Epidemiological week 19 of 2013 [6 12 May 2013]

Transcription

1 National Summary Indicator Epidemiological week 19 % of Districts reporting Median % HU reporting % Timely District reports AFP 0(0) 4(0) Animal bites 387(2) 196(1) 10(0) 44(0) Dysentery 1728(1) 820(0) Guinea Worm 0(0) 0(0) Malaria 205, ,204(2 (45) 2) Measles 51(0) 291(0) Meningitis 4(2) 2(0) NNT 0(0) 3(2) Plague 0(0) 0(0) Typhoid 1573(0) 292(0) S/Sickness 0(0) 0(0) Human Influenza 0(0) 0(0) Nodding Syndrome 0(0) 0(0) Yellow Fever 0(0) 0(0) Epidemiological week 19 of 2013 [6 12 May 2013] Highlights of the Week Completeness & Timeliness of Reporting This week, 106 (95%) of the districts submitted their weekly reports as opposed to 65 (58%) for the corresponding week of The mean intra-district completeness this week is 72% [median 77%]; compared to the mean intra-district completeness of 86% [median 93%] for the corresponding week of Only 48 (45%) of the districts that reported this week attained an intradistrict completeness of at least 80% as opposed to 43 (66%) for the corresponding week of A total of six (6) districts including Kaabong, Kabale, Kampala, Kumi, Mukono, & Pader never submitted reports this week. Timeliness for weekly reporting is 98 (88%) for the reporting week; which corresponds with 57 (88%) for the corresponding week of Public Health Emergencies/Disease Outbreaks Floods: Floods hit Kasese district following torrential rains that started on 1 st May Six (6) deaths were reported with over 25,445 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). : Eleven (11) new cholera cases were reported from Buliisa, Nebbi, Arua, & Zombo districts. The cumulative number of districts affected by cholera this year is nine (9) with a cumulative total of 456 cases and 13 deaths (details annex 2). Viral Hemorrhagic Fever 0(0) 0(0) MDR-TB: A total of nineteen (19) new MDR-TB cases were confirmed in January & April 2013 from sixteen (16) districts. Treatment of MDR- TB cases started in 2012 at the following treatment centres [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 5 th May 2013; a total of 1094 specimens had been analyzed [by NIC & MUWRP] with 97 isolates [A(H3) 16; Influenza B 59; Type A[not sub-typed] 5; & Influenza A(H1N1)pdm09 17]. (details annex 2). Makerere University Walter Reed Project [MUWRP] is implementing a complementary Influenza surveillance program. By the end of the 18 th epidemiological week of 2013 a total of 400 human samples [all included in the NIC total above] had been analyzed with 21 isolates [A(H3) 5; Influenza B 9; Type A[not sub-typed] 5; & Influenza A(H1N1)pdm09 2]. During the same period, a total of 834 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 (40 confirmed cases with 20 deaths from 6 countries [France, Germany, Jordan, Qatar, Saudi Arabia, & UK]) and due to the more recent emergence of Influenza A (H7N9) cases from eight (8) provinces in China. To date, a total of 131 patients have been laboratory confirmed with influenza A(H7N9); including 36 deaths in China. At this time, there is no evidence of sustained human-to-human transmission and the outbreak appears to be receding; WHO does not advise special screening at points of entry, nor does it recommend that any travel or trade restrictions

2 Weekly Incidence for Selected Priority Diseases in the Country This week; we present a concise profile of the seven top priority diseases including, Dysentery, Malaria; Meningitis, Measles, Suspect Rabies, and Typhoid Fever] reported during the 19 th Epidemiological week of Note all priority disease trends have been adjusted for differences in reporting rates. : This week, a total of 11 cholera cases were reported from Arua (2 cases); Buliisa (2 cases); Nebbi (5 cases), and Zombo district (2 cases & 1 death). Zombo is the most recently affected with two suspect cases including one death being reported among fish traders who had traveled to Panyimur in Nebbi district prior to the onset of the illness. Overall, the cholera cases for the current period are much lower than those from the corresponding period of The figure below shows the cholera trends for 2012 & Dysentery (Bloody diarrhea): A total of 1728 cases of bloody diarrhea were reported from 98 districts during the current week. The top 10 districts [Kotido, Namayingo, Hoima, Nakapiripirit, Apac, Kisoro, Mbale, Bukwo, Luweero, & Nakasongola] reported cases each this week. The figure below shows the number of bloody diarrhea cases reported by week for 2012 & In an effort to determine the etiology of the bloody diarrhea cases, a protocol has been developed though the funds have not yet been identified. Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, 205,548 cases including 45 deaths were reported from the 106 districts that submitted weekly reports for the current epidemiological week. The top 10 districts [Tororo, Wakiso, Kamuli, Rakai, Jinja, Amuria, Moyo, Luweero, Butaleja, Buikwe] reported 4,500-9,000 cases of clinical malaria this week. Data for the lab. confirmed malaria cases per week is being analyzed and will be presented in subsequent weeks. The figure below shows the.number of malaria cases reported by week for 2012 & 2013.

