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KeyHighlights
• 03cumulativecases(00probable03confirmed)• All(03)confirmedcaseshavedied(CFR=100%)• Todayisday5sincethedeathofthelastconfirmedcasewhopassedonthe13June2019whileontransferto
theDRCforfurthermanagement• Thereare93contactsunderfollowup
o 86werefolloweduptodayo Nonehasdevelopedsymptomstodate
• 02suspectcasesonadmissioninETU• Activecasesearchanddeathsurveillanceareongoinginthehealthfacilitiesandthecommunitiesasthedistrict
responseteamcontinuetoinvestigateallalerts• 147contactshavebeenvaccinatedtoday• High level community engagement was done in Karambi subcounty to address community hostility against
responseteams• WelfareofETUhealthworkersneedurgentattention
EPIDEMIOLOGICALSUMMARY
BackgroundOn 11th June 2019, theMinistry of Health of Uganda declared the 6th outbreak of Ebola Virus Disease (EVD) in thecountryaffectingKasesedistrictinSouthWesternUganda.Thefirstcasewasafive-year-oldchildwitharecenthistoryoftraveltotheDemocraticRepublicofCongo(DRC).Thischildwasoneof6peoplethattravelledfromtheDRCwhilestillbeingmonitoredassuspectcasesfollowingaburialofthegrandfatherwhosuccumbedtoEVD.Thechildwasillby
1. Situation update Cases
03
Deaths
03
EBOLA VIRUS DISEASE IN UGANDA 18 June 2019 as of 20 00 Hrs SitRep #07 Situation Report
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thetimehecrossedintoUgandaandthemothertookhimformedicalcareatKagandohospitalinKasesedistrictwithsymptoms of vomiting blood, bloody diarrhea,muscle pain, headache, fatigue and abdominal pain. The child testedpositiveforEbolaZairebyPCRandhelaterdiedon11thJune2019.Twoothermembersofthefamily,agrandmotherand3-year-oldbrotheralsotestedpositiveforEbolaon12June2019andthegrandmotherdiedlaterthesameday.The3-year-oldbrotheralsodiedonthe13June2019. Asoftoday,there isnoconfirmedEVDcase inUganda,however2suspectcasesareadmittedatBweraEbolaTreatmentUnit.Ninety-three(93)contactsarebeingfollowedup.Figure1:MovementoftheEVDcasesfromCongointoUganda
Table1:SummaryofEbolavirusDiseaseoutbreakinKasese,June2019SUMMARYOFCASES(asof17/June/2019) Newsuspectcasestoday 01Newdeathstoday 00Cumulativecases(probableandconfirmed) 03
Probable 00
Confirmed 03Cumulativedeaths(probableandconfirmed) 031Healthfacilities 03Community 00Deathsamongconfirmedcases 03Numberofcasesonadmission(probableandconfirmed) 00Probable 00Confirmed 00Suspectcasesonadmissionunderinvestigation 022
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Cumulativeconfirmedcasesdischarged 00Caseswhoarehealthworkers 00Runawaysfromisolation 00Cumulativenumberofcontactslistedasoftoday 93Numberofcontactsthathavecompleted21days 00Numberofcontactsunderfollowup 93Numberofcontactsfolloweduptoday 86Cumulativenumberofcontactswhodevelopedsymptoms 00Cumulativenumberofcontactsvaccinated 2753Numberofcontactsvaccinatetoday 1473Specimenscollectedandsenttothelab.Today 2Cumulativespecimenscollected 184Cumulativecaseswithlabconfirmation 03Cumulativesamplestestednegative 09Specimenswithpendingresults 00Dateofdischarge/deathoflastconfirmedcase 13June20191includes1deathintheDRC2ExcludestwocaseswithrepeatnegativePCRplannedfordischargetomorrow.3Includescontactsofcontacts46arerepeatsamplesFigure2:EpidemiccurveofEbolaVirusDiseaseoutbreakinKasese,June2019
CoordinationToday the EVD District Task Forcemeeting was chaired by Deputy Resident District Commissioner. ThemeetingdiscussedactionpointsraisedduringtheDTFmeetingheldthepreviousday.Italsoreceivedfeedbackfromthesub-committeesfollowingtheactivitiesconductedthepreviousday.AcommunityengagementmeetinginKarambiSub-countywasheldtointensifysocialmobilizationandriskcommunicationsincethecommunitywasbecominghostile
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1
2
3
4
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Num
bero
fcases
Onsetdate
Confirmedcasesonly
Grandmother
BurialofGrandfather
Brothers(3and5-year-old)
Deathof5-year,grandmotherand3-year-oldrespectivelypectively
2. Public Health Actions to date
June 2019
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duetoEbolaresponse.ThepoliticalleadershipemphasizedcommunityledEbolaresponseandaskedallcommunityleaderstocooperateandsupportresponseteams.
