Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Viral causes of Influenza Like Illness in Uganda, 2008 to 2017.

Introduction: Respiratory pathogens continue to present an ever increasing threat to public health (1,2). Influenza, Respiratory syncytial virus, human metapneumovirus and other respiratory viruses are major etiological agents for influenza like illnesses (ILI) (3-5). Establishment of viral causes of ILI is critical for prevention and mitigation strategies to disease threats. Makerere University Walter Reed Project (MUWRP) together with the Ugandan Ministry of Health and partners undertook surveillance to determine viral causes of influenza-like illness in Uganda.Methods: From 2008, MUWRP established hospital-based sentinel sites for surveillance activities. A total of five hospital-based sites were established, where patients aged 6 months or older presenting with ILI were enrolled. Consents were obtained as required, and a throat and/ or nasopharyngeal swab collected. Samples were screened by PCR for viral causes.Results: From October 2008 to March 2017 a total of 9,472 participants were enrolled in the study from five hospital-based surveillance sentinel sites. Majority of participants were children under 5 years n= 8,169 (86.2%). 615 (6.5%) samples tested positive for influenza A, while 385 (4.1%) tested positive for influenza B viruses and 10 (0.1%) were co-infections between influenza A and B. Of the 2,062 influenza negative samples, results indicated positivity for the following organisms; adenoviruses (9.4%), respiratory syncytial B (7.3%), parainfluenza-3 (4.5%), parainfluenza-1 (4.3%), respiratory syncytial A (3.5%), human bocavirus (1.7%), human metapneumovirus (1.7%), human coronavirus (1.5%), parainfluenza-4 (1.4%) and parainfluenza-2 (0.9%) by PCR.Conclusions: Influenza viruses account for about 11% of the causes of influenza like illness, with influenza A being the dominant type. Among the other viral causes of ILI, adenoviruses were the most dominant. Detection of other viral causes of ILI is an indication of the public health threats posed by respiratory pathogens

Epidemiology and Surveillance of Influenza Viruses in Uganda between 2008 and 2014

<div><p>Introduction</p><p>Influenza surveillance was conducted in Uganda from October 2008 to December 2014 to identify and understand the epidemiology of circulating influenza strains in out-patient clinic attendees with influenza-like illness and inform control strategies.</p><p>Methodology</p><p>Surveillance was conducted at five hospital-based sentinel sites. Nasopharyngeal and/or oropharyngeal samples, epidemiological and clinical data were collected from enrolled patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed to identify and subtype influenza strains. Data were double-entered into an Epi Info 3.5.3 database and exported to STATA 13.0 software for analysis.</p><p>Results</p><p>Of the 6,628 patient samples tested, influenza virus infection was detected in 10.4% (n = 687/6,628) of the specimens. Several trends were observed: influenza circulates throughout the year with two peaks; the major one from September to November and a minor one from March to June. The predominant strains of influenza varied over the years: Seasonal Influenza A(H3) virus was predominant from 2008 to 2009 and from 2012 to 2014; Influenza A(H1N1)pdm01 was dominant in 2010; and Influenza B virus was dominant in 2011. The peaks generally coincided with times of higher humidity, lower temperature, and higher rainfall.</p><p>Conclusion</p><p>Influenza circulated throughout the year in Uganda with two major peaks of outbreaks with similar strains circulating elsewhere in the region. Data on the circulating strains of influenza and its patterns of occurrence provided critical insights to informing the design and timing of influenza vaccines for influenza prevention in tropical regions of sub-Saharan Africa.</p></div

Average temperatures and monthly number of flu cases.

<p>Average temperatures and monthly number of flu cases.</p

Rainfall and monthly number of flu cases.

<p>Rainfall and monthly number of flu cases.</p

Humidity and monthly number of flu cases.

<p>Humidity and monthly number of flu cases.</p

MUWRP Influenza Surveillance Work Flow.

<p>MUWRP Influenza Surveillance Work Flow.</p

Distribution of type and subtypes of influenza virus in Uganda from October 2008 to December 2014.

<p>Distribution of type and subtypes of influenza virus in Uganda from October 2008 to December 2014.</p

Temporal distribution of influenza type and subtype by month.

<p>Temporal distribution of influenza type and subtype by month.</p