Advanced field epidemiology residents in Uganda identify 106 missed Mpox cases through community-level surveillance

Following a surge in confirmed and suspected Mpox cases in the southwestern metropolis of Mbarara, a multidisciplinary team from the Uganda Public Health Fellowship Program (UPHFP), including fellows of the 2025 cohort of the Advanced Field Epidemiology Training Program (FETP), in collaboration with the Ministry of Health, conducted a comprehensive outbreak investigation in Mbarara City from April 28 to May 10, 2025.

The investigation aimed to verify community disease burden, detect missed cases, and explore household transmission patterns.

“The investigation commenced with stakeholder engagement and a systematic review of 442 patient records at the Mpox isolation unit of Mbarara Regional Referral Hospital (MRRH) to assess the epidemiologic profile, clinical presentation, and spatial distribution of cases,” a report from the investigation concludes. “Preliminary findings identified Nyamityobora Parish as one of the key hotspots, prompting a targeted door-to-door household active case search, supported by Village Health Teams (VHTs).”

Against this backdrop, the team then engaged in a targeted, door-to-door active case search and community engagement campaign in the most affected areas. Through this, the team verified the community burden of disease, detected unreported or missed cases, and investigated household-level transmission dynamics. This yielded the reported 106 positive cases.

Concurrently, health education sessions were conducted with community members to enhance awareness on mpox transmission, symptoms, and the importance of early health-seeking behaviour.

Reflecting on the activity, Kigongo John Vianney, who led the FETP residents described the investigation as largely successful and met its objectives. “It [response] improved awareness of mpox among the affected communities and generated actionable evidence to inform outbreak control measures. The cooperation of community members, the commitment VHTs, and the technical and logistical support were all instrumental in the success of the activity.”

However, Mr Kigongo noted that the team encountered a few challenges which included disruptions in some case investigation activities, “and community-related barriers such as stigma and hesitancy in high-transmission slum areas, particularly those associated with informal brothel operations. These factors occasionally impeded rapid case identification and full community participation.”

The resident fellows worked under the supervision of senior epidemiologists from the Uganda National Institute of Public Health and the Ministry of Health. The team worked in close collaboration with Mbarara City Surveillance Officers, Village Health Teams (VHTs), and healthcare personnel from Mbarara Regional Referral Hospital (MRRH). The investigation was further supported by the Mbarara City and District Health Offices, the Public Health Emergency Operations Centre (PHEOC) in Mbarara, Baylor-Uganda, and technical experts from the U.S. Centers for Disease Control and Prevention (CDC).