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Plague preparedness assessment in six border districts of Uganda’s West Nile sub region shows serious gaps

Plague-endemic is commonly found in the West Nile sub-region of Uganda particularly in Arua and Zombo districts.  Plague is a zoonosis, an animal disease that can spread to humans and is caused by Yersinia pestis bacteria .

A team of FETP fellows from the Uganda Public Health Fellowship program, and staff from the Ministry of Health (MoH) and Uganda Virus Research Institute (UVRI), in a recent outbreak response, identified seventy-eight (78) plague cases recorded from the year 2008-2016. Two human plague cases including one fatality occurred in West Nile Region in 2019 following importation from the neighbouring Democratic Republic of Congo (DRC).

Fataki Health Zone in the DRC which was last affected by plague at least 10 years back is currently experiencing a re-emergence of the outbreak. Fataki Health zone registered at least 37 suspected pneumonic plague cases, including 12 deaths, (CFR =32.4%) between 22 April-13 June 2021. Due to the proximity of the health facility to the Ugandan border (80 km from Zombo border) and the neighbouring Uganda districts were at risk.

In response, a multi-sectoral national rapid response team was deployed to assess the risk in each border district and one city for plague importation, to determine the level of preparedness of individual districts to respond in the event of an outbreak and assess community knowledge and practices about plague.

All districts that were assessed have no capacity to respond to the importation of plague from DRC. The risk of plague importation from DRC to West Nile was found to be high due to high connectivity across borders using both legal and illegal routes in all the six districts and one city. No health facility was prepared to respond to the outbreak/importation of plague.  Community members exhibited high knowledge on plague, its modes of transmission and prevention. The district leadership was also aware of the risk of importation and would integrate the district task force to respond to plague amidst the COVID-19 response in the event of an outbreak.

The risk is amplified as there is currently no commercially available vaccine or preventive medication against Plague.

A detailed report was written and submitted to the Ministry of Health, the Emergency Operation Center (EOC) and the Centers for Disease Control and Prevention (CDC) among others. 

More about the plague:

It is transmitted to humans through the bite of infected fleas that live among rodents such as squirrels, chipmunks, woodrats, prairie dogs, rabbits, and mice. Persons occupationally exposed to wild rodents in endemic areas are at great risk of exposure. They present with Flu-like symptoms which appear 1 to 10 days after being bitten by a rodent. These symptoms include fever, headache, chills, muscle pain, weakness. Plaque is also characterized by painful lymph glands. If untreated, the infection can spread to the bloodstream, also known as septicemic plague, which is accompanied by abdominal pain, shock, internal bleeding of organs and skin tissue that may turn black. Pneumonic plague can also develop if bubonic or septicemic plague is untreated. In this case, symptoms include shortness of breath, chest pain, and coughing blood or watery mucous. Shock and respiratory failure can become fatal. 

Immaculate Atuhaire at Vurra health centre iii during health facility assessment for plague-Arua district