Highlights of the Week

Transcription

1 Epidemiological week 15 of 2014 [7 April 13 April 2014] National Summary Indicator Epidemiological week 15 % of Districts reporting investigate the outbreak Median % HU reporting % Timely District reports AFP 1(0) 2(0) Animal bites 369(1) 309(1) Cholera 13(0) 2(0) Dysentery 1067(1) 1136(0) Guinea Worm 0(0) 0(0) Malaria (40) (22) Measles 63(0) 53(0) Meningitis 21(1) 6(1) NNT 1(0) 0(0) Plague 0(0) 0(0) Typhoid 1414(2) 1180(1) S/Sickness 0(0) 0(0) Human Influenza 0 1(0) Nodding Syndrome 0(0) 25(0) Yellow Fever 0(0) 0(0) 0(0) 0(0) Viral Hemorrhagic Fever Maternal Deaths Highlights of the Week Completeness & Timeliness of Reporting This week, 110 (98.21%) districts submitted their weekly reports as opposed to 100 (89.29%) for the corresponding week of The mean intra-district completeness this week is 56 [median 60.5%]; compared to the mean intra-district completeness of 66 [median 73.5%] for the corresponding week of Only 26 (23.64%) of the districts that reported this week attained an intra-district completeness of at least 80% as opposed to 38 (38.0%) for the corresponding week of This week only two (2) district2 [Busia and Agago] never submitted reports [see annex 1]. Timeliness for weekly reporting is 110 (98.21%) for the current week; and 93 (83.04%) for the corresponding week of The proportion of health facilities submitting weekly reports in each of the reporting districts is way below the national target of 80% in most of the districts. DHOs and district surveillance focal persons (DSFPs) are urged to ensure districts submit their weekly reports and to actively follow-up silent health facilities. Public Health Emergencies/Disease Outbreaks Suspected Disease outbreak Moyo: A suspected disease outbreak has been reported in Moyo district, the index case was reported on the 25 th /04/2014. Since then a cumulative number of cases of 76 including 4 deaths has been recorded. Cases are being treated at Obongi H/C IV Moyo district with presenting symptoms of diarrhea, vomiting and some reporting fever and bloody diarrhea. Cases are being managed on IV fluids and antibiotics. Stool and blood samples have been sent to CPHL and UVRI for testing. A team from MOH has been sent to Moyo district Suspect Cholera - Arua: A Cholera outbreak has been reported in Arua district. Since the 21/04/2014, 91 cases including 4 deaths have so far been reported from Rigbo and Pawor subcounties, 2 samples that were earlier collected and sent to CPHL showed no growth, more samples have however been sent to CPHL for confirmation of the (annex 2). Rare disease, Mubende& Mityana: On12 th March 2014, the district rapid response team of Mubende reported a strange disease (that causes a skin rash in patterns corresponding to numbers) in Mugolola Parish, Kiganda Sub County. The cases presented with fever, vomiting, diarrhea, and in some cases abdominal pain. No history of bloody diarrhea or bleeding. Another cluster of 17 cases with similar symptoms has been reported from two sub counties in Mityana district starting April 4, Six blood samples have been obtained from this recent cluster and shipped to UVRI for testing. Hepatitis E Virus [HEV] outbreak, Napak: This outbreak rages on with a total of 1113 cases including 26 deaths being reported 15 of which are pregnant mothers. A comprehensive response is underway using a strategy focused on improving access to safe drinking water, behavioral change communication to improve sanitation and hygiene practices, targeting pregnant mothers for HEV prevention, enhanced HEV case surveillance at health facility and community levels, and supportive care to admitted pregnant mothers and other cases with severe disease. (annex 2 for details).

