Browsing by Author "Balinandi, Stephen"
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Item First Laboratory-Confirmed Outbreak of Human and Animal Rift Valley Fever Virus in Uganda in 48 Years(The American journal of tropical medicine and hygiene, 2019) Shoemaker, Trevor R.; Nyakarahuka, Luke; Balinandi, Stephen; Ojwang, Joseph; Tumusiime, Alex; Mulei, Sophia; Kyondo, Jackson; Lubwama, Bernard; Sekamatte, Musa; Namutebi, Annemarion; Tusiime, Patrick; Monje, Fred; Mayanja, Martin; Ssendagire, Steven; Dahlke, Melissa; Kyazze, Simon; Wetaka, Milton; Makumbi, Issa; Borchert, Jeff; Zufan, Sara; Patel, Ketan; Whitmer, Shannon; Brown, Shelley; Davis, William G.; Klena, John D.; Nichol, Stuart T.; Rollin, Pierre E.; Lutwama, JuliusIn March 2016, an outbreak of Rift Valley fever (RVF) was identified in Kabale district, southwestern Uganda. A comprehensive outbreak investigation was initiated, including human, livestock, and mosquito vector investigations. Overall, four cases of acute, nonfatal human disease were identified, three by RVF virus (RVFV) reverse transcriptase polymerase chain reaction (RT-PCR), and one by IgM and IgG serology. Investigations of cattle, sheep, and goat samples from homes and villages of confirmed and probable RVF cases and the Kabale central abattoir found that eight of 83 (10%) animals were positive for RVFV by IgG serology; one goat from the home of a confirmed case tested positive by RT-PCR. Whole genome sequencing from three clinical specimens was performed and phylogenetic analysis inferred the relatedness of 2016 RVFV with the 2006–2007 Kenya-2 clade, suggesting previous introduction of RVFV into southwestern Uganda. An entomological survey identified three of 298 pools (1%) of Aedes and Coquillettidia species that were RVFV positive by RT-PCR. This was the first identification of RVFV in Uganda in 48 years and the 10th independent viral hemorrhagic fever outbreak to be confirmed in Uganda since 2010.Item Genetic Diversity of Bundibugyo Ebolavirus from Uganda and the Democratic Republic of Congo(bioRxiv, 2021) Omara, Isaac Emmanuel; Kiwuwa-Muyingo, Sylvia; Balinandi, Stephen; Nyakarahuka, Luke; Kiconco, Jocelyn; Kayiwa, John Timothy; Mboowa, Gerald; Jjingo, Daudi; Lutwama, Julius J.The Ebolavirus is one of the deadliest viral pathogens which was first discovered in the year 1976 during two consecutive outbreaks in the Democratic Republic of Congo and Sudan. Six known strains have been documented. The Bundibugyo Ebolavirus in particular first emerged in the year 2007 in Uganda. This outbreak was constituted with 116 human cases and 39 laboratory confirmed deaths. After 5 years, it re-emerged and caused an epidemic for the first time in the Democratic Republic of Congo in the year 2012 as reported by the WHO. Here, 36 human cases with 13 laboratory confirmed deaths were registered. Despite several research studies conducted in the past, there is still scarcity of knowledge available on the genetic diversity of Bundibugyo Ebolavirus. We undertook a research project to provide insights into the unique variants of Bundibugyo Ebolavirus that circulated in the two epidemics that occurred in Uganda and the Democratic Republic of CongoItem Intervention To Stop Transmission of Imported Pneumonic Plague — Uganda, 2019(Morbidity and Mortality Weekly Report, 2019) Apangu, Titus; Acayo, Sarah; Atiku, Linda A.; Apio, Harriet,; Candini, Gordian; Okoth, Felix; Kaggwa Basabose, John; Ojosia, Lawrence; Ajoga, Sam; Mongiba, Grace; Makoba Wetaka, Milton; Kayiwa, Joshua; Balinandi, Stephen; Schwartz, Amy; Yockey, Brook; Sexton, Christopher; Dietrich, Elizabeth A.; Pappert, Ryan; Petersen, Jeannine M.; Mead, Paul S.; Lutwama, Julius J.; Kugeler, Kiersten J.Plague, an acute zoonosis caused by Yersinia pestis, isendemic in the West Nile region of northwestern Uganda andneighboring northeastern Democratic Republic of the Congo(DRC) (1–4). The illness manifests in multiple clinical forms,including bubonic and pneumonic plague. Pneumonic plagueis rare, rapidly fatal, and transmissible from person to person via respiratory droplets. On March 4, 2019, a patient withsuspected pneumonic plague was hospitalized in West