Epidemiological week 17 of 2013 [22 – 28 April 2013]

National Summary

Completeness & Timeliness of Reporting This week, 103 (92%) of the districts submitted their weekly reports as opposed to 65 (58%) for the corresponding week of 2012. The mean intra-district completeness this week is 66% [median 69%]; compared to the mean intra-district completeness of 86.3% [median 92.5%] for the corresponding week of 2012. Only 41 (39.8%) of the districts that reported this week attained an intra-district completeness of at least 80% as opposed to 49 (75.4%) for the corresponding week of 2012. A total of nine (9) districts including Amuria, Busia, Kaberamaido, Kitgum, Kumi, Nakapiripirit, Namutumba, Pader, & Tororo never submitted reports this week. Timeliness for weekly reporting is 94 (84%) for the reporting week; representing an improvement from 58 (51.8%) for the corresponding week of 2012. Public Health Emergencies/Disease Outbreaks Floods: Floods hit Kasese district following torrential rains that started on 1st May 2013. Five (5) deaths have been reported with over 1,200 people displaced. Affected areas include Bulembya & Nyamwamba divisions in Kasese municipality where River Nyamwamba burst its banks and Kyarumba and Kyondo sub-counties where the floods were linked to River Nyamwasana. (Details annex 2). Cholera: Seven (7) new cholera cases were reported from Buliisa, Nebbi, & Hoima districts. The cumulative number of districts affected by cholera this year is eight (8) with a cumulative total of 445 cases and 13 deaths (details annex 2). MRD-TB: A total of nine (9) new MDR-TB cases were confirmed in January 2013 from six (6) districts. Treatment of MDR-TB cases started

in 2012 with 79 cases currently on treatment in Mulago NRH; Mbarara RRH; Kitgum hospital; & Arua RRH. New MDR-TB treatment centres will be opened in Mbale RRH & Gulu RRH on 20/05/2013. Health workers are urged to screen all suspects for TB & to advise all TB cases to adhere & complete TB treatment to prevent MDR-TB. (details annex 2).

Human Influenza Surveillance: The National Influenza Centre in UVRI maintains sentinel surveillance sites for ILI/SARI countrywide (details annex 2). As of 27th Apr. 2013; a total of 402 specimens had been analyzed with 17 isolates [A(H3) – 4; Influenza B – 9; Type A[not sub-typed] – 2; & Influenza A(H1N1)pdm09 – 2]. (details annex 2). Makerere University Walter Reed Project is implementing a complementary Influenza surveillance program. By the end of the 16th epidemiological week of 2013 a total of 338 human samples had been analyzed with 17 isolates [A(H3) – 5; Influenza B – 7; Type A[not sub-typed] – 3; & Influenza A(H1N1)pdm09 – 2]. During the same period, a total of 673 non-human samples had been analyzed with no influenza isolates (details annex 2). Districts and international ports of entry have been urged to look out for cases of the severe acute respiratory infection (SARI). This follows the emergence of cases of the novel Coronavirus (nCoV) Respiratory infections (24 confirmed cases with 16 deaths among nationals & international travellers from the Middle East) http://www.who.int/csr/don/2013_05_02_ncov/en/index.html and due to the more recent emergence of Influenza A (H7N9) cases from eight (8) provinces in China. To date, a total of 128 patients have been laboratory confirmed with influenza A(H7N9); including 26 deaths in China. At this time, there is no evidence of sustained human-to-human transmission; WHO does not advise special screening at points of entry, nor does it recommend that any travel or trade restrictions http://www.who.int/csr/don/2013_05_02/en/index.html

Indicator Epidemiological week 17

2013 2012 Median

2008-2012 % of Districts reporting

92 58

% HU reporting 66 86.3 % Timely District reports

84 51.8

AFP 4(0) 0(0) Animal bites 408(1) 248(0) Cholera 7(0) 72(0) Dysentery 1218(0) 865(0) Guinea Worm 0(0) 0(0) Malaria 194,719

(18) 117,043(2

9)

