My Fellows wshi hip Achi hievem evements nts Pande Gerald, BEH, - - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Track

My Fellows wshi hip Achi hievem evements nts

Pande Gerald, BEH, MPH Fellow, Cohort 2015

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My Fellowship Achievements

Host site - AIDS Control Programme

• ACP is mandate

ated d to provide ide leadership ip in health th sector HIV/AIDS respons nse in the countr try:

 Policy

cy

 Coor

• rdination
• n of the respon
• nse

 Resou

• urce

ce mobilization

• n

 Planning  Repor

• rting on HIV/AIDS

DS

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My Fellowship Achievements

Public health surve veillance ce

• Twelve

ve months retention in care among HIV clients as reported in the HMIS (2011 - 2014)

 There

re is no differe rence in retention for r both men and females.

 Retention for

r childre ren was very ry low compare red to the adult

 Low retention at referra

rral hospitals compared to other r leve vels

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My Fellowship Achievements

Response to public c health emergency cy

• Led outbr

break ak investig tigatio tion

Cholera Outbre reak Caused by y Dri rinking g Contaminated Water r from a Lakeshore re Water-Collection Site – Uga ganda, June 2015

• Partic

icip ipate ated in other outbr break ak investig tigatio ations ns

A wide cholera outbre reak in Kasese distri rict that affected ove ver r 80 village ges Typhoid outbreak inve vestiga gation in Kampala Typhoid veri rification in Luwero ro and Nakaseke

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My Fellowship Achievements

Epidemiologica cal study y

• Evaluatio

uation n of the Communi nity ty-Bas ased d HIV Service Delivery Models used to reach Sex Workers along ng Malaba aba –Kampal ala a high way

– It included hot spot are reas in six x distri ricts – Thre ree models were re assessed :Static facility y servi rvices,

• utre

reaches & Peer r to peer r mechanisms

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My Fellowship Achievements

Oral presentation at conference ces

• Internatio

national al night t EIS conferenc nce 2016 Atlan anta ta

 Ranked 1st

st out 420 abstra

racts submitted

• Presentatio

ntation n made at the 16th

th Uganda

da society ty for health th scientis ntists ts conf nferenc nce ,6th-7th

th August

t 2015

• Presente

nted d during ng the 11th

th JASH conferenc

nce 23rd

rd-

25 25th

th Sept 2015

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My Fellowship Achievements

Communica cation skills

• Co

Co-autho uthor in a publi licatio ation n on the typhoid id outbr break ak in Kampa pala,2 la,2015 –BMC public ic health h

• Publis

ishe hed d three artic icle les in the MoH quarte terly ly epidemio iolo logic ical al bulle letin tin

• Publis

ishe hed d an article le in the New visio ion about ut the need for male involv lvement nt eMTCT

• First

t autho hor on cholera a outbreak ak in a fishi hing ng village –Epide idemio iolo logy and infectio tion n journal nal

• Co

Co-autho uthor on a case study dy about ut chole lera in a fishi hing ng villag age

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My Fellowship Achievements

Leadership and management

• Organi

nizin ing committe ittee for two eMTCT regional nal campaig aigns ns

• Development

nt of the 1st

st comprehe

hens nsiv ive cholera a plan for Uganda da

• Weekly

ly review meeting ng for optio ion n B+

• Natio

ional al Rapid d Response nse Team Member

• 2017 Natio

ional nal Cholera a Treatment nt Guidelin ines Review

• Mento

tor and traine ner for the frontli ntline ne FETP

Public Health Fellowship Program – Field Epidemiology Track

Cholera ra Outbr break ak Caused d by Drink nking ng Contam aminat nated d Water r from a Lakesho hore re Water-Collection n Site – Uganda anda, June 2015

Pande Gerald, ld, BEH, , MPH Fellow, , Cohort t 2015

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Cholera outbreak in a fishing community

Lake Edward

20 June 2015: : Kasese Distr tric ict t reporte ted a cholera a

• utbr

break ak in Katwe Villag age, , affectin ting >30 persons ns

• Katwe Villag

age: : Fishin ing villag age

• n shore of Lake Edward
• 1st

st case on 16 June;

; cases sharply ply increas ased afterwar ards

• Ongoin

ing outbr break ak (seroty type pe Inaba ba) in Kasese District t since Mar 2015

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Cholera outbreak in a fishing community

Objecti ctive ves

• To identif

tify mode of transm nsmiss issio ion

• To recommend

nd contr trol l measur ures

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Cholera outbreak in a fishing community

Case definition

• Suspecte

ted d case: : Onset t of acute watery diarrho hoea a from 1 June 2015 onwar ard

• Confirmed

d case: A suspe pecte ted d case with Vibrio cholerae identif tified d in stool l sampl ple by cultur ture

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Cholera outbreak in a fishing community

61 suspected cases identified

# of cases Suspecte ted cases 61 61 Rapid Diag agnos nosti tic Test t pos

• siti

tive 19 19 Cultur ture confirmed 8

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Cholera outbreak in a fishing community

Point-source ce exposure: 16-17 June, followe wed by scattered cases in community

1d

4 8 12 16 20 14 18 22 26 30 04 08 June July

Onset Date Cases Incubation of Cholera (Inaba):

• Median: 3 days
• Range: a few hours – 5 days

Investigation & initial control Primary case 5d 3d

Exposure: 16-17 June

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Cholera outbreak in a fishing community

All age groups were affected

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79

Age (years) # Cases

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Cholera outbreak in a fishing community

