Browsing by Author "Wamala, Joseph"

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    Is nodding syndrome an Onchocerca volvulus induced neuro-inflammatory disorder? Uganda's story of research in understanding the disease
    (International Journal of Infectious Diseases, 2016) Idro, Richard; Opar, Bernard; Wamala, Joseph; Abbo, Catherine; Onzivua, Sylvester; Mwaka, Deogratius Amos; Kakooza-Mwesige, Angelina; Mbonye, Anthony; Aceng, Jane R.
    Nodding syndrome is a devastating neurological disorder, mostly affecting children in eastern Africa. An estimated 10 000 children are affected. Uganda, one of the most affected countries, set out to systematically investigate the disease and develop interventions for it. On December 21, 2015, the Ministry of Health held a meeting with community leaders from the affected areas to disseminate the results of the investigations made to date. This article summarizes the presentation and shares the story of studies into this peculiar disease. It also shares the results of preliminary studies on its pathogenesis and puts into perspective an upcoming treatment intervention. Clinical and electrophysiological studies have demonstrated nodding syndrome to be a complex epilepsy disorder. A definitive aetiological agent has not been established, but in agreement with other affected countries, a consistent epidemiological association has been demonstrated with infection by Onchocerca volvulus. Preliminary studies of its pathogenesis suggest that nodding syndrome may be a neuroinflammatory disorder, possibly induced by antibodies to O. volvulus cross-reacting with neuron proteins. Histological examination of post-mortem brains has shown some yet to be characterized polarizable material in the majority of specimens. Studies to confirm these observations and a clinical trial are planned for 2016.
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    Is Nodding Syndrome an Onchocerca Volvulus-Induced Neuroinflammatory Disorder? Uganda’s Story of Research in Understanding the Disease
    (International Journal of Infectious Diseases, 2016) Idro, Richard; Opar, Bernard; Wamala, Joseph; Abbo, Catherine; Onzivua, Sylvester; Mwaka, Deogratius Amos; Kakooza-Mwesige, Angelina; Mbonye, Anthony; Aceng, Jane R.
    The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.
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    Managing Ebola from rural to urban slum settings: experiences from Uganda
    (African health sciences, 2015) Okware, Sam I.; Omaswa, Francis; Talisuna, Ambrose; Amandua, Jacinto; Amone, Jackson; Onek, Paul; Opio, Alex; Wamala, Joseph; Lubwama, Julius; Luswa, Lukwago; Kagwa, Paul; Tylleskar, Thorkild
    Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. Methods: Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. Results: Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. Conclusion: Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior.
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    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.
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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.