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Case Reports
. 2019 Mar 18;13(3):e0007257.
doi: 10.1371/journal.pntd.0007257. eCollection 2019 Mar.

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

Luke Nyakarahuka  1   2 , Trevor R Shoemaker  3 , Stephen Balinandi  1 , Godfrey Chemos  4 , Benon Kwesiga  5 , Sophia Mulei  1 , Jackson Kyondo  1 , Alex Tumusiime  1 , Aaron Kofman  3 , Ben Masiira  6 , Shannon Whitmer  3 , Shelley Brown  3 , Debi Cannon  3 , Cheng-Feng Chiang  3 , James Graziano  3 , Maria Morales-Betoulle  3 , Ketan Patel  3 , Sara Zufan  3 , Innocent Komakech  7 , Nasan Natseri  7 , Philip Musobo Chepkwurui  4 , Bernard Lubwama  8 , Jude Okiria  8 , Joshua Kayiwa  9 , Innocent H Nkonwa  5 , Patricia Eyu  5 , Lydia Nakiire  5 , Edward Chelangat Okarikod  4 , Leonard Cheptoyek  4 , Barasa Emmanuel Wangila  4 , Michael Wanje  4 , Patrick Tusiime  8 , Lilian Bulage  5 , Henry G Mwebesa  8 , Alex R Ario  5 , Issa Makumbi  9 , Anne Nakinsige  8 , Allan Muruta  8 , Miriam Nanyunja  7 , Jaco Homsy  3 , Bao-Ping Zhu  5 , Lisa Nelson  3 , Pontiano Kaleebu  1 , Pierre E Rollin  3 , Stuart T Nichol  3 , John D Klena  3 , Julius J Lutwama  1
Affiliations
Case Reports

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

Luke Nyakarahuka et al. PLoS Negl Trop Dis. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map showing areas affected by the 2017 MVD outbreak.
This figure was created specifically for this manuscript in ArcGIS using open source data from ESRI and DIVA-GIS for the background layers, and GPS points collected in the field for the points. (ESRI - http://opendata.arcgis.com/about, DIVA-GIS—http://www.diva-gis.org/).
Fig 2
Fig 2. Transmission chain for MVD cases, Kween District, 2017.
Fig 3
Fig 3. Epidemic curve of the MVD outbreak in Kween District between, September 10 to December 10, 2017.
Fig 4
Fig 4. Phylogenetic tree inferring the relationship of Marburg virus from the 2017 outbreak with previous MVD outbreaks in Uganda.
Fig 5
Fig 5. Kaptum cave and gopil falls on the sundet river in Kween District, home of the probable case, salt mined in the cave and bats of Rousettus species inside the cave (credit: luke nyakarahuka).
See this image and copyright information in PMC

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