Measles 71(0) 306(5) Meningitis 6(0) 2(0) NNT 1(0) 1(0) Plague 0(0) 0(0) Typhoid 1426(0) 161(0) S/Sickness 0(0) 0(0) Human Influenza 2(0) 0(0) Nodding Syndrome 0(0) 0(0) Yellow Fever 0(0) 0(0) Viral Hemorrhagic Fever

0(0) 0(0)

Highlights of the Week

Weekly Incidence for Selected Priority Diseases in the Country This week; we present a concise profile of the four top priority diseases [including Malaria; Typhoid Fever; Dysentery; & Animal bites] reported during the 17th Epidemiological week of 2013. Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, 194,719 cases including 18 deaths were reported from the 103 districts that submitted weekly reports for the current epidemiological week. This translates into a weekly incidence rate of 61.3 cases per 10,000 populations as opposed to the weekly incidence rate of 36.8 cases per 10,000 for the corresponding week during 2012. The top 10 districts [Abim, Lyantonde, Butambala, Butaleja, Kiruhura, Serere, Bukwo, Katakwi, Ibanda, & Kyegegwa] had a malaria incidence of 138-235 cases per 10,000 during the current reporting period. The figure below shows the .number of malaria cases reported by week for 2012 & 2013.

Typhoid Fever: A total of 1426 (4.5 cases per 100,000) suspect typhoid cases were reported from 69 districts. The top 10 districts [Isingiro, Kibaale, Kanungu, Mityana, Wakiso, Rakai, Mbale, Kween, Ssembabule, & Sheema] reported 34-142 cases each this week. The figure below shows the number of Typhoid fever cases reported by week for 2012 & 2013. These trends are being investigated.

Dysentery (Bloody diarrhea): A total of 1218 cases (3.8 cases per 100,000) of bloody diarrhea were reported from 90 districts during the current week. The top 10 districts [Kotido, Mbale, Nebbi, Hoima, Kaabong, Moyo, Napak, Bukwo, Bundibugyo, & Kisoro] reported 31-83 cases each this week. The figure below shows the number of bloody diarrhea cases reported by week for 2012 & 2013.

Animal bites (Suspect human rabies): A total of 408 cases (1.3 cases per 100,000) including one (1) death of suspect rabies were reported from 74 districts during the current week. The top 10 districts [Wakiso, Kotido, Soroti, Serere, Bukwo, Nakaseke, Kapchorwa, Masindi, & Hoima Kibaale] reported 11-54 cases each this week. The figure below shows the number of suspect rabies cases reported by week for 2012 & 2013.

For comments please contact: The Epidemiological Surveillance Division- M.O.H

P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108 email: esd@health.go.ug or esduganda@yahoo.co.uk

Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Immaculate Nabukenya, Mr. Luswa Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr. Issa Makumbi Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero Dr. N. Ndayimirigye Mr. L. Luswa Dr. N. Bakyaita, Mr. M. Mugagga

4

Annex 1: Summary of District Reports for Epidemiological week 17 of 2013 [22 – 28 April 2013] (Numbers in brackets indicate deaths)

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Abim 100 T 0 4 0 26 0 1299 0 0 0 0 0 0 Amolatar 100 T 0 0 0 10 0 1417 0 0 0 0 6 0

Amudat 100 T 0 0 0 13 0 443 0 0 0 0 3 0 KZ 12, ,

Bududa 100 T 0 4 0 2 0 2119 0 0 0 0 0 0 Bukwo 100 L 0 16 0 34 0 991 0 0 0 0 0 0 Bulambuli 100 T 0 3 0 19 0 1578 0 0 0 0 0 0 Butaleja 100 T 0 2 0 8 0 4077(1) 0 0 0 0 0 0 Butambala 100 T 0 1 0 6 0 1934(1) 1 0 0 0 6 () , 0 , Buvuma 100 T 0 2 0 7 0 701(1) 2 0 0 0 2 () , 0 , Dokolo 100 T 0 5 0 10 0 1261 0 0 0 0 6 () , 0 , Kibuku 100 T 0 1 0 9 0 1985 1 0 0 0 0 0 Koboko 100 T 0 5 0 16 0 2494 0 0 0 0 1 () , 0 , Kotido 100 L 0 19 0 83 0 1837 0 0 0 0 34 0

