Epidemiological Week 32 of 2013 [5 – 11 August 2013] National Summary

Epidemiological week 32 of 2013 [5 – 11 August 2013]

National Summary Indicator Epidemiological week 32 Highlights of the Week 2013 2012 Median 2008-2012 Completeness & Timeliness of Reporting This week, 105 (93.75%) of the districts submitted their weekly reports % of Districts 93.75 86.61 reporting as opposed to 97 (86.61%) for the corresponding week of 2012. The mean intra-district completeness this week is 55% [median 60%]; % HU reporting 55 69 compared to the mean intra-district completeness of 69% [median 88%] % Timely District 91.96 67.86 for the corresponding week of 2012. reports AFP 1(0) 2(0) Only 25 (23.81%) of the districts that reported this week attained an intra-district completeness of at least 80% as opposed to 54 (55.67%) for Animal bites 326(0) 522(0) the corresponding week of 2012. A total of seven (7) districts including Cholera 31(01) 32(4) Bugiri, Bukedea, Kaabong, Kapchorwa, Katakwi, Kumi, & Dysentery 734(0) 1213(0) Manafwa never submitted reports this week [see annex 1].

Guinea Worm 0(0) 0(0) Timeliness for weekly reporting is 103 (91.96%) for the reporting week; Malaria 146,139 196,561 and 76 (67.86%) for the corresponding week of 2012. (31) (31) Measles 52(0) 191(0) The proportion of health facilities submitting weekly reports in each of Meningitis 22(01) 2(0) the reporting districts is still below the national target of 80% in most of the districts. DHOs are urged to ensure districts submit their weekly NNT 0(0) 1(1) reports and to actively follow-up silent health facilities. Plague 0(0) 0(0) Typhoid 1316(01) 674(0) Public Health Emergencies/Disease Outbreaks Crimean-Congo Hemorrhagic Fever [CCHF]: A sample collected 0(0) 0(0) S/Sickness from a suspect viral hemorrhagic fever case in Agago district has tested Human Influenza 2(0) 0(0) positive for CCHF. The confirmed case is a 68 year old male from Omot th Nodding Syndrome 0(0) 0(0) sub-county whose illness started on 8 August 2013. He was admitted to Kalongo hospital on 10th August 2013 and is improving on supportive 0(0) 0(0) Yellow Fever care in the isolation ward. The national and district taskforce have been Viral Hemorrhagic 0(0) 0(0) re-activated and a national rapid response team has been deployed to Fever conduct in-depth epidemiological investigation and to support initiation Maternal Deaths 4 --- of the immediate control measures in the district.

Cholera: This week, a total of 31 cases including one (1) death were reported from Buliisa [9 cases & 1 death], Hoima [20 cases], & Nebbi [5cases] districts. The cumulative number of districts affected by cholera this year is ten (10) with a cumulative total of 663 cases and 24 deaths (details annex 2).

Human Influenza Surveillance: The National Influenza Centre in the Uganda Virus Institute [UVRI] & Makerere University Walter Reed Project [MUWRP] maintain sentinel surveillance sites for ILI/SARI countrywide. As of 9th August 2013; a total of 2104 specimens had been analyzed [by NIC till Epi-week 31 & MUWRP till Epi-week 32] with 195 isolates. Heightened influenza surveillance is also ongoing after cases of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) (94 confirmed cases with 46 deaths] were reported largely from countries in the Middle East.

Due to the sustained transmission of MERS-CoV in the Middle East, all health workers are encouraged to maintain vigilance for severe acute respiratory infection (SARI) especially among recent travelers returning from the Middle East. Appropriate infection prevention and control measures should be observed in managing suspect cases and nasal swabs should be obtained and sent to the National Influenza Centre in Uganda Virus Research Institute for testing [for further guidance contact: 0752650251 or 0772477016].

Weekly Incidence for Selected Priority Diseases in the Country

This week; we present a concise profile of nine (9) top priority diseases/conditions including AFP (suspect Polio), Cholera, Bloody diarrhea, Malaria; Meningitis, Measles, Suspect Rabies, Typhoid Fever, & Maternal deaths] reported during the 31st Epidemiological week of 2013.

AFP (Suspect Polio): One (1) AFP case was reported from Amuria district. The National non-Polio AFP (NPAFP) rate for 2013 is 1.65/100,000 children <15 years of age which is below the national target of ≥4/100,000. Only 19 (17%) of districts have archived a NPAFP rate of 4/100,000 population <15 years. The non-Polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is 13% above the national target of ≥10%. Also, 90% of AFP cases have had at least two (2) stool specimens collected within 14 days of paralysis onset (national target ≥80%). UNEPI encourages all districts to conduct active search for AFP, measles, & NNT so that cases are detected and investigated. Additionally, AFP surveillance should be enhanced so that any importations from the ongoing WPV1 outbreaks in Somalia & Kenya can be detected. A cross-border meeting between Uganda and Kenya has also been organized to enhance cross-border surveillance (for district specific AFP performance see annex 3).

Cholera: week, a total of 31 cases including one (1) death were reported from Buliisa [9 cases & 1 death], Hoima [20 cases], & Nebbi [5cases] districts. Overall, the cholera cases for the current period are much lower than those from the corresponding period of 2012. But we notice an increase in cases from the previous weeks of 2013.The figure below shows the cholera trends for 2012 & 2013 [see annex 2].

