Kabwama Steven Ndugwa, Mafigiri Richardson, Balinandi Stephen, Kagirita Atek, Riolexus Alex Ario, Zhu Bao-Ping
Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
US Centers for Disease Control and Prevention, Kampala, Uganda.
Pan Afr Med J. 2017 Nov 8;28:215. doi: 10.11604/pamj.2017.28.215.12395. eCollection 2017.
On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors.
We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design.
We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (OR = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (OR = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (OR = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs.
This reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.
2015年9月17日，布利萨区卫生办公室向乌干达卫生部报告了多起因出血导致的死亡病例。我们开展了一项调查，以核实疫情是否存在，并确定疾病的性质、传播方式和风险因素。
我们将2015年6月1日至10月15日期间霍伊马、布利萨或周边地区居民出现呕血症状定义为疑似病例。我们通过查阅病历和在社区积极搜索来确定病例。我们对病例患者和医护人员进行了访谈，并进行描述性流行病学分析，以推测可能的暴露因素。在一项病例对照研究中，我们比较了21例病例和81例对照（按年龄（±10岁）、性别和居住村庄匹配）之间的暴露情况。我们从19例病例患者身上采集了22份生物样本，以检测是否感染病毒性出血热（VHF）。我们使用Mantel-Haenszel方法分析数据，以考虑匹配的研究设计。
我们确定了56例6月至10月发病的病例（布利萨区发病率为15/10万，霍伊马区为5.2/10万）。特定年龄发病率在31至60岁人群中最高（霍伊马为15/10万，布利萨为47/10万）；15岁以下人群无人患病。在病例对照研究中，42%（5/12）的病例有肝病，而对照中为0.0%（0/77）（比值比=∞；95%置信区间=3.7至∞）；71%（10/14）的病例有溃疡病，而对照中为35%（28/81）（比值比=13；95%置信区间=1.6至98）；27%（3/11）的病例在发病前使用过吲哚美辛，而对照中为14%（11/81）（比值比=6.0；95%置信区间=1.0至36）。所有血液样本的VHF检测均为阴性。
此次报告的呕血病例群是由易感因素和使用非甾体抗炎药（NSAID）导致的。应开展关于滥用NSAID危险性的健康教育，尤其是针对有易感因素的人群。