Lamwo 100 T 1 3 0 11 0 500 2 0 0 0 0 0 CP 1, ,

Manafwa 100 T 0 1(1) 0 13 0 2748 0 0 0 0 33 0 Moyo 100 T 0 9 0 38 0 3103 0 0 0 0 11 () , 0 , Napak 100 T 0 5 0 35 0 1357(1) 0 0 0 0 11 0 Ngora 100 T 0 0 0 7 0 1808 0 0 0 0 1 0 Otuke 100 T 0 0 0 6 0 974 0 0 0 0 0 0 Serere 100 T 0 18 0 7 0 1952 0 0 0 0 0 0 100 Masindi 97 T 0 12 0 21 0 2125 1 0 0 0 8 () , 0 , Rukungiri 97 T 0 3 0 3 0 4231 0 0 0 0 0 0

Katakwi 95 T 0 3 0 9 0 2348 0 0 0 0 0 0 CP 11, ,

Kayunga 92 T 0 3 0 18 0 3767(2) 0 0 0 0 1 0 Kisoro 92 T 0 2 0 31 0 836 0 0 0 0 9 () , 0 , Buliisa 90 T 0 0 4 20 0 443 0 0 0 0 7 () , 0 , Kiruhura 89 T 0 6 0 2 0 4886 0 1 0 0 10 () , 0 ,

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Mbale 89 T 0 6 0 50 0 5318 2 0 0 0 48 0 CP 23, ,

Ntoroko 89 T 0 1 0 4 0 484 2 0 0 0 3 () , 0 , Sheema 89 T 0 1 0 2 0 2397 0 0 0 0 34 0 Agago 88 T 0 2 0 27 0 1216 0 0 0 0 0 0 Buikwe 88 T 0 7 0 25 0 4860 8 0 0 0 33 () , 0 ,

Bukomansimbi 88 T 0 0 0 3 0 761 0 0 0 0 7 () , 0 , Kyegegwa 87 T 0 2 0 0 0 2045 1 0 0 0 6 () , 0 , Pallisa 86 T 0 1 0 15 0 2397 0 0 0 0 0 0 Alebtong 85 T 0 0 0 3 0 700(1) 0 0 0 0 0 0

Ssembabule 84 T 0 1 0 16 0 2343 0 0 0 0 38 () , 0 ,

Kole 82 T 0 0 0 1 0 318 0 0 0 0 0 0 CP 1, ,

Nakaseke 82 T 0 13 0 16 0 1801(3) 0 2 0 0 30 () , 0 , Nebbi 82 L 0 10 1 48 0 3665(2) 2 0 0 0 15 0

Kaabong 81 L 0 9 0 39 0 2322 0 0 0 0 3 0

CP 5, HepE 1,

Yumbe 78 T 0 2 0 24 0 2089 0 0 0 0 8 () , 0 , Mukono 77 T 0 2 0 19 0 3331 3 0 0 0 19 () , 0 , Sironko 76 T 0 2 0 11 0 2433 0 0 0 0 0 0 Bukedea 73 T 0 0 0 13 0 1284 0 0 0 0 10 0 Isingiro 73 T 0 1 0 10 0 3683 0 0 0 0 142 () , 0 , Kalangala 73 T 0 0 0 7 0 477 0 0 0 0 0 () , 0 ,

Bundibugyo 71 T 0 2 0 33 0 2392 0 0 0 0 17 () , 0 , Rubirizi 71 L 0 0 0 0 0 640 0 0 0 0 0 0

Kamwenge 70 T 0 7 0 2 0 3761 7 0 0 0 5 () , 0 , Apac 69 L 0 2 0 0 0 877 0 0 0 0 0 0

