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

Public Health Fellowship Program – Field Epidemiology Tra ck My Fellows wshi hip Achi hievem evements nts Pande Gerald, BEH, MPH Fellow, Cohort 2015

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 ordination on of the respon onse  Resou ource ce mobilization on  Planning  Repor orting on HIV/AIDS DS 2 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 3 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 4 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, outre reaches & Peer r to peer r mechanisms 5 My Fellowship Achievements

Oral presentation at conference ces  Internatio national al night t EIS conferenc nce 2016 Atlan anta ta  Ranked 1 st st out 420 abstra racts submitted  Presentatio ntation n made at the 16 th th Uganda da society ty for health th scientis ntists ts conf nferenc nce ,6th-7 th th August t 2015  Presente nted d during ng the 11 th th JASH conferenc nce 23 rd rd - 25 25 th th Sept 2015 6 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 7 My Fellowship Achievements

Leadership and management  Organi nizin ing committe ittee for two eMTCT regional nal campaig aigns ns  Development nt of the 1 st 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 8 My Fellowship Achievements

Public Health Fellowship Program – Field Epidemiology Tra ck 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

20 June 2015: : Kasese Distr tric ict t reporte ted a cholera a outbr break ak in Katwe Villag age, , affectin ting >30 persons ns  Katwe Villag age: : Fishin ing villag age on shore of Lake Edward  1 st 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 Lake Edward 10 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 11 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 12 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 ositi tive 19 19 Cultur ture confirmed 8 13 Cholera outbreak in a fishing community

Point-source ce exposure: 16-17 June, followe wed by scattered cases in community Exposure: Cases 16-17 June Incubation of Cholera (Inaba): 20 • Median: 3 days 5d • Range: a few hours – 5 days 3d Investigation & 16 initial control 12 8 Primary case 4 1d 0 14 18 22 26 30 04 08 June July Onset Date 14 Cholera outbreak in a fishing community

All age groups were affected # Cases 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 Age (years) 15 Cholera outbreak in a fishing community

Male and female residents equally affected Sex Cases Popn AR (/10 1000 00) Male 31 31 6466 6466 4.8 Female 30 30 5858 5858 5.1 16 Cholera outbreak in a fishing community

Attack ck rate (/1000) was >30 times higher in Kya yarukara Secti ction than in other sect ctions Rwenjubu Kyakitale 0 Tophill Kyarukara Kiganda 0 0.67 0.36 20 17 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. 18 Cholera outbreak in a fishing community

Water-Co Collecti ction Site A: Fence ced area on the shore of Lake Edward 0 0 0.67 20 0.36 Water Collection Point A Lake Edward 19 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 AR= 20/1000  Freque uenc ncy-matc tche hed d by neighbo bour urho hood d and age  Exposure of interest: t: Where Lake Edward case- and control-pe persons ns colle lecte ted d drink nkin ing water 20 Cholera outbreak in a fishing community

Drinking water collected from Water-Collection Site A associated with disease Usual water- % Cases % Controls OR M-H collection site (n=39) (n=156) (95% CI) Inside fenced area 9.3 (2.1 – 39) 95 67 at Site A Outside of fenced 5.0 33 ref area or elsewhere 21 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 – D efecated “near” Water Collection Site A Primary case-person ♪♪♪ “Oh, with good wind from the lake, this feels really cool!” ♪♪♪ 22 Cholera outbreak in a fishing community

Tap water system in the village broke ke-down wn 8 months ago 23 Cholera outbreak in a fishing community

Protected spring: 3km away; y; commerci cially y available at ~$1.5/100L 24 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 25 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 26 Cholera outbreak in a fishing community

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 Cases Investigation & initial 20 Specific control control 16 measures measures Outbreak 12 8 10 days 4 0 14 18 22 26 30 04 08 June July Onset Date 27 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 28 Cholera outbreak in a fishing community

Outbreak k cholera in Kasese district ct from Feb- May Suspected cases 1 st reported case (index case) Onset date 29 Cholera outbreak in a fishing community

Outbreak k started in Bwera; later spread to Kitswa wamba 30 Cholera outbreak in a fishing community