Browsing by Author "Lutwama, Julius"

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    Detection of Entebbe Bat Virus after 54 Years
    (The American journal of tropical medicine and hygiene, 2015) Kading, Rebekah C.; Kityo, Robert; Nakayiki, Teddie; Ledermann, Jeremy; Crabtree, Mary B.; Lutwama, Julius; Miller, Barry R.
    Entebbe bat virus (ENTV; Flaviviridae: Flavivirus), closely related to yellow fever virus, was first isolated from a little free-tailed bat (Chaerephon pumilus) in Uganda in 1957, but was not detected after that initial isolation. In 2011, we isolated ENTV from a little free-tailed bat captured from the attic of a house near where it had originally been found. Infectious virus was recovered from the spleen and lung, and the viral RNA was sequenced and compared with that of the original isolate. Across the polypeptide sequence, there were 76 amino acid substitutions, resulting in 97.8% identity at the amino acid level between the 1957 and 2011 isolates. Further study of this virus would provide valuable insights into the ecological and genetic factors governing the evolution and transmission of bat- and mosquitoborne flaviviruses.
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    Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned
    (BMC infectious diseases, 2011-12-28) Borchert,Matthias; Mutyaba,Imaam; Lutwama, Julius; Bisoborwa, Geoffrey
    Ebola haemorrhagic fever (EHF) is infamous for its high case-fatality proportion (CFP) and the ease with which it spreads among contacts of the diseased. We describe the course of the EHF outbreak in Masindi, Uganda, in the year 2000, and report on response activities. We analysed surveillance records, hospital statistics, and our own observations during response activities. We used Fisher's exact tests for differences in proportions, t-tests for differences in means, and logistic regression for multivariable analysis. The response to the outbreak consisted of surveillance, case management, logistics and public mobilisation. Twenty-six EHF cases (24 laboratory confirmed, two probable) occurred between October 21st and December 22nd, 2000. CFP was 69% (18/26). Nosocomial transmission to the index case occurred in Lacor hospital in Gulu, outside the Ebola ward. After returning home to Masindi district the index case became the origin of a transmission chain within her own extended family (18 further cases), from index family members to health care workers (HCWs, 6 cases), and from HCWs to their household contacts (1 case). Five out of six occupational cases of EHF in HCWs occurred after the introduction of barrier nursing, probably due to breaches of barrier nursing principles. CFP was initially very high (76%) but decreased (20%) due to better case management after reinforcing the response team. The mobilisation of the community for the response efforts was challenging at the beginning, when fear, panic and mistrust had to be countered by the response team. Large scale transmission in the community beyond the index family was prevented by early case identification and isolation as well as quarantine imposed by the community. The high number of occupational EHF after implementing barrier nursing points at the need to strengthen training and supervision of local HCWs. The difference in CFP before and after reinforcing the response team together with observations on the ward suggest a critical role for intensive supportive treatment. Collecting high quality clinical data is a priority for future outbreaks in order to identify the best possible FHF treatment regime under field conditions.
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    Field evaluation of the performance of seven Antigen Rapid diagnostic tests for the diagnosis of SARs-CoV-2 virus infection in Uganda
    (Plos one, 2022) Bwogi, Josephine; Lutalo, Tom; Tushabe, Phionah; Bukenya, Henry; Eliku, James Peter; Ssewanyana, Isaac; Nabadda, Susan; Nsereko, Christopher; Matthew, Cotten; Robert, Downing; Lutwama, Julius; Kaleebu, Pontiano
    Objective The objective of this study was to evaluate the performance of seven antigen rapid diagnostic tests (Ag RDTs) in a clinical setting to identify those that could be recommended for use in the diagnosis of SARS-CoV-2 infection in Uganda. Methods This was a cross-sectional prospective study. Nasopharyngeal swabs were collected consecutively from COVID-19 PCR positive and COVID-19 PCR negative participants at isolation centers and points of entry, and tested with the SARS-CoV-2 Ag RDTs. Test sensitivity and specificity were generated by comparing results against qRT-PCR results (Berlin Protocol) at a cycle threshold (Ct) cut-off of ≤39. Sensitivity was also calculated at Ct cut-offs ≤29 and ≤33. Results None of the Ag RDTs had a sensitivity of ≥80% at Ct cut-off values ≤33 and ≤39. Two kits, Panbio™ COVID-19 Ag and VivaDiag™ SARS-CoV-2 Ag had a sensitivity of ≥80% at a Ct cut-off value of ≤29. Four kits: BIOCREDIT COVID -19 Ag, COVID-19 Ag Respi-Strip, MEDsan® SARS-CoV-2 Antigen Rapid Test and Panbio™ COVID-19 Ag Rapid Test had a specificity of ≥97%. Conclusions This evaluation identified one Ag RDT, Panbio™ COVID-19 Ag with a performance at high viral load (Ct value ≤29) reaching that recommended by WHO. This kit was recommended for screening of patients with COVID -19-like symptoms presenting at health facilities.
