Thursday, June 14, 2018

PRO/AH/EDR> Crimean-Congo hem. fever - East Africa (05): Uganda (MD) alert

CRIMEAN-CONGO HEM. FEVER- EAST AFRICA(05): UGANDA (MUBENDE) ALERT
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International Society for Infectious Diseases
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Date: Mon 11 Jun 2018
Source: The Independent [edited]
<https://www.independent.co.ug/crimean-congo-fever-death-uganda-placed-on-high-alert/>


Experts are closely monitoring 5 people at an isolation center set up
in Mubende district. This was after a patient succumbed to
Crimean-Congo hemorrhagic fever (CCHF).

The 35-year old man was first recorded at a clinic in district with
high fever and persistent vomiting. When his symptoms did not subside
after a few days of treatment, he was on [23 May 2018] referred to
Mubende Regional Referral Hospital.

On arrival, several tests were carried out and turned out negative.
Suspicious health officials placed the patient in the isolation center
from where he received intravenous fluids. He died in the wee hours of
the night he was admitted.

Dr Sarah Opendi, the Minister of Health in charge of General Duties
told The Independent that samples from the patient tested at the
Uganda Virus Research Institute revealed he had succumbed to CCHF. The
incident immediately triggered the standard hemorrhagic fever
response, including monitoring of known contacts of the dead
patients.

A national rapid response team was dispatched to Mubende to collect
more information and assist the district to mount an appropriate
response that included orientating health workers on how to carefully
handle suspected patients.

Staff members of the hospital who got in contact with the dead patient
were given digital thermometers and instructed to record their body
temperatures twice daily to capture any changes in a timely manner.

Mortality rate from Crimean-Congo, according to experts is
approximately 30 percent, with death occurring in the 2nd week of
illness. But whenever it is confirmed, there is panic.

When it broke out early this year [2018] in Nakaseke and Luweero
districts, there was initially denial. The Ministry of Health
dismissed reports by district officials that a 9-year old girl who had
died in December [2017] had succumbed to any viral hemorrhagic fever.

But the incident sent a wave of fear among residents and district
leaders who demanded a clear explanation by government; especially
after 2 other people developed similar symptoms. That is when it was
confirmed there was actually an active outbreak.

The disease was first characterised in the Crimea in 1944 and given
the name Crimean hemorrhagic fever. It was then later recognised in
1969 as the cause of illness in the Congo, thus resulting in its
current name.

CCHF is generally a disease of animals but also attacks herders and
other people who come in contact with tick harboring animals. It can
also be transmitted human to human through contact with infected blood
or other bodily fluids.

Although Crimean-Congo fever behaves somewhat like Ebola hemorrhagic
fever which is currently ravaging people in the neighboring Democratic
Republic of Congo, Dr Julius Lutwama a virologist at the Uganda Virus
Research Institute says the 2 are not in the same viral family as CCHF
is a bunyavirus similar to Rift Valley fever which also attacks
animals.

Experts say the onset of the disease is sudden, with initial signs and
symptoms including headache, high fever, back pain, joint pain,
stomach pain, sore throat, and vomiting. As the illness progresses,
bleeding eyes, large areas of severe bruising, severe nosebleeds, and
uncontrolled bleeding at injection sites can be seen, beginning around
the 4th day of illness and lasting for about 2 weeks.

Lutwama who heads the Arbovirology, Emerging and Re-emerging Diseases
division at the institute says although the disease is not as fatal,
recovery is slow whereby improvement generally begins on the 9th or
10th day after the onset of illness. And, treatment is primarily
supportive. For him, the best way to go around the illness is working
really fast.

"The faster you can get a diagnosis of the fever, the faster you can
stop it," he told The Independent, "And the only way to stop it is to
break the chain of infection." Lutwama however says CCHF's laboratory
diagnosis is made when the infection is in acute stage where they use
different techniques to identify the virus through detecting
antibodies, the virus RNA or the virus itself. But, even before tests
are made, Lutwama says health workers must be able to easily identify
a suspected case and put them under surveillance to ensure that the
virus does not jump to another person.

