Epidemiological week 29 of 2013 [15 21 July 2013]

Transcription

1 Epidemiological week 29 of 2013 [15 21 July 2013] National Summary Indicator Epidemiological week 29 % of Districts reporting Median % HU reporting % Timely District reports AFP 2(0) 10(0) Animal bites 330(01) 253(0) 6(0) 110(02) Dysentery 995(02) 981(0) Guinea Worm 0(0) 0(0) Malaria 179, ,207 (52) (35) Measles 62(0) 54(0) Meningitis 4(01) 1(0) NNT 0(0) 0(0) Plague 0(0) 0(0) Typhoid 1579(01) 333(0) S/Sickness 0(0) 0(0) Human Influenza 5(0) 5(0) Nodding Syndrome 0(0) 0(0) Yellow Fever 0(0) 0(0) Viral Hemorrhagic Fever 0(0) 0(0) Maternal Deaths Highlights of the Week Completeness & Timeliness of Reporting This week, 105 (93.75%) of the districts submitted their weekly reports as opposed to 71 (63.39%) for the corresponding week of The mean intra-district completeness this week is 56% [median 55%]; compared to the mean intra-district completeness of 90% [median 96%] for the corresponding week of Only 26 (24.76%) of the districts that reported this week attained an intra-district completeness of at least 80% as opposed to 59 (83.10%) for the corresponding week of A total of seven (7) districts including Amolatar, Bugiri, Kampala, Kapchorwa, Katakwi, Kumi, & Pallisa never submitted reports this week. Timeliness for weekly reporting is 104 (92.86%) for the reporting week; and 58 (51.79%) for the corresponding week of The intra-district completeness for weekly reporting [proportion of health facilities submitting weekly reports in the district] has persistently remained very low despite the nearly universal coverage for mobile phone reporting [mtrac]. DHOs are therefore urged ensure districts submit their weekly reports and to actively follow-up silent health facilities. Public Health Emergencies/Disease Outbreaks Acute Jaundice Syndrome [AJS]: Cases of acute jaundice syndrome continue to be reported from Moroto & Napak districts since 20 Feb At least 57 AJS cases have been reported with a clinical presentation that is suggestive of HEV infection though one of the samples tested Yellow Fever IgM positive. PCR tests for YF and HEV were negative on all the samples tested at UVRI. HEV serological testing has not been undertaken as the reagents are out of stock. Further investigations into these findings are underway (details annex 2). Suspect cholera: On 14 July 2013, suspect cholera cases were reported among Congolese refugees in Bundibugyo district. Over 50 cases of acute watery diarrhea have been reported though none has tested positive for cholera. The nearly 7,000 refugees have now been resettled in Bubukwanga refugee camps. Disease surveillance in the refugees and host population has been enhanced and sanitation and hygiene promotion have been stepped up. (details annex 2). : Six (6) cholera cases were reported from Buliisa district. The cumulative number of districts affected by cholera this year is nine (9) with a cumulative total of 550 cases and 20 deaths (details annex 2, 2.2, & 2.3). MDR-TB: A total of 33 new MDR-TB cases were confirmed in January, April, & May 2013 from 21 districts. Currently, 100 MDR-TB patients are on treatment. The National TB & Leprosy Program (NTLP) has adopted the hospitalization & ambulatory (mixed) model for management of MDR-TB cases. Consequently, the NTLP appeals to all RRH, all other health centres to manage and/or support MDR TB cases to ensure DOT at all times (details annex 2). Human Influenza Surveillance: The National Influenza Centre in the Uganda Virus Institute [UVRI] & Makerere University Walter Reed Project [MUWRP] maintain sentinel surveillance sites for ILI/SARI countrywide. As of 20 th July 2013; a total of 1818 specimens had been analyzed [by NIC till Epi-week 26 & MUWRP till Epi-week 29] with 153 isolates. Heightened influenza surveillance is also ongoing after cases of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) (90 confirmed cases with 45 deaths] were reported from at least 9 countries and Influenza A (H7N9) [134 laboratory-confirmed cases, including 43 deaths].

