PLoS Neglected Tropical Diseases (Mar 2021)

Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018-January 2019.

  • Bernadette Basuta Mirembe,
  • Angella Musewa,
  • Daniel Kadobera,
  • Esther Kisaakye,
  • Doreen Birungi,
  • Daniel Eurien,
  • Luke Nyakarahuka,
  • Stephen Balinandi,
  • Alex Tumusiime,
  • Jackson Kyondo,
  • Sophia Mbula Mulei,
  • Jimmy Baluku,
  • Benon Kwesiga,
  • Steven Ndugwa Kabwama,
  • Bao-Ping Zhu,
  • Julie R Harris,
  • Julius Julian Lutwama,
  • Alex Riolexus Ario

DOI
https://doi.org/10.1371/journal.pntd.0009213
Journal volume & issue
Vol. 15, no. 3
p. e0009213

Abstract

Read online

IntroductionCrimean-Congo haemorrhagic fever (CCHF) is a tick-borne, zoonotic viral disease that causes haemorrhagic symptoms. Despite having eight confirmed outbreaks between 2013 and 2017, all within Uganda's 'cattle corridor', no targeted tick control programs exist in Uganda to prevent disease. During a seven-month-period from July 2018-January 2019, the Ministry of Health confirmed multiple independent CCHF outbreaks. We investigated to identify risk factors and recommend interventions to prevent future outbreaks.MethodsWe defined a confirmed case as sudden onset of fever (≥37.5°C) with ≥4 of the following signs and symptoms: anorexia, vomiting, diarrhoea, headache, abdominal pain, joint pain, or sudden unexplained bleeding in a resident of the affected districts who tested positive for Crimean-Congo haemorrhagic fever virus (CCHFv) by RT-PCR from 1 July 2018-30 January 2019. We reviewed medical records and performed active case-finding. We conducted a case-control study and compared exposures of case-patients with age-, sex-, and sub-county-matched control-persons (1:4).ResultsWe identified 14 confirmed cases (64% males) with five deaths (case-fatality rate: 36%) from 11 districts in western and central region. Of these, eight (73%) case-patients resided in Uganda's 'cattle corridor'. One outbreak involved two case-patients and the remainder involved one. All case-patients had fever and 93% had unexplained bleeding. Case-patients were aged 6-36 years, with persons aged 20-44 years more affected (AR: 7.2/1,000,000) than persons ≤19 years (2.0/1,000,000), p = 0.015. Most (93%) case-patients had contact with livestock ≤2 weeks before symptom onset. Twelve (86%) lived ConclusionsCCHF outbreaks occurred sporadically during 2018-2019, both within and outside 'cattle corridor' districts of Uganda. Most cases were associated with tick exposure. The Ministry of Health should partner with the Ministry of Agriculture, Animal Industry and Fisheries to develop joint nationwide tick control programs and strategies with shared responsibilities through a One Health approach.