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. 2024 May 23;24(1):520.
doi: 10.1186/s12879-024-09391-0.

Sudan virus disease super-spreading, Uganda, 2022

Allan Komakech  1   2 , Shannon Whitmer  3 , Jonathan Izudi  4   5 , Charles Kizito  6 , Mackline Ninsiima  7 , Sherry R Ahirirwe  7 , Zainah Kabami  7 , Alex R Ario  7 , Daniel Kadobera  7 , Benon Kwesiga  7 , Samuel Gidudu  7 , Richard Migisha  7 , Issa Makumbi  8 , Daniel Eurien  9 , Joshua Kayiwa  8 , Lilian Bulage  7 , Doreen N Gonahasa  7 , Irene Kyamwine  7 , Paul E Okello  7 , Hildah T Nansikombi  7 , Immaculate Atuhaire  7 , Alice Asio  7 , Sarah Elayeete  7 , Edirisa J Nsubuga  7 , Veronica Masanja  7 , Stella M Migamba  7 , Patience Mwine  7 , Petranilla Nakamya  7 , Rose Nampeera  7 , Andrew Kwiringira  7 , Rebecca Akunzirwe  7 , Helen Nelly Naiga  7 , Saudah K Namubiru  7 , Brian Agaba  7 , Jane Frances Zalwango  7 , Marie Gorreti Zalwango  7 , Patrick King  7 , Brenda Nakafeero Simbwa  7 , Robert Zavuga  7 , Mercy Wendy Wanyana  7 , Thomas Kiggundu  7 , Lawrence Oonyu  7 , Alex Ndyabakira  10 , Mariam Komugisha  7 , Brian Kibwika  7 , Innocent Ssemanda  7 , Yasin Nuwamanya  7 , Adams Kamukama  7 , Dorothy Aanyu  7 , Dominic Kizza  7 , Daniel Okello Ayen  10 , Sophia Mulei  11 , Stephen Balinandi  11 , Luke Nyakarahuka  11   12 , Jimmy Baluku  11 , Jackson Kyondo  11 , Alex Tumusiime  11 , Dativa Aliddeki  13 , Ben Masiira  14 , Esther Muwanguzi  15 , Ivan Kimuli  15 , Daniel Bulwadda  16 , Herbert Isabirye  16 , Deborah Aujo  17 , Arthur Kasambula  17 , Solome Okware  15 , Emmanuel Ochien  15 , Innocent Komakech  15 , Charles Okot  15 , Mary Choi  3 , Caitlin M Cossaboom  3 , Carrie Eggers  3 , John D Klena  3 , Modupe O Osinubi  3 , Katrin S Sadigh  3 , Mary C Worrell  3 , Amy L Boore  18 , Trevor Shoemaker  3 , Joel M Montgomery  3 , Susan N Nabadda  19 , Michael Mwanga  17 , Allan N Muruta  17 , Julie R Harris  18
Affiliations

Sudan virus disease super-spreading, Uganda, 2022

Allan Komakech et al. BMC Infect Dis. .

Abstract

Background: On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak.

Methods: In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases.

Results: Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data.

Conclusion: Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.

Keywords: Ebola; Sudan virus disease; Super-spreaders; Uganda.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient A clinical presentation, health facilities visited, and secondary cases during the SVD outbreak, Uganda, 2022
Fig. 2
Fig. 2
Patient B’s clinical presentation, health facilities visited, and secondary cases during the SVD outbreak, Uganda, 2022
See this image and copyright information in PMC

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