1

KeyHighlights

• 03cumulativecases(00probable03confirmed)• All(03)confirmedcaseshavedied(CFR=100%)• Todayisday6sincethedeathofthelastconfirmedcasewhopassedonthe13June2019whileontransferto

theDRCforfurthermanagement• Thereare106contactsunderfollowup

o 103werefolloweduptoday• 02suspectcasesonadmissioninETU• Activecasesearchanddeathsurveillanceareongoinginthehealthfacilitiesandthecommunitiesasthedistrict

responseteamcontinuetoinvestigateallalerts• 181contactshavebeenvaccinatedtoday

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.ThechildwasillbythetimehecrossedintoUgandaandthemothertookhimformedicalcareatKagandohospitalinKasesedistrictwithsymptoms of vomiting blood, bloody diarrhea,muscle pain, headache, fatigue and abdominal pain. The child testedpositiveforEbolaZairebyPCRandhelaterdiedon11thJune2019.Twoothermembersofthefamily,agrandmotherand3-year-oldbrotheralsotestedpositiveforEbolaon12June2019andthegrandmotherdiedlaterthesameday.The

1. Situation update Cases

03

Deaths

03

EBOLA VIRUS DISEASE IN UGANDA 19 June 2019 as of 20 00 Hrs SitRep #08 Situation Report

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3-year-oldbrotheralsodiedonthe13June2019. Asoftoday,there isnoconfirmedEVDcase inUganda,however2suspectcasesareadmittedatBweraEbolaTreatmentUnit.Onehundred-sixcontactsarebeingfollowedup.Figure1:MovementoftheEVDcasesfromCongointoUganda

Table1:SummaryofEbolavirusDiseaseoutbreakinKasese,June2019SUMMARYOFCASES(asof19/June/2019) Newsuspectcasestoday 00Newdeathstoday 00Cumulativecases(probableandconfirmed) 03

Probable 00Confirmed 03

Cumulativedeaths(probableandconfirmed) 031Healthfacilities 03Community 00Deathsamongconfirmedcases 03Numberofcasesonadmission(probableandconfirmed) 00Probable 00Confirmed 00Suspectcasesonadmissionunderinvestigation 02Cumulativenumberofhealthworkersdischarged 00Runawaysfromisolation 00Cumulativenumberofcontactslistedasoftoday 106

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Numberofcontactsthathavecompleted21days 00Numberofcontactsunderfollowup 106Numberofcontactsfolloweduptoday 103Cumulativenumberofcontactsvaccinated 456Numberofcontactsvaccinatedtoday 181Specimenscollectedandsenttothelab.Today 2Cumulativespecimenscollected 203Cumulativecaseswithlabconfirmation 03Cumulativesamplestestednegative 09Specimenswithpendingresults 2Dateofdischarge/deathoflastconfirmedcase 13-June-20191includes1deathintheDRC2includescontactsofcontacts3includes6arerepeatsamplesFigure2:EpidemiccurveofEbolaVirusDiseaseoutbreakinKasese,June2019

CoordinationTheDistrictchairpersonsocialservicescommitteechairedtoday’sEVDDistrictTaskForcemeeting.ThecommunitydialogueinKarambisubcountyyesterdaytaskedthecommunityleaderstoinformthecommunitymembersabouttheEbolavirusdiseasesituationinthedistrict.Theyurgedthecommunityleaderstoembracetheinterventionsputinplace.ThemeetingdiscussedactionpointsraisedduringtheDTFmeetingheldthepreviousday.Italsoreceivedfeedbackfromthesub-committeesfollowingtheactivitiesconductedthepreviousday.A4Wmatrixwasdevelopedandwillbepresentedtothedistrictfordiscussion.

Otherkeyissuesdiscussedincluded;- TheneedforconsistentsharingofcontactslistsbetweenDRCandUgandaofUgandaforadequatefollow-upof

contacts.- Theneedformoresupportfromthecorporatecompaniesinthedistrict- ProvisionofrefreshmentsforstaffworkingintheETU- Re-structuringtheETUtorelocatetheentranceormortuarylocationtobeaddressedbyMSF

0

1

2

3

4

5

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

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- ThecoordinationteamsupervisedPoEsitesandassessedcurrentpracticesSurveillance

• Contacttracingteamandvaccinationteammettoharmonizetheiroperations• Received two alert reports. One as a sudden death of a seemingly healthy 40-year-old man. Verification

including sample collection is underwaywithburial planned for tomorrow. The secondalert is a 40-year-oldman fromKatungulu subcounty;was verified and found to be a non-case. Cumulatively, 11 alerts have beenregisteredofwhich4wereverifiedassuspectcases,6verifiedasnonecaseand1asaknowncontactwithnosymptoms.

