessoa de Meia-Idade , Mortalidade , Uganda/epidemiologia , Cultura de Vírus
4.
Am J Trop Med Hyg ; 100(3): 659-671, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675833

RESUMO

In March 2016, an outbreak of Rift Valley fever (RVF) was identified in Kabale district, southwestern Uganda. A comprehensive outbreak investigation was initiated, including human, livestock, and mosquito vector investigations. Overall, four cases of acute, nonfatal human disease were identified, three by RVF virus (RVFV) reverse transcriptase polymerase chain reaction (RT-PCR), and one by IgM and IgG serology. Investigations of cattle, sheep, and goat samples from homes and villages of confirmed and probable RVF cases and the Kabale central abattoir found that eight of 83 (10%) animals were positive for RVFV by IgG serology; one goat from the home of a confirmed case tested positive by RT-PCR. Whole genome sequencing from three clinical specimens was performed and phylogenetic analysis inferred the relatedness of 2016 RVFV with the 2006-2007 Kenya-2 clade, suggesting previous introduction of RVFV into southwestern Uganda. An entomological survey identified three of 298 pools (1%) of Aedes and Coquillettidia species that were RVFV positive by RT-PCR. This was the first identification of RVFV in Uganda in 48 years and the 10th independent viral hemorrhagic fever outbreak to be confirmed in Uganda since 2010.


Assuntos
Surtos de Doenças , Gado , Febre do Vale de Rift/epidemiologia , Vírus da Febre do Vale do Rift/genética , Adolescente , Animais , Anticorpos Antivirais/sangue , Culicidae/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Uganda/epidemiologia
6.
PLoS Negl Trop Dis ; 12(5): e0006412, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29723189

RESUMO

BACKGROUND: Rift Valley fever (RVF) is a zoonotic disease caused by Rift Valley fever virus (RVFV) found in Africa and the Middle East. Outbreaks can cause extensive morbidity and mortality in humans and livestock. Following the diagnosis of two acute human RVF cases in Kabale district, Uganda, we conducted a serosurvey to estimate RVFV seroprevalence in humans and livestock and to identify associated risk factors. METHODS: Humans and animals at abattoirs and villages in Kabale district were sampled. Persons were interviewed about RVFV exposure risk factors. Human blood was tested for anti-RVFV IgM and IgG, and animal blood for anti-RVFV IgG. PRINCIPAL FINDINGS: 655 human and 1051 animal blood samples were collected. Anti-RVFV IgG was detected in 78 (12%) human samples; 3 human samples (0.5%) had detectable IgM only, and 7 (1%) had both IgM and IgG. Of the 10 IgM-positive persons, 2 samples were positive for RVFV by PCR, confirming recent infection. Odds of RVFV seropositivity were greater in participants who were butchers (odds ratio [OR] 5.1; 95% confidence interval [95% CI]: 1.7-15.1) and those who reported handling raw meat (OR 3.4; 95% CI 1.2-9.8). No persons under age 20 were RVFV seropositive. The overall animal seropositivity was 13%, with 27% of cattle, 7% of goats, and 4% of sheep seropositive. In a multivariate logistic regression, cattle species (OR 9.1; 95% CI 4.1-20.5), adult age (OR 3.0; 95% CI 1.6-5.6), and female sex (OR 2.1; 95%CI 1.0-4.3) were significantly associated with animal seropositivity. Individual human seropositivity was significantly associated with animal seropositivity by subcounty after adjusting for sex, age, and occupation (p < 0.05). CONCLUSIONS: Although no RVF cases had been detected in Uganda from 1968 to March 2016, our study suggests that RVFV has been circulating undetected in both humans and animals living in and around Kabale district. RVFV seropositivity in humans was associated with occupation, suggesting that the primary mode of RVFV transmission to humans in Kabale district could be through contact with animal blood or body fluids.