2 2 Weekly Incidence for Selected Priority Diseases in the Country This week; we present a concise profile of the nine (9) top priority diseases/conditions including AFP (suspect Polio),, Bloody diarrhea, Malaria; Meningitis, Measles, Suspect Rabies, Typhoid Fever, & Maternal deaths] reported during the 29 th Epidemiological week of AFP (Suspect Polio): Two (2) AFP cases were reported this week from Nakaseke, & Kween districts. The National non-polio AFP (NPAFP) rate for 2013 is 1.31/100,000 children <15 years of age which is below the national target of 4/100,000. Only 13 (11.6%) of districts have archived a NPAFP rate of 4/100,000 population <15 years. The non-polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is 12% above the national target of 10%. Also, 68% of AFP cases have received at least three doses of OPV and 92% of AFP cases have had at least two (2) stool specimens collected within 14 days of paralysis onset (national target 80%). UNEPI encourages all districts to conduct active search for AFP, measles, & NNT so that cases are detected and investigated. Additionally, AFP surveillance should be enhanced so that any importations from the ongoing WPV1 outbreaks in Somalia & Kenya can be detected. : This week, six (6) cholera cases were reported from Buliisa district. 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 & 2013 [see annex 2, 2.2, & 2.3 for district specific epidemiological data]. Dysentery (Bloody diarrhea): A total of 995 cases of bloody diarrhea were reported from 84 districts during the current week. This translates into a national weekly incidence of 3.13 cases of bloody diarrhea per 100,000. The top 10 districts [Sheema, Buliisa, Bukwo, Kotido, Agago, Abim, Kalangala, Nakasongola, Napak, & Nakapiripirit] had a weekly incidence of bloody diarrhea cases per 100,000. The figure below shows the number of bloody diarrhea cases reported by week for 2012 & Available at

3 3 Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, 179,593 cases including 52 deaths were reported from the 105 districts that submitted weekly reports. This translates into a national weekly incidence of 565 clinical malaria cases per 100,000. The top 10 districts [Tororo, Otuke, Butambala, Buliisa, Isingiro, Busia, Kiruhura, Rakai, Moyo, & Lira] had an incidence of 1,122-2,098 clinical malaria cases per 100,000 this week. The figure below shows the number of clinical malaria cases reported to the MoH by week for 2012 & The figure below shows the proportion of clinical malaria cases that have been tested and confirmed by week during 2013 using laboratory data for malaria submitted through mtrac and DHIS 2. During the current week [29 th Epidemiological week], a total of 170,322 clinical malaria cases were reported from the 85 districts that submitted laboratory testing data [through mtrac or DHIS2]. 119,053 of the clinical malaria cases were tested [RDT/microscopy] with 52,088 (43.75%) being confirmed to have malaria. Children under five years constituted 32.09% (16,725) of the malaria confirmed cases. Meningitis: Only sporadic cases of meningitis are being reported; with four (4) cases reported from the four (4) districts of Kabarole, Lira, Soroti, & Wakiso during the current week. The figure below shows the number of meningitis cases reported by week for 2012 & Available at

4 4 Measles: This week, a total of 62 suspect measles cases were reported from 30 districts. As of July 26, 2013, a total of 92 (82.14%) districts had investigated at least one suspect measles case. Consequently, the annualized rate for suspect measles cases investigated is 3.01/100,000 (national target 2/100,000). As of July 26, 2013, data from the EPI laboratory showed that 83/764 (10.3%) of investigated suspect measles cases had tested measles Ig M positive [measles cases have been confirmed from 24 districts]. Of the ten (10) suspect measles outbreaks reported this year; six (6) measles outbreaks have been confirmed in Hoima, Kabarole, Isingiro, Mubende, & Kyenjojo districts. The trends for the current period are generally far below the cases reported for the corresponding period of The figure below shows the number of suspect measles cases reported by week for 2012 & Animal bites (Suspect human rabies): A total of 330 cases of suspect rabies were reported from 64 districts during the current week. This translates into a national weekly incidence of 1.04 suspect rabies cases per 100,000. The top 10 districts [Sheema, Nebbi, Oyam, Moroto, Kyankwanzi, Maracha, Kitgum, Nwoya, Nakaseke, & Bukwo] had a weekly incidence of suspect rabies cases per 100,000. Available at

5 5 Typhoid Fever: A total of 1579 typhoid cases were reported from 73 districts during the current week. This translates into a national weekly incidence of 4.97 cases per 100,000. The top 10 districts [Bukwo, Isingiro, Mityana, Kanungu, Kween, Buliisa, Lyantonde, Nakaseke, Lira, & Lwengo] had a weekly incidence of cases per 100,000. 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 Maternal deaths: Maternal mortality trends are a national priority and consequently, these data are now submitted on a weekly basis by the health facilities where these events are detected. Available at