2 2 Human Influenza Surveillance - National: 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 14-Mar-2014; a total of 324 specimens had been analyzed [by NIC & MUWRP] with 12 isolates (see page 6). Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Heightened surveillance for Severe Acute Respiratory Infections (SARI) is also ongoing after 206 cases & 86 deaths of MERS-CoV were reported largely from the Middle East. Healthcare workers are urged to look out for cases of SARI or severe pneumonia requiring hospitalization especially among international travelers from the Middle East. These cases should be isolated immediately and reported to NIC-UVRI [ or ] for immediate investigation. Influenza A (H7N9): Surveillance for human cases of Influenza A (H7N9) continues globally after human cases emerge in China in So far, there is no evidence of human-to-human transmission. Health workers are urged to lookout for SARI cases among international travellers from China or their associates. These cases should be isolated immediately and reported to NIC-UVRI [ or ] for immediate investigation. Weekly Incidence for Selected Priority Diseases in the Country This week; we present a concise profile of twelve (12) top priority diseases/conditions including AFP (suspect Polio), Cholera, Bloody diarrhea, Malaria; Meningitis, Measles, Suspect Rabies, Typhoid Fever, Maternal deaths, Human Influenza, MDR-TB, & Acute viral hepatitis] reported during the 15 th Epidemiological week of AFP (Suspect Polio): This week, 1 AFP case was reported. The National non-polio AFP (NPAFP) rate is 0.64/100,000 children <15 years of age compared to 0.54/ children <15 for the corresponding week of 2013, which is below the national target of 4/100,000.Only 4 out 112 (3.57%) districts achieved a new NPAFP rate of 4/100,000 children <15 years,21 out of 112 (18.8%)attained a none polio AFP rate of 2/100,000 children <15 years.54 out of 112 (48.2%)districts have reported at least one AFP case this year. The non-polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is 10%, which corresponds with the national target of 10%. Adequate sample collection rate is 89%, equal to what was achieved during the corresponding week in Cholera: This week, thirteen (13) new cholera cases were reported from Luwero (3) and Nyadri (10) district. The figure below shows the cholera trends for 2012/14 [see annex 2]. Dysentery (Bloody diarrhea): A total of 1067 cases of bloody diarrhea were reported from 95 districts during the current week. This translates into a national weekly incidence of 3.1 cases of bloody diarrhea per 100,000. The top 10 districts [Nebbi, Hoima,, Nakapiripirit, Soroti, Wakiso, Gulu, Yumbe, Adjumani, Rakai, Kayunga] reported cases this week. The figure below shows the number of bloody diarrhea cases reported by week for 2012/14 [annex 1 for district specific reports].

3 3 Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, clinical malaria cases including 40 deaths were reported from the 110 districts that submitted weekly reports. The figure below shows the number of clinical malaria cases reported to the MoH by week for 2012/14 [annex 1 for district specific reports]. The figure below shows the proportion of clinical malaria cases that have been tested and confirmed by week during 2014 using malaria laboratory data submitted through mtrac and DHIS 2. During the current week [14 th Epidemiological week], a total of suspect malaria cases were reported from the 110 districts that submitted laboratory-testing data [through mtrac or DHIS2] of the suspect malaria cases were tested [RDT/microscopy] with (40.0%) being confirmed to have malaria. Children under five years constituted 29.22% (18447) of the malaria confirmed cases. The graph below shows the trends for the proportions of clinical malaria cases tested and confirmed during 2013/14.

4 4 Meningitis: This week, a total of twenty one (21) cases and one (1) death were reported from nine (9) districts [Tororo, Luweero, Soroti, Nakaseke, Mbale, Kibaale, Namayingo, Mbarara]. All meningitis epidemic prone districts [especially the ones hosting refugee populations in West Nile] are urged to enhance surveillance for suspect cases. The figure below shows the number of meningitis cases reported by week for 2012, 2013 & 2014 [annex 1 for district specific reports].