Assuntos
Doenças dos Bovinos/epidemiologia , Doenças das Cabras/epidemiologia , Febre do Vale de Rift/epidemiologia , Vírus da Febre do Vale do Rift/fisiologia , Doenças dos Ovinos/epidemiologia , Matadouros , Adolescente , Adulto , Animais , Anticorpos Antivirais/sangue , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/virologia , Criança , Feminino , Doenças das Cabras/sangue , Doenças das Cabras/virologia , Cabras , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Febre do Vale de Rift/sangue , Febre do Vale de Rift/virologia , Vírus da Febre do Vale do Rift/genética , Vírus da Febre do Vale do Rift/imunologia , Vírus da Febre do Vale do Rift/isolamento & purificação , Fatores de Risco , Ovinos , Doenças dos Ovinos/sangue , Doenças dos Ovinos/virologia , Uganda/epidemiologia , Adulto Jovem , Zoonoses/sangue , Zoonoses/epidemiologia , Zoonoses/virologia
7.
PLoS Negl Trop Dis ; 12(5): e0006460, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29727450

RESUMO

Rift Valley fever virus is an arbovirus that affects both livestock and humans throughout Africa and in the Middle East. Despite its endemicity throughout Africa, it is a rare event to identify an infected individual during the acute phase of the disease and an even rarer event to collect serial blood samples from the affected patient. Severely affected patients can present with hemorrhagic manifestations of disease. In this study we identified three Ugandan men with RVFV disease that was accompanied by hemorrhagic manifestations. Serial blood samples from these men were analyzed for a series of biomarkers specific for various aspects of human pathophysiology including inflammation, endothelial function and coagulopathy. There were significant differences between biomarker levels in controls and cases both early during the illness and after clearance of viremia. Positive correlation of viral load with markers of inflammation (IP-10, CRP, Eotaxin, MCP-2 and Granzyme B), markers of fibrinolysis (tPA and D-dimer), and markers of endothelial function (sICAM-1) were all noted. However, and perhaps most interesting given the fact that these individuals exhibited hemorrhagic manifestations of disease, was the finding of a negative correlation between viral load and P-selectin, ADAMTS13, and fibrinogen all of which are associated with coagulation pathways occurring on the endothelial surface.


Assuntos
Hemorragia/imunologia , Hemorragia/virologia , Febre do Vale de Rift/sangue , Febre do Vale de Rift/imunologia , Vírus da Febre do Vale do Rift/fisiologia , Proteína ADAMTS13/imunologia , Adolescente , Biomarcadores/sangue , Coagulação Sanguínea , Citocinas/imunologia , Hemorragia/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Selectina-P/imunologia , Febre do Vale de Rift/virologia , Vírus da Febre do Vale do Rift/genética , Vírus da Febre do Vale do Rift/imunologia , Vírus da Febre do Vale do Rift/isolamento & purificação , Carga Viral , Adulto Jovem
8.
PLoS Negl Trop Dis ; 12(3): e0006175, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29505579

RESUMO

BACKGROUND: Rift Valley Fever virus (RVF) is a zoonotic virus in the Phenuiviridae family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF. METHODOLOGY/PRINCIPAL FINDINGS: A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering. CONCLUSIONS: Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations.


Assuntos
Surtos de Doenças/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Equipamento de Proteção Individual/estatística & dados numéricos , Febre do Vale de Rift/fisiopatologia , Matadouros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Uganda , Adulto Jovem
10.
Int J Infect Dis ; 68: 88-93, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29382607

RESUMO

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Research Institute received an alert for a suspect VHF case in a 33-year-old male who presented with VHF compatible signs and symptoms at Mengo Hospital in Kampala. METHODS: A blood sample from the suspect patient was tested by RT-PCR for CCHF and found positive. Serological testing on sequential blood specimens collected from this patient showed increasing anti-CCHFV IgM antibody titers, confirming recent infection. Repeat sampling of the confirmed case post recovery showed high titers for anti-CCHFV-specific IgG. An epidemiological outbreak investigation was initiated following the initial RT-PCR positive detection to identify any additional suspect cases. RESULTS: Only a single acute case of CCHF was detected from this outbreak. No additional acute CCHF cases were identified following field investigations. Environmental investigations collected 53 tick samples, with only 1, a Boophilus decoloratus, having detectable CCHFV RNA by RT-PCR. Full-length genomic sequencing on a viral isolate from the index human case showed the virus to be related to the DRC (Africa 2) lineage. CONCLUSIONS: This is the fourth confirmed CCHF outbreak in Uganda within 2 years after more than 50 years of no reported human CCHF cases in this country. Our investigations reaffirm the endemicity of CCHFV in Uganda, and show that exposure to ticks poses a significant risk for human infection. These findings also reflect the importance of having an established national VHF surveillance system and diagnostic capacity in a developing country like Uganda, in order to identify the first cases of VHF outbreaks and rapidly respond to reduce secondary cases. Additional efforts should focus on implementing effective tick control methods and investigating the circulation of CCHFV throughout the country.