Kween 69 T 0 0 0 9 0 484 0 0 0 0 41 0 Bruce 10,

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Mpigi 69 T 0 4 0 5 0 1538 0 0 0 0 16 () , 0 , Bushenyi 68 T 0 6 0 2 0 1572 0 0 0 0 9 () , 0 , Ibanda 67 T 0 4 0 0 0 3344 0 0 0 0 1 () , 0 , Maracha 67 T 0 0 0 12 0 2060 0 0 0 0 25 () , 0 ,

National 66 84% 4(0) 408(1) 8(0) 1218(0) 0(0) 194719(18) 71(0) 6(0) 1(0) 0(0) 1426(0) 0(0)

Hoima 65 T 0 11 2 47 0 2222 7 0 0 0 24 () , 0 , Kamuli 65 T 0 2 0 1 0 5427(1) 0 0 0 0 4 () , 0 , Gomba 61 T 0 0 0 3 0 1056 1 0 0 0 0 () , 0 , Lwengo 61 T 0 3 0 5 0 761 0 0 0 0 16 () , 0 ,

Kiryandongo 57 T 0 2 0 7 0 761 0 0 0 0 7 () , 0 , Mityana 57 T 0 5 0 5 0 2579(1) 0 0 1 0 87 () , 0 , Kanungu 56 T 0 2 0 5 0 2001 0 0 0 0 90 () , 0 , Gulu 55 T 1 7 0 24 0 1603 0 0 0 0 24 () , 0 , Kaliro 55 T 0 2 0 0 0 1006 0 0 0 0 0 () , 0 , Kalungu 55 T 0 1 0 1 0 581 1 0 0 0 19 () , 0 , Kabarole 54 T 1 7 0 1 0 3006 1 0 0 0 34 () , 0 , Kiboga 54 T 0 0 0 2 0 557 0 0 0 0 12 () , 0 ,

Kyankwanzi 54 T 0 1 0 7 0 576 1 0 0 0 12 () , 0 , Jinja 53 T 0 9 0 11 0 4081 2 0 0 0 31 () , 0 , Luweero 53 T 0 1 0 7 0 3328 3 0 0 0 28 () , 0 , Rakai 53 T 0 1 0 16 0 4446 2 0 0 0 52 () , 0 , Lira 52 T 0 0 0 7 0 1359 0 0 0 0 1 () , 0 , Mbarara 52 T 0 2 0 6 0 1686 7 0 0 0 34 () , 0 , Mayuge 51 T 0 0 0 14 0 2718 0 0 0 0 3 () , 0 , Ntungamo 51 T 0 0 0 0 0 2799 1 0 0 0 22 () , 0 ,

Lyantonde 50 T 0 0 0 0 0 1591 0 0 0 0 17 () , 0 , Soroti 48 T 0 18 0 12 0 2779 0 2 0 0 8 () , 0 ,

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Wakiso 47 T 1 54 0 28 0 5741 3 0 0 0 69 () , 0 , Kyenjojo 46 T 0 5 0 3 0 720 0 0 0 0 6 () , 0 , Moroto 44 T 0 8 0 20 0 968 0 0 0 0 4 () , 0 , Amuru 42 T 0 0 0 10 0 271 0 0 0 0 0 () , 0 , Masaka 42 T 0 0 0 4 0 1142(1) 0 0 0 0 0 () , 0 , Buyende 40 T 0 3 0 7 0 897 3 1 0 0 0 () , 0 , Iganga 40 T 0 3 0 3 0 3971(1) 0 0 0 0 2 () , 0 , Kibaale 40 T 0 11 0 10 0 1528 1 0 0 0 91 () , 0 ,

Nakasongola 39 T 0 0 0 15 0 1159 2 0 0 0 4 () , 0 , Oyam 38 T 0 7 0 18 0 541 0 0 0 0 1 () , 0 , Mitooma 37 T 0 1 0 0 0 1075 0 0 0 0 0 () , 0 , Mubende 35 T 0 7 0 14 0 2415(2) 1 0 0 0 11 () , 0 , Luuka 32 T 0 0 0 1 0 1142 0 0 0 0 0 () , 0 , Buhweju 25 T 0 0 0 0 0 253 0 0 0 0 0 () , 0 , Zombo 25 T 0 2 0 13 0 509 0 0 0 0 9 () , 0 ,