The outbreaks that have happened in the country according to Lutwama
all confirm one point - that there should be constant surveillance for
all the viral hemorrhagic fevers. For now however, the Ministry has
embarked on creating awareness and warning people in the cattle
corridor districts to use protective wear while slaughtering and
handling animals to prevent transmission. They are also advised to use
insect repellents that are effective in warding off ticks from exposed
skin or clothing. To avoid infection at health facility level, medical
workers are advised to use proper infection control precautions to
prevent exposure.

Crimean-Congo fever outbreaks
-----------------------------
- 23 May 2018: a 35-year-old man from Nkoko sub-county in Kakumiro
district dies at Mubende Regional Referral Hospital.
- December 2017: a 9-year-old girl dies. 2 other people develop
symptoms in Nakaseke and Luweero districts.
- 2015: a 33-year-old male admitted to Mengo Hospital in Kampala
tested positive for the infection.
- September 2013: a female patient dies in Nansana on the outskirts of
Kampala city. The Ministry of Health had just declared that the
country was Crimean-Congo fever free.
- August 2013: a farmer in the northern Uganda district of Agago dies.
This was the 1st confirmed case after more than 50 years of no
reported human CCHF case. 3 others in the same area who had died
before this case was confirmed were also suspected to have succumbed
to the infection. Around the same time, another case was confirmed at
Mulago National Referral Hospital in Kampala.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The report above provides additional details on a fatal CCHF case
that was reported by ProMED in February 2018 (Crimean-Congo hem. fever
- East Africa (04): Uganda (MD)
http://promedmail.org/post/20180528.5821815) and the response
activities by health officials. - Mod.UBA

Maps of Uganda: <http://en.wikipedia.org/wiki/Districts_of_Uganda> and
<http://healthmap.org/promed/p/18249>]

[See Also:
Crimean-Congo hem. fever - East Africa (04): Uganda (MD)
http://promedmail.org/post/20180528.5821815
Crimean-Congo
hem. fever - East Africa (03): Uganda (NK)
http://promedmail.org/post/20180201.5598684
Crimean-Congo
hem. fever - East Africa (02): S Sudan (EL) susp, Uganda
(NK) RFI http://promedmail.org/post/20180117.5563295
Undiagnosed hemorrhagic illness - South Sudan: (EL) fatal
http://promedmail.org/post/20180109.5545676
Crimean-Congo
hem fever - East Africa: Uganda (LW)
http://promedmail.org/post/20180106.5541551
2017
----
Crimean-Congo hem. fever - Uganda (02)
http://promedmail.org/post/20170906.5299656
Crimean-Congo
hem. fever - Uganda: (QO, NK)
http://promedmail.org/post/20170828.5276952
2016
----
Undiagnosed hemorrhagic illness - South Sudan (05): new comment
http://promedmail.org/post/20160707.4332000
Undiagnosed hemorrhagic illness - South Sudan (04): addtl comment
http://promedmail.org/post/20160704.4324160
Undiagnosed hemorrhagic illness - South Sudan (03): comment
http://promedmail.org/post/20160702.4322974
Undiagnosed hemorrhagic illness - South Sudan (02): addtl. information
http://promedmail.org/post/20160625.4309572
Undiagnosed hemorrhagic illness - South Sudan
http://promedmail.org/post/20160519.4233420
2013
----
Crimean-Congo hem. fever - Uganda (04): clarification
http://promedmail.org/post/20130826.1903826
Crimean-Congo
hem. fever - Uganda (03): (KM, AG) fatal
http://promedmail.org/post/20130824.1899673
Crimean-Congo
hem. fever - Uganda (02): (AG) conf. case
http://promedmail.org/post/20130819.1888823
Crimean-Congo
hem. fever - Uganda: (AG) fatal
http://promedmail.org/post/20130816.18850562013
----
Undiagnosed hemorrhagic fever - Uganda: (LW) susp, RFI
http://promedmail.org/post/20131203.2089792
Crimean-Congo
hemorrhagic fever - Uganda (05): (AG, KM)
http://promedmail.org/post/20130918.1953109
2010
----
Crimean-Congo hem. fever 2008 - Sudan: nosocomial
http://promedmail.org/post/20100509.1511]
.................................................sb/uba/mj/jh
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