Nile,Uganda, 4 days after caring for her sister, who had come toUganda from DRC and died shortly thereafter, and 2 daysafter area officials received a message from a clinic in DRCwarning of possible plague. The West Nile-based Uganda Virus Research Institute (UVRI) plague program, together withlocal health officials, commenced a multipronged responseto suspected person-to-person transmission of pneumonicplague, including contact tracing, prophylaxis, and education.Plague was laboratoryconfirmed, and no additionaltransmission occurred in Uganda. This event transpired inthe context of heightened awareness of cross-border disease spread caused by ongoing Ebola virus disease transmission in DRC, approximately 400 km to the south. Building expertise in areas of plague endemicity can provide the rapid detection and effective response needed to mitigate epidemic spread and minimize mortality. Cross-border agreements can improve ability to respond effectively.Item Isolation of Genetically Diverse Marburg Viruses from Egyptian Fruit Bats(PLoS pathogens, 2009) Towner, Jonathan S.; Amman, Brian R.; Sealy, Tara K.; Carroll, Serena A. Reeder; Comer, James A.; Kemp, Alan; Swanepoel, Robert; Paddock, Christopher D.; Balinandi, Stephen; Khristova, Marina L.; Formenty, Pierre B. H.; Albarino, Cesar G.; Miller, David M.; Reed, Zachary D.; Kayiwa, John T.; Mills, James N.; Cannon, Deborah L.; Greer, Patricia W.; Byaruhanga, Emmanuel; Farnon, Eileen C.; Atimnedi, Patrick; Okware, Samuel; Mbidde, Edward Katongole; Downing, Robert; Tappero, Jordan W.; Zaki, Sherif R.; Ksiazek, Thomas G.; Nichol, Stuart T.; Rollin, Pierre E.In July and September 2007, miners working in Kitaka Cave, Uganda, were diagnosed with Marburg hemorrhagic fever. The likely source of infection in the cave was Egyptian fruit bats (Rousettus aegyptiacus) based on detection of Marburg virus RNA in 31/611 (5.1%) bats, virus-specific antibody in bat sera, and isolation of genetically diverse virus from bat tissues. The virus isolates were collected nine months apart, demonstrating long-term virus circulation. The bat colony was estimated to be over 100,000 animals using mark and re-capture methods, predicting the presence of over 5,000 virus-infected bats. The genetically diverse virus genome sequences from bats and miners closely matched. These data indicate common Egyptian fruit bats can represent a major natural reservoir and source of Marburg virus with potential for spillover into humans.Item Knowledge and Attitude towards Ebola and Marburg Virus Diseases in Uganda Using Quantitative and Participatory Epidemiology Techniques(PLoS neglected tropical diseases, 2017) Nyakarahuka, Luke; Skjerve, Eystein; Nabadda, Daisy; Sitali, Doreen Chilolo; Mumba, Chisoni; Mwiine, Frank N.; Lutwama, Julius J.; Balinandi, Stephen; Shoemaker, Trevor; Kankya, CloviceUganda has reported five (5) Ebola virus disease outbreaks and three (3) Marburg virus disease outbreaks from 2000 to 2016. Peoples’ knowledge and attitude towards Ebola and Marburg virus disease impact on control and prevention measures especially during outbreaks. We describe knowledge and attitude towards Ebola and Marburg virus outbreaks in two affected communities in Uganda to inform future outbreak responses and help in the design of health education and communication messages.The study was a community survey done in Luweero, Ibanda and Kamwenge districts that have experienced outbreaks of Ebola and Marburg virus diseases. Quantitative data were collected using a structured questionnaire and triangulated with qualitative participatory epidemiology techniques to gain a communities’ knowledge and attitude towards Ebola and Marburg virus disease.Out of 740 respondents, 48.5% (359/740) were categorized as being knowledgeable about Ebola and Marburg virus diseases, whereas 60.5% (448/740) were having a positive attitude towards control and prevention of Ebola and Marburg virus diseases. The mean knowledge and attitude percentage scores were 54.3 (SD = 23.5, 95%CI = 52.6–56.0) and 69.9 (SD = 16.9, 95%CI = 68.9–71.1) respectively. People educated beyond primary school were more likely to be knowledgeable about Ebola and Marburg virus