5 5 Measles: This week, a total of 63 suspect measles cases were reported from 25 districts. The top 10 districts included [Kibaale, Masindi, Mubende Buikwe, Mbale, Wakiso,, Kampala, Moroto, Kisoro, Nakaseke) which reported 2-7 cases each. Measles outbreaks have been confirmed in Adjumani, Arua, Hoima, Kibaale and Ntungamo. The cases in Ntungamo have been reported from Nyakyera, Itojo, and Kahunga sub counties from where a total of 6 cases were confirmed to have measles following tests conducted in the measles laboratory at UVRI on the 11 th March The outbreaks in Ajumani and Arua have been reported in camps hosting refugees from South Sudan while the cases in Hoima originated from Kyangwali sub county IDP camp and then spread to the neighboring sub counties. Measles vaccinations have been undertaken in the affected refugee populations targeting children less than five years of age while accelerated routine immunization has been implemented in the other affected areas. At the close of 2013, a total of 101 (90.18%) districts had investigated at least one suspect measles case. Consequently, the annualized rate for suspect measles cases investigated was 3.22/100,000 (national target 2/100,000). Also, 8% of investigated suspect measles cases had tested measles IgM positive [measles cases have been confirmed from 27districts]. The current trends are generally far below the cases reported for the corresponding period of 2012 & The figure below shows the number of suspect measles cases reported by week for 2012/14 [annex 1 for district specific reports]. Animal bites (Suspect human rabies): A total of 369 cases of suspect rabies were reported from 74 districts during the current week. This translates into a national weekly incidence of 1.09 suspect rabies cases per 100,000. The top 10 districts [Wakiso, Hoima, Mbale, Mubende, Lyantonde,, Tororo, Oyam, Luweero, Soroti, Nebbi] reported cases this week. Below is a trend graph for suspect rabies during 2012/14. Typhoid Fever: A total of 1414 cases of suspect typhoid fever including two (2) deaths were reported from 81 districts during the current week. This translates into a national weekly incidence of 4.16 cases per 100,000. The top 10 districts [Isingiro, Mbale, Kibaale, Mbarara, Nebbi, Bukwo Lyantonde, Gulu, Jinja, Wakiso] reported cases this week. The figure below shows the number of Typhoid fever cases reported by week for 2012, 2013 & 2014 with the cases reported since the beginning of 2014 exceeding those from the corresponding period of 2012/13 [annex 1 for district specific reports].

6 6 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. This week a total of 7 maternal deaths were reported from Six (6) districts as shown in the table below. Epi week Reporting_Date District Facility OPD_Mater nal_deaths 15 16/04/ :43:33 Kiboga Kiboga l Hospital /04/ :16:27 Bushenyi Ishaka Adventist Hospital /04/ :20:47 Kibaale Betania - Kasenyi HC II /04/ :32:47 Kayunga Kayunga Hospital /04/ :44:32 Tororo Mulanda HC IV /04/ :43:09 Serere Serere HC IV 1 Human Influenza: 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 28-Mar-2014; a total of 324 specimens had been analyzed [by NIC & MUWRP] with 12 isolates. The graph below shows the isolate trends from the NIC by epidemiological week with Influenza type B being the common isolate since the year started.

7 7 Makerere University Walter Reed Project [MUWRP] is implements a complementary Influenza surveillance program with sites in Gulu RRH, Jinja RRH, & Mulago NRH. By the end of the 12 th epidemiological week of 2014 a total of 324 human samples [included in the NIC total above] had been analyzed by MUWRP with 12 isolates. The isolate trends are shown in the figure below. Acute Viral Hepatitis [Hepatitis E Virus - HEV]:During 13 th epidemiological week, a total of 24 new HEV cases were reported from Iriiri [8 cases]; Lokopo [3 cases]; Lopeei [3 cases]; Lorengechora [1 case]; Lotome [2 cases]; Matany [4 cases]; Ngoleriet [2 cases]; Kotido [0 case]; Abim [0 case]; Nakapiripirit [0 case], Katakwi [1 case], & Moroto [0 case]. This brings the cumulative total to 1113 cases including 26 deaths; - with the majority reported from Napak and a few cases the neighboring districts of Moroto, Kotido, Nakapiripirit, Katakwi, Abim, & Amuria. Most of the fatal cases have occurred in pregnant women 16/26 (62%) and the most affected sub-counties in Napak are Lokopo, Lorengechora, Matany, & Lopee. Latrine coverage in Napak district is 18.6% and safe water coverage is 62% though 44% of the safe water sources are non-functional. A comprehensive response is underway using a strategy focused on improving access to safe drinking water, behavioral change communication to improve sanitation and hygiene practices, targeting pregnant mothers for HEV prevention, enhanced HEV case surveillance at health facility and community levels, and supportive care to admitted pregnant mothers and other cases with severe disease. Below is an epidemic curve showing the outbreak trends.

