On the 15th October 2017, the Uganda Ministry of Health (MoH) received an alert of a suspected death due Viral Haemorrhagic Fever (VHF) in Kween District, Eastern Uganda. A blood sample was taken off and sent to Uganda Virus Research Institute (UVRI); a National Reference Laboratory. On 17 October 2017, UVRI confirmed Marburg Virus and the MoH officially declared an outbreak of Marburg on 19 October 2017. With support from partners, MoH dispatched a rapid response team to support Kween District in responding to the outbreak. AFENET provided an epidemiologist to provide technical support to the response team and to FETP residents deployed in the field.
Kween District is located in Eastern Uganda and Kween District is bordered by Nakapiripirit District to the north, Amudat District to the northeast, Bukwo District to the east, the Republic of Kenya to the south, Kapchorwa District to the west and Bulambuli District to the northwest (Figure 1).
The index case (CA) was a 35 year-old male from Tulwo village (Kween District who fell sick of high grade fever, vomiting and diarrhoea, he was picked up by his sister (CC) and his brother (CJ) and transported to a local private clinic where he was referred to the district hospital (Kapchrowa hospital). His condition deteriorated and died on 25th September 2017. No samples were collected from CA for laboratory testing.
The first confirmed case (CC) was a sister to the index case (CA). She was a 50 year old female who transported CA to the hospital and nursed him until he died and she participated in the burial rituals. She subsequently fell sick with fever and bleeding manifestations and was admitted Kaproron Health Centre on 5 October 2017. She was referred to Kapchora hospital and died on 13 October 2017. She was given a supervised burial on 13 October 2017.
The second confirmed case (CJ) was a 39 year old brother to CA and CC. He transported CA and CC to hospital and participated in cultural rituals that were performed on CA and CC. The response team identified him as a high risk contact. On the 24 Oct 2017, he was admitted to the isolation and put on vigorous support treatment but passed away on 26 October 2017. He received a supervised burial on 26 October 2017. A blood taken off from CJ was confirmed positive for MVD 26 October 2017 by UVRI laboratory.
Findings and interventions
- As of 30 October 2017, a total of 7 cases had been identified of which 1 was probable, 4 were suspected and 2 were confirmed. The four suspected cases were ruled out; 3 tested negative for Marburg and 1 was ruled out because her symptoms and signs were consistent with malaria and had no contact with a confirmed/probable.
- A total of 187 contacts have been identified of which 55 belonged to the index case and had completed 21 days since last exposure and 123 were under close follow-up by a dedicated contact tracing team.
- The District Task Force (DTF) was activated and is currently coordinating the response at district level. The DTF conducts daily meetings to review the outbreak response progress, document challenges and identify mitigation measures and to guide response teams.
- A temporary isolation unit was constructed for isolation and management of cases.
- Social mobilization and risk communication activities have been intensified; using radios, sensitization meetings and distribution of IEC materials.
- The contact tracing team received training on infection prevention and control and the team is doing daily follow up of all contacts.
- Health workers are undergoing training on infection prevention and control, case detection and case management.
- The National Task Force on epidemics and emergencies was activated and is coordinating the response at national level, mobilizing resources and providing technical support to districts.