Another Crimean-Congo hemorrhagic fever outbreak in Uganda: Ongoing challenges with prevention, detection, and response

Jane Frances Zalwango , Patrick King , Marie Gorreti Zalwango , Helen Nelly Naiga , Rebecca Akunzirwe , Fred Monje , Richard Migisha , Lilian Bulage , Daniel Kadobera , Jackson Kyondo , Jimmy Baluku , Stephen Balinandi , Alex Riolexus Ario , Caitlin M. Cossaboom , Luke Nyakarahuka , Julie R. Harris
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Abstract

Objectives

To highlight the challenges associated with Crimean-Congo hemorrhagic fever (CCHF) prevention, detection, and response in Uganda.

Methods

We describe a single confirmed CCHF case in Rakai District in 2022. We reviewed medical records and conducted interviews on the case patient’s history and possible exposures. To understand CCHF prevention and response efforts, we conducted key informant interviews with the district health and veterinary officers and focus group discussions with farmers in the affected village.

Results

An 18-year-old Rakai District resident had fever onset on July 5, 2022. Despite hemorrhaging during hospital admission on July 6, a viral hemorrhagic fever was not suspected for 24 h and appropriate personal protective equipment was not used. A blood sample was collected for viral hemorrhagic fever testing on July 8; however, the patient was discharged before receiving results. The case patient tested positive for CCHF on July 12 and was readmitted. Key informant interviews and focus group discussions indicated poor tick control measures in the district. The district lacked a formal One Health team and experienced challenges with coordination for outbreak response.

Conclusions

CCHF prevention, detection, and response face challenges in Uganda and require strong clinical awareness for quick detection, collaboration between animal and human health stakeholders, and implementation of effective tick control measures.

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乌干达再次爆发克里米亚刚果出血热:预防、检测和应对方面的持续挑战
方法我们描述了 2022 年拉凯地区的一例克里米亚-刚果出血热确诊病例。我们查阅了病历,并就病例患者的病史和可能的接触情况进行了访谈。为了了解慢性阻塞性肺疾病的预防和应对工作,我们对地区卫生官员和兽医官员进行了关键信息访谈,并与受影响村庄的农民进行了焦点小组讨论。结果一名 18 岁的拉凯区居民于 2022 年 7 月 5 日开始发烧。尽管7月6日入院时出现出血,但24小时内并未怀疑是病毒性出血热,也未使用适当的个人防护设备。7 月 8 日采集了血液样本进行病毒性出血热检测,但患者在收到结果前就已出院。7 月 12 日,病例患者的出血热病毒检测呈阳性,并再次入院。关键信息提供者访谈和焦点小组讨论表明,该地区的蜱虫控制措施不力。该地区缺乏正式的 "统一健康 "团队,在疫情应对的协调方面面临挑战。结论 在乌干达,CCHF 的预防、检测和应对都面临挑战,需要临床医生具备快速检测的强烈意识、动物和人类健康利益相关者之间的合作,以及实施有效的蜱虫控制措施。
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