3 Meningitis: Only sporadic cases of meningitis are being reported; with cases reported from Soroti, Napak, & Zombo during the current week. The figure below shows the number of meningitis cases reported by week for 2012 & Measles: Though measles cases were recently confirmed [May 2, 2013] in Kyenjojo district in the sub-counties of Nyankwanzi, Katooke, & Butunduzi; the national measles trends are way below those for the corresponding period of Accelerated routine immunization and active surveillance with line listing are ongoing in Kyenjojo in response to the outbreak. The figure below shows the number of suspect measles cases reported by week for 2012 & Animal bites (Suspect human rabies): A total of 387 cases including two (2) deaths of suspect rabies were reported from 76 districts during the current week. The top 10 districts [Masindi, Ntungamo, Jinja, Mubende, Amuria, Nebbi, Soroti, Bukwo, Yumbe, & Kaberamaido] reported 8-25 cases each this week. The figure below shows the number of suspect rabies cases reported by week for 2012 & 2013.

4 Typhoid Fever: A total of 1573 typhoid cases were reported from 72 districts. The top 10 districts [Isingiro, Wakiso Mbarara, Kanungu, Luweero, Mubende, Sheema, Kibaale, Gulu, & Masindi] reported cases each this week. The figure below shows the number of Typhoid fever cases reported by week for 2012 & 2013 with the cases reported since the beginning of 2013 greatly exceeding those from the corresponding period of A protocol has been developed to investigate these trends though the funds have not yet been identified. For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: / 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

5 Annex 1: Summary of District Reports for Epidemiological week 19 of 2013 [6 12 May 2013] (Numbers in brackets indicate deaths) District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Amudat 100 T Bududa 100 T Bukomansimbi 100 T (), 0, Bukwo 100 L Busia 100 T Butaleja 100 L (1) CP 7,, Butambala 100 T (1) (), 0, Buvuma 100 T (), 0, Dokolo 100 T (), 0, Bruce Kapchorwa 100 T ,, Kibuku 100 L AEFI,, Koboko 100 T (), 0, Kyegegwa 100 T (), 0, Lamwo 100 L CP 8,, Manafwa 100 T Moyo 100 T (), 0, Nakapiripirit 100 T Namutumba 100 T Ngora 100 T Nwoya 100 T CP 26,, Otuke 100 T Sheema 100 L (2) , 0, Mbale 98 T CP 33,, Apac 97 T Kisoro 97 T (), 0, Masindi 97 T (), 0, Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others 5

6 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Tororo 97 L () CP 5,, Amuria 96 T (1) Yumbe 96 T , 0, Abim 95 T (1) Bulambuli 95 T Katakwi 95 T CP 4,, Kole 91 T CP 6,, Rukungiri 90 T CP 4,, Ntoroko 89 T (), 0, Namayingo 88 T Ssembabule 88 T Bundibugyo 86 T (), 0, Amolatar 83 T Kayunga 83 T (4) Nyadri 83 T , 0, Buikwe 82 T (), 0, Kiruhura 82 T (), 0, Kotido 82 T 1 1(1) 0 81(1) Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Nakaseke 82 T (), 0, Rubirizi 82 T Kitgum 81 T (3) CP 9,, Buliisa 80 T (), 0, Ntungamo 79 T (), 0, Gomba 78 T (), 0, Mpigi 78 T (1) (), 0, Alebtong 77 T Ibanda 77 T (), 0, Kyenjojo 77 T (), 0, 6

