Surveillance for Yellow Fever following an Outbreak in Northern Uganda, November 2010

Background: Two deaths from an unknown hemorrhagic disease were reported in Northern Uganda on 22nd October 2010. A multi-disciplinary team led by Ministry of Health set out to investigate the outbreak.

Methods: We conducted a cross-sectional study in ten affected districts. Case definitions:- "Community level suspect case"- any person with fever, associated with headache, joint/muscle pains, yellowing of eyes and any unexplained bleeding from any body part; "Facility suspect case"- any person with an acute onset of fever, with either a negative blood slide or rapid diagnostic test for malaria or failure to respond to a full course of anti-malarials and jaundice or bleeding from any body part. Community case reporting and active surveillance were carried out. All suspected cases were line-listed and case investigation forms completed. Serological investigations were done at local and reference laboratories.

Results: By 17th January, 2011: a total of 224 suspect cases, 53 deaths had been reported (CFR = 23.7%). Five laboratory tests confirmed yellow fever; PCR (2), robust molecular sequencing (1), Ig M (1) and immunohistochemical testing (1). Common symptoms were fever, headache, dizziness, epigastric pain, jaundice, epistaxis, melena stools and hematemesis. Convulsions and disorientation were terminal presentations. Risk factors included hunting, gold mining, proximity to wild animals especially monkeys, and bush cutting, wild search for bamboo, collecting and washing in unprotected water sources, and non-use of insecticide treated bed-nets.

Conclusion: Yellow fever outbreak was confirmed, associated with working in bushes and interacting with yellow fever reservoirs. We recommend to Ministry of Health urgent mass vaccination of the population at risk and education about vector control, and intensifying surveillance activities. Recommendations are currently being implemented. 

Author (s): 

Anwar Kakeeto, B. Lubwama, L. Basajjasubi, M. Musenero, J. Wamala, I. Makumbi

Presenter (s): 
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