disease than those who did not attain any formal education (OR = 3.6, 95%CI = 2.1–6.1). Qualitative data revealed that communities describe Ebola and Marburg virus diseases as very severe diseases with no cure and they believe the diseases spread so fast. Respondents reported fear and stigma suffered by survivors, their families and the broader community due to these diseases.Communities in Uganda affected by filovirus outbreaks have moderate knowledge about these diseases and have a positive attitude towards practices to prevent and control Ebola and Marburg viral diseases. The public health sector should enhance this community knowledge gap to empower them more by supplying educational materials for epidemic preparedness in future using appropriate communication channels as proposed by the communities.Item Multidistrict Outbreak of Marburg Virus Disease—Uganda, 2012(The Journal of infectious diseases, 2015) Knust, Barbara; Schafer, Ilana J.; Wamala, Joseph; Nyakarahuka, Luke; Okot, Charles; Shoemaker, Trevor; Dodd, Kimberly; Gibbons, Aridth; Balinandi, Stephen; Tumusiime, Alex; Campbell, Shelley; Newman, Edmund; Lasry, Estrella; DeClerck, Hilde; Boum, Yap; Makumbi, Issa; Bosa, Henry Kyobe; Mbonye, Anthony; Aceng, Jane Ruth; Nichol, Stuart T.; Ströher, Ute; Rollin, Pierre E.In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription–polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.Item Prevalence of Crimean-Congo haemorrhagic fever in livestock following a confrmed human case in Lyantonde district, Uganda(Parasites & Vectors, 2023) Atim, Stella A.; Niebel, Marc; Vudriko, Patrick; Odongo, Steven; Balinandi, Stephen; Aber, Peace; Bameka, Ronald; Ademun, Anna R.; Masembe, Charles; Tweyongyere, Robert; Thomson, Emma C.Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne viral infection, characterized by haemorrhagic fever in humans and transient asymptomatic infection in animals. It is an emerging human health threat causing sporadic outbreaks in Uganda. We conducted a detailed outbreak investigation in the animal population following the death from CCHF of a 42-year-old male cattle trader in Lyantonde district, Uganda. This was to ascertain the extent of CCHF virus (CCHFV) circulation among cattle and goats and to identify affected farms and ongoing increased environmental risk for future human infections.Item Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019(PLOS Neglected Tropical Diseases, 2021) Schuh, Amy J.; Kyondo, Jackson; Graziano, James; Balinandi, Stephen; Kainulainen, Markus H.; Tumusiime, Alex; Nyakarahuka, Luke; Mulei, Sophia; Baluku, Jimmy; Lonergan, William; Mayer, Oren; Masereka, Rastus; Masereka, Fredrick; Businge, Esther; Gatare, Alphonse; Kabyanga, Loice; Muhindo, Samuel; Mugabe, Raymond; Makumbi, Issa; Kayiwa, Joshua; Makoba Wetaka, Milton; Brown, Vance; Ojwang, Joseph; Nelson, Lisa; Millard, Monica; Nichol, Stuart T.; Montgomery, Joel M.; Taboy, Celine H.; Lutwama, Julius J.; Klena, John D.The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.Item Risk factors for Crimean-Congo Haemorrhagic Fever (CCHF) virus exposure in farming communities in Uganda(Journal of Infection, 2022) Atim, Stella A.; Ashraf, Shirin; Ademun, Anna R.; Nakayiki, Teddy; Balinandi, Stephen; Nakanjako, Gladys; Abaasa, Andrew; Odongo, Steven; Esau, Martin; Kaleebu, Pontiano; Lutwama, Julius J.; Masembe, Charles; Lambe, Teresa; Tweyongyere, RobertCrimean-Congo Haemorrhagic Fever (CCHF) is an emerging human-health threat causing sporadic outbreaks in livestock farming communities. However, the full extent and the risks associated with exposure of such communities has not previously been well-described. We collected blood samples from 800 humans, 666 cattle, 549 goats and 32 dogs in districts within and outside Ugandan cattle corridor in a cross-sectional survey, and tested for CCHFV-specific IgG antibodies using Enzyme-Linked Immunosorbent Assays. Sociodemographic and epidemiological data were recorded using structured questionnaire. Ticks were collected to identify circulating nairoviruses by metagenomic sequencing. CCHFV seropositivity was in 221/800 (27·6%) in humans, 612/666 (91·8%) in cattle, 413/549 (75·2%) in