Investigation of an isolated case of human Crimean–Congo hemorrhagic fever in Central Uganda, 2015☆

Details

• Alternative Title:
  Int J Infect Dis
• Personal Author:
  Balinandi, Stephen ; Patel, Ketan ; Ojwang, Joseph ; Kyondo, Jackson ; Mulei, Sophia ; Tumusiime, Alex ; Lubwama, Bernard ; Nyakarahuka, Luke ; Klena, John D. ; Lutwama, Julius ; Ströher, Ute ; Nichol, Stuart T. ; Shoemaker, Trevor R.
• Description:
  Background
  
  Crimean–Congo hemorrhagic fever (CCHF) is the most geographically widespread tick-borne viral infection. Outbreaks of CCHF in sub-Saharan Africa are largely undetected and thus under-reported. On November 9, 2015, the National Viral Hemorrhagic Fever Laboratory at the Uganda Virus Research Institute received an alert for a suspect VHF case in a 33-year-old male who presented with VHF compatible signs and symptoms at Mengo Hospital in Kampala.
  
  Methods
  
  A blood sample from the suspect patient was tested by RT-PCR for CCHF and found positive. Serological testing on sequential blood specimens collected from this patient showed increasing anti-CCHFV IgM antibody titers, confirming recent infection. Repeat sampling of the confirmed case post recovery showed high titers for anti-CCHFV-specific IgG. An epidemiological outbreak investigation was initiated following the initial RT-PCR positive detection to identify any additional suspect cases.
  
  Results
  
  Only a single acute case of CCHF was detected from this outbreak. No additional acute CCHF cases were identified following field investigations. Environmental investigations collected 53 tick samples, with only 1, a Boophilus decoloratus, having detectable CCHFV RNA by RT-PCR. Full-length genomic sequencing on a viral isolate from the index human case showed the virus to be related to the DRC (Africa 2) lineage.
  
  Conclusions
  
  This is the fourth confirmed CCHF outbreak in Uganda within 2 years after more than 50 years of no reported human CCHF cases in this country. Our investigations reaffirm the endemicity of CCHFV in Uganda, and show that exposure to ticks poses a significant risk for human infection. These findings also reflect the importance of having an established national VHF surveillance system and diagnostic capacity in a developing country like Uganda, in order to identify the first cases of VHF outbreaks and rapidly respond to reduce secondary cases. Additional efforts should focus on implementing effective tick control methods and investigating the circulation of CCHFV throughout the country.
  
  
• Subjects:
  Adult Animals Antibodies, Anti-Idiotypic Antibodies, Viral Article CCHF Chlorocebus Aethiops Crimean–Congo Hemorrhagic Fever Disease Outbreaks DNA Copy Number Variations Hemorrhagic Fever, Crimean Hemorrhagic Fever Virus, Crimean-Congo Humans Male Outbreak Phylogeny RNA, Viral Sequence Analysis, RNA Ticks Uganda Vero Cells

  More +
• Source:
  Int J Infect Dis. 68:88-93
• Pubmed ID:
  29382607
• Pubmed Central ID:
  PMC5893389
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  68
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2a823d403346542ae6060ff35ef565168a9b5e20f30a604ba807a894edec0cc2
• Download URL:
  https://stacks.cdc.gov/view/cdc/53232/cdc_53232_DS1.pdf
• File Type:
  [PDF - 791.27 KB ]