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KeyHighlights

• 03cumulativecases(00probable03confirmed)• All(03)confirmedcaseshavedied(CFR=100%)• Todayisday5sincethedeathofthelastconfirmedcasewhopassedonthe13June2019whileontransferto

theDRCforfurthermanagement• Thereare93contactsunderfollowup

o 86werefolloweduptodayo Nonehasdevelopedsymptomstodate

• 02suspectcasesonadmissioninETU• Activecasesearchanddeathsurveillanceareongoinginthehealthfacilitiesandthecommunitiesasthedistrict

responseteamcontinuetoinvestigateallalerts• 147contactshavebeenvaccinatedtoday• High level community engagement was done in Karambi subcounty to address community hostility against

responseteams• WelfareofETUhealthworkersneedurgentattention

EPIDEMIOLOGICALSUMMARY

BackgroundOn 11th June 2019, theMinistry of Health of Uganda declared the 6th outbreak of Ebola Virus Disease (EVD) in thecountryaffectingKasesedistrictinSouthWesternUganda.Thefirstcasewasafive-year-oldchildwitharecenthistoryoftraveltotheDemocraticRepublicofCongo(DRC).Thischildwasoneof6peoplethattravelledfromtheDRCwhilestillbeingmonitoredassuspectcasesfollowingaburialofthegrandfatherwhosuccumbedtoEVD.Thechildwasillby

1. Situation update Cases

03

Deaths

03

EBOLA VIRUS DISEASE IN UGANDA 18 June 2019 as of 20 00 Hrs SitRep #07 Situation Report

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thetimehecrossedintoUgandaandthemothertookhimformedicalcareatKagandohospitalinKasesedistrictwithsymptoms of vomiting blood, bloody diarrhea,muscle pain, headache, fatigue and abdominal pain. The child testedpositiveforEbolaZairebyPCRandhelaterdiedon11thJune2019.Twoothermembersofthefamily,agrandmotherand3-year-oldbrotheralsotestedpositiveforEbolaon12June2019andthegrandmotherdiedlaterthesameday.The3-year-oldbrotheralsodiedonthe13June2019. Asoftoday,there isnoconfirmedEVDcase inUganda,however2suspectcasesareadmittedatBweraEbolaTreatmentUnit.Ninety-three(93)contactsarebeingfollowedup.Figure1:MovementoftheEVDcasesfromCongointoUganda

Table1:SummaryofEbolavirusDiseaseoutbreakinKasese,June2019SUMMARYOFCASES(asof17/June/2019) Newsuspectcasestoday 01Newdeathstoday 00Cumulativecases(probableandconfirmed) 03

Probable 00

Confirmed 03Cumulativedeaths(probableandconfirmed) 031Healthfacilities 03Community 00Deathsamongconfirmedcases 03Numberofcasesonadmission(probableandconfirmed) 00Probable 00Confirmed 00Suspectcasesonadmissionunderinvestigation 022

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Cumulativeconfirmedcasesdischarged 00Caseswhoarehealthworkers 00Runawaysfromisolation 00Cumulativenumberofcontactslistedasoftoday 93Numberofcontactsthathavecompleted21days 00Numberofcontactsunderfollowup 93Numberofcontactsfolloweduptoday 86Cumulativenumberofcontactswhodevelopedsymptoms 00Cumulativenumberofcontactsvaccinated 2753Numberofcontactsvaccinatetoday 1473Specimenscollectedandsenttothelab.Today 2Cumulativespecimenscollected 184Cumulativecaseswithlabconfirmation 03Cumulativesamplestestednegative 09Specimenswithpendingresults 00Dateofdischarge/deathoflastconfirmedcase 13June20191includes1deathintheDRC2ExcludestwocaseswithrepeatnegativePCRplannedfordischargetomorrow.3Includescontactsofcontacts46arerepeatsamplesFigure2:EpidemiccurveofEbolaVirusDiseaseoutbreakinKasese,June2019

CoordinationToday the EVD District Task Forcemeeting was chaired by Deputy Resident District Commissioner. ThemeetingdiscussedactionpointsraisedduringtheDTFmeetingheldthepreviousday.Italsoreceivedfeedbackfromthesub-committeesfollowingtheactivitiesconductedthepreviousday.AcommunityengagementmeetinginKarambiSub-countywasheldtointensifysocialmobilizationandriskcommunicationsincethecommunitywasbecominghostile

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Num

bero

fcases

Onsetdate

Confirmedcasesonly

Grandmother

BurialofGrandfather

Brothers(3and5-year-old)

Deathof5-year,grandmotherand3-year-oldrespectivelypectively

2. Public Health Actions to date

June 2019

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duetoEbolaresponse.ThepoliticalleadershipemphasizedcommunityledEbolaresponseandaskedallcommunityleaderstocooperateandsupportresponseteams.