• Screened292peoplewhohadgatheredatachurchchoirpracticeatNsenyicatholicparish.• Conducted community engagement and sensitized people in Nsenyi parish focusing on EVD prevention and

notification.• Re-oriented64VHTsand12localcouncilleadersfrom15villagesinKathulhosubcountyfocusingonfactsabout

EbolaandnotificationmechanismsandIECmaterialsonEVD.• A team fromWHO country office trained the data teamonGoData software and installed it on the district

computers.• Theactive case search reviewed recordsat5health facilities includingKasangaHC III,MBHMarternity clinic,

KyambogoClinic,MpondweHCIIIandNyabugandoHCIII.Nocasewasidentified.• Atotalof106contactshavebeenlinelisted.Ofthese,103havebeenfollowedtoday.Threepeoplewerenot

followedbecause,onecouldnotbe located,onemovedtoKamwokya inKampalaandtheotherhadgonetotradeinthemarketandcouldnotbelocated.

• Oneofthecontactsofaconfirmeddead50-year-oldwomandevelopedahightemperature.However,shehadbeenvaccinatedthepreviousday.SheiscurrentlymanagedwithantipyreticsandIVfluidsinthegeneralward.

• Atotalof13newcontactswereidentifiedtoday.• Screeningwasconductedat6PoEsand6porouspoints.Atotalof3271men,2,204womenand821children

excludingMpondwescreeningpointswhichhasahugepopulationmovement.• Received8tentsfromBRAC-UGANDAforsomeporouspointsofentry.

Laboratory

• Securedelectricalandfurniturefittingintothemobilelabroom.• Twosampleswerereferredtothecentraltestinglaboratory(UVRI).Theyarebothrepeatsamples.• Twopendingresultsfortherepeatsamplescollectedtoday.• Cumulativenumberofreferredandtestedsamplesis20including6repeats.Threepositiveandninenegative.• Developed standard guidelines on sample and waste (both solid and liquid) management during mobile lab

operations.

LaboratoryPlannedactivities• Deliveryofpowerbackupequipment(generatorandUPS)toBwerafromUVRI.• Setupoftheequipmentinthemobilelab.

Casemanagement

• Today,theETUhastwoadmissionsof2suspectedcasescarriedonfromthepreviousday.Twopersonsweredischargedandintegratedintotheircommunities.

RiskCommunicationandCommunityEngagement

• Engaged35VHTsinMalibaSub-countyonEVD• strategicallydistributed75postersand16fliers• EngagedleadershipofMubukuprisontopmanagementandagreedonasensitisationprogram• ReachedMpondweLhubirihaandMpondweporousborderentrypointsandriskcommunicationisstillongoing

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• Engaged6healthworkersat2drugshopsand2pharmaciesandtheyweresensitisedonEVDprevention• Reached1410studentsand33teachersinNyamwambadivisionwithmessagesonEVD• Reached 736 individuals in Muhokya Sub-County and Mubuku Town Council with messages on EVD and

Sensitized122UPDFsoldiersinKayanzibarracks• Developedaradiotalk-showscheduleandconductedonradiotalk-show

InfectionPreventionandControl

Theteamoriented32healthworkersonimportanceofcleanenvironment,useofprotectivewear,mixingofchlorine,wastedisposalat6healthfacilities;KamasasaHCII,KambukamabweHCII,BukangaraHCII,KarambiHCIIIandKanyatsiandKitholhuHCIII.

Psychosocial• ConductedafollowupcounsellingvisitatSt.PaulHealthCenterIVwheresomehealthworkersweredistressed

followingcontactwithasuspectcase• Wealsodidcommunitypsycho-sensitizationinacommunityatKitanothatwashostiletooneofthecontacts• Wevisitedacontactwhohadrefusedtoreceiveavaccinebuthasfinallyagreedtoday• Wevisitedoneofthepatients(23-year-old)whowastransferredfromtheETUtogeneralward.Heisstillweak

andbeingmanaged.• Wewere able to resettle the two children that have been admitted at the ETU atMirami and Ihandiro. The

communitiesandtheirfamilieshavereceivedthemwell.Logistics

• Continued with training the district logistics management team in public health emergence supply chainmanagement.ThetrainingwasconductedbyMSH

• Carriedoutvaccinessupplyinventory• Issued100IECmaterials• Received02motorcyclesandonevehiclefromMOHdedicatedforEbolaresponse• Received100tinsofJIK(5litres)fromBRACand08infrathermometers

WASH

• ConductedinspectionofpublicplacesandassessedthelevelofsanitationandhygieneconditionsinregardtotheselectedwashaspectsgearedtowardstheEVDcontrolandprevention:inKatweKabatoroTownCouncil(3schools,1church,1hoteland1companyestablishment),KinyamasekeTownCouncil;6bars,KyarumbaTownCouncil;3schools,2hotels,1marketand3barswerevisited.