Assuntos
Surtos de Doenças , Vírus da Febre Hemorrágica da Crimeia-Congo/isolamento & purificação , Febre Hemorrágica da Crimeia/diagnóstico , Adulto , Animais , Anticorpos Anti-Idiotípicos/sangue , Anticorpos Antivirais/sangue , Variações do Número de Cópias de DNA , Humanos , Masculino , Filogenia , RNA Viral/isolamento & purificação , Análise de Sequência de RNA , Carrapatos/virologia , Uganda , Células Vero
11.
PLoS Negl Trop Dis ; 11(9): e0005907, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28892520

RESUMO

BACKGROUND: Uganda has reported five (5) Ebola virus disease outbreaks and three (3) Marburg virus disease outbreaks from 2000 to 2016. Peoples' knowledge and attitude towards Ebola and Marburg virus disease impact on control and prevention measures especially during outbreaks. We describe knowledge and attitude towards Ebola and Marburg virus outbreaks in two affected communities in Uganda to inform future outbreak responses and help in the design of health education and communication messages. METHODS: The study was a community survey done in Luweero, Ibanda and Kamwenge districts that have experienced outbreaks of Ebola and Marburg virus diseases. Quantitative data were collected using a structured questionnaire and triangulated with qualitative participatory epidemiology techniques to gain a communities' knowledge and attitude towards Ebola and Marburg virus disease. RESULTS: Out of 740 respondents, 48.5% (359/740) were categorized as being knowledgeable about Ebola and Marburg virus diseases, whereas 60.5% (448/740) were having a positive attitude towards control and prevention of Ebola and Marburg virus diseases. The mean knowledge and attitude percentage scores were 54.3 (SD = 23.5, 95%CI = 52.6-56.0) and 69.9 (SD = 16.9, 95%CI = 68.9-71.1) respectively. People educated beyond primary school were more likely to be knowledgeable about Ebola and Marburg virus disease than those who did not attain any formal education (OR = 3.6, 95%CI = 2.1-6.1). Qualitative data revealed that communities describe Ebola and Marburg virus diseases as very severe diseases with no cure and they believe the diseases spread so fast. Respondents reported fear and stigma suffered by survivors, their families and the broader community due to these diseases. CONCLUSION: Communities in Uganda affected by filovirus outbreaks have moderate knowledge about these diseases and have a positive attitude towards practices to prevent and control Ebola and Marburg viral diseases. The public health sector should enhance this community knowledge gap to empower them more by supplying educational materials for epidemic preparedness in future using appropriate communication channels as proposed by the communities.


Assuntos
Surtos de Doenças , Métodos Epidemiológicos , Conhecimentos, Atitudes e Prática em Saúde , Doença pelo Vírus Ebola/epidemiologia , Doença do Vírus de Marburg/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Ebolavirus/isolamento & purificação , Feminino , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/psicologia , Doença pelo Vírus Ebola/virologia , Humanos , Entrevistas como Assunto , Masculino , Doença do Vírus de Marburg/prevenção & controle , Doença do Vírus de Marburg/psicologia , Doença do Vírus de Marburg/virologia , Marburgvirus/isolamento & purificação , Pessoa de Meia-Idade , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Estigma Social , Uganda/epidemiologia , Adulto Jovem
12.
Emerg Infect Dis ; 23(6): 1001-1004, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28518032

RESUMO

In September 2014, a single fatal case of Marburg virus was identified in a healthcare worker in Kampala, Uganda. The source of infection was not identified, and no secondary cases were identified. We describe the rapid identification, laboratory diagnosis, and case investigation of the third Marburg virus outbreak in Uganda.


