Epidemiological week 28 of 2013 [8 14 July 2013]

Transcription

1 Epidemiological week 28 of 2013 [8 14 July 2013] National Summary Indicator Epidemiological week 28 % of Districts reporting Median % HU reporting % Timely District reports AFP 3(0) 7(0) Animal bites 308(0) 302(0) Cholera 2(0) 155(0) Dysentery 969(0) 1419(0) Guinea Worm 0(0) 0(0) Malaria 221, ,450 (58) (54) Measles 66(0) 238(0) Meningitis 5(01) 13(01) NNT 1(0) 6(02) Plague 0(0) 1(0) Typhoid 1771(0) 1103(0) S/Sickness 0(0) 0(0) Human Influenza 3(0) 0(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, 103 (91.96%) of the districts submitted their weekly reports as opposed to 97 (86.60%) for the corresponding week of The mean intra-district completeness this week is 65% [median 68%]; compared to the mean intra-district completeness of 74% [median 88%] for the corresponding week of Only 38 (36.89%) of the districts that reported this week attained an intra-district completeness of at least 80% as opposed to 57 (58.76%) for the corresponding week of A total of nine (9) districts including Amolatar, Bugiri, Kaabong, Kampala, Kapchorwa, Kole, Kumi, Kween, & Namutumba never submitted reports this week. Timeliness for weekly reporting is 102 (91.07%) for the reporting week; and 94 (83.93%) for the corresponding week of Though the majority of districts continue to submit their weekly reports on time, some districts don t submit their weekly reports and the intradistrict completeness for reporting is still very low. This compromises the sensitivity of the surveillance system in detecting disease outbreaks. All districts are therefore urged to submit their weekly reports and to actively follow-up silent health facilities. Public Health Emergencies/Disease Outbreaks Acute Jaundice Syndrome [AJS]: 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 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. A total of 17 suspect cases [15 from Nyahuka HCIV & another two (2) cases from Bundibugyo hospital] were reported. However, laboratory tests for cholera were negative, nevertheless, surveillance is ongoing and sanitation and hygiene promotion have been stepped up in the refugee settlements. (details annex 2). Cholera: Two (2) 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 544 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 19 th July 2013; a total of 1795 specimens had been analyzed [by NIC till Epi-week 26 & MUWRP till Epi-week 28] with 148 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), Cholera, Bloody diarrhea, Malaria; Meningitis, Measles, Suspect Rabies, Typhoid Fever, & Maternal deaths] reported during the 28 th Epidemiological week of AFP (Suspect Polio): Three (3) AFP cases were reported this week from Napak, Wakiso, & Moroto. 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 (for district-specific performance see annex 3). Cholera: This week, two (2) 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 969 cases of bloody diarrhea were reported from 85 districts during the current week. This translates into a national weekly incidence of 3.05 cases of bloody diarrhea per 100,000. The top 10 districts [Nakapiripirit, Bukwo, Kotido, Buvuma, Agago, Abim, Kalangala, Gulu, Moroto, & Pader] 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, 221,847 cases including 58 deaths were reported from the 103 districts that submitted weekly reports. This translates into a national weekly incidence of 698 clinical malaria cases per 100,000. The top 10 districts [Butaleja, Lyantonde, Tororo, Katakwi, Butambala, Rakai, Nakapiripirit, Otuke, Busia, & Isingiro] had an incidence of 1,531-2,303 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 [28 th Epidemiological week], a total of 196,814 clinical malaria cases were reported from the 93 districts that submitted laboratory testing data [through mtrac or DHIS2]. 139,356 of the clinical malaria cases were tested [RDT/microscopy] with 67,558 (48.48%) being confirmed to have malaria. Children under five years constituted 30.64% (20,698) of the malaria confirmed cases. Meningitis: Only sporadic cases of meningitis are being reported; with five (5) cases reported from the three (3) districts of Mbale, Masaka, & 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 66 suspect measles cases were reported from 22 districts. As of July 19, 2013, a total of 89 (79.46%) 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 19, 2013, data from the EPI laboratory showed that 81/734 (11%) 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 308 cases of suspect rabies were reported from 69 districts during the current week. This translates into a national weekly incidence of 0.97 suspect rabies cases per 100,000. The top 10 districts [Nwoya, Oyam, Dokolo, Bukwo, Amuru, Masindi, Ntoroko, Bushenyi, Kalangala, & Wakiso] had a weekly incidence of suspect rabies cases per 100,000. Available at