8 Cases [No.] 8 Epidemic curve HEV Napak, 3-Jan-13 to 30-Mar Died Alive '1 '3 '5 '7 '9 '11 '13 Epidemic curve 2013/2014 Multi-Drug Resistant Tuberculosis [MDR-TB]:A total of 491 MDR-TB cases have been detected between January 2008 and September During this period, MDR-TB case detection has increased from 30 cases in 2008 to 86 cases in 2010; 125 cases in 2012;& 129 cases by September 30, MDR-TB case detection is higher in districts close to the designated regional MDR-TB treatment centres in Kampala, Wakiso, Arua, Gulu, Kitgum, and Mpigi. During 2013, the new MDR-TB cases for the months of June, August, & September exceeded the median number of cases for the corresponding months during Similarly, the new MDR-TB cases during June, August, & September of 2013 exceeded the number of new cases for the corresponding months of 2012 (see figure below with MDR-TB trends for ). The National TB & Leprosy Program (NTLP) is currently using 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. The initiation facilities also orient staff at follow up facilities;supply infection control materials; and provide periodic mentorships. The Initiation facility and the follow up facility staff should visit the home of the patient as a requirement to educate the family of their role in supporting this patient during treatment; and also do contact examination. There are nine (9) MDR-TB initiation facilities [Mulago NRH, Mbarara RRH, Mbale RRH, Arua RRH, Masaka RRH, Fort portal RRH, Gulu RRH, Kitgum Hospital, and Iganga Hospital] and due to the lack of specialized isolation wards at RRH, all close-to-home facilities are used as follow up facilities for convenient management of MDR-TB patients.

9 9 The following RRH are being assessed and prepared for MDR-TB management: Lira RRH, Kabale RRH, Soroti RRH, Hoima RRH, Mubende RRH, Moroto RRH, and Mildmay Centre. These data show that the prevention and control of TB and MDR-TB is fast becoming a national emergency that requires multi-sectoral response with adequate resources to: enhance treatment support for drug susceptible TB cases; secure food for MDR-TB cases; enhance utilization of the 46 gene xpert machines by screening more HIV cases for TB & screening suspect MDR-TB cases; monthly sputum testing at the NTRL for all MDR-TB cases; and register, initiate treatment, and educate new TB cases on TB treatment compliance.

10 10 Editorial:Dr. Sarah Achen, 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 For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: /

11 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda Annex 1: Summary of District Reports for Epidemiological week 15 of 2014 [7 April 13 April 2014] (Numbers in brackets indicate deaths) 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) Dokolo 100 T Kayunga 100 T (1) Kyegeg wa 100 T (1) Moyo 100 T (2) Nyadri 100 T Yumbe 96 T (2) Nebbi 95 T (3) Zombo 95 T Bududa 93 T Kisoro 92 T Mbale 91 T (2) Adjuma ni 89 T (1) 0 1(1) Butamba la 87 T Kiruhura 87 T Serere 86 T Gulu 84 T Isingiro 83 T Nakasek e 83 T (1) Bukoma nsimbi 82 T

12 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda Bundibu gyo 82 T Kalangal a 82 T Masindi 82 T Koboko 81 T Mpigi 81 T (1) Amudat 80 T Buhweju 80 T Alebton g 79 T Ibanda 78 T Kabale 78 T Manafw a 78 T (2) (1) 0 Mbarara 78 T Ntoroko 78 T Kiryand ongo 76 T Bulambu li 75 T Kiboga 75 T (1) Kole 75 T Nwoya 75 T Kyenjoj o 73 T Otuke 73 T Kamwen ge 72 T Sironko 72 T

13 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda Kyankw anzi 71 T Soroti 71 T (2) Ssembab ule 71 T Lamwo 70 T Lira 70 T (2) Tororo 68 T (1) Bukwo 67 T Hoima 67 T (3) Buikwe 66 T Kabarole 66 T (6) Bukedea 64 T Budaka 62 T Mityana 62 T (1) Wakiso 61 T Buliisa 60 T Pallisa 60 T (1) Busheny i 59 T Nakapiri pirit 59 T Amolata r 58 T Luweero 58 T Ntunga mo 58 T Gomba 56 T