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    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, Julius
    In 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.
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    How Severe and Prevalent are Ebola and Marburg Viruses? A Systematic Review and Meta-Analysis of the Case Fatality Rates and Seroprevalence
    (BMC infectious diseases, 2016) Nyakarahuka, Luke; Kankya, Clovice; Krontveit, Randi; Mayer, Benjamin; Mwiine, Frank N.; Lutwama, Julius; Skjerve, Eystein
    Ebola and Marburg virus diseases are said to occur at a low prevalence, but are very severe diseases with high lethalities. The fatality rates reported in different outbreaks ranged from 24–100%. In addition, sero-surveys conducted have shown different seropositivity for both Ebola and Marburg viruses. We aimed to use a meta-analysis approach to estimate the case fatality and seroprevalence rates of these filoviruses, providing vital information for epidemic response and preparedness in countries affected by these diseases.Published literature was retrieved through a search of databases. Articles were included if they reported number of deaths, cases, and seropositivity. We further cross-referenced with ministries of health, WHO and CDC databases. The effect size was proportion represented by case fatality rate (CFR) and seroprevalence. Analysis was done using the metaprop command in STATA.The weighted average CFR of Ebola virus disease was estimated to be 65.0% [95% CI (54.0–76.0%), I2 = 97.98%] whereas that of Marburg virus disease was 53.8% (26.5–80.0%, I2 = 88.6%). The overall seroprevalence of Ebola virus was 8.0% (5.0%–11.0%, I2 = 98.7%), whereas that for Marburg virus was 1.2% (0.5–2.0%, I2 = 94.8%). The most severe species of ebolavirus was Zaire ebolavirus while Bundibugyo Ebolavirus was the least severe.The pooled CFR and seroprevalence for Ebola and Marburg viruses were found to be lower than usually reported, with species differences despite high heterogeneity between studies. Countries with an improved health surveillance and epidemic response have lower CFR, thereby indicating need for improving early detection and epidemic response in filovirus outbreaks.
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    Mpox global emergency: strengthening African leadership
    (Elsevier Ltd, 2024-10) Abubakar, Ibrahim; Lutwama, Julius; Kyobutungi, Catherine; Sankoh, Osman
    The resurgence of mpox during 2024 has been declared a continental emergency by the Africa Centres for Disease Control and Prevention (Africa CDC) and a Public Health Emergency of International Concern (PHEIC) by WHO and now affects 15 African countries.1,2 In Africa between Jan 1, 2024 and Sept 16, 2024, there were 6201 confirmed mpox cases and 32 confirmed deaths, among a much larger number of suspected cases and deaths.2 Cases of clade 1b mpox causing the current sustained human-to-human transmission are concentrated in Burundi, Central African Republic, Republic of the Congo, DR Congo, Kenya, Rwanda, and Uganda, while cases of clade 1a mpox have been reported from multiple countries across Central Africa associated with spillover events from animal reservoirs.2 Cases of clade 2 have been reported from Cote d'Ivoire, Liberia, Nigeria, and South Africa.2 The majority of cases and deaths have been reported in DR Congo, with an outsize toll on children.2 The epidemiology of mpox continues to evolve and gaps remain in our knowledge; evidence suggests there might be potential transmission from mother to fetus in utero and during breastfeeding.3,4 Further cases of clade 1 mpox have been reported beyond Africa including single cases in Sweden and Thailand.5 Calls for global action and response are important, especially for equity and solidarity in sharing countermeasures such as diagnostics and vaccines. Examples of African-led epidemiological research to understand transmission include the elucidation of the emergence of clade 1 with predominance of APOBEC3-type mutations associated with a propensity for human-to-human transmission11 and previous work on the clade 2b outbreak in Nigeria that helped identify the sexual spread of mpox.12,13 A One Health approach, which considers the interconnectedness of human, animal, and environmental health, is also important.12 Integrating data across African health systems14 and ensuring real-time information sharing will be vital to advance understanding of transmission patterns. The lessons learned from COVID-19 must be fully integrated into future planning to ensure that Africa is better prepared for subsequent outbreaks, with a focus on self-reliance and resilience.24 African leaders need to increase national funding for health care, prevention, research, and for health protection, including specifically