5 5 Typhoid Fever: A total of 1771 typhoid cases were reported from 77 districts during the current week. This translates into a national weekly incidence of 5.57 cases per 100,000. The top 10 districts [Bukwo, Isingiro, Mityana, Lyantonde, Luweero, Kalangala, Kanungu, Mbale, & Rakai Sheema] 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 11 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 230 maternal deaths have been reported from 54 districts. Epi week Reporting_Date Reporter Phone District Health Facillity No. Maternal Deaths 28 7/15/2013 4:08:23 PM Byamukama Jude Wakiso Kisubi HOSPITAL /15/2013 5:13:22 PM Byarufu Habib Hoima Hoima RR Hospital /15/ :20:07 AM Dominic Kiryandongo Diima HC III /16/2013 4:54:00 PM Kemigisha Dianah Kabarole Virika HOSPITAL 1 St. Joseph Kitovu 28 7/15/2013 5:31:23 PM Kiyingi Specy Masaka HOSPITAL /15/ :02:55 AM Lam Filder Mary Kitgum Okidi HC III /15/ :16:36 AM Mbogo David Kyenjojo Nyankwanzi HC III /15/2013 2:40:16 PM Nalubega Magret Mityana Namungo HCII /15/2013 9:20:02 AM Okello Sam Bill Zombo Nyapea HOSPITAL /16/2013 5:02:55 PM Tibagalika Enock Kamuli Kamuli Mission Hospital /15/2013 5:11:43 PM Urwonimungu Henry Nebbi Goli HC III NGO 1 Available at

7 7 For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: / 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

8 8 Annex 1: Summary of District Reports for Epidemiological week 28 of 2013 [8 14 July 2013] (Numbers in brackets indicate deaths) District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Alebtong 100 T Amudat 100 T CP 4,, Bududa 100 T (2) Busia 100 T Butaleja 100 T (2) CP 3,, Buvuma 100 T Katakwi 100 T Kisoro 100 T Koboko 100 T Masindi 100 T (2) Moyo 100 T Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Nakapiripirit 100 T (3) Ntoroko 100 T Otuke 100 T Sheema 100 T Tororo 100 T CP 4,, Yumbe 100 T (1) Dokolo 94 T Kyegegwa 93 T (1) Kibuku 92 T Kiryandongo 90 T Pallisa 90 L (2) Ibanda 89 T Kabale 89 T

9 9 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Kiruhura 89 T (1) Lira 89 T (1) Kiboga 88 T (1) Manafwa 87 T (4) Mbale 87 T (2) CP 4,, Buikwe 86 T Kitgum 86 T (2) CP 8,, Mukono 86 T Ssembabule 84 T Butambala 83 T (1) Kayunga 83 T (3) Kotido 82 T Bulambuli 81 T Lamwo 80 T Agago 79 T CP 5,, Lwengo 78 T Gulu 77 T Kyenjojo 77 T (1) Isingiro 75 T Kalungu 75 T Mpigi 75 T Mbarara 74 T (1) Zombo 74 T Amuru 73 T Bundibugyo 71 T Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others 9

10 10 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Bukomansim bi 69 T (2) Bushenyi 68 T Mityana 68 T (2) Hoima 65 T Kaliro 65 T (2) Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Kamwenge 65 T (2) National 65 NR 3(0) 308(1) 2(0) 969(0) 0(0) (58) 66(0) 5(1) 1(0) 0(0) 1771(0) 0(0) Kalangala 64 T Kamuli 64 T 0 1(1) (2) Luuka 64 T Ntungamo 63 T (1) Kyankwanzi 62 T Masaka 61 T (1) Nakaseke 61 T Nakasongola 61 T Buliisa 60 T Wakiso 59 T Jinja 58 T (2) Napak 58 T 0(0) (2) Maracha 58 T Soroti 58 T (1) Apac 56 T Buhweju 56 T Mitooma 56 T

11 11 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Rakai 56 T (3) Luweero 55 T Rukungiri 54 T Bukedea 50 T Gomba 50 T Kibaale 49 T Bukwo 47 T Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Lyantonde 47 T Kabarole 46 T Buyende 45 T Mubende 43 T (3) Kasese 42 T (3) Mayuge 42 T Oyam 42 T (2) Amuria 41 T Iganga 38 T Nebbi 38 T Rubirizi 35 T Moroto 33 T Nwoya 33 T Abim 30 T Kanungu 29 T Ngora 27 T Adjumani 26 T CP 5,, Namayingo 24 T

