Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015
Background: Crimean–Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Resear...
Main Authors: | , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2018-03-01
|
Series: | International Journal of Infectious Diseases |
Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971218300146 |
id |
doaj-3a3d0471d8ca49a19401d27eb9ef02d6 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stephen Balinandi Ketan Patel Joseph Ojwang Jackson Kyondo Sophia Mulei Alex Tumusiime Bernard Lubwama Luke Nyakarahuka John D. Klena Julius Lutwama Ute Strӧher Stuart T. Nichol Trevor R. Shoemaker |
spellingShingle |
Stephen Balinandi Ketan Patel Joseph Ojwang Jackson Kyondo Sophia Mulei Alex Tumusiime Bernard Lubwama Luke Nyakarahuka John D. Klena Julius Lutwama Ute Strӧher Stuart T. Nichol Trevor R. Shoemaker Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 International Journal of Infectious Diseases |
author_facet |
Stephen Balinandi Ketan Patel Joseph Ojwang Jackson Kyondo Sophia Mulei Alex Tumusiime Bernard Lubwama Luke Nyakarahuka John D. Klena Julius Lutwama Ute Strӧher Stuart T. Nichol Trevor R. Shoemaker |
author_sort |
Stephen Balinandi |
title |
Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 |
title_short |
Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 |
title_full |
Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 |
title_fullStr |
Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 |
title_full_unstemmed |
Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015 |
title_sort |
investigation of an isolated case of human crimean–congo hemorrhagic fever in central uganda, 2015 |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 |
publishDate |
2018-03-01 |
description |
Background: Crimean–Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Research Institute received an alert for a suspect VHF case in a 33-year-old male who presented with VHF compatible signs and symptoms at Mengo Hospital in Kampala. Methods: A blood sample from the suspect patient was tested by RT-PCR for CCHF and found positive. Serological testing on sequential blood specimens collected from this patient showed increasing anti-CCHFV IgM antibody titers, confirming recent infection. Repeat sampling of the confirmed case post recovery showed high titers for anti-CCHFV-specific IgG. An epidemiological outbreak investigation was initiated following the initial RT-PCR positive detection to identify any additional suspect cases. Results: Only a single acute case of CCHF was detected from this outbreak. No additional acute CCHF cases were identified following field investigations. Environmental investigations collected 53 tick samples, with only 1, a Boophilus decoloratus, having detectable CCHFV RNA by RT-PCR. Full-length genomic sequencing on a viral isolate from the index human case showed the virus to be related to the DRC (Africa 2) lineage. Conclusions: This is the fourth confirmed CCHF outbreak in Uganda within 2 years after more than 50 years of no reported human CCHF cases in this country. Our investigations reaffirm the endemicity of CCHFV in Uganda, and show that exposure to ticks poses a significant risk for human infection. These findings also reflect the importance of having an established national VHF surveillance system and diagnostic capacity in a developing country like Uganda, in order to identify the first cases of VHF outbreaks and rapidly respond to reduce secondary cases. Additional efforts should focus on implementing effective tick control methods and investigating the circulation of CCHFV throughout the country. Keywords: Crimean–Congo hemorrhagic fever, Uganda, Outbreak, CCHF |
url |
http://www.sciencedirect.com/science/article/pii/S1201971218300146 |
work_keys_str_mv |
AT stephenbalinandi investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT ketanpatel investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT josephojwang investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT jacksonkyondo investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT sophiamulei investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT alextumusiime investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT bernardlubwama investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT lukenyakarahuka investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT johndklena investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT juliuslutwama investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT uteströher investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT stuarttnichol investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 AT trevorrshoemaker investigationofanisolatedcaseofhumancrimeancongohemorrhagicfeverincentraluganda2015 |
_version_ |
1725276177253269504 |
spelling |
doaj-3a3d0471d8ca49a19401d27eb9ef02d62020-11-25T00:44:08ZengElsevierInternational Journal of Infectious Diseases1201-97122018-03-01688893Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015Stephen Balinandi0Ketan Patel1Joseph Ojwang2Jackson Kyondo3Sophia Mulei4Alex Tumusiime5Bernard Lubwama6Luke Nyakarahuka7John D. Klena8Julius Lutwama9Ute Strӧher10Stuart T. Nichol11Trevor R. Shoemaker12Viral Special Pathogens Branch, Centers for Disease Control and Prevention—Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, UgandaViral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USAGlobal Health Security Unit, Centers for Disease Control and Prevention—Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, UgandaDepartment of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, UgandaDepartment of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, UgandaViral Special Pathogens Branch, Centers for Disease Control and Prevention—Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, UgandaEpidemiological Surveillance Division, Ministry of Health, Plot 6, Lourdel Road, P.O. Box 7272, Kampala, UgandaDepartment of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, UgandaViral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USADepartment of Emerging, Reemerging and Arbovirus Infections, Uganda Virus Research Institute, Plot 51-57 Nakiwogo Road, P.O. Box 49, Entebbe, UgandaViral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USAViral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USAViral Special Pathogens Branch, Centers for Disease Control and Prevention—Uganda, U.S. Embassy, Plot 1577 Ggaba Road, P.O. Box 7007, Kampala, Uganda; Viral Special Pathogens Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, USA; Corresponding author at: Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A30, Atlanta, GA 30329, USA.Background: Crimean–Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Research Institute received an alert for a suspect VHF case in a 33-year-old male who presented with VHF compatible signs and symptoms at Mengo Hospital in Kampala. Methods: A blood sample from the suspect patient was tested by RT-PCR for CCHF and found positive. Serological testing on sequential blood specimens collected from this patient showed increasing anti-CCHFV IgM antibody titers, confirming recent infection. Repeat sampling of the confirmed case post recovery showed high titers for anti-CCHFV-specific IgG. An epidemiological outbreak investigation was initiated following the initial RT-PCR positive detection to identify any additional suspect cases. Results: Only a single acute case of CCHF was detected from this outbreak. No additional acute CCHF cases were identified following field investigations. Environmental investigations collected 53 tick samples, with only 1, a Boophilus decoloratus, having detectable CCHFV RNA by RT-PCR. Full-length genomic sequencing on a viral isolate from the index human case showed the virus to be related to the DRC (Africa 2) lineage. Conclusions: This is the fourth confirmed CCHF outbreak in Uganda within 2 years after more than 50 years of no reported human CCHF cases in this country. Our investigations reaffirm the endemicity of CCHFV in Uganda, and show that exposure to ticks poses a significant risk for human infection. These findings also reflect the importance of having an established national VHF surveillance system and diagnostic capacity in a developing country like Uganda, in order to identify the first cases of VHF outbreaks and rapidly respond to reduce secondary cases. Additional efforts should focus on implementing effective tick control methods and investigating the circulation of CCHFV throughout the country. Keywords: Crimean–Congo hemorrhagic fever, Uganda, Outbreak, CCHFhttp://www.sciencedirect.com/science/article/pii/S1201971218300146 |