14 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda National 56 1(0) 369(1) 13(0) 1067(1) 0(0) (40) 63(0) 21(1) 1(0) 0(0) 1414(2) 0(0) Kaliro 55 T Kalungu 55 T Masaka 55 T Kibaale 53 T Rukungi ri 53 T Amuria 50 T Apac 50 T (1) Katakwi 50 T Ngora 50 T Kaberam aido 48 T Kitgum 48 T Kumi 48 T Mukono 47 T Butaleja 46 T (1) Rakai 46 T Buvuma 45 T Kamuli 44 T (2) Oyam 44 T (1) Amuru 42 T Kapchor wa 41 T Kotido 41 T Namayin go 41 T

15 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda Sheema 41 T Luuka 39 T Lwengo 39 T Abim 37 T Lyanton de 37 T Jinja 36 T (1) Kasese 36 T (1) Namutu mba 36 T Buyende 35 T Mubend e 35 T (1) Kibuku 31 T Kanungu 30 T Nakason gola 30 T (1) 0 Mayuge 29 T Moroto 29 T Rubirizi 29 T Iganga 28 T Napak 25 T Arua 17 T Kween 12 T Pader 9 T Kaabong 7 T Kampala 5 T 0 2(1)

16 District % of H/U reporting Timely AFP Animal bite (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness New Others Annex to the Weekly Epidemiological Bulletin for Uganda Mitooma 4 T Bugiri 2 T Agago 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

17 Annex to the Weekly Epidemiological Bulletin for Uganda Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 13 of 2014 [24 30 Mar 2014] Condition Affected Cumulative districts Cases Suspected Disease outbreak New cases (deaths) 7 13 April 2014 [15 th Epi-week] Cumulati ve Deaths Moyo A suspected disease outbreak has been reported in Moyo district, the index case was reported on the 25 th /04/ Cumulative number of cases of 76 with 4 deaths has been recorded so far. 3. Cases are being treated at Obongi H/C IV Moyo district 4. Presenting symptoms are diarrhea, vomiting with some reporting fever and bloody diarrhea. 5. Cases are being managed with provisional diagnosis of cholera on IV fluids and antibiotics. 6. Stool and Blood samples have been sent to CPHL and UVRI for testing. 7. A team from MOH has been sent to Moyo district to investigate the outbreak. Rare disease, Mubende Mubende, Mityana On12 th March 2014, the district rapid response team of Mubende reported a strange disease (that causes a skin rash in patterns corresponding to numbers) in Mugolola Parish, Kiganda Sub County. The cases presented with fever, vomiting, diarrhea, and in some cases abdominal pain. No history of bloody diarrhea or bleeding. Another cluster of 17 cases with similar symptoms has been reported from two sub counties in Mityana district starting April 4, Six blood samples have been obtained from this recent cluster and shipped to UVRI for testing. Suspect Bubonic plague Epidemic meningitis [suspect] Foodborne illness [suspect] Cholera [suspect] Hepatitis E Virus (HEV) Zombo On 28-Mar-2014, the plague program in Arua reported a suspect plague case from Karombo Village, Abira West, Zombo Town Council. 2. Preliminary tests on her samples were negative for plague though she reported six rat deaths prior to the onset of her illness. Two of the rat carcasses picked from her hole tested positive for plague by DFA. 3. IRS for all the households in the affected village is scheduled for 1-April-2014 and will be supported by the DLG and CDC/UVRI plague program in Arua. Nakaseke On 6-Mar-2014, the DHO-Nakaseke reported a cluster of suspect meningitis cases in Ngoma sub-county. A total of ten (10) suspect cases including five (5) deaths were reported initially. However, following investigations conducted by the national rapid response team only five (5) cases including 2 deaths had a clinical presentation consistent with meningococcalmeningitis. All the five (5) cases were identified through retrospective investigation, lacked laboratory test results, and occurred without clustering in space and time Kibaale On 12-Mar-2014, the DHO Kibaale reported a suspect outbreak of Foodborne illness involving 25 boarding school students from Bishop Rwakaikara Primary School. The outbreak started on 10-Mar-2014 and followed a parents visitation day on 9-Mar The affected students were treated and discharged from Kagadi hospital after they improved on supportive treatment. No bacteria were isolated following tests done at CPHL Ntoroko Two new suspect cases have been reported from Ntoroko district. Investigations are underway to identify the etiology and risk factors. Napak HEV cases have been reported from all the seven sub-counties but the majority of the cases have been reported from the sub-counties of Lokopo, Lorengechora, and Matany. 3. Most of the fatal cases have occurred in pregnant women 4. Isolated cases have been reported from neighbouring districts of Moroto, Nakapiripirit, Katakwi, Kotido, Abim, & Amuria.

