Patterns of Human Plague in Uganda, 2008–2016

Forrester, Joseph D.; Apangu, Titus; Griffith, Kevin S.; Acayo, Sarah; Yockey, Brook; Kaggwa, John; Kugeler, Kiersten J.; Schriefer, Martin E.; Sexton, Christopher; Beard, Charles B.; Candini, Gordian; Abaru, Janet; Candia, Bosco; Okoth, Jimmy Felix; Apio, Harriet; Nolex, Lawrence; Ezama, Geoffrey; Okello, Robert; Atiku, Linda A.; Mpanga, Joseph T.; Mead, Paul S.

doi:10.3201/eid2309.170789

Cited by 23 publications

(29 citation statements)

References 16 publications

(16 reference statements)

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“…6 In Uganda, many disease-specific surveillance systems exist, such as for malaria, influenza, viral hemorrhagic fevers, and plague. 15,33,34 A more comprehensive and integrated approach to disease surveillance and laboratory evaluation can generate information to minimize inefficiencies of disease-specific surveillance silos and assure that limited public health resources are leveraged appropriately to improve health security.…”

Section: Resultsmentioning

confidence: 99%

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

et al. 2018

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Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.

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Section: Resultsmentioning

confidence: 99%

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

et al. 2018

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“…Despite sporadic cases of plague in Uganda, the incidence has gradually been decreasing [3]. This may be in part attributed to an enhanced surveillance program begun in 2003 by the Uganda Virus Research Institute (UVRI).…”

Section: Discussionmentioning

confidence: 99%

“…Pneumonic plague is the most virulent form and may result from progression of untreated bubonic plague or be transmitted by droplets from an infected person [2]. Septicemic plague manifests by darkening of parts of the body caused by infestation of the blood vessels by the bacteria [3]. The incubation period of plague ranges between 1-8 days, depending on the mechanism of infection and subsequent presentation [4].…”

Section: Introductionmentioning

confidence: 99%

“…It is located near the borders of DRC and South Sudan and predominantly has a subsistence agricultural economy. Over the years, there have been sporadic cases of plague in this region, with the overall incidence decreasing gradually since 2009 [3]. The decline in plague cases has likely been due to efforts by the Uganda Virus Research Institute to conduct plague surveillance and community sensitization on prevention methods in the region, including availing of RDT kits in the region [3].…”

Section: Introductionmentioning

confidence: 99%

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Fatal Cross-Border Plague in Zombo District, Uganda, March 2019

Gonahasa¹,

Amia²,

Basuta³

et al. 2020

Preprint

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Background: Plague, which is caused by Yersinia pestis, is a priority zoonotic disease targeted for elimination in Uganda. Untreated bubonic plague, resulting from a flea bite, can develop into pneumonic plague, or pneumonic plague may be transmitted in respiratory droplets from person to person. On 6 March 2019, the Uganda Ministry of Health was notified of a patient in Zombo District with clinical presentation similar to pneumonic plague, and a positive plague rapid diagnostic test (RDT). The patient had family links to the Democratic Republic of Congo (DRC). We determined the scope of the outbreak, determined the mode of transmission, and recommended evidence-based control and prevention measures.Methods: A suspected pneumonic plague case was ≥2 of: cough (bloody or wet), chest pain, difficulty in breathing, or fever in a resident of Zombo District during February 1-March 31, 2019. A confirmed case was a suspected case testing positive for Yersinia pestis by rapid diagnostic test, culture or serology. We actively searched for case-patients, traced contacts and took samples as appropriate. We performed descriptive epidemiology of the outbreak.Results: We identified one suspected and one confirmed pneumonic plague case. On February 26, 2019, a 4-year-old boy was buried in DRC near the Uganda border after reportedly succumbing to a disease consistent with bubonic plague. Case-patient A (35-year-old mother to the boy), fell ill with suspected pneumonic plague while attending to him. She was referred to a health facility in Uganda on February 28 but died on arrival. On March 4, Case-patient B (23-year-old sister to Case-patient A), who attended to Case-patient A, presented with pneumonic plague symptoms to the same Uganda facility and tested plague-positive by RDT, culture, and serological tests. Contacts (n=114) were traced and given antibiotics as prophylaxis; no new cases were reported.Conclusion: This fatal plague outbreak started as bubonic and later manifested as pneumonic. There was cross-border spread from DRC to Uganda with no cross-border efforts at prevention and control. Person-to-person transmission appears to have occurred. The quick and effective response likely minimized spread.

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“…Worldwide, the highest risk areas are found in the African region, which accounted for 97% of human cases reported to the World Health Organization (WHO) (11,247 of 11,598 cases) over the last decade (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Most of these cases were reported from Madagascar and the east African countries of Democratic Republic of the Congo, Tanzania, and Uganda where plague has a long history (Neerinckx et al 2010, Bertherat 2016, Forrester et al 2017.…”

Section: Introductionmentioning

confidence: 99%

The changing triad of plague in Uganda: invasive black rats(Rattus rattus), indigenous small mammals, and their fleas

Enscore

Babi

Amatre

et al. 2020

Journal of Vector Ecology

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Rattus rattus was first reported from the West Nile Region of Uganda in 1961, an event that preceded the appearance of the first documented human plague outbreak in 1970. We investigated how invasive R. rattus and native small mammal populations, as well as their fleas, have changed in recent decades. Over an 18‐month period, a total of 2,959 small mammals were captured, sampled, and examined for fleas, resulting in the identification of 20 small mammal taxa that were hosts to 5,109 fleas (nine species). Over three‐fourths (75.8%) of captured mammals belonged to four taxa: R. rattus, which predominated inside huts, and Arvicanthis niloticus, Mastomys sp., and Crocidura sp., which were more common outside huts. These mammals were hosts for 85.8% of fleas collected, including the efficient plague vectors Xenopsylla cheopis and X. brasiliensis, as well as likely enzootic vectors, Dinopsyllus lypusus and Ctenophthalmus bacopus. Flea loads on small mammals were higher in certain environments in villages with a recent history of plague compared to those that lacked such a history. The significance of these results is discussed in relation to historical data, the initial spread of plague in the WNR and the continuing threat posed by the disease.

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Patterns of Human Plague in Uganda, 2008–2016

Cited by 23 publications

References 16 publications

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Fatal Cross-Border Plague in Zombo District, Uganda, March 2019

The changing triad of plague in Uganda: invasive black rats(Rattus rattus), indigenous small mammals, and their fleas

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