Dysentery (Bloody diarrhea): A total of 734 cases of bloody diarrhea were reported from 87 districts during the current week. This translates into a national weekly incidence of 2.31 cases of bloody diarrhea per 100,000. The top 10 districts [Abim, Kotido, Kalangala, Bukwo, Buvuma, Agago, Amuru, Moroto, Buliisa, & Nakasongola] had a weekly incidence of 8-92.39 bloody diarrhea cases per 100,000. The figure below shows the number of bloody diarrhea cases reported by week for 2012 & 2013 [annex 1 for district specific reports].

Available at http://health.go.ug/mohweb/?page_id=1294 3

Malaria: Is the commonest cause of morbidity and mortality in the country; thus this week, 146,131 clinical malaria cases including 31 deaths were reported from the 105 districts that submitted weekly reports. This translates into a national weekly incidence of 460 clinical malaria cases per 100,000. The top 10 districts [Tororo, Busia, Kotido, Nakaseke, Buvuma, Isingiro, Bukwo, Ibanda, Otuke, & Kibuku] had an incidence of 969- 1,582 clinical malaria cases per 100,000 this week. The figure below shows the number of clinical malaria cases reported to the MoH by week for 2012 & 2013 [annex 1 for district specific reports].

The figure below shows the proportion of clinical malaria cases that have been tested and confirmed by week during 2013 using laboratory data for malaria submitted through mTrac and DHIS 2. During the current week [32st Epidemiological week], a total of 134,415 clinical malaria cases were reported from the 96 districts that submitted laboratory testing data [through mTrac or DHIS2]. 93,508 of the clinical malaria cases were tested [RDT/microscopy] with 40,089 (42.87%) being confirmed to have malaria. Children under five years constituted 30.97% (12,415) of the malaria confirmed cases.

Available at http://health.go.ug/mohweb/?page_id=1294 4

Meningitis: This week, 22 cases including one (1) death of meningitis were reported from the eight (8) districts of Kabarole, Mbale, Mbarara, Mubende, Nakaseke, Nebbi, Oyam, & Soroti during the current week. The figure below shows the number of meningitis cases reported by week for 2012 & 2013 [annex 1 for district specific reports]. The cases this week exceed those from the corresponding period of 2012.

Measles: This week, a total of 52 suspect measles cases were reported from 27 districts. As of 16th August, 2013, a total of 99 (88.39%) districts had investigated at least one suspect measles case. Consequently, the annualized rate for suspect measles cases investigated is 3.89/100,000 (national target 2/100,000). As of 16th August, 2013, data from the EPI/UVRI laboratory showed that 86/844 (10.2%) of investigated suspect measles cases had tested measles Ig M positive [measles cases have been confirmed from 25 districts]. Of the ten (10) suspect measles outbreaks reported this year; seven (7) measles outbreaks have been confirmed in Hoima, Kabarole, Isingiro, Mubende, Kyenjojo, & Kamwenge districts. The trends for the current period are generally far below the cases reported for the corresponding period of 2012. The figure below shows the number of suspect measles cases reported by week for 2012 & 2013.

Available at http://health.go.ug/mohweb/?page_id=1294 5

Animal bites (Suspect human rabies): A total of 326 cases of suspect rabies were reported from 64 districts during the current week. This translates into a national weekly incidence of 1.03 suspect rabies cases per 100,000. The top 10 districts [Nakaseke, Kotido, Abim, Bukwo, Moroto, Maracha, Kitgum, Mbale, Koboko, & Agago] had a weekly incidence of 3.68-10.08 suspect rabies cases per 100,000 [annex 1 for district specific reports].

Typhoid Fever: A total of 1316 suspect typhoid cases including one (1) death were reported from 75 districts during the current week. This translates into a national weekly incidence of 4.14 cases per 100,000. The top 10 districts [Bukwo, Mityana, Isingiro, Kanungu, Nakaseke, Mbale, Mbarara, Lyantonde, Kween, & Kotido] had a weekly incidence of 13.69-82.96 cases per 100,000. The figure below shows the number of Typhoid fever cases reported by week for 2012 & 2013 with the cases reported since the beginning of 2013 greatly exceeding those from the corresponding period of 2012 [annex 1 for district specific reports].

Available at http://health.go.ug/mohweb/?page_id=1294 6

Maternal deaths: Maternal mortality trends are a national priority and consequently, these data are now submitted on a weekly basis by the health facilities where these events are detected.

This week a total of four (4) maternal deaths were reported from three (3) districts as shown in the table below.

Epi District Facility No. Maternal Deaths Comments week Reported After verification 32 Gulu Minakulu HC 54 0 coding error 32 Kasese Mukathi HC III 222 0 coding error 32 Hoima Hoima RRH 1 1 32 Kibaale Kagadi HOSPITAL 2 2 32 Namutumba Namusita HC II 86 0 coding error 32 Ibanda Ibanda HOSPITAL 1 1 32 Ibanda Birongo HC II 118 0 coding error 32 Total 484 4

Available at http://health.go.ug/mohweb/?page_id=1294 7

Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, Dr. Immaculate Nabukenya, Mr. Luswa Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr. Issa Makumbi

Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero Dr. N. Ndayimirigye Mr. L. Luswa Dr. N. Bakyaita, Mr. M. Mugagga

For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108

Email: [email protected]

Available at http://health.go.ug/mohweb/?page_id=1294 8

Annex 1: Summary of District Reports for Epidemiological week 32 of 2013 [5 – 11 Aug 2013] (Numbers in brackets indicate deaths)

