180 17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477 study, we determined the prevalent strains of O. tsutsugamushi The AFI serosurvey is part of a multi-phase collaboration between circulating in Assam and their origin with respect to 56 kDa TSA Uganda Ministry of Health, Uganda Virus Research Institute (UVRI) gene. and CDC-Atlanta/CDC-Uganda to investigate AFI in Uganda. Methods & Materials: 370 clinical serum samples from sus- Methods & Materials: We selected a random 3097-sample pected scrub typhus and other unidentified fever cases were subset from 19,656 UHSBS banked sera for inclusion in the AFI sero- received from tertiary hospitals in Assam. Serological screening was survey; 2705 were ultimately analyzed after applying exclusion done using Scrub Typhus Detect IgM ELISA (InBios International, criteria. Data from laboratory testing were analyzed and mapped Inc., USA). Positive and equivocal samples were subjected to PCR. using SAS v9.3 and ArcGIS 10, respectively. Nested PCR was performed using primers specific for O. tsutsug- Results: Laboratory diagnostic testing results demonstrated: amushi 56 kDa gene. Phylogenetic analysis was performed using leptospirosis ELISA and microagglutination test (MAT) (10.4% MEGA 6 software. weighted proportion, SE = 1.2%), brucellosis MAT (0.3% weighted Results: 19.4% sera (72/370) were found to be IgM positive and proportion, SE = 0.1%), spotted fever group rickettsiae ELISA (56.7% 6.4% (24/370) were equivocal. 13 of these samples were PCR posi- weighted proportion, SE = 1.4%) and typhus group rickettsiae ELISA tive for 56 kDa gene. Phylogenetic analysis of study strains showed (41.6% weighted proportion, SE = 1.4%), malaria MSP119 ELISA variations in sequence homologies that formed 3 distinct clades (88.4% weighted proportion, SE = 0.7%), orthopoxvirus IgG ELISA that clustered with reference strains from: 1) India 2) Taiwan and (13.5% weighted proportion, SE = 0.8%), chikungunya IgM ELISA 3) Thailand. (31.1% weighted proportion, SE = 1.0%), dengue IgM ELISA (1.0% Conclusion: In summary, we have identified strains of O. tsut- weighted proportion, SE = 0.2%) and IgG ELISA (0.7% weighted sugamushi circulating in Assam and established their evolutionary proportion, SE = 0.2%). A specimen subset (n = 198) was tested relationship with reference strains by analyzing a variable por- for melioidosis using indirect hemagglutination (IHA); 4.6% were tion of 56 kDa gene. Understanding the evolution of the prevalent seropositive. strains is important to understand the genetic differences which Conclusion: Pre-existing national serosurveys can be a source may help in planning control strategies as well as prophylactic of information on prevalence of AFI etiologic agents. This AFI measures including development of vaccines. serosurvey describes the distribution, regional risk, and interre- gional variability for selected diseases contributing to AFI across http://dx.doi.org/10.1016/j.ijid.2016.02.421 Uganda; it will inform prioritization of infectious disease surveil- lance and laboratory capacity-building activities. Results from this Type: Poster Presentation study combined with similarly obtained results from the ongoing testing from the 2011 Uganda AIDS Indicator Survey-based serosur- vey will demonstrate changing seroprevalence patterns, allowing Final Abstract Number: 41.234 for evaluation of potential ecologic drivers for disease distribution Session: Poster Session I variances. Date: Thursday, March 3, 2016 Time: 12:45-14:15 http://dx.doi.org/10.1016/j.ijid.2016.02.422 Room: Hall 3 (Posters & Exhibition) Type: Poster Presentation

Uganda National Acute Febrile Illness Agent Detection Serosurvey 2004-2005 Final Abstract Number: 41.235 G. Kharod 1,∗, D. haberling 2, M. Person 2,A. Session: Poster Session I Folkema 3, R. Galloway 2, M. Elrod 2, J. Perniciaro 2, Date: Thursday, March 3, 2016 W. Nicholson 2, N. Patel 2, J. Bwogi 4, H. Bukenya 4, Time: 12:45-14:15 C. Drakeley 5, S. Mbulaiteye 6, D. Blaney 2,S. Room: Hall 3 (Posters & Exhibition) Shadomy 2