Sex Cases Popn AR (/10 1000 00) Male 31 31 6466 6466 4.8 Female 30 30 5858 5858 5.1 Male and female residents equally affected

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Cholera outbreak in a fishing community

0.67 0.36

Attack ck rate (/1000) was >30 times higher in Kya yarukara Secti ction than in other sect ctions

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Kyarukara Rwenjubu Kyakitale Tophill Kiganda

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Cholera outbreak in a fishing community

Hypotheses generating intervi view w of 10 case-persons

• No large gatherin

ing between 16-17 June that t could ld explain in the outbr break ak

• 9 of 10 case-pe

persons ns usuall ally collecte ted d water from lakesho hore Water Collectio tion n Site A

• No case-pe

persons ns treate ted d or boile led d drinkin ing water Hypoth thesis is: : Drinkin ing wate ter collected d from Wate ter Collectio tion n Site te A caused this outbr break ak.

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Cholera outbreak in a fishing community Lake Edward

0.67

20

0.36

Water Collection Point A

Water-Co Collecti ction Site A: Fence ced area on the shore of Lake Edward

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Cholera outbreak in a fishing community

Case-co control study

• 39 suspe

pecte ted d cases from Kyarak aka a Section n (highe hest t AR)

• 156 contr

trols ls: : Same sectio ion n of villag age; ; asympto ptomati atic

• Freque

uenc ncy-matc tche hed d by neighbo bour urho hood d and age

• Exposure of interest:

t: Where case- and control-pe persons ns colle lecte ted d drink nkin ing water

Lake Edward AR= 20/1000

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Cholera outbreak in a fishing community

Usual water- collection site % Cases (n=39) % Controls (n=156) ORM-H (95% CI) Inside fenced area at Site A 95 67 9.3 (2.1–39) Outside of fenced area or elsewhere 5.0 33 ref

Drinking water collected from Water-Collection Site A associated with disease

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Cholera outbreak in a fishing community

Primary y case-person: A fisherman

• 15-16 June: Fished on

lake

• 16 June, Day: Fell sick
• 16 June, Night:

– Came ashore – Defecated “near” Water Collection Site A Primary case-person

♪♪♪“Oh, with good wind from the lake, this feels really cool!”♪♪♪

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Cholera outbreak in a fishing community

Tap water system in the village broke ke-down wn 8 months ago

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Cholera outbreak in a fishing community

Protected spring: 3km away; y; commerci cially y available at ~$1.5/100L

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Cholera outbreak in a fishing community

Concl clusion

• This point

nt-sour urce chole lera outbr break ak was caused d by drinkin ing lake water collecte ted at Site A

• Primar

ary case-person’s faeces contaminated water insid ide fenced d area at Water Collectio tion n Site A

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Cholera outbreak in a fishing community

At our reco commendation, the village administration:

• Provide

ided d chlorin ine H2O treatm tment t table lets ts

• Issue

ued d water boili ling ng advisory

• Rigorously disinfected all patients’ faeces
• Fixed

d tap-wate ater syste tem 3 weeks later

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Cholera outbreak in a fishing community 4 8 12 16 20 14 18 22 26 30 04 08 June July

This outbr break ak stopp pped d 10 days after interventio ntion; n; Kasese Distr tric ict t outbr break ak laste ted d several al months ths

Investigation & initial control measures Onset Date Cases Specific control measures

Outbreak

10 days

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Cholera outbreak in a fishing community

Ackn knowl wledgements

• Minis

istr try of Health th

• US

US-CDC

• MaKSPH
• PHFP
• Mentors
• Dr Makumbi Fredrick

ck

• Dr Musinguzi Joshua
• Dr Shaban Mugerwa
• Dr Kansiime Edgar

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Cholera outbreak in a fishing community

Outbreak k cholera in Kasese district ct from Feb- May

1st reported case (index case)

Onset date Suspected cases

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Cholera outbreak in a fishing community

Outbreak k started in Bwera; later spread to Kitswa wamba

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Cholera outbreak in a fishing community

Attack rate is highest in Kyarukara villages

Village/Ward Population Cases Attack Rate (/1000) Kyakitale 2813 Top hill 1500 1 0.67 Kyarukara 2855 59 20 Kiganda 2760 1 0.36 Rwenjubu 2396 Total 12324 61 4.9

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Cholera outbreak in a fishing community

Cholera RDT princi ciple

• Uses monoclonal antibodies to detect

lipopolysaccharides (LPS) antigen on surface of V. cholerae

• Sensitivity: about 80–90%; specificity: 60–70%

when used directly with patients’ fecal specimens

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Cholera outbreak in a fishing community

Chlorine solution mixi xing formula

• X = CV/O.
• Where; X is amount of solution, C is the desired

concentration, V is the amount in litres of solution required and O is the strength of the of the jik.

• Example; X= (0.2 x 20)/3.8. X = 1.05.
• Get 19 litres of water to add 1litre of Jik to get 20

liters of 0.2% chlorine solution

• Do this for different

t % 0.05, , 0.5,0 ,0. . 1,

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Cholera outbreak in a fishing community

Possibility y of seco condary y transmission

• Of 8 case after 22 June, 4 had potential epi-links

– 3 were family members of cases in point-source epi-curve – 1 was schoolmate and friend of a case in the point-source epi-curve

• Differences between onset dates

– 3d – 4d – 8d – 9d Potential secondary cases Not secondary cases