District H/U % of reporting Timely AFP bite Animal (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness Others New Amudat 100 T 0 1 0 5 0 588 0 0 0 0 2 0 CP 2, , Busia 100 T 0 1 0 4 0 4198 0 0 0 0 0 0 Buvuma 100 T 0 0 0 7 0 559(1) 0 0 0 0 0 0 Kiryandongo 100 T 0 7 0 5 0 1320 1 0 0 0 24 0 Koboko 100 T 0 8 0 2 0 1379 0 0 0 0 4 0 Otuke 100 T 0 0 0 1 0 782(1) 0 0 0 0 0 0 Tororo 100 T 0 4 0 2 0 7333 0 0 0 0 0 0 CP 4, , Moyo 98 T 0 3 0 19 0 3360(1) 1 0 0 0 23 0 Kisoro 97 T 0 1 0 6 0 537 0 0 0 0 10 0 Yumbe 96 T 0 8 0 24 0 2365(1) 0 0 0 0 19 0 Nakaseke 91 T 0 18 0 3 0 2058 3 1 0 0 50 0 Buliisa 90 T 0 2 9(1) 8 0 691 0 0 0 0 6 0 Pallisa 90 T 0 1 0 9 0 3011 0 0 0 0 0 0 Ntoroko 89 T 0 0 0 2 0 452 0 0 0 0 1 0

Bukomansimbi 88 T 0 0 0 0 0 477 0 0 0 0 0 0 Dokolo 88 T 0 5 0 7 0 1034 0 0 0 0 4 0 Kayunga 88 T 0 1 0 10 0 2414(1) 0 0 0 0 4 0 Adjumani 86 T 0 0 0 9 0 1378 0 0 0 0 0 0 CP 2, , Ibanda 84 T 0 6 0 0 0 2380 0 0 0 0 2 0 Kiboga 83 T 0 2 0 4 0 733(2) 0 0 0 0 12 0 Maracha 83 T 0 8 0 7 0 874(1) 0 0 0 0 1 0 Kalangala 82 T 0 0 0 13 0 364 1 0 0 0 6 0 Kotido 82 T 0 19 0 65 0 2796 0 0 0 0 28 0 Kitgum 81 T 0 10 0 11 0 905 0 0 0 0 0 0 8

District H/U % of reporting Timely AFP bite Animal (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness Others New Bukwo 80 T 0 4 0 14 0 666 0 0 0 0 56 0 Zombo 79 T 0 5 0 5 0 749 0 0 0 0 3 0 Kabale 77 T 0 3 0 0 0 486 0 0 0 0 2 0 Kibuku 77 T 0 0 0 6 0 1639 0 0 0 0 0 0 Kyenjojo 77 T 0 3 0 1 0 717(1) 1 0 0 0 20 0 Buikwe 76 T 0 8 0 8 0 3100 3 0 0 0 41 0 Isingiro 76 T 0 0 0 7 0 3935 0 0 0 0 116 0 Bulambuli 75 T 0 0 0 4 0 1143 0 0 0 0 0 0 Gulu 74 T 0 1 0 27 0 1618 0 0 0 0 17 0 Kole 73 T 0 0 0 0 0 210 0 0 0 0 0 0 Kyegegwa 73 T 0 1 0 1 0 635 2 0 0 0 5 0 Masindi 72 T 0 10 0 5 0 1482 1 0 0 0 8 0 Mbarara 72 T 0 13 0 4 0 1893 0 3 0 0 83 0 Abim 70 T 0 4 0 51 0 1598 0 0 0 0 3 0 Mpigi 69 T 0 4 0 3 0 1020(1) 1 0 0 0 6 0 Kamuli 67 T 0 5 0 1 0 3599 0 0 0 0 10 0 Lira 67 T 0 1 0 9 0 1952 1 0 0 0 26 0 Kiruhura 66 T 0 2 0 0 0 2457 0 0 0 0 3 0 Butambala 65 T 0 0 0 0 0 626 0 0 0 0 2 0 Kalungu 65 T 0 0 0 2 0 459 1 0 0 0 4 0

Bundibugyo 64 T 0 2 0 17 0 1769 0 0 0 0 2 0 Hoima 63 T 0 9 20 25 0 2171 5 0 0 0 23 0 Alebtong 62 T 0 0 0 1 0 368 0 0 0 0 3 0

Kamwenge 62 T 0 0 0 1 0 1148 1 0 0 0 2 0

District H/U % of reporting Timely AFP bite Animal (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness Others New

Kyankwanzi 62 T 0 3 0 4 0 390 5 0 0 0 7 0 Agago 61 T 0 10 0 36 0 1310 0 0 0 0 0 0 Amuru 61 T 0 2 0 20 0 319(1) 0 0 0 0 0 0 Gomba 61 T 0 0 0 2 0 639 0 0 0 0 4 0 Mityana 60 T 0 2 0 4 0 2077(1) 0 0 0 0 95 0

Ssembabule 60 T 0 2 0 4 0 479 0 0 0 0 5 0 Luweero 59 T 0 0 0 10 0 2635(1) 1 0 0 0 46 0 Rukungiri 59 T 0 1 0 0 0 1591 0 0 0 0 3 0 Bushenyi 58 T 0 3 0 4 0 1405(2) 0 0 0 0 15 0 Masaka 58 T 0 0 0 1 0 736 1 0 0 0 8 0 Mukono 58 T 0 1 0 11 0 1369 0 0 0 0 6 0 Kabarole 57 T 0 4 0 11 0 2683(1) 1 1 0 0 12 0 Bruce Kween 56 L 0 1 0 2 0 712 0 0 0 0 13 0 13, , Ntungamo 56 T 0 5 0 1 0 344(1) 0 0 0 0 2 0 National 55 NR 1(0) 326(0) 31(1) 734(0) 0(0) 146139(31) 52(0) 22(1) 0(0) 0(0) 1316(1) 0(0)