Adjumani 24 T 0 0 0 5 0 853 0 0 0 0 0 0 CP 1, ,

Kapchorwa 24 L 0 13 0 0 0 485 0 0 0 0 0 0 Arua 11 L 0 0 0 7 0 1012 0 0 0 0 0 0 Budaka 11 T 0 2 0 4 0 603 0 0 0 0 0 () , 0 ,

Nwoya 10 T 0 0 0 0 0 69 0 0 0 0 0 0 CP 2, ,

Kabale 8 T 0 4 0 4 0 291 0 0 0 0 8 0 Kasese 7 L 0 0 0 0 0 954 0 0 0 0 0 0 Bugiri 5 T 0 0 0 0 0 90 0 0 0 0 6 () , 0 , Kampala 3 T 0 2 0 11 0 7289 3 0 0 0 31 0

Namayingo 3 T 0 0 0 0 0 12 0 0 0 0 0 0 Amuria NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Busia NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

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Kaberamaido NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kitgum NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kumi NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Nakapiripirit NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Namutumba NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Pader NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Tororo NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

HU= Health Units, NR = Not reported, CP = Chicken Pox, KZ = Kalazar, Sch = Schistosomiasis, MP= Malaria in pregnancy; Nodding Syndrome

Color codes for Completeness of reporting: Dark Yellow; (80-100%); & Light Brown (0-79%)

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Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 17 of 2013 [22 – 28 April 2013] Condition Affected

districts New cases

(deaths) 22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

Floods Kasese 0 5 5 1. Floods hit Kasese district following torrential rains that started on 1st May 2013. A total of five (5) deaths have been reported with over 1,200 people displaced.

2. Kilembe hospital in the municipality has been closed and patients transferred elsewhere after the wards were flooded and staff quarters housing at least 50 nurses were destroyed.

3. The affected areas include Bulembya & Nyamwamba divisions in Kasese municipality where River Nyamwamba burst its banks and Kyarumba and Kyondo sub-counties where the floods were linked to River Nyamwasana.

4. Relief teams from the Office of the Prime Minister and Uganda Red Cross are already in the district to offer relief supplies to the displaced. The district epidemic preparedness plan has been finalised and forwarded to the Office of the Permanent Secretary, MoH.

Rubella (confirmed)

Kibaale 3 3 0 1. Following reports of suspect measles cases in Mpeefu sub-county, Kibaale district; five blood samples were collected on 18th April 2013 & submitted for testing in the UVRI/EPI laboratory where three (60%) of the samples tested positive for Rubella.

2. The cases are aged 5-11 years with a median of 6 years. Rubella is teratogenic in the first trimester of pregnancy but there is no cause for alarm since the current cases have been reported in children.

3. Districts have been urged to line-list all the subsequent cases to allow monitoring of epidemiological trends.

Rubella (confirmed)

Kamwenge 5 5 0 1. Following reports of suspect measles cases by Kekubo sub-county, Kamwenge district; five blood samples were submitted on 23-April-2013 for testing in the UVRI/EPI laboratory where five (100%) of the samples tested positive for Rubella.

2. The cases are aged 2-10 years with a median of 4 years. Rubella is teratogenic in the first trimester of pregnancy but there is no cause for alarm since the current cases have been reported in children.

3. Districts have been urged to line-list all the subsequent cases to allow monitoring of epidemiological trends.

Cholera (suspect)

Buliisa 4 12 0 1. Initial cases were reported on 14-05-2013 from landing sites in Kigwera sub-county among cases who originated from Kigorobya sub-county. The cases are being managed in Buliisa HCIV. The initial samples tested negative for Vibrio Cholerae at CPHL but further samples are being analyzed.

