p Achie ievemen ments ts My Fellowshi hip Dr.Fred Nsubuga, - - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Track

My Fellowshi hip p Achie

ievemen ments ts

Dr.Fred Nsubuga, MBChB, B, MPH

Fellow, Cohort rt 2015

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My Fellowship Achievements

Host Site-UNEPI NEPI

• Goal

– Ensure that every child and high-risk k grou

• up is fully

vacci cinated with high quality and effect ctive vacci cines

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My Fellowship Achievements

Public health surve veillance ce

• Measle

les surveil illan lance data a analy lysis is ; 2012-2015

• Traine

ned DHTs on surveil illa lanc nce during ng implementatio ntation n of hous use to house polio io campaig ign

• Evaluatio

uation n of AFP surveil illan lance syste tem in Ugand nda

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My Fellowship Achievements

Response to public c health emergence ce

• Outbr

break ak investig tigatio ations ns

– Measles outbreak k in Kamwenge district ct, Western Uganda, 2015 – Typhoi

• id verifica

cation

• n exerci

cise in Bukwo – Outbreak investigation that assessed “Risk factors for measles death: Kyegegwa District, Western Uganda” – Rapid assessment of a suspect cted measles outbreak k at Rwamwanja primary schoo

• ol

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My Fellowship Achievements

Response to public c health emergence ce

• Outbr

break ak investig tigatio ations ns

– measles outbreak k investigation

• n in Rwamwanja refugee

settlement – Typhoi

• id verifica

cation

• n in Pallisa District

ct – Outbreak k of typhoi

• id fever in Kampala in 2015

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My Fellowship Achievements

Epidemiologica cal study

• Conduc

ucte ted d study that t compar ared the proportio tion n of childr dren n reache hed d durin ing stati tic and outreac ach h immuni nizatio ation strate ategies, , Ugand nda

• Conduc

ucte ted d a study dy to assess factors that affect t immuni nizatio ation data a quali lity ty in Kabarole le distr tric ict

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My Fellowship Achievements

Scientific c communica cation

• Manus

uscript ipt title led: d: Facto tors contr tributin ibuting to measles transmis issio ion n in Kamweng nge Distric ict t – BMC Public ic Health th

• Co

Co-autho uthor in a publi licatio ation n on measle les death in Kyegegwa 2016 – BMC Infectio tious us Health th Journal nal

• Co

Co-autho uthor in a publi licatio ation n on a large typhoid id

• utbr

break ak in Kampala ala – BMC Public ic Health th

• Co

Co-autho uthor in a publi licatio ation n facto tors affectin ting virolo logic ical al non suppr pressio ion among HIV patie ients nts on ART in Uganda da – BMC Infectio tious us diseas ase

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My Fellowship Achievements

Scientific c communica cation

• Presente

nted d at AFENET Conferenc nce and got an award d as 2nd

nd run-up

up

• Presente

nted d at 2 natio iona nal l conferenc nces: : Regional al HIV Conferenc nce and National nal Epide demio iolo logy Conferenc nce

• Publis

ishe hed d 1 artic icle le in MOH quarte terly epidemio iolo logy bulletin tin

• 1 newspape

paper artic icle le in New Visio ion

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My Fellowship Achievements

Leadership and Management

• Facili

litat tated d a sessio ion on the management nt of measle les outbreak ak for medical al stude dents nts at the College of Health th Sciences, , Makerere University ty

• Member of TWG that

t update ated d Immuniz izatio ation n in Practic tice Manual ual for Uganda da

• Traine

ned Gulu u regional nal teams on polio io end game to prepar are for IPV introduc uctio tion, n, switc tch h and SIAs

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My Fellowship Achievements

Leadership and Management

• Natio

ional al supervis isor/tr train ainer durin ing the Sub Natio ional nal Immuni nizatio ation n Days for polio io in Lamwo Distric ict

• Led and coordin

dinate ted d the writin ing of natio iona nal l report t

• n sub-na

natio tiona nal l immuni nizatio ation n days, , 2016

• Member of the NTF

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My Fellowship Achievements

Director TEPHINET

End of Fellows wship Achieve vements

Public Health Fellowship Program – Field Epidemiology Track

Large ge Outbr break ak of Typho hoid Fever r in Kampa pala, a, Uganda; nda; Januar uary – June 2015

Dr.Fred Nsubuga, MBChB, MPH On behalf of Cohort 2015 Fellows of the Uganda Public Health Fellowship Program – Field Epidemiology Track

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Typhoid outbreak

Strange disease reported in Kampala Feb 2015

2nd 3rd 4th 5th 6th 7th 8th 9th 10th Index patient hospitalised Symptoms:

• Abdominal pain
• Prolonged fever
• Jaundice

Start of investigation Death of index patient Reported to city authority and MoH Feb

14

Typhoid outbreak

Initial inve vestigation indicated typhoid

• Docto

tor: : Index patie ient nt had severe abdomin inal al pain n and (+) Widal al Test

• A

A hospital pitalise ised patie ient nt had simil ilar ar sympto toms

– Many of her colleagues sicke ckened; some died – Her husband had similar symptom