Kibaale 53 T 0 0 0 8 0 1192 1 0 0 0 40 0 Lwengo 52 T 0 0 0 0 0 342 0 0 0 0 19(1) 0 Mbale 52 L 0 16 0 19 0 3243 1 3 0 0 102 0

Nakasongola 52 T 0 4 0 12 0 1439 5 0 0 0 5 0 Wakiso 52 T 0 35 0 20 0 4437 3 0 0 0 82 0 Buhweju 50 T 0 0 0 0 0 552 0 0 0 0 0 0 Rakai 50 T 0 3 0 5 0 3342(2) 0 0 0 0 27 0 Kasese 49 T 0 0 0 12 0 2707(1) 0 0 0 0 4 0

District H/U % of reporting Timely AFP bite Animal (Suspected Rabies) Cholera Dysentery Guinea Worm Malaria Measles Meningitis NNT Plague Typhoid Fever Sleeping Sickness Others New Jinja 47 T 0 2 0 7 0 2595 0 0 0 0 23 0 Kaliro 45 T 0 0 0 0 0 968 0 0 0 0 1 0 Soroti 45 T 0 8 0 10 0 1995 0 6 0 0 38 0 Amuria 44 T 1 1 0 5 0 2324 0 0 0 0 0 0 Luuka 43 T 0 0 0 2 0 959 1 0 0 0 0 0 Mubende 43 T 0 10 0 12 0 2195(1) 4 1 0 0 12 0 Butaleja 42 T 0 1 0 4 0 1932 0 0 0 0 0 0 Nebbi 41 T 0 5 2 9 0 1236(5) 0 6 0 0 5 0 Sironko 41 T 0 0 0 4 0 885 0 0 0 0 1 0 Buyende 40 T 0 1 0 0 0 600 0 0 0 0 0 0

Namutumba 36 T 0 0 0 2 0 1826 1 0 0 0 0 0 Lamwo 35 T 0 0 0 5 0 256 0 0 0 0 0 0 Mayuge 35 T 0 1 0 3 0 1513(1) 0 0 0 0 0 0 Budaka 32 T 0 5 0 9 0 1044(1) 0 0 0 0 9 0 Oyam 31 T 0 3 0 1 0 332 0 1(1) 0 0 1 0 Iganga 30 T 0 0 0 2 0 2600 0 0 0 0 0 0 Mitooma 30 T 0 0 0 0 0 792 0 0 0 0 0 0 Serere 30 T 0 0 0 0 0 618 0 0 0 0 0 0 Kanungu 29 T 0 3 0 0 0 795 1 0 0 0 68 0 Nwoya 29 T 0 0 0 2 0 175 0 0 0 0 2 0

Lyantonde 28 T 0 0 0 3 0 709 0 0 0 0 12 0 Moroto 28 T 0 7 0 14 0 1038 0 0 0 0 4 0 Ngora 27 T 0 0 0 0 0 567 0 0 0 0 1 0 Arua 25 T 0 4 0 13 0 1698(1) 0 0 0 0 5 0

Kaberamaido 24 T 0 0 0 4 0 705 0 0 0 0 1 0

Namayingo 24 T 0 0 0 1 0 1079 0 0 0 0 0 0

Nakapiripirit 22 T 0 1 0 4 0 462 0 0 0 0 0 0 Pader 20 T 0 2 0 5 0 360 0 0 0 0 3 0 Bududa 19 T 0 0 0 2 0 448(2) 0 0 0 0 1 0 Sheema 19 T 0 0 0 0 0 463 0 0 0 0 1 0 Apac 12 T 0 0 0 1 0 148 0 0 0 0 0 0 Amolatar 8 T 0 0 0 3 0 0 0 0 0 0 0 0 Napak 8 T 0 0 0 0 0 174 0 0 0 0 0 0 Kampala 3 T 0 0 0 6 0 903 2 0 0 0 0 0 Bugiri NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Bukedea NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kaabong NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Kapchorwa NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Katakwi NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Kumi NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR Manafwa NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR HU= Health Units, NR = Not reported, CP = Chicken Pox, KZ = Kalazar, Sch = Schistosomiasis, MP= Malaria in pregnancy; Nodding Syndrome

Color codes for Completeness of reporting: Dark Yellow; (80-100%); & Light Brown (0-79%); Red (No Report)

