Sudan virus disease super-spreading, Uganda, 2022
Author:
Komakech Allan1, Whitmer Shannon2, Izudi Jonathan3, Kizito Charles4, Ninsiima Mackline1, Ahirirwe Sherry R.1, Kabami Zainah1, Ario Alex R.1, Kadobera Daniel1, Kwesiga Benon1, Gidudu Samuel1, Migisha Richard1, Makumbi Issa5, Eurien Daniel6, Kayiwa Joshua5, Bulage Lilian1, Gonahasa Doreen N.1, Kyamwine Irene1, Okello Paul E.1, Nansikombi Hildah T.1, Atuhaire Immaculate1, Asio Alice1, Elayeete Sarah1, Nsubuga Edirisa J.1, Masanja Veronica1, Migamba Stella M.1, Mwine Patience1, Nakamya Petranilla1, Nampeera Rose1, Kwiringira Andrew1, Akunzirwe Rebecca1, Naiga Hellen N.1, Namubiru Saudah K.1, Agaba Brian1, Zalwango Jane Frances1, Zalwango Marie Gorreti1, King Patrick1, Simbwa Brenda Nakafeero1, Zavuga Robert1, Wanyana Mercy Wendy1, Kiggundu Thomas1, Oonyu Lawrence1, Ndyabakira Alex7, Komugisha Mariam1, Kibwika Brian1, Ssemanda Innocent1, Nuwamanya Yasin1, Kamukama Adams1, Aanyu Dorothy1, Kizza Dominic1, Ayen Daniel Okello7, Mulei Sophia8, Balinandi Stephen8, Nyakarahuka Luke8, Baluku Jimmy8, Kyondo Jackson8, Tumusiime Alex8, Aliddeki Dativa9, Masiira Ben10, Muwanguzi Esther11, Kimuli Ivan11, Bulwadda Daniel12, Isabirye Herbert12, Aujo Deborah13, Kasambula Arthur13, Okware Solome11, Ochien Emmanuel11, Komakech Innocent11, Okot Charles11, Choi Mary2, Cossaboom Caitlin M.2, Eggers Carrie2, Klena John D.2, Osinubi Modupe O.2, Sadigh Katrin S.2, Worrell Mary C.2, Boore Amy L.2, Shoemaker Trevor2, Montgomery Joel M.2, Nabadda Susan14, Mwanga Michael13, Muruta Allan N.13, Harris Julie R.2
Affiliation:
1. Uganda National Institute of Public Health 2. United States Centers for Disease Control and Prevention 3. Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST) 4. Kikandwa Health Center III 5. National Public Health Emergency Operations Center 6. Baylor College of Medicine Children’s Foundation 7. Kampala City Council Authority 8. Uganda Virus Research Institute 9. Africa Centres for Disease Control and Prevention 10. African Field Epidemiology Network 11. World Health Organization 12. Infectious Diseases Institute 13. Ministry of Health 14. Uganda National Health Laboratory Services
Abstract
Abstract
Background: On September 20, 2023, Uganda declared its 5th Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We describe persons to whom exposure resulted in an unusual number of cases during the outbreak.
Methods: We defined a super-spreader person (SSP) as any person with RT-PCR-confirmed SVD linked to 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 were identified (Patient A, a 33-year-old male, and Patient B, a 26-year-old male), linked to 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, 1 probable), including 3 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 and friends and family who interacted with him throughout his illness, prayed over him while he was near death, or exhumed his body. Intensive community engagement and awareness-buildling was initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of 3 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 detected late in infection may help reduce the impact of super-spreading events.
Publisher
Research Square Platform LLC
Reference53 articles.
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