Abstract
IntroductionOn 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors.MethodsWe defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design.ResultsWe identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs.ConclusionThis reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.
Highlights
On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health
Our data suggested that this illness cluster might have been caused by a combination of predisposing conditions and the misuse of NonSteroidal Anti-inflammatory Drugs (NSAID) that are known to trigger bleeding in patients with a bleeding tendency
In reviewing detailed clinical information of 31 patients with a post-mortem diagnosis of peptic ulcers, Felix and Stahlgren found that hematemesis was the initial symptom for 35% (11/31) of the patients; autopsy showed that 58% (18/31) of the patients had an ulcer located in the duodenum and 12 patients had an ulcer in the stomach and 10 of those patients had a bleeding ulcer [11]
Summary
On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. Methods: We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. Results: We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). A loss of gastro-intestinal micro-vascular integrity is a characteristic of Viral Haemorrhagic Fevers (VHF) such as Ebola, Marburg, Lassa fever, Yellow fever and Rift valley fever [3]; hematemesis might indicate a VHF especially if it is accompanied by fever and bleeding from other orifices. On 17 September 2015 the Ministry of Health of Uganda received a report from Buliisa District Health Office in western Uganda about a cluster of a mysterious fatal disease in Butiaba Sub-county. We conducted an investigation to establish the existence of an outbreak, verify the diagnosis of the disease and inform public health interventions
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