Annex 2: Summary of Epidemics and Response Activities initiated by Epidemiological week 32 of 2013 [5th to 11th August 2013] Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] CCHF Agago 0 1 0 1. A suspect VHF case involving a 60 year old male from Omot sub-county in Agago district was admitted into the isolation ward at Kalongo hospital on 10-08-2013. 2. He presented with a high grade fever of 39°C with bleeding from the orifices but was not jaundiced. No additional cases have been linked to the case and there is no history of travel. 3. A sample collected from the case has tested positive for CCHF. 4. The national and district taskforce have been re-activated and a national rapid response team has been deployed to conduct in-depth epidemiological investigation and to support initiation of the immediate control measures in the district. Cholera Lamwo 0 1 0 5. On 12-08-2013; a 54 year old male was confirmed to have cholera following a RDT test undertaken at Madi-Opei HCIV. Further isolation is ongoing at St. Joseph’s Hospital Kitgum. 6. The case travelled from Lucimdic village at the border with South Sudan on 9-08-2013 to Central village, Kal parish, Madi-Opei Trading Centre where the symptoms started on 12-08- 2013. 7. No additional cases have been identified following active case search but his contacts are under surveillance. 8. Community sensitization and mobilization for cholera prevention has been initiated and the district task force has embarked on developing a preparedness and response plan to guide the response. Hailstorm Bududa 0 11 1 9. Heavy rains with hailstones and eventually mudslides were reported in Bushiyi sub-county on with 10th & 11th August 2013. mudslides 10. Four villages were seriously affected with at least 96 households being destroyed. 11. At least 10 people who suffered minor injuries (largely bruises & hypothermia) were admitted in Bududa hospital and have all been discharged. One four year old succumbed to the injuries sustained. 12. Relief efforts are underway and the MoH has already sent emergency supplies to the district. Measles Kamwenge 03 03 0 13. A measles outbreak has been confirmed in Buguli sub-county, Kamwenge district with three 13

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] (confirmed) (3) cases being confirmed by the EPI/UVRI laboratory on 9 August 2013. 14. The confirmed cases were 12-14 years of age with undocumented vaccination status. 15. Accelerated routine immunization activities have been initiated to contain the outbreak. Rubella Kasese 6 6 0 1. A Rubella outbreak has been confirmed in Kilembe sub-county, Kasese district with six (6) (confirmed) cases being confirmed by the EPI laboratory in UVRI on 30 July 2013. 2. All the cases are children 11-54 months and surveillance is ongoing. Acute Moroto & 0 57 0 1. A total of 57 cases of AJS with a mild illness and jaundice but without any other significant Jaundice Napak manifestations have been reported from Moroto & Napak districts since 20 Feb. 2013. Syndrome 2. One of the samples tested Yellow Fever IgM positive. PCR tests for YF and HEV were negative [AJS] on all the samples. HEV serological testing has not been undertaken as the reagents are out of stock. 3. Further investigations are underway to identify the definitive cause and risk factors. Measles Mubende 03 16 0 1. A measles outbreak has been confirmed in the sub-counties of Kitanga, Kiganda, Kibalinga, Bageza, & Kiyuni in Mubende district. 2. 5/6 (83.3%) cases tested positive for measles IgM on 5 July 2013. 3. All the cases are under five years of age with a third lacking documented evidence of vaccination status. 4. Accelerated routine immunization has been initiated and the outbreak has been controlled. The most recent case was discharged on 22/07/2013. Measles Isingiro 0 15 0 1. The outbreak has been controlled with no additional cases reported in the last one week. (confirmed) 2. On 23-June-2013; an outbreak of measles was confirmed in Mbaare sub-county, Isingiro district among cases identified in Mbaare HCIII during the month of June 2013. 3. A total of six (6) out of 8 samples submitted to the EPI lab in UVRI on 20th June 2013 tested positive for measles IgM. 38% of the confirmed cases were children below five (5) years of age. A total of 12 cases with 2 deaths have been line listed since the outbreak stated. 4. Accelerated routine immunisation activities are ongoing.

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] 5. The majority of the cases [75%] were female; with 50% being under five years of age; while 60% of cases were from Bugango Parish. Cholera Buliisa 9(01) 79 02 1. Transmission continues with additional cases reported from Buliisa HCIV, Bugoigo HCII, (suspect) Butiaba HCII, & Biiso HCIII. 2. Response activities are still limited due to logistical challenges. 3. The initial cases were from Kigwera South East Village, Kigwera Parish, Kigwera Sub-county, Buliisa district starting 16 July 2013. 4. Prior to the current outbreak, cases were reported from landing sites on Lake Albert in Kigwera sub-county starting 14-05-2013. The cases were managed in Buliisa HCIV. All samples tested negative for Vibrio Cholerae at CPHL since most patients take antibiotics before reporting to the CTC for treatment. Cholera Hoima 20(0) 142 5 1. Cholera cases continue to be reported in from Kijangi Village, Toonya Parish, Buseruka Sub- (suspect) (CFR county, Hoima district where the initial case was reported starting 26 July 2013. Twenty (20) 3.52%) additional cases have been reported from the affected areas. V 2. ibrio Cholerae 01 inaba sensitive to ciprofloxacin and tetracyclines has been isolated from one of the samples collected from suspect cases. 3. Prior to the outbreak in Buseruka, cases were also reported from Runga village/landing site, Kapaapi Parish, Kigorobya sub-county starting 12_04_2013. World Vision Uganda supported the establishment of a CTC at Runga landing site. Other partners like URCS are supported active case finding with health education at the landing site; and provision of Jerry cans for safe water storage. Cholera Nebbi 5(0) 180 9 1. The outbreak has been controlled with no new cases reported since 14-06-2013. (suspect) (CFR 2. The initial cases were reported from Angum village, Nyakagei Parish, Panyimur sub-county on 5%) the shores of Lake Albert starting 16th January 2013. 3. Epidemiological analysis of the outbreak reveals that females constituted 54% of the cases; 71.8% of the cases were aged 0-29 years; & the epidemic curve shows successive peaks typical of a propagated outbreak with most cases originating from the fishing villages on Lake Albert in Panyimur sub-county. 4. Intense behavioural change campaign (sensitisations and inspection of public places and domestic areas to enforce sanitation and hygiene standards) was launched by the district 15

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] taskforce. 5. Sporadic cases were also been reported from Parombo, Erussi, and Nyaravur sub-counties. Cholera Arua 0(0) 162 4 1. The outbreak has been controlled with no new cases reported since 01-06-2013. (confirmed) (CFR 2. Initial cases were reported from Aiivu s/county & Oli division starting 12-02-2013. Two peaks 2.4%) were registered on 17.2.2013 and 01.03.2013; & currently the outbreak has been controlled [figures in annex 2.2]. 3. Vibrio Cholerae was confirmed from two (2) specimens collected from Oli division at the onset of the outbreak. 4. Epidemiological analysis of the outbreak shows that 59% cases were female; 54% cases were aged 10-39 years; & Aivu sub-county and Oli division in Arua municipality accounted for 79% of the cases.

