PHEOC spearheads Yellow Fever enhanced surveillance in 18 at risk districts

Between March and April 2016, Yellow fever outbreaks were confirmed in Masaka and Kalangala districts in central region and Rukungiri district in Western Uganda. Yellow fever is an acute viral hemorrhagic fever transmitted by bites of infected Aedes mosquitoes.

The disease initially presents with sudden onset of fever, chills, headache, backache, myalgia, prostration, nausea and vomiting. 15% of the cases progress to the more severe form which presents with jaundice, hemorrhage, shock and multiorgan failure. The case fatality rate ranges from 20-50% among the cases with hepatorenal dysfunction.

A total of 22 cases were documented including seven (7) laboratory confirmed cases with a case fatality rate of 40%. Subsequently, the Ministry of health (MOH) together with partners instituted measures to prevent the spread of the outbreak to neighboring districts., A comprehensive response plan was implemented which included treatment of cases, strengthening surveillance, creation of public awareness, assessment of mosquito distribution in the three districts and epidemiological assessment of other high risk districts.

As part of this response, the Public Health Emergency operation Centre (PHEOC) with support from the CDC went ahead to implement enhanced surveillance in 18 neighboring high risk districts with the goal of strengthening surveillance. This was through training of health workers and strengthening of the laboratory system to collect and transport specimen of suspected yellow fever cases. The workshops aimed at highlighting the distribution, clinical presentation of yellow fever, and the differential diagnoses The training also highlighted the national laboratory specimen transport system and national communication system for public health events.

The workshops were facilitated by a team from PHEOC, the Public Health fellowship Programme, Central Public Health Laboratories and laboratory specialist from the Uganda Virus Research Institute. This activity kicked off on 23/05/16 with workshops on yellow fever and Onyong Nyong fever in 18 districts neighboring the three high risk districts. The Enhanced yellow fever surveillance workshops were hosted in Masaka, Mbarara and Ka- bale districts with a total of 291 health works trained. The workshops lasted for three days and attracted frontline health workers from 18 districts in the Masaka and Mbarara health regions.. The cadres trained included district surveillance focal persons, district laboratory focal per- sons, Hub system coordinators, clinicians from hospitals, health centre IV and health centre III.

The National Specimen Transport and Laboratory referral Network- Hub system plays a central role in confirming and monitoring the course of an outbreak. The Hub-system which is PEPFER funded was established in 2013 to improve efficiency of specimen transportation and turnaround time of the results from the laboratory. During the workshop participants were trained on role and functioning of the Hub-system

Communication is vital to link the districts to the national level once a sample for a suspected case is taken off until results are sent back to clinicians from the laboratory. The communication system which is hosted by the national data base, District Health Information System 2 (DHIS2) is managed by the PHEOC. The registered district health workers were provided with toll free sms codes “AlertYF” and AlertON which are to be sent to 8228. For unregistered cadres the sms code PHEOC was provided to be sent to 8228.

The national surveillance system can detect the yellow fever cases in the neighboring districts when there is case identification, the national specimen transport network and communication are emphasized at health facilities and the community. Efficiency of these three platforms will improve surveillance in the district