Clinical and Molecular Epidemiology of Crimean-Congo Hemorrhagic Fever in Humans in Uganda, 2013-2019

Crimean-Congo Hemorrhagic Fever (CCHF) is endemic in Uganda, yet its epidemiology remains largely uncharacterized. To better understand its occurrence within Uganda, case reports of patients hospitalized with CCHF between 2013 and 2019 were reviewed. Further, genome sequences of CCHF-positive RNA obtained during this period were determined for phylogenetic comparisons. We found that a total of 32 cases (75% males; CFR, 31.2%), aged between 9 to 68 years, were reported during the study period. Most cases were detected during July to December of each outbreak year (81.2%; P < 0.01) and were located along the "cattle corridor" (68.7%, P = 0.03). The most common presenting symptoms were fever (93.8%), hemorrhage (81.3%), headache (78.1 %), fatigue (68.8%), vomiting (68.8%), and myalgia (65.6%). In five patients for whom hematological data were available, varied abnormalities were observed including thrombocytopenia, leukopenia, anemia, lymphopenia, lymphocytosis, polycythemia, and microcytosis. About 56.3% (P = 0.47) of patients reported tick bites or exposure to livestock as their potential source of infection. Person-to-person transmission was suspected for two cases. Using unbiased metagenomics, we found that the viral S- and L- segments have remained conserved in Africa 2 Glade since the 1950s. In contrast, the M segment split into two geographically interspersed Glades; one that belongs to Africa 2 and another that is ancestral to Africa 1 and 2. Overall, this data summarizes information on the history and clinical presentation of human CCHF in Uganda. Importantly, it identifies vulnerable populations as well as temporal and geographic regions in Uganda where surveillance and control interventions could be focused

Persistence of Ebola virus in ocular fluid during convalescence

Please note: A correction to the original article has been published. “From New England Journal of Medicine, Jay B. Varkey, Jessica G. Shantha, Ian Crozier, Colleen S. Kraft, G. Marshall Lyon, Aneesh K. Mehta, Gokul Kumar, Justine R. Smith, Markus H. Kainulainen, Shannon Whitmer, Ute Ströher, Timothy M. Uyeki, Bruce S. Ribner, and Steven Yeh, Persistence of Ebola Virus in Ocular Fluid during Convalescence, 2015; 372:2423-2427. Copyright © (2015) Massachusetts Medical Society. Reprinted with permission.Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.Supported by a grant from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000454, to the Atlanta Clinical and Translational Science Institute), an unrestricted grant from Research to Prevent Blindness and a grant from the National Eye Institute (P30-EY06360, to the Department of Ophthalmology, Emory University School of Medicine), and a fellowship grant from the Australian Research Council (FT130101648, to Dr. Smith). Favipiravir was provided by the Department of Defense Joint Project Manager Medical Countermeasure Systems

First laboratory confirmation and sequencing of Zaire ebolavirus in Uganda following two independent introductions of cases from the 10th Ebola Outbreak in the Democratic Republic of the Congo, June 2019.

Uganda established a domestic Viral Hemorrhagic Fever (VHF) testing capacity in 2010 in response to the increasing occurrence of filovirus outbreaks. In July 2018, the neighboring Democratic Republic of Congo (DRC) experienced its 10th Ebola Virus Disease (EVD) outbreak and for the duration of the outbreak, the Ugandan Ministry of Health (MOH) initiated a national EVD preparedness stance. Almost one year later, on 10th June 2019, three family members who had contracted EVD in the DRC crossed into Uganda to seek medical treatment. Samples were collected from all the suspected cases using internationally established biosafety protocols and submitted for VHF diagnostic testing at Uganda Virus Research Institute. All samples were initially tested by RT-PCR for ebolaviruses, marburgviruses, Rift Valley fever (RVF) virus and Crimean-Congo hemorrhagic fever (CCHF) virus. Four people were identified as being positive for Zaire ebolavirus, marking the first report of Zaire ebolavirus in Uganda. In-country Next Generation Sequencing (NGS) and phylogenetic analysis was performed for the first time in Uganda, confirming the outbreak as imported from DRC at two different time point from different clades. This rapid response by the MoH, UVRI and partners led to the control of the outbreak and prevention of secondary virus transmission

Ebola virus epidemiology, transmission, and evolution during seven months in Sierra Leone

The 2013-2015 Ebola virus disease (EVD) epidemic is caused by the Makona variant of Ebola virus (EBOV). Early in the epidemic, genome sequencing provided insights into virus evolution and transmission and offered important information for outbreak response. Here, we analyze sequences from 232 patients sampled over 7 months in Sierra Leone, along with 86 previously released genomes from earlier in the epidemic. We confirm sustained human-to-human transmission within Sierra Leone and find no evidence for import or export of EBOV across national borders after its initial introduction. Using high-depth replicate sequencing, we observe both host-to-host transmission and recurrent emergence of intrahost genetic variants. We trace the increasing impact of purifying selection in suppressing the accumulation of nonsynonymous mutations over time. Finally, we note changes in the mucin-like domain of EBOV glycoprotein that merit further investigation. These findings clarify the movement of EBOV within the region and describe viral evolution during prolonged human-to-human transmission

Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings.