Otherkeyissuesdiscussedincluded;
- TheneedforadequatecoordinationbetweenthesurveillanceteamsinDRCandthoseinUgandatounderstandclearlytheoutbreakpatterns.
- TheneedformoreRadioAirtimetocoverotherradiostationsascurrenteffortsarefocusingononlytwoRadiostations(MessiahFMandGuideFM)Leavingoutotherradiostations.
- DelayedpaymentofstaffwhoweretrainedsinceEbolapreparednessphase.ThesepeopleweretobepaidbyWHO.ThisisdemoralizingstafffromparticipatinginongoingactivitiesinResponse.
- Theurgentneed to stopVHTsactivities in communitymalariadiagnosis andoffering familyplanning services(injectable)incommunitiesuntilfurthernoticebecauseoftheincreasedriskofEbola.
Surveillance
• Onealertwasreceivedthatwasverifiedasanon-case.Cumulatively,9alertshavebeenregisteredofwhich3wereverifiedassuspectcases,5verifiedasnonecaseand1asaknowncontactwithnosymptoms.
• Screened317mournersataburialinNyabugandotownduringEventbasesurveillance.• CommunityBasedDiseasesurveillancegroupre-oriented29VHTsand7localleadersin12outof15villagesin
IsangosubcountyfocusingonfactsaboutEbolaandnotificationmechanismsandIECmaterialsonEVD.• Fromactive case search the team identified five casesofbloodydiarrhoeadiagnosedasdysenteryatKabirizi
KatweHCIIofwhichonewasfollowedupandconfirmedthatsymptomsresolvedupontreatment.Theotherfourcasescouldnotbetracedastheyaremobilecommunities.
• Activecasesearchinschoolsyieldednosymptomaticcases.• Screened12886peopleat6pointofentry(POEs).However,therearenoscreeningservicesat18PoEand6bus
terminalsduetoshortageofmanpowerandlogistics(handwashing,tents,thermometersandchlorine)LaboratoryCumulativenumberofreportedsamplestodateis12(excluding6repeatsamples),threepositiveandninenegative
• Procuredservicesforelectricalandfurniturefittingintothemobilelabworkroom• StartedonthesetupofthemobilelabatBwerahospitaluponstaffdecontaminatingtheworkspace• Results for yesterdays’ two referred sampleswere reported.Onewas a repeat and the otherwas for a new
admission.AllarePCRnegative.Plannedactivities
• Electricalandfurniturefittinginthemobilelabworkroom• Developstandardguidelinesonmanagementofsamplesandwasteinthemobilelaboratory.• Securepowerbackup(GeneratorandUps)tosupportconstantlabworkoperations.Procurementoftheseitems
hasbeeninitiatedandismovingforwardCasemanagementToday,theETUhasfouradmissionsincludingonenewsuspectcasewhowasadmittedlastnightat8:30pm,andthreepatientswhowerecarriedonfromthepreviousdayassummarizedinthetablebelow.
Table2.0SummaryofpatientsadmittedinETUasof18-June-2019
Case Description 1sSample 2ndSample 1stResult 2ndResult CommentCase1 45year/Male Taken to be taken
tomorrowNegative - Investigationongoing
Case2 3year/Male Taken taken Negative Negative To be discharged afterpsychosocial team has preparedhisvillagetoreceivehim
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Case3 3year/Male taken
to be takentomorrow
Negative - Investigationongoing
Case4 7year/Male taken taken Negative Negative To be discharged tomorrow,awaitingpsychosocial topreparehiscommunity
TheCoordinationteamheldameetingwithETUmemberstodiscusstheirgrievancewithrespecttotheirfacilitation.ItwasobservedthattheyhaveneverbeenpaidsinceAugust2018andtheyaretotallyfrustrated.Weadvisedonthelogisticsmanagementandincreasedhumanresourcemanagement.Theremaining4nonvaccinatedhealthworkersinETUwillbevaccinatedtomorrow.ETUsecurityhasbeenbeefedupwithMilitary.