Assuntos
Surtos de Doenças , Doença do Vírus de Marburg/epidemiologia , Doença do Vírus de Marburg/prevenção & controle , Marburgvirus/genética , Filogenia , Adulto , Animais , Quirópteros/virologia , Reservatórios de Doenças/virologia , Evolução Fatal , Humanos , Masculino , Marburgvirus/classificação , Marburgvirus/isolamento & purificação , Equipamento de Proteção Individual/estatística & dados numéricos , Uganda/epidemiologia
13.
MMWR Morb Mortal Wkly Rep ; 65(43): 1200-1201, 2016 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-27811840

RESUMO

On March 9, 2016, a male butcher from Kabale District, Uganda, aged 45 years, reported to the Kabale Regional Referral Hospital with fever, fatigue, and headache associated with black tarry stools and bleeding from the nose. One day later, a student aged 16 years from a different sub-county in Kabale District developed similar symptoms and was admitted to the same hospital. The student also had a history of contact with livestock. Blood specimens collected from both patients were sent for testing for Marburg virus disease, Ebola virus disease, Rift Valley fever (RVF), and Crimean Congo Hemorrhagic fever at the Uganda Virus Research Institute, as part of the viral hemorrhagic fevers surveillance program. The Uganda Virus Research Institute serves as the national viral hemorrhagic fever reference laboratory and hosts the national surveillance program for viral hemorrhagic fevers, in collaboration with the CDC Viral Special Pathogens Branch and the Uganda Ministry of Health.


Assuntos
Surtos de Doenças/prevenção & controle , Vigilância da População , Febre do Vale de Rift/diagnóstico , Febre do Vale de Rift/prevenção & controle , Adolescente , Animais , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais , Vírus da Febre do Vale do Rift/isolamento & purificação , Uganda/epidemiologia
14.
J Infect Dis ; 212 Suppl 2: S119-28, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26209681

RESUMO

In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription-polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.


Assuntos
Doença do Vírus de Marburg/epidemiologia , Marburgvirus/isolamento & purificação , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doença do Vírus de Marburg/virologia , Pessoa de Meia-Idade , Uganda/epidemiologia , Adulto Jovem
16.
Am J Trop Med Hyg ; 90(5): 790-793, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24515940

RESUMO

Outbreaks of Ebola and Marburg virus diseases have recently increased in frequency in Uganda. This increase is probably caused by a combination of improved surveillance and laboratory capacity, increased contact between humans and the natural reservoir of the viruses, and fluctuations in viral load and prevalence within this reservoir. The roles of these proposed explanations must be investigated in order to guide appropriate responses to the changing epidemiological profile. Other African settings in which multiple filoviral outbreaks have occurred could also benefit from such information.


Assuntos
Surtos de Doenças , Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/epidemiologia , Doença do Vírus de Marburg/epidemiologia , Marburgvirus/isolamento & purificação , Animais , Quirópteros/virologia , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/virologia , Interações Hospedeiro-Patógeno , Humanos , Doença do Vírus de Marburg/transmissão , Doença do Vírus de Marburg/virologia , Prevalência , Uganda/epidemiologia , Carga Viral
17.
MMWR Morb Mortal Wkly Rep ; 63(4): 73-6, 2014 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-24476978

RESUMO

Increasingly, the need to strengthen global capacity to prevent, detect, and respond to public health threats around the globe is being recognized. CDC, in partnership with the World Health Organization (WHO), has committed to building capacity by assisting member states with strengthening their national capacity for integrated disease surveillance and response as required by International Health Regulations (IHR). CDC and other U.S. agencies have reinforced their pledge through creation of global health security (GHS) demonstration projects. One such project was conducted during March-September 2013, when the Uganda Ministry of Health (MoH) and CDC implemented upgrades in three areas: 1) strengthening the public health laboratory system by increasing the capacity of diagnostic and specimen referral networks, 2) enhancing the existing communications and information systems for outbreak response, and 3) developing a public health emergency operations center (EOC) (Figure 1). The GHS demonstration project outcomes included development of an outbreak response module that allowed reporting of suspected cases of illness caused by priority pathogens via short messaging service (SMS; i.e., text messaging) to the Uganda District Health Information System (DHIS-2) and expansion of the biologic specimen transport and laboratory reporting system supported by the President's Emergency Plan for AIDS Relief (PEPFAR). Other enhancements included strengthening laboratory management, establishing and equipping the EOC, and evaluating these enhancements during an outbreak exercise. In 6 months, the project demonstrated that targeted enhancements resulted in substantial improvements to the ability of Uganda's public health system to detect and respond to health threats.