1 CDC, Atlanta, Georgia, USA Spotted fever group and typhus fever group 2 CDC, Atlanta, USA rickettsiosis in South Western India 3 Region of Waterloo Public Health, CDC, Ontario, ,∗ M. Koralur 1 , I. Bairy 2, M. Varma 3, E. Athan 4,J. Canada Stenos 5 4 UVRI, Entebbe, Uganda 5 The London School of Hygiene and Tropical 1 Kasturba Medical College, Manipal, Karnataka, Medicine, London, United Kingdom India 6 NIH, Bethesda, USA 2 Melaka Manipal Medical College, Manipal Campus, Manipal, India Background: Due to their non-specific clinical presentation, 3 KMC Manipal, Manipal, India acute febrile illnesses (AFI) are often diagnosed clinically as diseases 4 Barwon Health, Victoria, Australia known to be endemic to the region in which they are found. Uganda 5 Australian Rickettsial Reference Laboratory, Vic, has been the site of multiple emerging-disease outbreaks, and there Australia are several diseases that present with undifferentiated AFI, requir- ing further laboratory confirmation; however, limited laboratory Background: Rickettsial diseases are a group of zoonotic acute capacity can impair timely diagnosis and public health interven- febrile illness transmitted to humans by vectors. They are classi- tions. This results in misdiagnosis and underreporting of emerging fied into spotted fever group (SFG), typhus fever group (TG) and diseases of public health importance. The 2004-2005 Uganda scrub typhus group (STG). STG remains the major cause of acute National AFI Agent Detection Serosurvey (AFI serosurvey)–a ret- febrile illness requiring hospitalization in the tsutsugamushi tri- rospective investigation of seroprevalence of exposure to selected angle, however, the true picture of the SFG and TG rickettsiosis is infectious agents–involved testing a subset of banked sera from not clear in India. Immunofluorescence assay (IFA) is the serolog- the 2004-2005 Uganda HIV/AIDS Serobehavioural Survey (UHSBS). ical gold standard test for the diagnosis of rickettsial disease and 17th International Congress on Infectious Diseases / International Journal of Infectious Diseases 45S (2016) 1–477 181 was used to elucidate the disease burden in the Indian population There are limited studies analyzing pediatric clinical outcomes requiring hospitalization in EVD. In current study, we describe age-specific mortality and Methods & Materials: Hospitalized patients with strong clinical predictors of clinical outcomes of EVD in two districts where trans- suspicion towards rickettsial diseases other than ST were recruited mission happened in distinct phases and successive time periods. from June 2012 and Jan 2015 at Kasturba Hospital, Manipal, India. Methods & Materials: We performed secondary data analy- Cases with significant titers by Weil-Felix test and/or those which sis on the national EVD outbreak database. Data was abstracted were clinical diagnosed as rickettsial fever were further analyzed for Kailahun and Western districts’ for RT-PCR EBOV-positive and using IFA for confirmatory purposes. Slides were observed under probable cases. We defined the study population as subjects aged a fluorescent microscope for fluorescence. Samples were screened ≤18 years in the database. Analysis was performed with STATA at a dilution of 1:128 and positives, serially titrated to a dilution of Version 12 package. 1024. Customized slides were supplied by the ARRL and standard Ethical clearance was sought from Ministry of Health, Sierra IFA procedures followed. Leone Research and Ethics committee. Results: Out of the 1036 cases, 71 cases were suspected for rick- Results: A total number of confirmed and probable cases in ettsial diseases other than STG. At a dilution of 1:128 dilution, 22 the two districts were 5,160 with male: female ratio 1:1, median (2.1%) cases were positive for SFG and 19 (1.8%) cases for TG. Also, age 27years (IQR:15-40). The majority, 4,497(87.3%) were from the among these cases, 14 of the cases had shown significant titers for Western District. A total of 5130 (99.4%) presented alive to health both SFG and TG. At endpoint dilution (ranging from 1:128-1:1024), facilities with fever and fatigue, 77% and 74.4% as the commonest there was cross reaction between strains among the SFG and to the presenting complaints respectively. TG. 18 cases were positive for R. australis, 16 for R. honei, 15 for Pediatric observations accounted for 1,452 (28%) with major- R. conorii, 16 for R. africae, 15 for R. rickettsii, 11 for R. felis, 4 for ity (90%) from the Western District. The mean age was 8years R.prowazekii and 6 cases for R.typhi (SD ± 5.6) with males accounting for 48%. Overall pediatric mor- Conclusion: SFG and TG rickettsiosis are prevalent in our part tality was 29% and highest in Western area with the most affected of the India. SFG is more prevalent than TG. Antigenic cross reac- age groups being <2 and 2-5 years with 9.9% and 8.1% mortality tions between many strains were observed even at the end point respectively. dilutions and the exact nature of the disease causative strain could Probability to death in the first 6 days of the illness was highest not be determined. Cultures and molecular confirmation of the for >2 years age-group (85%) followed by 2-5, 6-12 and >12<18 causative agents will ultimately strengthen our findings years; 74%, 50% and 27% respectively (log rank p value <0.0001). http://dx.doi.org/10.1016/j.ijid.2016.02.423

Type: Poster Presentation

Final Abstract Number: 41.236 Session: Poster Session I Date: Thursday, March 3, 2016 Time: 12:45-14:15 Room: Hall 3 (Posters & Exhibition)

Predictors of pediatric clinical outcomes and associated age-specific mortality in the West African Ebola epidemic, 2014-15: A comparative secondary data analysis of two districts in Sierra Leone

H. Kyobe Bosa 1,∗, J.T. Orikiiriza 2, F. Vairo 3,F. Mubiru 2, D. Bulwadda 4, C. Suleiman Kamara 5,F. Sahr 6

1 College of Health Sciences, Makerere University, Kampala, Uganda 2 Infectious Diseases Institute, Kampala, Uganda 3 National Institute for Infectious Diseases INMI Conclusion: The high peadiatric mortality and deeper analy- “L.Spallanzani, Rome, Italy sis of mortality findings in this study have not been documented 4 Makerere University, College of Health Sciences, before. Except the higher probability and shorter duration to death Kampala, Uganda in this study, other findings are comparable with most of tropical 5 34 Military Hospital, Freetown, Freetown, Sierra diseases. leone The belated introduction of pediatric clinical guidelines which 6 University Of Sierra Leone, Freetown, Sierra leone coincided with EVD introduction in Western District did not reverse Background: Prior to the recent Ebola Virus Disease (EVD) out- pediatric deaths. break, the pediatric age-group remained largely minimally affected or undetected/unreported. Given magnitude of this outbreak there http://dx.doi.org/10.1016/j.ijid.2016.02.424 has been a considerable proportion of children infected. This his- torical perspective may have limited inter-epidemic introduction of pediatric-specific treatment guidelines whereby clinical care was based on consultation of adult guidelines.