Viral Hemorrhagic Fever Surveillance, Laboratory Testing, and Outbreak Response in Uganda: 2010-2012

Abstract

Background: Uganda is endemic for viral hemorrhagic fevers (VHFs) and other zoonotic diseases. Beginning in July 2010 the Viral Special Pathogens Branch (VSPB), CDC, the Uganda Virus Research Institute (UVRI), and the Ministry of Health (MOH) established a first of it’s kind National VHF surveillance program. In addition, a permanent National VHF diagnostics reference laboratory has been established at the UVRI in Entebbe.

Objective: To establish and maintain a National standardized, integrated, viral hemorrhagic fever surveillance system in Uganda that will detect the first instances of suspect VHFs, report them to rapidly report them to the national level, and perform rule-out testing within 24 hours of sample receipt.

Methodology: Training on VHF case definitions, data collection, and clinical case identification was carried out at 6 VHF sentinel sites. Training on safe sample collection and transport was also performed.

Results: Since July 2010, 6 sentinel VHF surveillance sites were established and over 30 clinical and laboratory staff were trained on case identification, reporting, and sample collection for suspect cases. The laboratory has tested over 1000 clinical samples for suspect VHFs and serosurveys. The program identified an outbreak of Yellow Fever in Northern Uganda in 2010. The program also confirmed three outbreaks of Ebola hemorrhagic fever. The first was a single Ebola case in Luwero district in May, 2011. The second outbreak was in Kibaale District, Uganda in June 2012. 115 suspect, 13 probable, and 11 laboratory confirmed Ebola cases were identified (CFR=67%). A third outbreak was confirmed in Isiro, DRC and is currently ongoing. The VHF surveillance program continues to receive suspect VHF case reports from Uganda and the region.

Conclusions: Rapid identification and confirmation of VHF cases has led to the rapid response and containment of recent outbreaks in Uganda and DRC. Continued efforts are needed to build and sustain VHF surveillance networks throughout Africa.