18 Condition Epidemic meningitis [confirmed] Epidemic meningitis [probable] Suspect VHF (ruled out) Suspect VHF (ruled out) Affected districts New cases (deaths) 7 13 April 2014 [15 th Epi-week] Annex to the Weekly Epidemiological Bulletin for Uganda Cumulative Cumulati Cases ve Deaths 5. Latrine coverage in the district is 18.6% and safe water coverage is 62% though 44% of the safe water sources are non-functional. 6. The current response efforts are coordinated by the National and district taskforce committees 7. Following an assessment undertaken by the national rapid response team; a response plan has been developed and is currently being reviewed by the national task force. 8. Otherwise, response in the affected district has stalled due to the absence of resources to support the planned activities. Adjumani District authorities in Adjumani district, West Nile sub- region, reported a suspected meningitis epidemic on the 2 nd February The index case was reported to have occurred on 31 st January A Ministry of Health team confirmed the outbreak using a combination of Latex agglutination (Pastorex kit) testing and microbiological culturing as due to Neisseria meningitidis serotype W Eight (8) samples collected in Adjumani have tested positive for Neisseria meningitidis serotype W Two sub-counties [Dzaipi & Adropi] in Adjumani surpassed the epidemic and alert thresholds respectively during the 6th epidemiological week are slated for vaccination during the 12th epidemiological week. 5. A total of 6680 doses of the Trivalent AC W135 vaccine, procured with support from Government, UNICEF, & WHO, are already in the country to facilitate the vaccination campaign 6. A meningitis vaccination campaign was conducted in Adropi and Dzaipi sub-counties in Adjumani district during March 21-24, Only 47% of the targeted 58,120 population in Adropi and Dzaipi sub-counties were vaccinated. Arua In Arua, 65 suspect cases have been reported but only one case has been confirmed to have Neisseria meningitidis serogroup W135 BUT cases continue to occur without clustering in time and space. Hoima On 14 Jan. 2014, the DHO Hoima received reports of a cluster of five deaths in Kiyora village, Bugambe subcounty, Hoima district. 3. The cases presented with bloody diarrhea, vomiting, abdominal pains, headache, and low grade fevers. The cases were reported among immigrants from Kabale district that had just recently settled in an area with poor access to safe water and sanitation facilities. 4. All the initial five cases never sought healthcare and eventually died from their illness in the community. 5. During the ensuing investigations, the district rapid response team identified two additional cases. These cases were investigated and promptly initiated on treatment using broad-spectrum antibiotics. 6. These two cases tested negative for cholera using the rapid cholera kits; and no pathogens were isolated from the national reference laboratory following stool cultures. The two cases have since recovered from their illness and no additional cases have been reported from the area in the last two weeks after the rapid response team sensitized the locals on good sanitation, hygiene, and health seeking behaviors. 7. Surveillance has been intensified in this area to detect any additional cases. Kyegegwa On 28 Jan 2014; the Ministry of Health received a report of suspect viral hemorrhagic fever cases in Mpara subcounty, Kyegegwa district.