for the mpox response.25 Assistance from global development partners to African governments should come in the form of investment, collaboration, and equitable partnership for sustainable development rather than knee-jerk, crisis-dependent aid.26 IA reports funding from the European Union under grant agreement no 101046314 and the UK National Institute for Health and Care Research (NIHR) under grant NF-SI-0616–10037. Challenges Solutions Inadequate domestic funding for the mpox response and the health system Current over-reliance on donor funding The commitment by heads of state in Africa to spend 15% of national budgets on health (as in the 2001 Abuja Declaration) should be implemented and is crucial for health and economic development Outbreak response infrastructure Subnational supporting infrastructure essential in every nation to support the progress on establishing some National Public Health Institutes and continental coordination by Africa CDC Invest in local and district level networks of disease surveillance and diagnostic and response infrastructure, including environmental and animal testing Technical skills and human resources Limited availability of skilled public health and laboratory staff at local centres, and insufficient industry expertise Invest in training and improve staff remuneration and working conditions Research and science Greater coordination and funding needed, building on regional and national centres of excellence in pandemic prone infections Build on Nursing & Allied Health Premium
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    Outbreak of Anthrax Associated with Handling and Eating Meat from a Cow, Uganda, 2018
    (Emerging Infectious Diseases, 2020) Kisaakye, Esther; Riolexus Ario, Alex; Bainomugisha, Kenneth; Cossaboom, Caitlin M. Ping Zhu; Lowe, David; Bulage, Lilian; Kadobera, Daniel; Sekamatte, Musa; Lubwama, Bernard; Tumusiime, Dan; Tusiime, Patrick; Downing, Robert; Buule, Joshua; Lutwama, Julius; Salzer, Johanna S.; Matkovic, Eduard; Joy Gary, Jana Ritter,; Zhu, Bao-Ping
    On April 20, 2018, the Kween District Health Office in Kween District, Uganda reported 7 suspected cases of human anthrax. A team from the Uganda Ministry of Health and partners investigated and identified 49 cases, 3 confirmed and 46 suspected; no deaths were reported. Multiple exposures from handling the carcass of a cow that had died suddenly were significantly associated with cutaneous anthrax, whereas eating meat from that cow was associated with gastrointestinal anthrax. Eating undercooked meat was significantly associated with gastrointestinal anthrax, but boiling the meat for >60 minutes was protective. We recommended providing postexposure antimicrobial prophylaxis for all exposed persons, vaccinating healthy livestock in the area, educating farmers to safely dispose of animal carcasses, and avoiding handling or eating meat from livestock that died of unknown causes.
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    Proportion of Deaths and Clinical Features in Bundibugyo Ebola Virus Infection, Uganda
    (Emerging infectious diseases, 2010) MacNeil, Adam; Farnon, Eileen C.; Wamala, Joseph; Okware, Sam; Cannon, Deborah L.; Reed, Zachary; Towner, Jonathan S.; Tappero, Jordan W.; Lutwama, Julius; Ksiazek, Thomas G.; Rollin, Pierre E.; Downing, Robert; Nichol, Stuart T.
    Ebola hemorrhagic fever (EHF) is a severe disease caused by several species of Ebolavirus (EBOV), in the family Filoviridae. Before 2007, four species of EBOV had been identifi ed; 2 of these, Zaire ebolavirus and Sudan ebolavirus, have caused large human outbreaks in Africa, with proportion of deaths ≈80%–90% and 50%, respectively (1–5). Large outbreaks are associated with person-to-person transmission after the virus is introduced into humans from a zoonotic reservoir. Data suggest that this reservoir may be fruit bats (6,7). During outbreaks of EHF, the virus is commonly transmitted through direct contact with infected persons or their bodily fl uids (8–11). The onset of EHF is associated with nonspecifi c signs and symptoms, including fever, myalgias, headache, abdominal pain, nausea, vomiting, and diarrhea; at later stages of disease, overt hemorrhage has been reported in ≈45% of cases (12). Bundibugyo District is located in western Uganda, which borders the Democratic Republic of Congo. After reports of a mysterious illness in Bundibugyo District, the presence of a novel, fi fth EBOV virus species, Bundibugyo ebolavirus (BEBOV), was identifi ed in diagnostic samples submitted to the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA, in November 2007 (13). In response to detection of EBOV, an international outbreak response was initiated. In this report, we summarize fi ndings of laboratory-confi rmed cases of BEBOV infection.