7 7 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Pallisa 76 T (5) () Guinea Worm Kween 75 T Kaberamaido 73 T CP 22,, Serere 73 T 0 3(1) (1) Sironko 72 L , 0, National (0) 387(2) 11(0) 1728(1) (45) 51(0) 4(2) 0(0) 0(0) 1573(0) 0(0) Isingiro 70 T (), 0, Kalungu 65 T (1) (), 0, Gulu 63 T (), 0, Kamuli 62 T (5) (), 0, Kiboga 62 T (), 0, Kiryandongo 62 T (), 0, Kyankwanzi 62 T (1) (), 0, Agago 61 T CP 15,, Hoima 61 T (), 0, Nebbi 61 T (2) Bukedea 60 T Kabarole 59 T (), 0, Kamwenge 59 T (), 0, Amuru 58 T (), 0, Bushenyi 58 T (), 0, Jinja 58 T (), 0, Nakasongola 58 T (), 0, Napak 58 T (2) 1 1(1) Lwengo 57 T (), 0, Mbarara 57 T (), 0, Luweero 56 T (2) (), 0, Kalangala 55 T (), 0, Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Bruce 6, CP 2,

8 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Wakiso 54 T Rakai 50 T AEFI,, Lira 48 T (), 0, Masaka 48 T (2) (), 0, Zombo 47 T Buyende 45 T (), 0, Kaliro 45 T (), 0, Kibaale 44 T (), 0, Iganga 43 T (), 0, Mityana 42 T (), 0, Soroti 42 T () Mubende 41 T (1) (), 0, Mayuge 40 T (), 0, Luuka 39 T (), 0, Buhweju 38 T (), 0, Oyam 38 T , 0, Kanungu 35 T (), 0, Lyantonde 34 T (), 0, Mitooma 33 T (), 0, Moroto 33 T (), 0, Adjumani 29 T CP 2,, Budaka 16 T (), 0, Arua 12 L Kasese 8 T Bugiri 2 T (), 0, Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Kaabong NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kabale NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kampala NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 8

9 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Kumi NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Mukono 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 Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others 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%) 9

10 Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 19 of 2013 [6 12 May 2013] Condition Affected districts Cumulative Cases Comments and Actions Suspect VHF Measles 10 New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumula tive Deaths Ibanda 0(0) A suspect VHF case was reported to the MoH on May 9, 2013; the case is on admission in Ibanda hospital. However the sample shipped to UVRI tested negative for Ebola and Marburg by PCR. Kyenjojo 0(0) Measles outbreak has been confirmed in Kyenjojo district in the sub-counties of Nyankwanzi, Katooke, & Butunduzi. Four samples from suspect cases tested positive for measles IgM on May 2, % of the cases confirmed cases are children below 5 years of age and 4/5(80%) lacked any form of documentation for their vaccination status. 2. The district has been advised to implement accelerated routine vaccination and intensified measles surveillance. Floods Kasese 0(0) Floods hit Kasese district following torrential rains that started on 1 st May A total of six (6) deaths have been reported with over 25,445 people displaced. 2. Kilembe hospital in the municipality was closed and patients transferred after 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. Efforts are underway to restore piped water supply to Kasese Municipality; provide water purification tablets; & water storage tanks for the displaced persons. 5. 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 was finalised and forwarded to the Office of the Permanent Secretary, MoH. Rubella Kibaale 0(0) Following reports of suspect measles cases in Mpeefu sub-county, Kibaale district; five blood samples were collected on 18 th 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.

11 Condition Rubella (suspect) (suspect) (suspect) (suspect) 11 Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Cumula tive Deaths Comments and Actions Kamwenge 0(0) 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. Zombo 2(1) Two suspect cholera cases were treated in Nyapea Hospital stating May 3, The initial case was 43 year from Kengu village, Paley Parish, Zombo TC and a driver for fish traders from Panyimur; he was treated for cholera symptoms between May 3-16, The second case was 45 year old fishmonger from Asina village, Pamitu Parish, Abanga sub-county. He frequented Panyimur in Nebbi and became ill on May 6, 2013 and died May 7, 2013, only one day after admission to Nyapea hospital. Buliisa 2(0) The outbreak has been controlled with no cases currently on admission. The most recent case was discharged from Buliisa HCIV on May 6, Initial cases were reported on from landing sites in Kigwera sub-county among cases who originated from Kigorobya sub-county. The cases are being managed in Buliisa HCIV. The all samples tested negative for Vibrio e at CPHL since most patients take antibiotics before reporting to the CTC for treatment. Hoima 0(0) 66 3 (CFR 4.5%) Nebbi 5(0) (CFR 2.32%) 1. The outbreak has been controlled with no cases admitted currently in any of the two subcounties [Kyangwali & Kigorobya]. 2. The outbreak started on 12_04_2013 with cases originating from Runga village/landing site, Kapaapi Parish, Kigorobya sub-county. 3. 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. 4. The DHO has requested the MoH to supply ORS, Ringers lactate, and chlorine to support case management in the CTC. 1. The initial cases were reported from Angum village, Nyakagei Parish, Panyimur sub-county on the shores of Lake Albert starting 16 th January 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