Nodding Kitgum OPD – 2,034 5 1. Case management ongoing at the treatment centre and outreach posts. Syndrome IPD – 162 2. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from cases seen at NS treatment centre – Kitgum hosp. & outreaches. Lamwo OPD - 349 1. Case management ongoing at the treatment centre and outreach posts. IPD – 39 2. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from patients seen at NS treatment centres – Padibe HCIV & the 12 outreaches conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili & Lokung sub-counties. 4. Aerial spraying along rivers Pager & Aswa finalised in November/December 2012. 5. Food received from OPM was distributed to the affected families on [3/02/13]. Pader OPD – 1,210 15 1. Case management ongoing at the treatment centre and outreach posts. IPD – 108 2. Nodding syndrome census finalised in Feb. 2013 and the data analysis is underway. 3. The data presented here is derived from patients seen at NS treatment centres – Atanga HCIII & outreaches. Gulu 330 1 1. Case management ongoing at the treatment centre and outreach posts. 2. One death was reported from Aromowanglobo; after he missed a scheduled refill visit and fitted while alone at home. 16

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] 3. A total of 15 HCW trained in NS case management; & they subsequently conducted verification in Omel & Cwero Parishes in Paicho sub-county; & Paibona parish in Awac sub- county. 4. NS treatment centres set up in Odek HCIII; Aromowanglobo HCII; Cwero HCII; & Labworomo HCIII. 5. Food donations from WVU have been distributed to affected families. & Additional funds have been provided by WVU to train more HCW on NS case management. Lira 13 1. A total of 13 NS cases registered but only three are attending care at Aromo HC while the rest are attending care in Aromowanglobo in Gulu. No admissions to date. Amuru 61 1. No new cases recorded; cases are getting care from the treatment centre in Atiak HCIV and at the four (4) outreach sites [Ogomraa Community School; Okidi HCII; Pacilo HCII; & Gunya Community School]. 2. A total of 10 HCW trained in NS case management. 3. Mass treatment for onchocerciasis with ivermectin conducted in October 2012. Epilepsy Kitgum OPD – 1,321 Data derived from cases seen at NS treatment centre – Kitgum hosp. & outreaches. IPD – 25 Lamwo OPD – 122 The data presented here is derived from patients seen at the NS treatment centres – Padibe HCIV IPD – 0 & the 12 outreaches conducted monthly to Palabek Kal; Palabek Gem; Palabek Ogili & Lokung sub-counties. Pader OPD – 1,251 The data presented here is derived from patients seen at NS treatment centres – Atanga HCIII & IPD – 41 outreaches. Gulu 268 Data derived from Nodding Syndrome treatment centres. Lira 344 Current data derived from cases seeking care from the treatment centre in Aromo HC Amuru 62 Data derived from Nodding Syndrome treatment centres. Human 2 195 0 1. The National Influenza Centre in UVRI maintains sentinel surveillance sites for ILI at Influenza (Entebbe hospital, Kampala [Kawala HC, Kisenyi HC, Kitebi HC], and Lobule HC [Koboko (confirmed) district]); and SARI at (Entebbe hospital, Tororo hospital, Fort Portal hospital, Mbarara hospital, Arua hospital, Koboko HCIV). 2. As of 16th August 2013; a total of 2104 specimens had been analyzed [by NIC till Epi-week 31 & MUWRP till Epi-week 32] with 195 isolates [A(H3) – 19; Influenza B – 134; Type A[not sub-typed] 17

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] – 4; & Influenza A(H1N1)pdm09 – 38]. 3. Makerere University Walter Reed Project [MUWRP] is implementing a complementary Influenza surveillance program. The MUWRP human influenza surveillance sites are located in Gulu RRH, Jinja RRH, & Mulago NRH. 4. MUWRP on a regular basis collects non-human samples from potential Influenza reservoirs like the waterfowl from the Western Rift Valley Lakes, Lake Victoria shores, and the wetlands in Eastern Uganda. Non-human samples are also obtained from other potential reservoirs in Eastern, West Nile, Central, Northern, & Western Uganda. nd 5. By the end of the 32 epidemiological week of 2013 a total of 784 human samples [included in the NIC total above] had been analyzed by MUWRP with 67 isolates [A(H3) – 7; Influenza B – 47; Type A[not sub-typed] – 7; & Influenza A(H1N1)pdm09 – 6] . 6. During the same period, a total of 1094 non-human samples had been analyzed by MUWRP Human with no influenza isolates. Influenza 7. Heightened influenza surveillance is also ongoing after cases of the Middle East Respiratory (confirmed) Syndrome coronavirus (MERS-CoV) (94 confirmed cases with 46 deaths] were reported from at least 9 countries. 8. Due to the sustained transmission of MERS-CoV in the Middle East, all health workers are encouraged to maintain vigilance for severe acute respiratory infection (SARI) especially among recent travelers returning from the Middle East. 9. Appropriate infection prevention and control measures should be observed in managing suspect cases and nasal swabs should be obtained and sent to the National Influenza Centre in Uganda Virus Research Institute for testing. 10. For further guidance contact: 0752650251 or 0772477016]. MDR-TB 33 1. A total of 33 new MDR-TB cases were confirmed in January, April, & May 2013. 2. Since 2008; a total of 348 MDR-TB cases have been diagnosed with 30 cases being reported in 2008; 50 cases in 2009; 86 cases in 2010; 71 cases in 2011; & 110 cases in 2012. 3. Currently, 100 MDR-TB patients are on treatment in [Mulago NRH-55; Kitgum hospital-25; Mbale RRH-5; Mbarara RRH-5; Arua RRH-9; Kabarole RRH-1; & Gulu RRH-1] 4. Masaka RRH; Iganga Hospital; Jinja RRH are being prepared to commence treatment of MDR- TB cases.

