Kabwama Steven Ndugwa, Bulage Lilian, Nsubuga Fred, Pande Gerald, Oguttu David Were, Mafigiri Richardson, Kihembo Christine, Kwesiga Benon, Masiira Ben, Okullo Allen Eva, Kajumbula Henry, Matovu Joseph K B, Makumbi Issa, Wetaka Milton, Kasozi Sam, Kyazze Simon, Dahlke Melissa, Hughes Peter, Sendagala Juliet Nsimire, Musenero Monica, Nabukenya Immaculate, Hill Vincent R, Mintz Eric, Routh Janell, Gómez Gerardo, Bicknese Amelia, Zhu Bao-Ping
Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
Makerere University College of Health Science Microbiology Laboratory, Kampala, Uganda.
BMC Public Health. 2017 Jan 5;17(1):23. doi: 10.1186/s12889-016-4002-0.
On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.
We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.
From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (OR = 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (OR = 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.
Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.
2015年2月6日，坎帕拉市当局向乌干达卫生部通报了一种“怪病”，该疾病导致1人死亡，数十人患病。我们开展了一项流行病学调查，以确定该疾病的性质、传播方式和风险因素，为及时有效的控制措施提供依据。
我们将疑似病例定义为发热（≥37.5°C）持续3天以上，伴有腹痛、头痛、疟疾检测阴性或抗疟治疗无效，且至少具备以下2项症状：腹泻、恶心或呕吐、便秘、疲劳。可能病例定义为TUBEX® TF检测呈阳性的疑似病例。确诊病例为血培养检出伤寒沙门氏菌。我们开展了一项病例对照研究，比较33例疑似病例患者和78名对照的暴露情况，并检测了水和果汁样本。
2月17日至6月12日期间，我们共识别出10230例疑似病例、1038例可能病例和51例确诊病例。约22.58%（7/31）的病例患者和2.56%（2/78）的对照饮用过小塑料袋装的水（比值比[OR]=8.90；95%置信区间[CI]=1.60-49.00）；54.54%（18/33）的病例患者和19.23%（15/78）的对照饮用过当地自制饮料（OR=4.60；95%CI：1.90-11.00）。所有分离株对环丙沙星和头孢曲松敏感。水和果汁样本显示有粪便污染迹象。
受污染的水和街头贩卖的饮料可能是此次疫情的传播媒介。在我们的建议下，当局关闭了不安全的水源，并向受影响地区供应了安全的水。
