Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings.

• Main Authors: Luke Nyakarahuka (Author), Trevor R Shoemaker (Author), Stephen Balinandi (Author), Godfrey Chemos (Author), Benon Kwesiga (Author), Sophia Mulei (Author), Jackson Kyondo (Author), Alex Tumusiime (Author), Aaron Kofman (Author), Ben Masiira (Author), Shannon Whitmer (Author), Shelley Brown (Author), Debi Cannon (Author), Cheng-Feng Chiang (Author), James Graziano (Author), Maria Morales-Betoulle (Author), Ketan Patel (Author), Sara Zufan (Author), Innocent Komakech (Author), Nasan Natseri (Author), Philip Musobo Chepkwurui (Author), Bernard Lubwama (Author), Jude Okiria (Author), Joshua Kayiwa (Author), Innocent H Nkonwa (Author), Patricia Eyu (Author), Lydia Nakiire (Author), Edward Chelangat Okarikod (Author), Leonard Cheptoyek (Author), Barasa Emmanuel Wangila (Author), Michael Wanje (Author), Patrick Tusiime (Author), Lilian Bulage (Author), Henry G Mwebesa (Author), Alex R Ario (Author), Issa Makumbi (Author), Anne Nakinsige (Author), Allan Muruta (Author), Miriam Nanyunja (Author), Jaco Homsy (Author), Bao-Ping Zhu (Author), Lisa Nelson (Author), Pontiano Kaleebu (Author), Pierre E Rollin (Author), Stuart T Nichol (Author), John D Klena (Author), Julius J Lutwama (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2019-03-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1935-2727; 1935-2735; 10.1371/journal.pntd.0007257
• Keywords: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270
• Source: PLoS Neglected Tropical Diseases, Vol 13, Iss 3, p e0007257 (2019)

INTRODUCTION:In October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations. METHODS:A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus. RESULTS:Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda. CONCLUSION:This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.