Assuntos
Fortalecimento Institucional/organização & administração , Surtos de Doenças/prevenção & controle , Saúde Global , Cooperação Internacional , Vigilância da População , Humanos , Uganda , Estados Unidos , Organização Mundial da Saúde
18.
Emerg Infect Dis ; 18(9): 1480-3, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22931687

RESUMO

Two large outbreaks of Ebola hemorrhagic fever occurred in Uganda in 2000 and 2007. In May 2011, we identified a single case of Sudan Ebola virus disease in Luwero District. The establishment of a permanent in-country laboratory and cooperation between international public health entities facilitated rapid outbreak response and control activities.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Surtos de Doenças , Ebolavirus/genética , Doença pelo Vírus Ebola/epidemiologia , Criança , Doenças Transmissíveis Emergentes/diagnóstico , Ebolavirus/classificação , Ebolavirus/isolamento & purificação , Monitoramento Epidemiológico , Evolução Fatal , Feminino , Doença pelo Vírus Ebola/diagnóstico , Humanos , Uganda/epidemiologia
19.
Clin Infect Dis ; 55(7): 960-6, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22715169

RESUMO

BACKGROUND: Herpes zoster (HZ) vaccine was recommended in the United States to reduce HZ-associated morbidity. Vaccination may reduce HZ-associated mortality, but no strategy exists to monitor mortality trends. METHODS: We validated HZ coding on death certificates from California, using hospital records as the gold standard, and applied the results to national-level data to estimate HZ mortality. RESULTS: In the validation phase of the study, among 40 available hospital records listing HZ as the underlying cause of death, HZ was the underlying cause for 21 (52.5%) and a contributing cause for 5 (12.5%). Among the 21 hospital records listing HZ as the underlying cause of death, the median age of decedents was 84 years (range, 50-99); 60% had no contraindications for HZ vaccination. Of the 37 available records listing HZ as a contributing cause of death, HZ was a contributing cause for 2 (5.4%) and the underlying cause for 6 (16.2%). Nationally, in the 7 years preceding the HZ vaccination program, the average annual number of deaths in which HZ was reported as the underlying cause of death was 149; however, based on our validation study, we estimate the true number was 78 (range, 31-118). CONCLUSIONS: National death certificate data greatly overestimate deaths in which HZ is the underlying or contributing cause of death. The HZ vaccination program could prevent some HZ-related deaths, but the impact will be difficult to assess using national mortality data.


Assuntos
Herpes Zoster/mortalidade , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Atestado de Óbito , Feminino , Registros Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida
20.
Int J Infect Dis ; 16(7): e536-42, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22575876

RESUMO

BACKGROUND: In November 2010, following reports of an outbreak of a fatal, febrile, hemorrhagic illness in northern Uganda, the Uganda Ministry of Health established multisector teams to respond to the outbreak. METHODS: This was a case-series investigation in which the response teams conducted epidemiological and laboratory investigations on suspect cases. The cases identified were line-listed and a data analysis was undertaken regularly to guide the outbreak response. RESULTS: Overall, 181 cases met the yellow fever (YF) suspected case definition; there were 45 deaths (case fatality rate 24.9%). Only 13 (7.5%) of the suspected YF cases were laboratory confirmed, and molecular sequencing revealed 92% homology to the YF virus strain Couma (Ethiopia), East African genotype. Suspected YF cases had fever (100%) and unexplained bleeding (97.8%), but jaundice was rare (11.6%). The overall attack rate was 13 cases/100000 population, and the attack rate was higher for males than females and increased with age. The index clusters were linked to economic activities undertaken by males around forests. CONCLUSIONS: This was the largest YF outbreak ever reported in Uganda. The wide geographical case dispersion as well as the male and older age preponderance suggests transmission during the outbreak was largely sylvatic and related to occupational activities around forests.


Assuntos
Surtos de Doenças , Febre Amarela/epidemiologia , Vírus da Febre Amarela/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Sangue/virologia , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade , Reação em Cadeia da Polimerase , Uganda/epidemiologia , Febre Amarela/mortalidade , Febre Amarela/fisiopatologia , Febre Amarela/transmissão , Vírus da Febre Amarela/classificação , Vírus da Febre Amarela/genética , Vírus da Febre Amarela/imunologia , Adulto Jovem
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