Cholera Kasese 0 1 0 1. Following verification with the DHO; this case has been de-notified after it turned out that

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Condition Affected districts

New cases (deaths)

22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

(suspect) this was an error in data entry. Cholera (suspect)

Hoima 2 65 3 (CFR 4.6%)

2. The outbreak has declined with no case currently admitted in the treatment centre at Runga landing site. However, new cases have emerged from Kyangwali sub-county and are being treated at Kyangwali HCIII though there no cases on admission currently.

3. The outbreak started on 12_04_2013 with cases originating from Runga village/landing site, Kapaapi Parish, Kigorobya sub-county.

4. World Vision Uganda supported the establishment of a CTC at Runga landing site. Other partners like URCS are supporting active case finding with health education at the landing site; and provision of Jerry cans for safe water storage.

5. The DHO has requested the MoH to supply ORS, Ringers lactate, and chlorine to support case management in the CTC.

Cholera (suspect)

Nebbi 1(0) 124 3 (CFR 2.4%)

1. The initial cases were reported from Angum village, Nyakagei Parish, Panyimur sub-county on the shores of Lake Albert starting 16th January 2013. Cases were subsequently reported from Akworo sub-county; which together with Panyimur sub-county recorded the bulk of the cholera cases reported during the outbreak.

2. Intense behavioural change campaign (sensitisations and inspection of public places and domestic areas to enforce sanitation and hygiene standards) launched with the stewardship of the district taskforce. Consequently; only sporadic cases have been reported from Parombo, Erussi, and Nyaravur sub-counties in the recent weeks.

3. NMS delivered cholera case management supplies but intravenous fluids were lacking in the consignment.

Cholera (confirmed)

Ntoroko 0 43 0 1. The outbreak was controlled in early February 2013 following the discharge of last case on 10th February 2013.

2. The outbreak started on 27th December 2013 with cases being reported from Kanara Town Council. Most of the subsequent cases were reported from Kanara TC except for two (2) cases that were reported from Kanara sub-county. The onset of the outbreak followed torrential rains that caused flooding; submerging pit latrines & leaving the local population to resort to open defecation with the risk of contaminating unprotected water sources. The floods were reported in Bweramure, Batungama, Rwebisengo & Rwangara (Kanala).

3. Five samples have been sent to Bundibugyo hospital laboratory with Vibrio Cholerae being isolated from one of the samples. The cholera treatment centre was set up at Ntoroko HCIII.

4. Community education and sanitation/hygiene inspections were intensified during the outbreak.

Cholera Arua 1 148 4 1. The outbreak is nearly controlled with no cases currently on admission [most recent case

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Condition Affected districts

New cases (deaths)

22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

(confirmed) (CFR 2.7%)

discharged on 23-April-2013]. Initial cases were reported from Aiivu sub-county and Oli division starting 12-02-2013. Eventually cases were reported from Katini, Omugo, & Bileafe sub-counties.

2. Vibrio Cholerae was confirmed from two (2) specimens collected from Oli division at the onset of the outbreak.

3. The outbreak intensified in March 2013 but following sustained interventions; the outbreak is now nearly controlled.

4. The district taskforce met only twice but the DHT has been meeting weekly to coordinate upstream interventions for improving sanitation, personal and food hygiene, and drinking treated water in both the affected and at-risk sub-counties.

5. The NMS delivered case management supplies to the district with adequate stocks reported till now.

Cholera (confirmed)

Maracha 0 15 01 (CFR 6.7%)

1. The outbreak is controlled with no new cases reported in the district in the last four (5) weeks.

2. The initial cases were reported from Nyadri sub-county in Late February 2013. The outbreak was imported from Arua by a family that attended a funeral in Aiivu sub-county, Arua district where a cholera outbreak was already ongoing at the time.

3. Cholera cases were reported from Nyadri and Yivu sub-counties; and following intense surveillance and health education to the initial clusters; the outbreak is now under control.

4. No supplies were delivered for case management. Cholera (confirmed)

Yumbe 0 12 0 1. The outbreak has been controlled hence no new cases have been reported in the last five (5) weeks; the last case was discharged on 16_03_2013.

2. The initial cases were reported from Lodonga HC III on 24th February 2013. On 27th February 2013, two (2) specimens we sent to the Arua RRH where Vibrio Cholerae was isolated.