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

Virus genomes reveal factors that spread and sustained the Ebola epidemic.

The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics

Development Of Gesture-Based Commands For Natural User Interfaces

Human-computer interfaces are changing to meet the evolving needs of users and overcome limitations of previous generations of computer systems. The current state of computers consists largely of graphical user interfaces (GUI) that incorporate windows, icons, menus, and pointers (WIMPs) as visual representations of computer interactions controlled via user input on a mouse and keyboard. Although this model of interface has dominated human-computer interaction for decades, WIMPs require an extra step between the user’s intent and the computer action, imposing both limitations on the interaction and introducing cognitive demands (van Dam, 1997). Alternatively, natural user interfaces (NUI) employ input methods such as speech, touch, and gesture commands. With NUIs, users can interact directly with the computer without using an intermediary device (e.g., mouse, keyboard). Using the body as an input device may be more “natural” because it allows the user to apply existing knowledge of how to interact with the world (Roupé, Bosch-Sijtsema, &amp; Johansson, 2014). To utilize the potential of natural interfaces, research must first determine what interactions can be considered natural. For the purpose of this paper, we focus on the naturalness of gesture-based interfaces. The purpose of this study was to determine how people perform natural gesture-based computer actions. To answer this question, we first narrowed down potential gestures that would be considered natural for an action. In a previous study, participants ( n=17) were asked how they would gesture to interact with a computer to complete a series of actions. After narrowing down the potential natural gestures by calculating the most frequently performed gestures for each action, we asked participants ( n=188) to rate the naturalness of the gestures in the current study. Participants each watched 26 videos of gestures (3-5 seconds each) and were asked how natural or arbitrary they interpreted each gesture for the series of computer commands (e.g., move object left, shrink object, select object, etc.). The gestures in these videos included the 17 gestures that were most often performed in the previous study in which participants were asked what gesture they would naturally use to complete the computer actions. Nine gestures were also included that were created arbitrarily to act as a comparison to the natural gestures. By analyzing the ratings on a continuum from “Completely Arbitrary” to “Completely Natural,” we found that the natural gestures people produced in the first study were also interpreted as the intended action by this separate sample of participants. All the gestures that were rated as either “Mostly Natural” or “Completely Natural” by participants corresponded to how the object manipulation would be performed physically. For example, the gesture video that depicts a fist closing was rated as “natural” by participants for the action of “selecting an object.” All of the gestures that were created arbitrarily were interpreted as “arbitrary” when they did not correspond to the physical action. Determining how people naturally gesture computer commands and how people interpret those gestures is useful because it can inform the development of NUIs and contributes to the literature on what makes gestures seem “natural.” </jats:p

Individual Differences In Middle School And College Students\u27 Texting

The present study surveyed a sample of middle school students on their technology habits, with a primary focus on texting behaviors. A secondary sample of college students was surveyed as a comparison group to examine individual differences in texting behaviors. Results indicate that college students text more frequently than middle schoolers; however, college students\u27 texting behaviors decrease in frequency as they get older, whereas middle schoolers\u27 texting behaviors increase in frequency. Females also generally reported texting more frequently than males. Extraversion was found to be predictive of texting in the middle school sample, but both Extraversion and Neuroticism were found to be predictive of texting in the college sample. Results are discussed in the context of previous research and with respect to human factors and developmental psychology, such that the study of technology use could offer insight into the social development of adolescents and young adults

Time To Decide: To Call Or Not To Call 911 During Weather Crises

The purpose of this study was to measure response and reaction time (RT) to call 911 for five weather emergencies in order to determine whether participants considered them serious enough to call for help. Past research has shown that people fail to take emergency warnings seriously, possibly due to past experience and poor risk assessment. Participants were asked if they would call 911 if they witnessed weather emergencies. Response and RT were recorded. Results showed that participants did not agree on whether to call 911, showing a 50-50 split on most decisions. Participants were fast to indicate they would call 911 for tornadoes and hurricanes. No sex differences in RTs were found, but there was some variation within each sex. Fast RTs were predicted by news exposure, suggesting that recent experience is influential on one\u27s mental model, processing speed, and decision-making. Future research should use professionals and emergency personnel as a comparison group to this sample of young adults and further examine reasons why people decide to call 911

Measurement Of Technology Behaviors: A Look At Texting Scales

The measurement of technology behaviors occurs in everyday interactions with websites and smart devices, and can be applied to customize interfaces to improve users\u27 experiences as well as increasing revenues via targeted ads. This is possible because technology behaviors can reflect underlying personal and psychological characteristics about users that can be utilized to deliver custom-tailored content to each user. Texting is a one technology behavior that has been shown to be associated with a variety of psychological variables, including personality, depression, and anxiety, and has been shown to relate to socio-developmental differences among different age groups. Thus, the measurement of texting behaviors could have potential applications for researchers and practitioners. The present study examined a new scale to measure texting behavior: the Texting Behaviors Index (TBX; Schroeder & Sims, 2017), alongside two scales that measure problematic aspects of mobile phone use (Merlo, Stone, & Bibbey, 2013) and motivations for texting (Reid & Reid, 2007). Results indicate that measures from the TBX converge with the other texting scales, and support the TBX\u27s usefulness as a measure of texting behavior