12 Condition Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Cumula tive Deaths Comments and Actions 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. Ntoroko 0(0) The outbreak was controlled in early February 2013 following the discharge of last case on 10 th February The outbreak started on 27 th 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 e 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. Arua 2(0) (CFR 2.67%) Maracha 0(0) (CFR 6.7%) 1. The outbreak is nearly controlled with no cases currently on admission. Initial cases were reported from Aiivu sub-county and Oli division starting Eventually cases were reported from Katini, Omugo, & Bileafe sub-counties. 2. Vibrio e 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. 1. The outbreak is controlled with no new cases reported in the district in the last eight (8) weeks. 2. The initial cases were reported from Nyadri sub-county in Late February The outbreak was imported from Arua by a family that attended a funeral in Aiivu sub-county, Arua district 12

13 Condition Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Cumula tive Deaths Comments and Actions where a cholera outbreak was already ongoing at the time. 3. 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. Yumbe 0(0) 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_ The initial cases were reported from Lodonga HC III on 24 th February On 27 th February 2013, two (2) specimens we sent to the Arua RRH where Vibrio e 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. 5. Effective control interventions were initiated with no fatal cases being registered and NMS delivered drug supplies for case management. Koboko 0(0) 26 2 (CFR 6.25%) 1. The outbreak has been controlled hence no new cases have been reported in the last eight (8) weeks. 2. The initial cases were reported on 26 th 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 e 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. 13

14 Condition Nodding Syndrome 14 Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Kitgum OPD 2,034 IPD 162 Lamwo OPD IPD 38 Pader OPD 1,210 IPD 108 Cumula tive Deaths Comments and Actions 3 1. Nodding syndrome census finalised in Feb and the data analysis is underway. 2. The data presented here is derived from cases seen at NS treatment centre Kitgum hosp. & outreaches. 1. Nodding syndrome census finalised in Feb 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 Food received from OPM was distributed to the affected families this week [3/02/13] Nodding syndrome census finalised in Feb and the data analysis is underway. 2. The data presented here is derived from patients seen at NS treatment centres Atanga HCIII & outreaches. Gulu 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 subcounty. 3. NS treatment centres set up in Odek HCIII; Aromowanglobo HCII; Cwero HCII; & Labworomo 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 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 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 Epilepsy Kitgum OPD 1,321 IPD 25 Lamwo OPD 122 IPD 0 Data derived from cases seen at NS treatment centre Kitgum hosp. & outreaches. 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.

15 Condition Human Influenza Human Influenza 15 Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Cumula tive Deaths Comments and Actions Pader OPD 1,251 IPD 41 The data presented here is derived from patients seen at NS treatment centres Atanga HCIII & outreaches. Gulu 268 Data derived from Nodding Syndrome treatment centres. Lira 344 Current data derived from cases seeking care from the treatment centre in Aromo HC Amuru 62 Data derived from Nodding Syndrome treatment centres 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 5 th May 2013; a total of 1094 specimens had been analyzed [by NIC & MUWRP] with 97 isolates [A(H3) 16; Influenza B 59; Type A[not sub-typed] 5; & Influenza A(H1N1)pdm09 17]. 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 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 18 th epidemiological week of 2013 a total of 400 human samples [all included in the NIC total above] had been analyzed with 21 isolates [A(H3) 5; Influenza B 9; Type A[not sub-typed] 5; & Influenza A(H1N1)pdm09 2]. 7. During the same period, a total of 834 non-human samples had been analyzed 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 follows the emergence of cases of the novel Coronavirus (ncov) Respiratory infections (40 confirmed cases with 20 deaths from 6 countries [France, Germany, Jordan, Qatar, Saudi Arabia, & UK]) and due to the more recent emergence of Influenza A (H7N9) cases from eight (8) provinces in China. To date, a total of 131 patients have been laboratory confirmed with influenza A(H7N9); including 36 deaths in

16 Condition Affected districts New cases (deaths) 6 th to 12 th May 2013 [19 th Epiweek] Cumulative Cases Cumula tive Deaths Comments and Actions China. At this time, there is no evidence of sustained human-to-human transmission and the outbreak appears to be receding; WHO does not advise special screening at points of entry, nor does it recommend that any travel or trade restrictions MDR-TB A total of nineteen (19) new MDR-TB cases were confirmed in January & April 2013 from sixteen (16) districts. 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 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/ 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. For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: / 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 16