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

• Published in: PLoS neglected tropical diseases Vol. 13; no. 3; p. e0007257
• Main Authors: Nyakarahuka, Luke, Shoemaker, Trevor R, Balinandi, Stephen, Chemos, Godfrey, Kwesiga, Benon, Mulei, Sophia, Kyondo, Jackson, Tumusiime, Alex, Kofman, Aaron, Masiira, Ben, Whitmer, Shannon, Brown, Shelley, Cannon, Debi, Chiang, Cheng-Feng, Graziano, James, Morales-Betoulle, Maria, Patel, Ketan, Zufan, Sara, Komakech, Innocent, Natseri, Nasan, Chepkwurui, Philip Musobo, Lubwama, Bernard, Okiria, Jude, Kayiwa, Joshua, Nkonwa, Innocent H, Eyu, Patricia, Nakiire, Lydia, Okarikod, Edward Chelangat, Cheptoyek, Leonard, Wangila, Barasa Emmanuel, Wanje, Michael, Tusiime, Patrick, Bulage, Lilian, Mwebesa, Henry G, Ario, Alex R, Makumbi, Issa, Nakinsige, Anne, Muruta, Allan, Nanyunja, Miriam, Homsy, Jaco, Zhu, Bao-Ping, Nelson, Lisa, Kaleebu, Pontiano, Rollin, Pierre E, Nichol, Stuart T, Klena, John D, Lutwama, Julius J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.03.2019; Public Library of Science (PLoS)
• Subjects: Adult; Animals; Beef cattle; Biology and life sciences; Bleeding; Blood; Blood tests; Clinical Laboratory Techniques - methods; Cluster Analysis; Communicable Disease Control - methods; Community involvement; Containment; Control; Detection; Disease control; Disease Outbreaks; Disease prevention; Disease transmission; Disease Transmission, Infectious - prevention & control; Ebola virus; Ecological monitoring; Epidemics; Epidemiologic methods; Epidemiology; Family Health; Fatalities; Female; Fever; High-Throughput Nucleotide Sequencing; Humans; Infection; Infections; Infectious diseases; Laboratory tests; Local government; Male; Marburg disease; Marburg virus disease; Marburg Virus Disease - epidemiology; Marburg Virus Disease - mortality; Marburg Virus Disease - pathology; Marburgvirus; Marburgvirus - isolation & purification; Medical laboratories; Medicine and Health Sciences; Microbiological strains; Middle Aged; Mortality; Next-generation sequencing; Orifices; Outbreaks; Pain; People and Places; Public health; Risk factors; Signs and symptoms; Strains; Symptoms; Task forces; Testing; Transmission; Tropical diseases; Uganda - epidemiology; Ultrasonic testing; Very high frequencies; Veterinary medicine; Viral diseases; Virus Cultivation; Virus diseases; Viruses; Vomiting; Uganda; Entebbe Uganda; Atlanta Georgia; Kenya; United States > US; Kampala Uganda
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007257

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. 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. 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. 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.