• ms, took antibiot
• tics

cs and got better

• Communi

nity ty intervie iews and observatio tions ns identif tifie ied d

• ther people

le with simila lar sympto toms

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Typhoid outbreak

Case definition

• Suspecte

ted d case:

– Onset of fever ≥5 days since 1/1/2015, not respon

• nding to

antimalarial treatment, in a p person

• n worki

king or living in Kampala – Plus ≥2 of the following: abdominal pain; diarrhea; headach che; nausea/vom

• miting; or altered mental state
• Probabl

able case: : Suspe pecte ted d case plus TUBEX X test (+)

• Confirmed

d case: : Suspecte ted case plus Salmone nella Typhi hi (+) from blood d cultur ure

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Typhoid outbreak

Case finding

• Active

ve case finding in areas where

• utbreak

k had been reported

• Setting up free treatment centers

throughout the city

• Media outreach

ch

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Typhoid outbreak

Case count 30-Mar-2015 2015

• 3817 Suspected cases
• 1033 Probable cases
• 46 Confirmed cases

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Typhoid outbreak

1623 cases have been found (as of 12 Mar); Cases Reported throughout Kampala

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Typhoid outbreak

Demographic c info (as of March ch 30th) Age (years) Mean = 26 Range = 1-79 Sex Male 55.0% Female 45.0%

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Typhoid outbreak

50 100 150 200 250 300 350 400 450

Investigation began

Epi Curve ve, Suspect ct Typhoid Feve ver Cases meeting the case definition– Kampala, 2014 2014-2015, n = 4,139*

Number of cases Date of illness onset

*for whom date of illness

• nset is available

Death of index patient

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Typhoid outbreak

Food-borne or water-borne?

• Case distr

tribut buted d throug ugho hout ut Kampala ala

• Cases reporte

ted d buying ng unbott ttled drink nks at unreas asona nably bly low price

• Hypoth

thesis-gene nerating ating intervie iews: : Patients ts more likely ly to get drinking ing water from workpl plac ace

Strong g suspicion of water er-borne e outbrea eak

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Typhoid outbreak

Case-co control study

• 33 cases
• 78 controls
• Frequency

cy-match ched by sex x and place ce of work

• Info on water and food intake

ke

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Typhoid outbreak

Consuming loca cally made drinks and water associ ciated with disease

Usually drank…

ORM-H (95% CI) Kaveera water (Y/N) 8.9 (1.6-49) Butunda (Y/N) 4.6 (1.9-11) Obushera (Y/N) 2.8 (0.76-10) Munanansi (Y/N) 2.0 (0.74-5.2) Bottled water and food items were not associated with disease

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Typhoid outbreak

Munanansi Kaveera water Butunda Obushera

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Typhoid outbreak

Dose-response

# of types of locally made drinks % cases (n=33) % controls (n=78) OR (95%CI)* 36 64 1 (Ref) 1 27 26 1.9 (0.68-5.1) 2 15 9 3.0 (0.80-11) 3-4 21 1 29 (3.2-260)

*Chi-square test for linear trend: Chi-square =14.65, p = 0.00013

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Typhoid outbreak

1 2 3 4

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Typhoid outbreak

Butunda - passion fruit juice

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Typhoid outbreak

Laboratory y inve vestigation 9th

th April

• 46 blood

d sample les (+) for Salmonella typhi hi by cultur ure

• All drinks and water heavily contam

aminate nated d with faecal al matte ter

– 9/9 juice ce samples – 18/20 water samples

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Typhoid outbreak

Concl clusions

• Large outbreak

ak of typhoid id fever

• Caused

d by consumin ing locall lly made drink nks, , made with h contam tamin inate ated d underground nd water

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Typhoid outbreak

Public health actions take ken

• Provide

ided d safe water to most heavily ly affecte ted areas

• Closed

d off underground und water sources

• Health

th educatio ation

– Drink k only boiled water – Avoid drinki king unclean water and juice ce from marke kets

Public Health Fellowship Program – Field Epidemiology Track

Ackn know

• wledge

gements

KCCA MOH CPHL EOC - MoH Makere rere re College ge of Health Sciences Micro robiology gy Labora ratory ry MoH-MAKSPH-CDC PHFP-FET Mark rket committee members rs Health work rkers rs at the are rea HCs

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Typhoid outbreak

BACK UP SLIDE DES:

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Typhoid outbreak

Typhoid feve ver

• Salmonella typhi
• Major signs/symptoms

– Prolonged fever – Abdominal pain – Vomiting

• Transmission – fecal oral

– Waterborne – Foodborne

• Incubation period

– Most common: 8-14 days – Range: 3-60 days

• Humans are the only host

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Typhoid outbreak

Other variables

Sealed Water 0.6 (0.2-1.7) Unsealed Water 1.8 (0.7-4.8) Lunch food Market 0.3 (0.1-1.1) Breakfast food Market 0.2 (0.1-0.9)

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Typhoid outbreak

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Typhoid outbreak

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Typhoid outbreak