12 12 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Pader 24 T Arua 22 T (1) Sironko 22 T Serere 20 T Budaka 16 T Kaberamaido 5 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 Kaabong 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 Kole 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 Kween 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 HU= Health Units, NR = Not reported, CP = Chicken Pox, KZ = Kalazar, Sch = Schistosomiasis, MP= Malaria in pregnancy; Nodding Syndrome Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Color codes for Completeness of reporting: Dark Yellow; (80-100%); & Light Brown (0-79%); Red (No Report) 12

13 Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 28 of 2013 [8 th to 14 th July 2013] Condition Affected districts Cumulative Cases Comments and Actions Suspect cholera Acute Jaundice Syndrome [AJS] 13 New cases (deaths) 8 th to 14 th July 2013 [28 th Epiweek] Cumulat ive Deaths 13 Bundibugyo On 14 July 2013, suspect cholera cases were reported among Congolese refugees in Bundibugyo district. 2. A total of 17 suspect cases [15 from Nyahuka HCIV & another two (2) cases from Bundibugyo hospital] were reported. 3. However, laboratory tests for cholera were negative, nevertheless, surveillance is ongoing and sanitation and hygiene promotion have been stepped up in the refugee settlements. (details annex 2). 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 and the deaths as they

14 14 Condition Measles (confirmed) Measles (confirmed) Cholera (suspect) Cholera (suspect) Affected districts New cases (deaths) 8 th to 14 th July 2013 [28 th Epiweek] Cumulative Cases Cumulat ive Deaths Comments and Actions were and related 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 2(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 Cholerae 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. 14

15 15 Condition Cholera (suspect) Cholera (confirmed) Affected districts New cases (deaths) 8 th to 14 th July 2013 [28 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 [see figures annex 2.3]. 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 Cholerae 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 [figures in annex 2.2]. Nodding Syndrome 15 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.

16 Condition 16 Affected districts New cases (deaths) 8 th to 14 th July 2013 [28 th Epiweek] Cumulative Cases Lamwo OPD IPD 39 Pader OPD 1,210 IPD 108 Cumulat ive Deaths 16 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.

17 17 Condition Human Influenza (confirmed) Human Influenza (confirmed) Affected districts New cases (deaths) 8 th to 14 th July 2013 [28 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 19 th July 2013; a total of 1745 specimens had been analyzed [by NIC till Epi-week 26 & MUWRP till Epi-week 28] with 148 isolates [A(H3) 19; Influenza B 98; 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 28 th epidemiological week of 2013 a total of 687 human samples [included in the NIC total above] had been analyzed by MUWRP with 52 isolates [A(H3) 7; Influenza B 32; 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. 17

18 Condition Affected districts New cases (deaths) 8 th to 14 th July 2013 [28 th Epiweek] Cumulative Cases Cumulat ive Deaths 18 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. 18

19 Annex 2.1: Epidemiological Description of the Measles Outbreak in Kyenjojo April to June Cases by sex Count of S/No Age (Months)2 Total % 0-4 yrs yrs Grand Total 26 Cases by Age Cases by time C o u n t o f S /N o Su b - co u n ty T o ta l % B u ga aa k i 3 12 B u tu n d u zi K ye n jo jo T C 1 4 N ya n kw a n zi Gran d To ta l Cases by sub-county 19

20 20 Annex 2.2: Epidemiological Description of the Cholera Outbreak in Arua

21 Annex 2.3: Epidemiological Description of the Cholera Outbreak in Nebbi

22 Annex 3: AFP Performance Indicators by district as of June 23, 2013 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis 22 AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Abim % 100% 100% 100% 0% Adjumani % 50% 100% 100% 50% Agago % 100% 100% 100% 0% Alebtong % 0% 0% 0% 0% Amolatar % 0% 0% 0% 0% Amudat % 0% 0% 0% 0% Amuria % 100% 100% 100% 0% Amuru % 100% 100% 100% 0% Apac % 0% 0% 0% 0% Arua % 100% 100% 100% 0% Budaka % 100% 100% 100% 0% Bududa % 100% 100% 100% 0% Bugiri % 100% 100% 100% 0% Buhweju % 0% 0% 0% 0% Buikwe % 100% 100% 100% 100% Bukedea % 80% 100% 100% 0% Bukomansimbi % 75% 100% 100% 0% Bukwo % 100% 100% 100% 0% Bulambuli % 0% 0% 0% 0% Buliisa % 0% 0% 0% 0% Bundibugyo % 100% 100% 100% 0% 22

