Conference abstract

Public health surveillance, outbreak investigations and response to an outbreak of a bleeding illness in Hoima and Buliisa districts, Western Uganda, Sep-Oct 2015

Pan African Medical Journal - Conference Proceedings. 2017:6(5).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.5.487

Contact the corresponding author
Keywords: Surveillance, outbreaks, bleeding disease, Uganda
Plenary

Public health surveillance, outbreak investigations and response to an outbreak of a bleeding illness in Hoima and Buliisa districts, Western Uganda, Sep-Oct 2015

Steven Ndugwa Kabwama1,&, Richard Mafigiri1, Stephen Balinandi2, Atek Kagirita3, Alex Riolexus Ario1, Bao-Ping Zhu2

1Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda, 2Centers for Disease Control and Prevention, Kampala, Uganda, 3Central Public Health Laboratories, Kampala, Uganda

&Corresponding author
Steven Ndugwa Kabwama, Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda

Abstract

Introduction: on 17th September 2015, the Ugandan Ministry of Health received reports from Buliisa District about mysterious death of people. The predominant symptom was hematemesis (vomiting of blood). By September 24, 2015, there had been 4 deaths. We investigated to verify the existence of an outbreak, to determine the mode of disease transmission, and identify risk factors.

Methods: we conducted a community-based active case finding in Hoima and Buliisa districts, Western Uganda, between the 3 and 17 October 2015. A suspected case was defined as a resident of Hoima, Buliisa or neighbouring districts who had onset of hematemesis between 1 June 2015 and 15 October 2015. A control was an individual without any history of hematemesis. Biological specimens were collected from 19 cases and tested for viral haemorrhagic fevers (VHFs), including Ebola, Marburg, Crimean-Congo Haemorrhagic Fever and Rift Valley Fever viruses. Histopathology and bacterial examinations were also conducted. In a case-control study, we compared exposures of 21 cases and 81 controls. We used Mantel-Haenszel method to estimate odds ratios (OR) associated with exposures.

Results: our active case finding identified 56 hematemesis cases with disease onset between June and October 2015. The epidemic curve showed about 3 cases occurred per week from June 2015 to September 2015. Persons aged 31-60 had highest attack rates: 15/100,000 in Hoima, and 47/100,000 in Buliisa. No persons < 15 years were affected. The case-control study showed that 42% (5/12) of cases and 0% (0/77) of controls had history of liver disease (ORΜ-Η = ∞;95% CI = 3.7 - ∞); 71% (10/14) of cases and 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6 - 98); 27% (3/11) of cases and 14% (11/81) of controls used indomethacin, a Non-Steroidal Anti-Inflammatory Drug (NSAID) sold over the counter in Uganda (ORΜ-Η= 6.0; 95% CI = 1.0-36.0). All 17 samples tested were negative for VHFs. Rectal swabs of 2 patients did not have any significant growth of microbiological pathogens using general culture.

Conclusion: hematemesis illness was endemic in this community and due to predisposing conditions such as liver disease, ulcer disease, combined with NSAID. We recommended regulation of sale of indomethacin and other potentially harmful NSAIDs, and health education on danger of NSAID misuse in persons with predisposing conditions.