Conference abstract

Spreading like a wild fire: a tale of three cholera outbreaks, Namayingo District, Uganda, March 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(1).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.1.483

Contact the corresponding author
Keywords: Cholera, disease outbreaks, water, Uganda
Plenary

Spreading like a wild fire: a tale of three cholera outbreaks, Namayingo District, Uganda, March 2016

Annet Joselyn Atuhairwe1,&, David Were Oguttu1, Alex Riolexus Ario1, Daniel Kadobera1, Bao-Ping Zhu2

1Uganda Public Health Fellowship Program, Kampala, Uganda, 2US Centers for Disease Control and Prevention, Kampala, Uganda

&Corresponding author
Annet Joselyn Atuhairwe, Uganda Public Health Fellowship Program, Kampala, Uganda

Abstract

Introduction: on 15 March 2016, Namayingo District reported a cholera outbreak in three locations, with four confirmed cases. We investigated to identify the mode of transmission and recommend evidence-based control measures.

Methods: we defined a suspected case which was a sudden onset of watery diarrhoea in a resident (aged ≥ 2 years) of the three affected communities (villages V1, V2; island Y) from 1 March onwards. A confirmed case was a suspected case with Vibrio cholerae cultured from stool. We reviewed hospital records and conducted active community case finding. We conducted three case control studies in affected communities. Controls were asymptomatic village residents matched by age group.

Results: we identified 161 cases including 4 deaths (case fatality rate = 2.5%). On 3 March, a continuous common source outbreak started in V1; 28 (58%) out of 49 case persons and 19 (14%) out of 132 control persons collected drinking water at water point A (ORM-H = 9.0, 95% CI = 4.2 - 19). On 15 March, one case person travelled from V1 to V2 and ignited a continuous common source outbreak in V2; 16 (55%) of 29 case persons and 25 (24%) of 106 of control persons collected drinking water at water point B (ORM-H = 4.0, 95% CI = 1.7 - 9.0). On Y, which was frequented by fish traders from V1, initial sporadic cases occurred during 21 - 31 March. Heavy rain occurred on 31 March, followed by a point source outbreak which peaked on 4 April; 9 (43%) out of 21 case persons and 11 (13%) out of 84 control persons drank “Kaveera” water (ORM-H = 5.0; 95% CI=2.0 - 15) made with lake water collected at water point C near the initial case persons’ homes, where open defecation was evident.

Conclusion: travels of case persons spread the outbreaks geographically. Drinking contaminated water appeared to have caused transmissions locally. We recommended the following; limiting travels of symptomatic cas -patients, providing safe water to residents, improving water and sanitation conditions, and identifying and controlling outbreaks early to prevent spreading.