3. Two (2) cholera treatment centres (Yumbe hospital and Lodonga HC III) were established and the District Disaster Task Force was reactivated to coordinate the investigations and response to control the outbreak.

4. The initial cases in the district originated from Atu river village, Lobule sub-county in Koboko and travelled to Yumbe for a marriage feast where they fell sick and were subsequently admitted in Lodonga HCIII. The affected sub counties included: Lodonga, Drajini, Kuru, Yumbe Town Council and Apo.

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Condition Affected districts

New cases (deaths)

22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

5. Effective control interventions were initiated with no fatal cases being registered and NMS delivered drug supplies for case management.

Cholera (confirmed)

Koboko 0 26 2 (CFR

6.25%)

1. The outbreak has been controlled hence no new cases have been reported in the last four (4) weeks.

2. The initial cases were reported on 26th February 2013 among family members who travelled to Aiivu sub-county, in Arua for a traditional function. Cases were initially reported from Lobule (where the majority of the cases occurred. Suspect cases were subsequently reported from Midia; and Kuluba sub-counties among relatives who attended a family function but laboratory tests indicated food poisoning.

3. Vibrio Cholerae was isolated in Arua RRH laboratory from specimens collected from cases in Lobule sub-county.

4. Effective control interventions were initiated and the outbreak is now reported to be under control.

Nodding Syndrome

Kitgum 0 OPD – 2,034 IPD – 162

3 1. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway. 2. The data presented here is derived from cases seen at NS treatment centre – Kitgum hosp. &

outreaches. Lamwo 0 OPD - 347

IPD – 38 1. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway.

2. The data presented here is derived from patients seen at NS treatment centres – Padibe HCIV & the 12 outreaches conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili & Lokung sub-counties.

3. Aerial spraying along rivers Pager & Aswa finalised in November/December 2013. 4. Food received from OPM was distributed to the affected families this week [3/02/13].

Pader 0 OPD – 1,210 IPD – 108

15 1. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway. 2. The data presented here is derived from patients seen at NS treatment centres – Atanga

HCIII & outreaches. Gulu 0 330 1 1. There was one death in the index case from Aromowanglobo; after he missed a scheduled

refill visit and fitted while alone at home. 2. A total of 15 HCW trained in NS case management; & they subsequently conducted

verification in Omel & Cwero Parishes in Paicho sub-county; & Paibona parish in Awac sub-county.

3. NS treatment centres set up in Odek HCIII; Aromowanglobo HCII; Cwero HCII; & Labworomo

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Condition Affected districts

New cases (deaths)

22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

HCIII. 4. Food donations from WVU have been distributed to affected families. & Additional funds

have been provided by WVU to train more HCW on NS case management. Lira 0 13 1. A total of 13 NS cases registered but only three are attending care at Aromo HC while the

rest are attending care in Aromowanglobo in Gulu. No admissions to date. Amuru 0 61 1. No new cases recorded; cases are getting care from the treatment centre in Atiak HCIV and

at the four (4) outreach sites [Ogomraa Community School; Okidi HCII; Pacilo HCII; & Gunya Community School].

2. A total of 10 HCW trained in NS case management. 3. Mass treatment for onchocerciasis with ivermectin conducted in October 2012.

Epilepsy Kitgum 0 OPD – 1,321 IPD – 25

Data derived from cases seen at NS treatment centre – Kitgum hosp. & outreaches.

Lamwo 0 OPD – 122 IPD – 0

The data presented here is derived from patients seen at the NS treatment centres – Padibe HCIV & the 12 outreaches conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili & Lokung sub-counties.

Pader 0 OPD – 1,251 IPD – 41

The data presented here is derived from patients seen at NS treatment centres – Atanga HCIII & outreaches.

Gulu 0 268 Data derived from Nodding Syndrome treatment centres. Lira 0 344 Current data derived from cases seeking care from the treatment centre in Aromo HC Amuru 0 62 Data derived from Nodding Syndrome treatment centres.

