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1. Uganda’s experience in Ebola virus disease outbreak preparedness, 2018–2019

Author

Jane Ruth Aceng, Alex R. Ario, Allan N. Muruta, Issa Makumbi, Miriam Nanyunja, Innocent Komakech, Andrew N. Bakainaga, Ambrose O. Talisuna, Collins Mwesigye, Allan M. Mpairwe, Jayne B. Tusiime, William Z. Lali, Edson Katushabe, Felix Ocom, Mugagga Kaggwa, Bodo Bongomin, Hafisa Kasule, Joseph N. Mwoga, Benjamin Sensasi, Edmund Mwebembezi, Charles Katureebe, Olive Sentumbwe, Rita Nalwadda, Paul Mbaka, Bayo S. Fatunmbi, Lydia Nakiire, Mohammed Lamorde, Richard Walwema, Andrew Kambugu, Judith Nanyondo, Solome Okware, Peter B. Ahabwe, Immaculate Nabukenya, Joshua Kayiwa, Milton M. Wetaka, Simon Kyazze, Benon Kwesiga, Daniel Kadobera, Lilian Bulage, Carol Nanziri, Fred Monje, Dativa M. Aliddeki, Vivian Ntono, Doreen Gonahasa, Sandra Nabatanzi, Godfrey Nsereko, Anne Nakinsige, Eldard Mabumba, Bernard Lubwama, Musa Sekamatte, Michael Kibuule, David Muwanguzi, Jackson Amone, George D. Upenytho, Alfred Driwale, Morries Seru, Fred Sebisubi, Harriet Akello, Richard Kabanda, David K. Mutengeki, Tabley Bakyaita, Vivian N. Serwanjja, Richard Okwi, Jude Okiria, Emmanuel Ainebyoona, Bernard T. Opar, Derrick Mimbe, Denis Kyabaggu, Chrisostom Ayebazibwe, Juliet Sentumbwe, Moses Mwanja, Deo B. Ndumu, Josephine Bwogi, Stephen Balinandi, Luke Nyakarahuka, Alex Tumusiime, Jackson Kyondo, Sophia Mulei, Julius Lutwama, Pontiano Kaleebu, Atek Kagirita, Susan Nabadda, Peter Oumo, Robinah Lukwago, Julius Kasozi, Oleh Masylukov, Henry Bosa Kyobe, Viorica Berdaga, Miriam Lwanga, Joe C. Opio, David Matseketse, James Eyul, Martin O. Oteba, Hasifa Bukirwa, Nulu Bulya, Ben Masiira, Christine Kihembo, Chima Ohuabunwo, Simon N. Antara, Wilberforce Owembabazi, Paul B. Okot, Josephine Okwera, Isabelle Amoros, Victoria Kajja, Basnet S. Mukunda, Isabel Sorela, Gregory Adams, Trevor Shoemaker, John D. Klena, Celine H. Taboy, Sarah E. Ward, Rebecca D. Merrill, Rosalind J. Carter, Julie R. Harris, Flora Banage, Thomas Nsibambi, Joseph Ojwang, Juliet N. Kasule, Dan F. Stowell, Vance R. Brown, Bao-Ping Zhu, Jaco Homsy, Lisa J. Nelson, Patrick K. Tusiime, Charles Olaro, Henry G. Mwebesa, and Yonas Tegegn Woldemariam

Subjects
Ebola, Viral Haemorrhagic fever, Epidemic preparedness, Disease outbreaks, Global Health security, Uganda, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness. Results On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. Conclusion As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.

Published
2020
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2. Timing of Onset of Symptom for COVID-19 from Publicly Reported Confirmed Cases in Uganda

Author

Alex Riolexus Ario, Bernadette Basuta Mirembe, Claire Biribawa, Lilian Bulage, Daniel Kadobera, Henry Bosa Kyobe, Noah Kiwanuka, and Robert Wamala

Abstract

Background: The incubation period for COVID-19, which is the time from exposure to symptom onset, is on average five to six days but reach 14 days. The question is, the timing of onset of various signs and symptoms of COVID-19 along the period amongst cases in Uganda is not known. Methodology: We utilized administrative data of publicly reported real-time RT-PCR laboratory COVID-19 confirmed cases in Uganda to investigate the timing of symptom onset, from 21-Marto 4-Sep-2020. Since timing of COVID-19 symptom onset is highly likely to be an interval rather than a point estimate, we generated three tertile categories of the period – 1st, 2nd, and 3rd tertiles denoting symptom presentation within 3, 4-6 and at least 7-days respectively. All signs and symptoms reported in the database were considered. We did not make any inferences about asymptomatic infection with SARS-COV-2. We analysed using frequency distributions, Chi-square test and Multinomial Logistic Regression; and controlled for age and sex.Results: We analysed a total of 420 symptomatic case-patients. The case-patients were predominantly male, 72.0% (304/420), median age of 33 years, IQR=26-41. The common symptoms of SARS-CoV-2 were: cough (47.6%), running nose (46.2%), fever (27.4%), headache (26.4%) and sore throat (20.5%). We utilized only 293 COVID-19 symptomatic cases that had clinical symptom onset date recorded for analysis of the timing of symptom onset. Most case-patients, 37.5% (109/293) - presented symptom within 3-days after laboratory confirmation, 31.4% (92/293) had symptoms in the 2nd and another 31.4% (92/293) in 3rd tertile, denoting 4-6 days and at-least 7 days after exposure, respectively. Running nose (RRR =0.45, 95% CI 0.24 - 0.84) and chest pain (RRR = 0.64, 95% CI 0.09 – 0.72) were less likely to occur in the 1st tertile and 2nd tertile rather than in the 3rd tertile. Case-patients aged ≥20yrs were less likely to have symptoms in the 1st and 2nd tertile compared to ≤20 years (p < 0.05). Conclusion: Our study provides empirical evidence for epidemiological characterization of cases by signs and symptoms along the incubation period among case-patients. This complements the current proposals for the length of active monitoring of persons exposed to SARS-CoV-2.

Published
2020
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