6 6 This week a total of 17 maternal deaths were reported from 11 districts as shown in the table below. The maternal death audits are being undertaken by the Reproductive Health Division in the Ministry of Health in collaboration with the reporting districts. This year a cumulative total of 247 maternal deaths have been reported from 55 districts. Epiweek Reporting Date Phone District Facility No. Maternal Deaths 29 7/24/ :04:16 PM Soroti Soroti RRH /25/2013 1:24:21 PM Sironko Buteza HC III /23/2013 9:35:02 AM Hoima Azur HC III /22/2013 3:41:23 PM Kasese Bwera HOSPITAL /22/2013 2:23:51 PM Masaka St. Joe. Kitovu HOSPITAL /23/2013 3:39:37 PM Bundibugyo Bundibugyo Hospital /23/2013 7:15:07 PM Mpigi Nkozi HOSPITAL /22/2013 1:44:29 PM Kitgum Loborom HC III /22/ :19:32 PM Kasese Kagando HOSPITAL /23/ :46:40 PM Mubende Mubende RR HOSPITAL 1 For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: / esduganda@yahoo.co.uk Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, 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 Available at

7 7 Annex 1: Summary of District Reports for Epidemiological week 29 of 2013 [15 21 July 2013] (Numbers in brackets indicate deaths) District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Alebtong 100 T Bududa 100 T (3) Busia 100 T Butambala 100 T (1) Koboko 100 T Kole 100 T Moyo 100 T Maracha 100 T Otuke 100 T Tororo 100 T CP 6,, Kisoro 97 T Kaabong 96 T Lira 96 T Kitgum 95 T (2) CP 10,, Masindi 95 T (1) (1) Yumbe 92 T (2) Ntoroko 89 T Kiruhura 87 T Manafwa 87 T (1) Buikwe 84 T Kiboga 83 T (1) Kalangala 82 T Kiryandongo 81 T Buliisa 80 T Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others CP 1, HepE 2, 7

8 8 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Kyegegwa 80 T (1) Ssembabule 80 T Mukono 79 T Zombo 79 T Bulambuli 75 T Bundibugyo 75 T Kyankwanzi 75 T Napak 75 T (2) CP 2,, Isingiro 73 T Kabale 72 T Kayunga 71 T Lwengo 70 T Mbale 70 T (2) CP 4,, Mbarara 69 T (2) Bushenyi 68 T Gulu 65 T Jinja 64 T (1) Ibanda 62 T Mpigi 62 T (1) 0 Agago 61 T CP 4,, Masaka 61 T Kamwenge 59 T Rukungiri 59 T Ntungamo 58 T (2) Mityana 57 T (2)

9 9 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Bukomansimbi 56 T Dokolo 56 T Hoima 56 T ( National 56 NR 2(0) 330(1) 6(0) 995(2) 0(0) 52) 62(0) 4(0) 0(0) 0(0) 1579(1) 0(0) NR Abim 55 T , 0, Buvuma 55 T Kibuku 54 T Kyenjojo 54 T Wakiso 54 T Kotido 53 T Amuru 52 T Nakaseke 52 T Kamuli 51 T (1) Kibaale 51 T Kaliro 50 T Kalungu 50 T Kabarole 49 T (3) Sironko 47 T Luuka 46 T Rakai 46 T Nakasongola 45 T Mayuge 44 T Butaleja 42 T (1) Iganga 42 T (2) Kasese 42 T 0 2(1) (3)

10 10 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Soroti 42 T (1) Amudat 40 T Bukwo 40 T Buyende 40 T Luweero 40 T Nakapiripirit 39 T Buhweju 38 T Nebbi 38 T (9) Ngora 36 T Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Namayingo 34 T Gomba 33 T Mitooma 33 T Mubende 33 T (2) Amuria 32 T Kanungu 31 T (1) Kween 31 L Oyam 31 T (2) Nwoya 29 T CP 5, Bruce 6, Lyantonde 28 T Moroto 28 T (2) Namutumba 27 T Lamwo 26 T (1) Sheema 22 T Budaka 21 T (1) Pader 20 T

11 11 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Dysentery Guinea Worm Rubirizi 20 T Serere 20 T Arua 19 T (1) Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Kaberamaido 14 T Apac 12 T Adjumani 6 T , 0, Bukedea 6 T Amolatar NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Bugiri 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 Kapchorwa NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Katakwi 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 Pallisa 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%); Red (No Report) 11