19 Condition Confirmed Measles outbreaks, Plague Alert (rodent cases) Cholera (suspect) Affected districts Hoima, Arua, Kibaale, & Adjumani New cases (deaths) 7 13 April 2014 [15 th Epi-week] Annex to the Weekly Epidemiological Bulletin for Uganda Cumulative Cumulati Cases ve Deaths 2. A drug shop owner who attended to the four cases relayed the report to MoH using mtrac. 3. The DHO Kyegegwa was alerted and he promptly constituted a team to verify the reports on 29 Jan A total of 4 cases (including 2 deaths) aged 4, 3, 3.5, & 13 years; all from different villages in Mpara sub-county and with no epidemiological link were seen at the drug shop during 28/12/2013 and 28/1/ The presentation of the cases was consistent with severe malaria complicated by severe anaemia requiring transfusion. The two survivors were transfused and eventually recovered after receiving treatment for severe malaria. 6. Two blood samples were obtained from the survivors for testing at UVRI. They both tested negative for Ebola, Marburg, & CCHF. No additional cases were identified and surveillance has been enhanced in the sub-county. 0(0) Measles outbreaks have been confirmed in Adjumani, Arua, Hoima, Kibaale and Ntungamo. The cases in Ntungamo have been reported from Nyakyera, Itojo, and Kahunga sub counties from where a total of 6 cases were confirmed to have measles following tests conducted in the measles laboratory at UVRI on the 11 th March The outbreaks in Adjumani and Arua have been reported in camps hosting refugees from South Sudan while the cases in Hoima originated from Kyangwali sub county IDP camp and then spread to the neighboring sub counties. Measles vaccinations have been undertaken in the affected refugee populations targeting children less than five years of age while accelerated routine immunization has been implemented in the other affected areas. Zombo As part of the ongoing CDC Rat-fall surveillance program in the plague endemic sub-counties of Arua and Zombo districts, two rodents [Rattus rattus species] from Surusoni village, Jiki parish and Andruvu village, Anyavu parish in Logiri sub-county, Arua district tested positive for plague by DFA-test and the corresponding cultures have been initiated. 2. Indoor residual spraying is therefore recommend to protect the inhabitants of the two affected villages 3. Though insecticides, protective wear, and spray pumps are available under the CDC/UVRI program; the districts lack operational funds to conduct the IRS. 4. Several villages in Arua & Zombo therefore remain unsprayed despite confirmation of rodent and/or human plague cases in the recent months. Arua A Cholera outbreak has been reported in Arua district. Since the 21/04/2014, 91 cases including 4 deaths have so far been reported from Rigbo and Pawor subcounties, 2 samples that were collected and sent to CPHL earlier showed no growth, more samples have however been sent to CPHL for confirmation of the outbreak 6. District task force meeting have been convened 7. Cases are being managed at Pawor H/C III, Rhino camp H/CIV and Olujobo H/C III Cholera (confirmed) Nebbi 0 (0) Sporadic cholera cases continue to be reported in Panyimur, Nebbi district where transmission has been ongoing since 16 Jan This indicates a sub-optimal response and failure to address the underlying risk factors inadequate access to safe water; & poor sanitation and hygiene. 3. A thorough evaluation of the outbreak trends and response is warranted to ensure that sustainable interventions are initiated to curtail the current transmission. Cholera Arua During week 13,a suspect cholera case was reported from Arua and nine (9) satellite cases in Maracha district. The

20 Condition (suspect) Cholera (suspect) Nodding Syndrome Affected districts New cases (deaths) 7 13 April 2014 [15 th Epi-week] Maracha Kitgum OPD 2,034 IPD 162 Lamwo OPD IPD 39 Pader OPD 1,210 IPD 108 Annex to the Weekly Epidemiological Bulletin for Uganda Cumulative Cumulati Cases ve Deaths outbreak in Maracha was linked to a suspect cholera death in Rhino camp, Arua that was eventually buried in Maracha district. 2. The outbreak in Maracha started on 28 th March 2014 with the index case being 55-year-old female from Okaa village, Oluffe sub-county. She was admitted to Maracha hospital and following a positive rapid test for cholera; she underwent treatment from 30 th March to 4 th April Samples have not been sent to CPHL for confirmatory testing. 4. Adequate supplies are available in the districts to manage cases Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalized 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. 1. Case management ongoing at the treatment centre and outreach posts. 2. Nodding syndrome census finalized 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 finalized 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 finalized 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 sub-county. 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 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.

21 Condition Affected districts New cases (deaths) 7 13 April 2014 [15 th Epi-week] Annex to the Weekly Epidemiological Bulletin for Uganda Cumulative Cumulati Cases ve Deaths Pader OPD 1,251 The data presented here is derived from patients seen at NS treatment centres Atanga HCIII & outreaches. IPD 41 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.

22 Annex to the Weekly Epidemiological Bulletin for Uganda Editorial:Dr. Sarah Achen, Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, Dr. ImmaculateNabukenya, 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 For comments, please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: /