Riskcommunicationandsocialmobilization
• Sensitised201sub-countycouncilors,localcouncilonechairpersonsandUPDFsoldiersonEVD• Communitydriveswithfilmvansensitisedanapproximateof385people,625Marketvendors,1,812pupilsin6
schools,oneononediscussionsensitized105people,conducted37smallgroupleveldiscussions,sensitisedand36householdvisitssensitised175people
• Distributed110posters,219leafletstargetingmarketvendorsandUPDFsoldiers
Psychosocialteam• Conductedafollow-upvisitwiththe2youngmenwhoweretransferredfromtheETUandarecurrentlyreceiving
treatmentonthegeneralwardatBwerahospital.Theyarerecoveringandtheirfamiliesarenowmoresupportive.• Counselledthenursewhoisacontactandshehasnotreportedanysymptomstoday• Offeredpsychosocialsupporttoattendantsof2patientstransferredfromETUtothegeneralwardVaccinationThevaccinationteamhasvaccinatedacumulativenumberof275contactswith147vaccinatedtodayintwomainrings.The147vaccinatedincluded51healthworkers.Theteamcontinuestoidentifynewcontactsandcontactsofcontacts.WASH
• TheWASHteamassessedtheWASHinterventionsin6schools,landingsiteofKigendoandNationalWaterandSewerageCorporationofficesinKatweT.C
• Trained101EarlyChildDevelopmentcentreHeadTeachersandcaregiversonhandwashingandwatertreatingstrategy
• Assessedtheavailabilityandfunctionalityofhandwashingfacilitiesandwater;7schools,7restaurants,3healthfacilities,2churchesand1marketinKabatoroTownCouncil,HimaTownCouncil, MpondweLhubirihaandIbandaKyanaTownCouncils
• Keyobservationsmade;Outofthe26institutionsvisited,only15hadhandwashingfacilitiesprovidedwithjikorchlorineasadisinfectant
Infectionpreventionandcontrol
Theteamorientedhealthworkersonimportanceofcleanenvironment,useofprotectivewear,wastedisposalat6healthfacilities;BikunyaHCII,BubotyoHCII,BuhungamuyaghaHCIII,IhandiroHCIIIandBweraGeneralHospital
Logistics• ConductedEVDvaccinesupply inventory.Thedistrict logisticsmanagement teamwastrained inpublichealth
emergencesupplychainmanagementbyMSH
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Keyplannedactivities• Conductactivecasesearch,contactlistingandfollowupinhealthfacilitiesinallHealthSub-districts• Thewashcommitteetogetherwithallenvironmentalhealthstaffinthedistrictwillvisitmoreinstitutions
(schools,markets,healthfacilities)toassesstheWASHinterventionstowardsEVDpreventionandcontrol• TheriskcommunicationteamtocontinueworkingwithvaccinationteaminBweraoncommunityengagement
toaddressrumorsthroughcommunitydialoguemeetings• EngagementofcommunityleadersinKilembeandMukunyuonhostilityagainstCongolesenationals• Sensitisecommunitymembers, stopmassgatherings,alleviate fearsandanxietyamongcommunitymembers
onEVDandencouragepeople tohandwashand stophandshaking.Thecommunitywill also sensitiseon theimportanceofsafeanddignifiedburialfollowingresistanceatSDBofasuspectcase.
• CommunityengagementatmarketstoenhancealertnessandenablereportingofanyEbola-relatedeventstothedistrictauthorities
• TheriskcommunicationteamwillvisitthemarketsandotherpublicplacestoconductsensitizationandengagementmeetingsonEVDalertness
• InvolvementofVHT/volunteerstosupportriskcommunicationatPOEswithriskcommunicationteamsChallenges
• TheETUmembersarerequestingforPerdiemsincetheyrenttheiraccommodationtobeclosetothetreatmentUnit.
• Inadequatescreeningservicesat18PoEand6busterminals• Oneofthecontactsundergoingpsychosocialsupporthasrefusedtobevaccinated• PeopleinKatirivillage,KyanjukiparishinBulembyapeoplehaveabeliefthatifyoutakefirewoodashyouwould
betreatringEbola.Alsobelievethateatingbushmeetyoulivelonger• ScreeningatMiramimwanalhobeingdoneinopenwithnotentandchairs•
CommunityawarenessoftheriskofEbolainfectionishighandthecommunityisverysuspiciousofanyonewitharecent travel to the DRC. Supplies of response items have improved but more forecasting is needed to avoidstockouts of essential items like PPEs and other sundries. TheWelfare of the healthworkers in ETU need to beurgentlyaddressed.
The following partners are supporting Ebola response in Kasese district;WHO, CDC, USAID CHC, UNICEF, Red Cross,AFENET,ECHO,DFID,UNHCR,IRC,IOM,Baylor,BRACUganda,MSH,SavetheChildrenandMSF.
3. Conclusion
4. Partnerships