12 Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 29 of 2013 [15 th to 21 st July 2013] Condition Affected districts Cumulative Cases Comments and Actions Suspect cholera Acute Jaundice Syndrome [AJS] 12 New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulat ive Deaths 12 Bundibugyo On 14 July 2013, suspect cholera cases were reported among Congolese refugees in Bundibugyo district. 2. Over 50 cases of acute watery diarrhea have been reported though none has tested positive for cholera. 3. The nearly 7,000 refugees have now been resettled in Bubukwanga refugee camps. 4. Disease surveillance in the refugees and host population has been enhanced and sanitation and hygiene promotion have been stepped up. Moroto & Napak A total of 57 cases of AJS with a mild illness and jaundice but without any other significant manifestations have been reported from Moroto & Napak districts since 20 Feb One of the samples tested Yellow Fever IgM positive. PCR tests for YF and HEV were negative on all the samples. HEV serological testing has not been undertaken as the reagents are out of stock. 3. Further investigations are underway to identify the definitive cause and risk factors. Measles Mubende A measles outbreak has been confirmed in the sub-counties of Kitanga, Kiganda, Kibalinga, Bageza, & Kiyuni in Mubende district. 2. 5/6 (83.3%) cases tested positive for measles IgM on 5 July All the cases are under five years of age with a third lacking documented evidence of vaccination status. 4. Accelerated routine immunization has been initiated and the outbreak has been controlled. The most recent case was discharged on 22/07/2013. Suspect Hepatitis B Virus [HBV] Lira On 3 July 2013; the DHO Lira received reports of suspect HBV related deaths in two parishes [Ayira & Ayamo] in Barr sub-county dating back to February The case symptoms included vomiting, diarrhea, abdominal pains, enlarged abdomen and swollen legs, and jaundice. 2. Verification by the DHO ruled out HBV or an outbreak as the cause as they were unrelated

13 13 Condition Measles (confirmed) Measles (confirmed) (suspect) (suspect) Affected districts New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulative Cases Cumulat ive Deaths Comments and Actions and were attributed to natural causes. Isingiro The outbreak has been controlled with no additional cases reported in the last one week. 2. On 23-June-2013; an outbreak of measles was confirmed in Mbaare sub-county, Isingiro district among cases identified in Mbaare HCIII during the month of June A total of six (6) out of 8 samples submitted to the EPI lab in UVRI on 20 th June 2013 tested positive for measles IgM. 38% of the confirmed cases were children below five (5) years of age. A total of 12 cases with 2 deaths have been line listed since the outbreak stated. 4. Accelerated routine immunisation activities are ongoing. 5. The majority of the cases [75%] were female; with 50% being under five years of age; while 60% of cases were from Bugango Parish. Kyenjojo This outbreak started on 8 April 2013 and has finally been controlled since no new cases have been reported in the past four weeks. 2. An epidemiological description of the cases reveals that 54% of cases are male; 30.8% are under five years; & cases reported from four (4) sub-counties Nyankwanzi (42%); Butunduzi (42%); Bugaaki (12%); & Kyenjojo TC (4%) [see annex 2.1] 3. The outbreak is on the decline with two peaks registered; the highest peak of 4 cases recorded on 30 April 2013 [see annex 2.1] 4. A total of six (6) out of 8 samples submitted to the EPI lab in UVRI tested positive for measles IgM. 6. Accelerated routine immunisation activities are ongoing. Buliisa 6(0) Though sporadic cases continue to be reported, the outbreak is controlled. Initial cases were reported on from landing sites on Lake Albert in Kigwera sub-county among cases who originated from Kigorobya sub-county in Hoima district. The cases were managed in Buliisa HCIV. All samples tested negative for Vibrio e at CPHL since most patients take antibiotics before reporting to the CTC for treatment. Hoima 0(0) The outbreak has been controlled with only sporadic cases being reported in the last six (CFR weeks. 13

14 14 Condition (suspect) (confirmed) Affected districts New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulative Cases Cumulat ive Deaths Nebbi 0(0) (CFR 5.2%) Arua 0(0) (CFR 2.4%) Comments and Actions 3.7%) 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 supported active case finding with health education at the landing site; and provision of Jerry cans for safe water storage. 1. The outbreak has been controlled with no new cases reported since The initial cases were reported from Angum village, Nyakagei Parish, Panyimur sub-county on the shores of Lake Albert starting 16 th January Epidemiological analysis of the outbreak reveals that females constituted 54% of the cases; 71.8% of the cases were aged 0-29 years; & the epidemic curve shows successive peaks typical of a propagated outbreak with most cases originating from the fishing villages on Lake Albert in Panyimur sub-county. 4. Intense behavioural change campaign (sensitisations and inspection of public places and domestic areas to enforce sanitation and hygiene standards) was launched by the district taskforce. 5. Sporadic cases were also been reported from Parombo, Erussi, and Nyaravur sub-counties. 1. The outbreak has been controlled with no new cases reported since Initial cases were reported from Aiivu s/county & Oli division starting Two peaks were registered on and ; & currently the outbreak has been controlled [figures in annex 2.2]. 3. Vibrio e was confirmed from two (2) specimens collected from Oli division at the onset of the outbreak. 4. Epidemiological analysis of the outbreak shows that 59% cases were female; 54% cases were aged years; & Aivu sub-county and Oli division in Arua municipality accounted for 79% of the cases. Nodding Syndrome 14 Kitgum OPD 2,034 IPD Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalised in Feb and the data analysis is underway. 3. The data presented here is derived from cases seen at NS treatment centre Kitgum hosp. & outreaches.