Otherkeyissuesdiscussedincluded;

- TheneedforadequatecoordinationbetweenthesurveillanceteamsinDRCandthoseinUgandatounderstandclearlytheoutbreakpatterns.

- TheneedformoreRadioAirtimetocoverotherradiostationsascurrenteffortsarefocusingononlytwoRadiostations(MessiahFMandGuideFM)Leavingoutotherradiostations.

- DelayedpaymentofstaffwhoweretrainedsinceEbolapreparednessphase.ThesepeopleweretobepaidbyWHO.ThisisdemoralizingstafffromparticipatinginongoingactivitiesinResponse.

- Theurgentneed to stopVHTsactivities in communitymalariadiagnosis andoffering familyplanning services(injectable)incommunitiesuntilfurthernoticebecauseoftheincreasedriskofEbola.

Surveillance

• Onealertwasreceivedthatwasverifiedasanon-case.Cumulatively,9alertshavebeenregisteredofwhich3wereverifiedassuspectcases,5verifiedasnonecaseand1asaknowncontactwithnosymptoms.

• Screened317mournersataburialinNyabugandotownduringEventbasesurveillance.• CommunityBasedDiseasesurveillancegroupre-oriented29VHTsand7localleadersin12outof15villagesin

IsangosubcountyfocusingonfactsaboutEbolaandnotificationmechanismsandIECmaterialsonEVD.• Fromactive case search the team identified five casesofbloodydiarrhoeadiagnosedasdysenteryatKabirizi

KatweHCIIofwhichonewasfollowedupandconfirmedthatsymptomsresolvedupontreatment.Theotherfourcasescouldnotbetracedastheyaremobilecommunities.

• Activecasesearchinschoolsyieldednosymptomaticcases.• Screened12886peopleat6pointofentry(POEs).However,therearenoscreeningservicesat18PoEand6bus

terminalsduetoshortageofmanpowerandlogistics(handwashing,tents,thermometersandchlorine)LaboratoryCumulativenumberofreportedsamplestodateis12(excluding6repeatsamples),threepositiveandninenegative

• Procuredservicesforelectricalandfurniturefittingintothemobilelabworkroom• StartedonthesetupofthemobilelabatBwerahospitaluponstaffdecontaminatingtheworkspace• Results for yesterdays’ two referred sampleswere reported.Onewas a repeat and the otherwas for a new

admission.AllarePCRnegative.Plannedactivities

• Electricalandfurniturefittinginthemobilelabworkroom• Developstandardguidelinesonmanagementofsamplesandwasteinthemobilelaboratory.• Securepowerbackup(GeneratorandUps)tosupportconstantlabworkoperations.Procurementoftheseitems

hasbeeninitiatedandismovingforwardCasemanagementToday,theETUhasfouradmissionsincludingonenewsuspectcasewhowasadmittedlastnightat8:30pm,andthreepatientswhowerecarriedonfromthepreviousdayassummarizedinthetablebelow.

Table2.0SummaryofpatientsadmittedinETUasof18-June-2019

Case Description 1sSample 2ndSample 1stResult 2ndResult CommentCase1 45year/Male Taken to be taken

tomorrowNegative - Investigationongoing

Case2 3year/Male Taken taken Negative Negative To be discharged afterpsychosocial team has preparedhisvillagetoreceivehim

5

Case3 3year/Male taken

to be takentomorrow

Negative - Investigationongoing

Case4 7year/Male taken taken Negative Negative To be discharged tomorrow,awaitingpsychosocial topreparehiscommunity

TheCoordinationteamheldameetingwithETUmemberstodiscusstheirgrievancewithrespecttotheirfacilitation.ItwasobservedthattheyhaveneverbeenpaidsinceAugust2018andtheyaretotallyfrustrated.Weadvisedonthelogisticsmanagementandincreasedhumanresourcemanagement.Theremaining4nonvaccinatedhealthworkersinETUwillbevaccinatedtomorrow.ETUsecurityhasbeenbeefedupwithMilitary.