Condition Affected New cases Cumulative Cumulat Comments and Actions districts (deaths) Cases ive 29th July to Deaths 4th Aug 2013 [31tt Epi- week] 5. The National TB & Leprosy Program (NTLP) has adopted the hospitalization & ambulatory (mixed) model for management of MDR-TB cases. This model entails initiation of MDR-TB patients on treatment at accredited facilities; with the subsequent daily follow-up being undertaken at the health facility nearest to the patient’s home. 6. Consequently, the NTLP appeals to all RRH, all other health centres to manage and/or support MDR TB cases to ensure DOT at all times. 7. All accredited RRH should accelerate initiation of MDR TB; accord extra care to MDR-TB cases; & minimize delays in initiating MDR-TB treatment since MDR TB medicines are available though some expire quickly.

Annex 3: AFP Performance indicators by District as of 4th August 2013 District Non-polio AFP rate per 100,000 Percent of Percent of Percent of Percent of population less than 15 years of AFP specimens specimens specimens age cases from AFP from AFP from AFP with 2 cases arriving cases cases which stool at national arriving at non-polio specimen level within 3 the lab in enterovirus collected days of being `good was isolated within 14 collected condition` days of onset of paralysis Targets ≥ 4 /100,000 ≥ 80% ≥ 80% ≥ 80% ≥ 80% ≥ 10%

Abim 3.50 100% 100% 100% 100% 0% Adjumani 1.05 100% 50% 100% 100% 50% Agago 1.32 50% 100% 100% 100% 0% Alebtong 0.00 0% 0% 0% 0% 0% Amolatar 0.00 0% 0% 0% 0% 0% Amudat 1.74 100% 0% 100% 100% 100% Amuria 6.33 69% 92% 100% 100% 0% Amuru 1.11 100% 100% 100% 100% 0% Apac 0.00 0% 0% 0% 0% 0% Arua 1.02 100% 100% 100% 100% 0% Budaka 1.11 100% 100% 100% 100% 0% Bududa 1.10 0% 100% 100% 100% 0% Bugiri 0.93 100% 100% 100% 100% 0% Buhweju 0.00 0% 0% 0% 0% 0% Buikwe 0.46 100% 100% 100% 100% 100% Bukedea 5.31 100% 80% 100% 100% 0% Bukomansimbi 5.14 100% 75% 100% 100% 0% Bukwo 8.09 33% 100% 33% 100% 0% Bulambuli 0.00 0% 0% 0% 0% 0% Buliisa 2.45 100% 100% 100% 100% 0% Bundibugyo 1.51 50% 100% 100% 100% 0% Bushenyi 0.79 100% 100% 0% 100% 0% Busia 2.66 75% 100% 100% 100% 0% Butaleja 2.69 100% 100% 100% 100% 0% Butambala 5.97 100% 100% 100% 100% 33%

District Non-polio AFP rate per 100,000 Percent of Percent of Percent of Percent of population less than 15 years of AFP specimens specimens specimens age cases from AFP from AFP from AFP with 2 cases arriving cases cases which stool at national arriving at non-polio specimen level within 3 the lab in enterovirus collected days of being `good was isolated within 14 collected condition` days of onset of paralysis Targets ≥ 4 /100,000 ≥ 80% ≥ 80% ≥ 80% ≥ 80% ≥ 10%

Buvuma 7.16 100% 100% 50% 100% 0% Buyende 0.00 0% 0% 0% 0% 0% Dokolo 7.56 100% 100% 86% 100% 0% Gomba 0.00 0% 0% 0% 0% 0% Gulu 2.00 50% 100% 100% 100% 25% Hoima 1.08 100% 100% 100% 100% 0% Ibanda 2.32 67% 100% 100% 100% 67% Iganga 4.75 67% 100% 100% 100% 17% Isingiro 0.94 100% 100% 100% 100% 0% Jinja 0.39 0% 100% 100% 100% 0% Kaabong 1.00 100% 50% 100% 100% 0% Kabale 1.19 67% 100% 100% 100% 0% Kabarole 2.38 100% 40% 100% 100% 0% Kaberamaido 2.98 33% 100% 100% 100% 33% Kalangala 2.99 100% 0% 100% 100% 0% Kaliro 8.23 78% 89% 100% 100% 22% Kalungu 0.00 0% 0% 0% 0% 0% Kampala 1.72 60% 93% 100% 100% 33% Kamuli 0.79 50% 50% 50% 100% 0% Kamwenge 2.98 60% 80% 100% 100% 40% Kanungu 0.79 100% 100% 100% 100% 0% Kapchorwa 5.20 100% 100% 100% 100% 33% Kasese 1.06 75% 100% 100% 100% 0% Katakwi 0.00 0% 0% 0% 0% 0% Kayunga 1.10 100% 100% 100% 100% 0% Kibaale 0.29 100% 0% 100% 100% 0% 21