• The team also visited 1 school, 1 church, 2 hotels and 1marketwere also inspected in Bulembia Division, 4schoolswerevisitedinIbandaKyanaTownCouncil,4schoolsinNyamwambaDivisionand3privateschools,3hotelsand5barswerealsovisitedandinspectedinMpondweLhubirihaTownCouncilrespectively

• Mpondwe lhubiriha screening point, Kayanzi screening point, Katwe screening point and Kyakitale screeningpointwerevisitedtoassessthelevelofsanitationandtheavailabilityofwaterandhandwashingfacilities

Vaccination• 181contactswerevaccinated(ofthese92areHCWs/FLWsand3high-riskcontacts.Therestwerecontactsof

contacts)Theteamcontinuestoidentifynewcontactsandcontactsofcontacts.Keyplannedactivities

• Conductactivecasesearch,contactlistingandfollowupinhealthfacilitiesinallHealthSub-districts• Thewashcommitteetogetherwithallenvironmentalhealthstaffinthedistrictwillvisitmoreinstitutions

(schools,markets,healthfacilities)toassesstheWASHinterventionstowardsEVDpreventionandcontrol

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• TheriskcommunicationteamtocontinueworkingwithvaccinationteaminBweraoncommunityengagementtoaddressrumorsthroughcommunitydialoguemeetings

• EngagementofcommunityleadersinKilembeandMukunyuonhostilityagainstCongolesenationals• Sensitisecommunitymembers, stopmassgatherings,alleviate fearsandanxietyamongcommunitymembers

onEVDandencouragepeople tohandwashand stophandshaking.Thecommunitywill also sensitiseon theimportanceofsafeanddignifiedburialfollowingresistanceatSDBofasuspectcase.

• CommunityengagementatmarketstoenhancealertnessandenablereportingofanyEbola-relatedeventstothedistrictauthorities

• TheriskcommunicationteamwillvisitthemarketsandotherpublicplacestoconductsensitizationandengagementmeetingsonEVDalertness

• InvolvementofVHT/volunteerstosupportriskcommunicationatPOEswithriskcommunicationteamsChallengesandobservations

• NegativeattitudesofhealthworkersonuseofPPEs.EginKarambiHCIII• ThecommunitiesstillhavefearsabouttheEVDvaccine• Prisonsneedinfra-redthermometers• Inadequatescreeningservicesat18PoEand6busterminals• Oneofthecontactsundergoingpsychosocialsupporthasrefusedtobevaccinated• Reluctancebymostprivateinstitutionstoprovidethenecessarysanitaryfacilitiessuchashandwashingfacilities• StockoutofIECmaterials• Inadequateriskcommunicationpersonnelonthegroundaswellastransportfortheteam

o NeedmoreriskcommunicationpersonnelfromMoH• Patientsgoingtoatraditionalhealer

o Needtoengagetraditionalhealersintheresponse

•

Surveillancehasbeen intensified in thedistrict andCommunity awarenesshas alsoheightened. Transport challengeshavelessenedandthereismorepoliticalinvolvementintheresponse.

WeacknowledgethesupportfromthefollowingpartnersinresponsetoKaseseEbolaoutbreak.ThematicArea Partner

Coordination WHOSurveillance IRC,AFENET,WHO,CDC,UgandaRedCross

3. Conclusion

4. Partnerships

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Laboratory CDCUganda

RiskCommunication UNICEF,WHO,UPDF,BRAC-Uganda,USAIDCHC-Obulamu,URC,SavetheChildren,St.John’sAmbulance,

CaseManagement WHO,MSFInfectionPrevention&Control/WASH WHO,UNICEF,BaylorUganda,St.John’sAmbulance,Save

theChildren,UgandaRedCross,IRCPsychosocialSupport AFENET

Logistics WHO,UNICEF,BaylorUganda,WFP,UgandaRedCross,BRACUganda

Security UPDF,UgandaPolicePointsofEntry WHO,AFENET,UgandaRedCross,IRC,IOM

Vaccineandtherapeutics WHO,MSF

Screening at PoE Psychosocial team addressing the community

5. Pictorial