Human Influenza (confirmed) Human Influenza (confirmed)

34 0 1. The National Influenza Centre in UVRI maintains sentinel surveillance sites for ILI at (Entebbe hospital, Kampala [Kawala HC, Kisenyi HC, Kitebi HC], and Lobule HC [Koboko district]); and SARI at (Entebbe hospital, Tororo hospital, Fort Portal hospital, Mbarara hospital, Arua hospital, Koboko HCIV).

2. As of 27th Apr. 2013; a total of 402 specimens had been analyzed by the 13th epidemiological week of 2013 with 17 isolates [A(H3) – 4; Influenza B – 9; Type A[not sub-typed] – 2; & Influenza A(H1N1)pdm09 – 2].

3. Makerere University Walter Reed Project is implementing a complementary Influenza surveillance program.

4. The human influenza surveillance sites are located in Gulu RRH, Jinja RRH, & Mulago NRH. 5. The non-human component collects samples on a regular basis from potential Influenza

reservoirs like the waterfowl from the Western Rift Valley Lakes, Lake Victoria shores, and

14

Condition Affected districts

New cases (deaths)

22nd to 28th

April 2013 [17th Epi-

week]

Cumulative Cases

Cumulative Deaths

Comments and Actions

the wetlands in Eastern Uganda. Non-human samples are also obtained from other potential reservoirs in Eastern, West Nile, Central, Northern, & Western Uganda.

6. By the end of the 16th epidemiological week of 2013 a total of 338 human samples had been analyzed with 17 isolates [A(H3) – 5; Influenza B – 7; Type A[not sub-typed] – 3; & Influenza A(H1N1)pdm09 – 2].

7. During the same period, a total of 673 non-human samples had been analysed with no influenza isolates.

8. While there is low seasonal influenza activity in most parts of the country; districts and international ports of entry have been urged to look out for cases of the severe acute respiratory infection (SARI) particularly among international travellers.

9. Districts and international ports of entry have been urged to look out for cases of the severe acute respiratory infection (SARI) particularly among international travellers. This heightened surveillance for SARI cases is crucial following the emergence of cases of the novel Coronavirus Respiratory infections (24 confirmed cases with 16 deaths among nationals & international travellers from the Middle East) http://www.who.int/csr/don/2013_05_02_ncov/en/index.html and due to the more recent emergence of Influenza A (H7N9) cases from five (5) provinces in China. To date, a total of 128 patients have been laboratory confirmed with influenza A(H7N9); including 26 deaths from eight (8) provinces in China. At this time, there is no evidence of sustained human-to-human transmission; WHO does not advise special screening at points of entry, nor does it recommend that any travel or trade restrictions http://www.who.int/csr/don/2013_05_02/en/index.html

MDR-TB 9 1. A total of nine (9) new MDR TB cases were confirmed in January 2013 from six (6) districts [Kampala-4; & one each from Alebtong, Buikwe, Mbarara, Nebbi, & Dokolo].

2. Since 2008; a total of 348 MDR-TB cases have been diagnosed with 30 cases being reported in 2008; 50 cases in 2009; 86 cases in 2010; 71 cases in 2011; & 110 cases in 2012.

3. Treatment of MDR-TB cases started last year [2012] with 79 cases currently on treatment in Mulago NRH-40 cases; Mbarara RRH-2 cases; Kitgum hospital-30 cases; & Arua RRH-7cases.

4. New MDR-TB treatment centres will be opened in Mbale RRH & Gulu RRH on 20/05/2013. 5. Health workers are urged to screen all suspects for TB & to advise all TB cases to adhere &

complete TB treatment to prevent the emergence of MDR-TB cases.

15

For comments please contact: The Epidemiological Surveillance Division- M.O.H

P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108 email: esd@health.go.ug or esduganda@yahoo.co.uk

Editorial: Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Immaculate Nabukenya, Mr. Luswa Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr. Issa Makumbi Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero Dr. N. Ndayimirigye Mr. L. Luswa Dr. N. Bakyaita, Mr. M. Mugagga