Kiboga 1.20 0% 100% 100% 100% 0% Kibuku 2.18 100% 50% 100% 100% 50% Kiruhura 1.97 100% 100% 100% 100% 0% Kiryandongo 3.12 60% 80% 100% 100% 20% Kisoro 0.00 0% 0% 0% 0% 0% Kitgum 0.00 0% 0% 0% 0% 0% Koboko 2.51 100% 100% 100% 100% 33% Kole 0.85 100% 0% 100% 100% 100% Kotido 0.85 100% 100% 100% 100% 0% Kumi 0.00 0% 0% 0% 0% 0% Kween 13.41 57% 86% 100% 100% 0% Kyankwanzi 1.08 100% 100% 100% 100% 0% Kyegegwa 3.72 67% 100% 100% 100% 33% Kyenjojo 1.55 67% 67% 100% 100% 33% Lamwo 3.47 100% 100% 100% 100% 0% Lira 0.49 100% 100% 100% 100% 0% Luuka 0.00 0% 0% 0% 0% 0% Luwero 0.45 0% 100% 100% 100% 0% Lwengo 0.00 0% 0% 0% 0% 0% Lyantonde 0.00 0% 0% 0% 0% 0% Manafwa 0.00 0% 0% 0% 0% 0% Maracha 1.99 100% 100% 100% 100% 0% Masaka 2.36 100% 67% 100% 100% 0% Masindi 1.12 50% 100% 100% 100% 50% Mayuge 0.86 50% 100% 100% 100% 50% Mbale 0.90 100% 100% 50% 100% 0% 22

Mbarara 2.67 100% 83% 100% 100% 17% Mitooma 2.02 50% 100% 100% 100% 0% Mityana 0.00 0% 0% 0% 0% 0% Moroto 2.91 50% 100% 100% 100% 0% Moyo 0.48 100% 100% 100% 100% 0% Mpigi 4.59 100% 100% 100% 100% 0% Mubende 0.97 67% 100% 100% 100% 0% Mukono 0.36 100% 100% 100% 100% 0% Nakapiripirit 2.45 100% 100% 100% 100% 0% Nakaseke 6.21 67% 100% 100% 100% 17% Nakasongola 2.53 0% 100% 100% 100% 0% Namaingo 1.70 100% 100% 100% 100% 0% Namutumba 0.90 100% 100% 100% 100% 0% Napak 1.00 100% 100% 100% 100% 0% Nebbi 0.00 0% 0% 0% 0% 0% Ngora 0.00 0% 0% 0% 0% 0% Ntoroko 7.06 67% 100% 100% 100% 33% Ntungamo 0.00 0% 0% 0% 0% 0% Nwoya 7.33 50% 100% 100% 100% 0% Otuke 2.30 100% 100% 100% 100% 0% Oyam 0.00 0% 0% 0% 0% 0% Pader 0.85 100% 100% 100% 100% 0% Pallisa 1.09 0% 100% 100% 100% 0% Rakai 0.82 50% 100% 100% 100% 0% Rubirizi 0.00 0% 0% 0% 0% 0% Rukungiri 0.62 100% 0% 100% 100% 0% 23

Sembabule 2.02 100% 100% 100% 100% 0% Serere 0.90 100% 100% 100% 100% 0% Sheema 0.83 100% 100% 100% 100% 0% Sironko 0.61 100% 0% 100% 100% 0% Soroti 5.41 50% 100% 100% 100% 0% Tororo 4.06 90% 80% 100% 100% 20% Wakiso 2.74 100% 95% 100% 100% 21% Yumbe 1.09 67% 100% 100% 100% 33% Zombo 2.70 67% 100% 67% 100% 0% National Total 1.65 79% 90% 94% 100% 13%

KEY Target achieved (Non -polio AFP rate of ≥4/100,000 population less than 15 years of age) Moderate achievement (Non-polio AFP rate of 3.0 - 3.9/100,000 population less than 15 years of age) Moderate achievement (Non-polio AFP rate of 2.0 - 2.9/100,000 population less than 15 years of age) Moderate achievement (Non-polio AFP rate of <2/100,000 population less than 15 years of age) Worst achievement (Non-polio AFP rate of 0/100,000 population less than 15 years of age) - No AFP case investigated

Editorial: Editorial: Dr. Joseph F. Wamala, Dr. Robert Musoke, Mr. M. Mugagga, Dr. Charles Okot, Dr. Edson Katushabe, Dr. Immaculate Nabukenya, Mr. Luswa Lukwago, Dr. James Sekajugo, Dr. Francis Adatu, Dr. Issa Makumbi

Founders:Dr. Jimmy Kamugisha (RIP), Dr. J. Wanyana, Dr. M. Lamunu, Dr. C. Mugero Dr. N. Ndayimirigye Mr. L. Luswa Dr. N. Bakyaita, Mr. M. Mugagga

For comments please contact: The Epidemiological Surveillance Division- M.O.H P.O BOX 7272 Kampala, Tel: 0414-340874/0414-345108 Email: [email protected]