goats and 18/32 (56·2%) in dogs. Human seropositivity was associated with livestock farming (AOR=5·68, p<0·0001), age (AOR=2·99, p=0·002) and collecting/eating engorged ticks (AOR=2·13, p=0·004). In animals, seropositivity was higher in cattle versus goats (AOR=2·58, p<0·0001), female sex (AOR=2·13, p=0·002) and heavy tick infestation (>50 ticks: AOR=3·52, p=0·004). CCHFV was identified in multiple tick pools of Rhipicephalus appendiculatus.Item Severe morbidity and hospital-based mortality from Rift Valley fever disease between November 2017 and March 2020 among humans in Uganda(BMC, 2024-05) Anywaine, Zacchaeus; Hansen, Christian; Warimwe, George M; Abu-Baker Mustapher, Ggayi; Nyakarahuka, Luke; Balinandi, Stephen; Ario, Alex Riolexus; Lutwama, Julius J; Elliott, Alison; Kaleebu, PontianoAbstract Background Rift Valley fever (RVF) is a zoonotic viral disease of increasing intensity among humans in Africa and the Arabian Peninsula. In Uganda, cases reported prior to 2016 were mild or not fully documented. We report in this paper on the severe morbidity and hospital-based mortality of human cases in Uganda. Methods Between November 2017 and March 2020 human cases reported to the Uganda Virus Research Institute (UVRI) were confirmed by polymerase chain reaction (PCR). Ethical and regulatory approvals were obtained to enrol survivors into a one-year follow-up study. Data were collected on socio-demographics, medical history, laboratory tests, potential risk factors, and analysed using Stata software. Results Overall, 40 cases were confirmed with acute RVF during this period. Cases were not geographically clustered and nearly all were male (39/40; 98%), median age 32 (range 11–63). The median definitive diagnosis time was 7 days and a delay of three days between presumptive and definitive diagnosis. Most patients (31/40; 78%) presented with fever and bleeding at case detection. Twenty-eight (70%) cases were hospitalised, out of whom 18 (64%) died. Mortality was highest among admissions in regional referral (11/16; 69%) and district (4/5; 80%) hospitals, hospitalized patients with bleeding at case detection (17/27; 63%), and patients older than 44 years (9/9; 100%). Survivors mostly manifested a mild gastro-intestinal syndrome with nausea (83%), anorexia (75%), vomiting (75%), abdominal pain (50%), and diarrhoea (42%), and prolonged symptoms of severe disease including jaundice (67%), visual difficulties (67%), epistaxis (50%), haemoptysis (42%), and dysentery (25%). Symptom duration varied between two to 120 days. Conclusion RVF is associated with high hospital-based mortality, severe and prolonged morbidity among humans that present to the health care system and are confirmed by PCR. One-health composite interventions should be developed to improve environmental and livestock surveillance, prevent infections, promptly detect outbreaks, and improve patient outcomes.Item Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018- January 2019(PLoS neglected tropical diseases, 2019) Mirembe, Bernadette Basuta; Musewa, Angella; Kadobera, Daniel; Kisaakye, Esther; Birungi, Doreen; Eurien, Daniel; Nyakarahuka, Luke; Balinandi, Stephen; Tumusiime, Alex; Kyondo, Jackson; Mbula Mulei, Sophia; Baluku, Jimmy; Kwesiga, Benon; Ndugwa Kabwama, Steven; Zhu, Bao-Ping; Harris, Julie R.; Lutwama, Julius Julian; Alex, Riolexus ArioCrimean-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. We defined a confirmed case as sudden onset of fever (�37.5 ̊C) with �4 of the following signs and symptoms: anorexia, vomiting, diarrhea, 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). We identified 14 confirmed cases (64% males) with five deaths (case-fatality rate: 36%) from 11 districts in the 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 <1 km from grazing fields compared with 27 (48%) controls (OR M-H = 18, 95% CI = 3.2-1) and 10 (71%) of 14 case-patients found ticks attached to their bodies �2 weeks before symptom onset, compared to 15 (27%) of 56 control-persons (OR M-H = 9.3, 95%CI = 1.9–46). CCHF outbreaks occurred sporadically during 2018–2019, both within and outside the ‘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.