15 Condition 15 Affected districts New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulative Cases Lamwo OPD IPD 39 Pader OPD 1,210 IPD 108 Cumulat ive Deaths 15 Comments and Actions 1. Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalised in Feb and the data analysis is underway. 3. 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. 4. Aerial spraying along rivers Pager & Aswa finalised in November/December Food received from OPM was distributed to the affected families on [3/02/13] Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalised in Feb and the data analysis is underway. 3. The data presented here is derived from patients seen at NS treatment centres Atanga HCIII & outreaches. Gulu Case management ongoing at the treatment centre and outreach posts. 2. One death was reported from Aromowanglobo; after he missed a scheduled refill visit and fitted while alone at home. 3. 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. 4. NS treatment centres set up in Odek HCIII; Aromowanglobo HCII; Cwero HCII; & Labworomo HCIII. 5. 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 Data derived from cases seen at NS treatment centre Kitgum hosp. & outreaches.

16 16 Condition Human Influenza (confirmed) Human Influenza (confirmed) Affected districts New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulative Cases Lamwo OPD 122 IPD 0 Cumulat ive Deaths Comments and Actions 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 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 26 th July 2013; a total of 1818 specimens had been analyzed [by NIC till Epi-week 26 & MUWRP till Epi-week 29] with 153 isolates [A(H3) 19; Influenza B 103; Type A[not sub-typed] 1; & Influenza A(H1N1)pdm09 30]. 3. Makerere University Walter Reed Project [MUWRP] is implementing a complementary Influenza surveillance program. The MUWRP human influenza surveillance sites are located in Gulu RRH, Jinja RRH, & Mulago NRH. 4. MUWRP on a regular basis collects non-human samples 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. 5. By the end of the 29 th epidemiological week of 2013 a total of 710 human samples [included in the NIC total above] had been analyzed by MUWRP with 57 isolates [A(H3) 7; Influenza B 37; Type A[not sub-typed] 7; & Influenza A(H1N1)pdm09 6]. 6. During the same period, a total of 954 non-human samples had been analyzed by MUWRP with no influenza isolates. 7. 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. 16

17 Condition Affected districts New cases (deaths) 15 th to 21 st July 2013 [29 th Epiweek] Cumulative Cases Cumulat ive Deaths 17 Comments and Actions 8. 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 Heightened influenza surveillance is ongoing after cases of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) (90 confirmed cases with 45 deaths] were reported from at least 9 countries and Influenza A (H7N9) [134 laboratory-confirmed cases, including 43 deaths]. MDR-TB A total of 33 new MDR-TB cases were confirmed in January, April, & May 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 Currently, 100 MDR-TB patients are on treatment in [Mulago NRH-55; Kitgum hospital-25; Mbale RRH-5; Mbarara RRH-5; Arua RRH-9; Kabarole RRH-1; & Gulu RRH-1] 4. Masaka RRH; Iganga Hospital; Jinja RRH are being prepared to commence treatment of MDR- TB cases. 5. The National TB & Leprosy Program (NTLP) has adopted the hospitalization & ambulatory (mixed) model for management of MDR-TB cases. This model entails initiation of MDR-TB patients on treatment at accredited facilities; with the subsequent daily follow-up being undertaken at the health facility nearest to the patient s home. 6. Consequently, the NTLP appeals to all RRH, all other health centres to manage and/or support MDR TB cases to ensure DOT at all times. 7. All accredited RRH should accelerate initiation of MDR TB; accord extra care to MDR-TB cases; & minimize delays in initiating MDR-TB treatment since MDR TB medicines are available though some expire quickly. For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: / esduganda@yahoo.co.uk Editorial: Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, 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 17