Abstract
BackgroundOn 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.MethodsWe defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.ResultsFrom 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.ConclusionContaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.
Highlights
On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens
We found that 22.58% (7/31) of casepatients compared with 2.56% (2/78) of controls usually drank locally packaged water in small plastic bags called “kaveera water” (ORM-H = 8.90; 95% CI = 1.60–49.00); 55% (18/33) of case-patients compared with 19.23%
Based on the evidence we presented, the Kampala Capital City Authority sealed off all underground water sources and worked with the National Water and Sewerage Corporation to ensure the provision of accessible alternative sources of water to the affected communities
Summary
On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. Typhoid fever is a systemic disease caused by Salmonella enterica serovar Typhi, a Gram-negative bacterium. Typhoid fever is preventable through public health interventions such as provision of safe water, ensuring proper sanitation and waste disposal systems, and excluding disease carriers from handling food [4]. The global burden of the disease in low- and middle-income countries in 2010 was estimated to be 11.9 million cases, including 129,000 fatalities, after adjusting for water-related risk factors [5]. In Uganda, an outbreak of typhoid fever in Kasese District sickened 8092 persons from 27 December 2007 to 30 July 2009, resulting in at least 249 intestinal perforations and 47 deaths [6]. In 2011, numerous typhoid cases were again reported in Kasese and neighboring Bundibugyo District with many more intestinal perforations and emergence of multidrug resistant strains [7]
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