Riskcommunicationandsocialmobilization

• Sensitised201sub-countycouncilors,localcouncilonechairpersonsandUPDFsoldiersonEVD• Communitydriveswithfilmvansensitisedanapproximateof385people,625Marketvendors,1,812pupilsin6

schools,oneononediscussionsensitized105people,conducted37smallgroupleveldiscussions,sensitisedand36householdvisitssensitised175people

• Distributed110posters,219leafletstargetingmarketvendorsandUPDFsoldiers

Psychosocialteam• Conductedafollow-upvisitwiththe2youngmenwhoweretransferredfromtheETUandarecurrentlyreceiving

treatmentonthegeneralwardatBwerahospital.Theyarerecoveringandtheirfamiliesarenowmoresupportive.• Counselledthenursewhoisacontactandshehasnotreportedanysymptomstoday• Offeredpsychosocialsupporttoattendantsof2patientstransferredfromETUtothegeneralwardVaccinationThevaccinationteamhasvaccinatedacumulativenumberof275contactswith147vaccinatedtodayintwomainrings.The147vaccinatedincluded51healthworkers.Theteamcontinuestoidentifynewcontactsandcontactsofcontacts.WASH

• TheWASHteamassessedtheWASHinterventionsin6schools,landingsiteofKigendoandNationalWaterandSewerageCorporationofficesinKatweT.C

• Trained101EarlyChildDevelopmentcentreHeadTeachersandcaregiversonhandwashingandwatertreatingstrategy

• Assessedtheavailabilityandfunctionalityofhandwashingfacilitiesandwater;7schools,7restaurants,3healthfacilities,2churchesand1marketinKabatoroTownCouncil,HimaTownCouncil, MpondweLhubirihaandIbandaKyanaTownCouncils

• Keyobservationsmade;Outofthe26institutionsvisited,only15hadhandwashingfacilitiesprovidedwithjikorchlorineasadisinfectant

Infectionpreventionandcontrol

Theteamorientedhealthworkersonimportanceofcleanenvironment,useofprotectivewear,wastedisposalat6healthfacilities;BikunyaHCII,BubotyoHCII,BuhungamuyaghaHCIII,IhandiroHCIIIandBweraGeneralHospital

Logistics• ConductedEVDvaccinesupply inventory.Thedistrict logisticsmanagement teamwastrained inpublichealth

emergencesupplychainmanagementbyMSH

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Keyplannedactivities• Conductactivecasesearch,contactlistingandfollowupinhealthfacilitiesinallHealthSub-districts• Thewashcommitteetogetherwithallenvironmentalhealthstaffinthedistrictwillvisitmoreinstitutions

(schools,markets,healthfacilities)toassesstheWASHinterventionstowardsEVDpreventionandcontrol• TheriskcommunicationteamtocontinueworkingwithvaccinationteaminBweraoncommunityengagement

toaddressrumorsthroughcommunitydialoguemeetings• EngagementofcommunityleadersinKilembeandMukunyuonhostilityagainstCongolesenationals• Sensitisecommunitymembers, stopmassgatherings,alleviate fearsandanxietyamongcommunitymembers

onEVDandencouragepeople tohandwashand stophandshaking.Thecommunitywill also sensitiseon theimportanceofsafeanddignifiedburialfollowingresistanceatSDBofasuspectcase.

• CommunityengagementatmarketstoenhancealertnessandenablereportingofanyEbola-relatedeventstothedistrictauthorities

• TheriskcommunicationteamwillvisitthemarketsandotherpublicplacestoconductsensitizationandengagementmeetingsonEVDalertness

• InvolvementofVHT/volunteerstosupportriskcommunicationatPOEswithriskcommunicationteamsChallenges

• TheETUmembersarerequestingforPerdiemsincetheyrenttheiraccommodationtobeclosetothetreatmentUnit.

• Inadequatescreeningservicesat18PoEand6busterminals• Oneofthecontactsundergoingpsychosocialsupporthasrefusedtobevaccinated• PeopleinKatirivillage,KyanjukiparishinBulembyapeoplehaveabeliefthatifyoutakefirewoodashyouwould

betreatringEbola.Alsobelievethateatingbushmeetyoulivelonger• ScreeningatMiramimwanalhobeingdoneinopenwithnotentandchairs•

CommunityawarenessoftheriskofEbolainfectionishighandthecommunityisverysuspiciousofanyonewitharecent travel to the DRC. Supplies of response items have improved but more forecasting is needed to avoidstockouts of essential items like PPEs and other sundries. TheWelfare of the healthworkers in ETU need to beurgentlyaddressed.

The following partners are supporting Ebola response in Kasese district;WHO, CDC, USAID CHC, UNICEF, Red Cross,AFENET,ECHO,DFID,UNHCR,IRC,IOM,Baylor,BRACUganda,MSH,SavetheChildrenandMSF.

3. Conclusion

4. Partnerships