Background: On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. Methods: In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. Results: Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. Conclusion: Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.

Objectives: Early isolation and care for Ebola disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda. Methods: We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry ("delays") as short ( <= 2), moderate (3-5), and long ( >= 6); the latter two were "delayed isolation." We categorized symptom onset timing as "earlier" or "later," using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews. Results: Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation (crude risk ratio = 1.8, 95% confidence interval (1.2-2.8]). Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors. Conclusion: Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

On September 20, 2022, an Ebola Disease (EBOD) outbreak was declared in Mubende district, Central Uganda. Following a rapid surge in the number of cases and mortality, the Government of Uganda imposed a lockdown in the two most affected districts, Mubende and Kassanda. We describe the trends in EBOD incidence and mortality nationally and in the two districts before and during the lockdown and the lessons learned during the epidemic response. We retrieved data from the Ministry of Health situation reports from September 20, 2022, when the EBOD outbreak was declared until November 26, 2022, when the lockdown ended. We graphed trends in EBOD morbidity and mortality during a 3-week and 6-week lockdown, computed the EBOD case fatality rate, and summarized the major lessons learned during the epidemic response. We found case fatality rate during the pre-lockdown, 3-week lockdown, and 6-week lockdown period was 37.9% (22/58), 39.3% (53/135), and 38.7% (55/142), respectively. In the early weeks of the lockdown, EBOD incidence and mortality increased nationally and in Kassanda district while Mubende district registered a decline in incidence and stagnation in mortality. With the extension of the lockdown to six weeks, the EBOD incidence and mortality during the 4-6-week lockdown declined compared to the pre-lockdown period. In conclusion, the EBOD incidence and mortality remained higher in the early weeks of the lockdown than during the pre-lockdown period nationally and in one of the two districts. With extended lockdown, incidence and mortality dropped in the 4-6-week period than the pre-lockdown period. Therefore, reliance on known public health measures to control an EBOD outbreak is important.

Introduction: The mortality rates associated with cardiovascular disease (CVD) and diabetes exhibit disparities by region, with Central Africa ranking fourth globally in terms of mortality rate. The Democratic Republic of Congo (DRC) does not possess mortality data pertaining to these specific underlying causes of death. This study aimed to determine the death rate attributable to CVD and diabetes in two cities in the DRC. Methodology: The data on CVD and diabetes utilized in this study were obtained from a pilot project and were registered in the National Health Information System (NHIS). Data quality was initially evaluated using an automated Digital Open Rule Integrated Selection (DORIS), followed by an assessment conducted manually by three assessors. Descriptive and comparative analyses were carried out to determine the proportion of mortality related to CVD and diabetes. Results: CVD accounted for 20.4% (95%CI: 17.7–23.4%) of deaths in the two cities (Kinshasa and Matadi), whereas diabetes accounted for 5.4% (95%CI: 3.9–7.2%). After adjusting for age and city, the proportional mortality from CVD and diabetes was higher for women than men and increased with age. This study recorded 4.4% of deaths among men and 7.0% among women as the proportional mortality from diabetes. Conclusions: Non-communicable diseases (NCDs) continue to be a major cause of death, and CVD and diabetes are among the leading causes of early mortality in adults in urban areas. The proportional mortality related to CVD and diabetes appears to be higher in women than in men. Special emphasis should be placed on women, particularly during adulthood, to ensure the prompt detection of diabetes and cardiovascular conditions.

Background: Uganda started AstraZeneca COVID-19 vaccination in March 2021 but information about adverse events is limited. We assessed adverse events following AstraZeneca vaccination among adults in Greater Kampala, Uganda. Methods: In this cross-sectional study, we systematically sampled persons who had received ≥1 dose of the AstraZeneca vaccine and collected data between March and April 2021 through telephone interviews. We defined adverse events as any untoward medical occurrence after vaccination and serious adverse events as any event leading to hospitalization, persistent disability >28 days, death, or congenital anomaly. Results: Of 374 participants aged 20-85 years, the prevalence of adverse events was 76.5%. Common adverse events included injection site redness and hadache; no serious adverse event was reported. Participants aged 20–29 years (Adjusted odds ratio (AOR) 4.58; 95% confidence interval (CI): 1.92–10.95), 30-39 years (AOR 3.69; 95% CI: 1.81–7.51) and 40-49 years (AOR 2.78; 95% CI 1.26–4.90) were more likely to develop adverse events compared to those aged ≥50 years. Conclusion: Adverse events are prevalent, largely among those aged <50 years; serious adverse events are rare. Persons aged <50 years should be targeted for surveillance of adverse events alongside appropriate health education and counselling. Keywords: Adverse events; assessment; COVID-19; Greater Kampala; Uganda.

Background: During 2018-2020, almost half of all neonatal deaths reviewed in Uganda were due to birth asphyxia. In 2015, Uganda adopted the Every Newborn Action Plan interventions to renew the focus on surveillance for birth asphyxia and other childhood-related illnesses. In 2016, the Ministry of Health implemented an evidence-based educational program for birth attendants about neonatal resuscitation techniques to improve the management of birth asphyxia. We described the trends and distribution of birth asphyxia in Uganda during 2017–2020 following these renewed efforts. Methods: We analysed birth asphyxia surveillance data from the District Health Information System 2 from January 2017–December 2020. We calculated the incidence of birth asphyxia per 1,000 deliveries at district, regional, and national levels. We used line graphs to demonstrate the trend of birth asphyxia incidence with the corresponding reporting rates at national and regional levels. We used logistic regression to evaluate the significance of the trends. Using choropleth maps, we described the distribution of birth asphyxia incidence at district level. Results: The average national annual incidence of birth asphyxia in 2020 was 31 per 1,000, with an increase of 4.5% from 2017 to 2020 (OR=1.05; 95%CI=1.04-1.05, p=0.001), with national quarterly reporting rates of 70-80% over the same period. Incidence in the Northern and Eastern Regions increased by 6% (OR=1.06; 95%CI=1.05-1.07, p=0.001) and 5% (OR=1.05; 95%CI=1.03-1.05, p=0.001), respectively, over the study period. Bundibugyo, Iganga, and Mubende Districts had rates of >60/1,000 during each of the four years of the study period. The least affected district was Kazo District, with an overall incidence of 3/1,000 over the study period. Conclusion: The incidence of birth asphyxia increased nationally from 2017-2020. We recommend efforts towards reducing the burden of birth asphyxia in Uganda, with emphasis on the most affected districts. Keywords: Trends; Distribution; Birth asphyxia; Uganda.