23 23 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Bushenyi % 0% 0% 0% 0% Busia % 100% 100% 100% 0% Butaleja % 100% 100% 100% 0% Butambala % 100% 100% 100% 33% Buvuma % 100% 100% 100% 0% Buyende % 0% 0% 0% 0% Dokolo % 100% 100% 100% 0% Gomba % 0% 0% 0% 0% Gulu % 100% 100% 100% 33% Hoima % 100% 100% 100% 0% Ibanda % 100% 100% 100% 67% Iganga % 100% 100% 100% 11% Isingiro % 100% 100% 100% 0% Jinja % 100% 100% 100% 0% Kaabong % 50% 100% 100% 0% Kabale % 100% 100% 100% 0% Kabarole % 40% 100% 100% 0% Kaberamaido % 100% 100% 100% 50% Kalangala % 0% 0% 0% 0% Kaliro % 89% 100% 100% 11% Kalungu % 0% 0% 0% 0% Kampala % 100% 100% 100% 36% 23

24 24 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Kamuli % 0% 0% 0% 0% Kamwenge % 80% 100% 100% 40% Kanungu % 100% 100% 100% 0% Kapchorwa % 100% 100% 100% 33% Kasese % 100% 100% 100% 0% Katakwi % 100% 100% 100% 0% Kayunga % 100% 100% 100% 0% Kibaale % 0% 0% 0% 0% Kiboga % 100% 100% 100% 0% Kibuku % 0% 100% 100% 0% Kiruhura % 100% 100% 100% 0% Kiryandongo % 75% 100% 100% 25% Kisoro % 0% 0% 0% 0% Kitgum % 0% 0% 0% 0% Koboko % 100% 100% 100% 0% Kole % 0% 100% 100% 0% Kotido % 0% 0% 0% 0% Kumi % 0% 0% 0% 0% Kween % 100% 100% 100% 0% Kyankwanzi % 0% 0% 0% 0% Kyegegwa % 100% 100% 100% 0% Kyenjojo % 100% 100% 100% 0% 24

25 25 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Lamwo % 100% 100% 100% 0% Lira % 100% 100% 100% 0% Luuka % 0% 0% 0% 0% Luwero % 100% 100% 100% 0% Lwengo % 0% 0% 0% 0% Lyantonde % 0% 0% 0% 0% Manafwa % 0% 0% 0% 0% Maracha % 100% 100% 100% 0% Masaka % 100% 100% 100% 0% Masindi % 100% 100% 100% 0% Mayuge % 100% 100% 100% 50% Mbale % 100% 100% 100% 0% Mbarara % 80% 100% 100% 0% Mitooma % 100% 100% 100% 0% Mityana % 0% 0% 0% 0% Moroto % 0% 0% 0% 0% Moyo % 0% 0% 0% 0% Mpigi % 100% 100% 100% 0% Mubende % 100% 100% 100% 0% Mukono % 100% 100% 100% 0% Nakapiripirit % 100% 100% 100% 0% Nakaseke % 100% 100% 100% 25% 25

26 26 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Nakasongola % 0% 0% 0% 0% Namaingo % 100% 100% 100% 0% Namutumba % 100% 100% 100% 0% Napak % 0% 0% 0% 0% Nebbi % 0% 0% 0% 0% Ngora % 0% 0% 0% 0% Ntoroko % 100% 100% 100% 50% Ntungamo % 0% 0% 0% 0% Nwoya % 100% 100% 100% 0% Otuke % 100% 100% 100% 0% Oyam % 0% 0% 0% 0% Pader % 100% 100% 100% 0% Pallisa % 100% 100% 100% 50% Rakai % 100% 100% 100% 0% Rubirizi % 0% 0% 0% 0% Rukungiri % 0% 100% 100% 0% Sembabule % 100% 100% 100% 0% Serere % 100% 100% 100% 0% Sheema % 100% 100% 100% 0% Sironko % 0% 100% 100% 0% Soroti % 100% 100% 100% 0% Tororo % 88% 100% 100% 13% 26

27 27 District Non-polio AFP rate per 100,000 population less than 15 years of age AFP cases with 2 stool specimen collected within 14 days of onset of paralysis AFP cases arriving at national level within 3 days of being collected AFP cases arriving at the lab in `good condition` AFP cases which non-polio enterovirus was isolated Targets 4 /100,000 80% 80% 80% 80% 10% Wakiso % 100% 100% 100% 20% Yumbe % 100% 100% 100% 50% Zombo % 100% 67% 100% 0% Total % 92% 99% 100% 12% 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 27