Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 51 - 59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
Virol J. 2024 May 3;21(1):104. doi: 10.1186/s12985-024-02377-z.
Rift Valley fever (RVF) is a zoonotic viral disease of increasing intensity among humans in Africa and the Arabian Peninsula. In Uganda, cases reported prior to 2016 were mild or not fully documented. We report in this paper on the severe morbidity and hospital-based mortality of human cases in Uganda.
Between November 2017 and March 2020 human cases reported to the Uganda Virus Research Institute (UVRI) were confirmed by polymerase chain reaction (PCR). Ethical and regulatory approvals were obtained to enrol survivors into a one-year follow-up study. Data were collected on socio-demographics, medical history, laboratory tests, potential risk factors, and analysed using Stata software.
Overall, 40 cases were confirmed with acute RVF during this period. Cases were not geographically clustered and nearly all were male (39/40; 98%), median age 32 (range 11-63). The median definitive diagnosis time was 7 days and a delay of three days between presumptive and definitive diagnosis. Most patients (31/40; 78%) presented with fever and bleeding at case detection. Twenty-eight (70%) cases were hospitalised, out of whom 18 (64%) died. Mortality was highest among admissions in regional referral (11/16; 69%) and district (4/5; 80%) hospitals, hospitalized patients with bleeding at case detection (17/27; 63%), and patients older than 44 years (9/9; 100%). Survivors mostly manifested a mild gastro-intestinal syndrome with nausea (83%), anorexia (75%), vomiting (75%), abdominal pain (50%), and diarrhoea (42%), and prolonged symptoms of severe disease including jaundice (67%), visual difficulties (67%), epistaxis (50%), haemoptysis (42%), and dysentery (25%). Symptom duration varied between two to 120 days.
RVF is associated with high hospital-based mortality, severe and prolonged morbidity among humans that present to the health care system and are confirmed by PCR. One-health composite interventions should be developed to improve environmental and livestock surveillance, prevent infections, promptly detect outbreaks, and improve patient outcomes.
裂谷热（RVF）是一种在非洲和阿拉伯半岛人类中不断加剧的人畜共患病毒性疾病。在乌干达，2016 年之前报告的病例症状较轻或未完全记录。我们在此报告乌干达人类病例的严重发病率和基于医院的死亡率。
2017 年 11 月至 2020 年 3 月，向乌干达病毒研究所（UVRI）报告的人类病例均通过聚合酶链反应（PCR）确诊。获得伦理和监管部门的批准，以招募幸存者参加为期一年的随访研究。收集社会人口统计学、病史、实验室检测、潜在危险因素等数据，并使用 Stata 软件进行分析。
在此期间，共确诊 40 例急性裂谷热病例。病例未呈地理聚集性，几乎均为男性（39/40；98%），中位年龄 32 岁（范围 11-63 岁）。中位明确诊断时间为 7 天，在推定诊断和明确诊断之间存在 3 天的延迟。大多数患者（31/40；78%）在病例检出时表现出发热和出血。28 例（70%）住院，其中 18 例（64%）死亡。死亡率最高的是地区转诊（11/16；69%）和地区（4/5；80%）医院的住院患者，在病例检出时出血的住院患者（17/27；63%），以及 44 岁以上的患者（9/9；100%）。幸存者主要表现为轻度胃肠综合征，伴有恶心（83%）、厌食（75%）、呕吐（75%）、腹痛（50%）和腹泻（42%），以及严重疾病的症状持续时间延长，包括黄疸（67%）、视力障碍（67%）、鼻出血（50%）、咯血（42%）和痢疾（25%）。症状持续时间为 2 至 120 天不等。
裂谷热与人类中基于医院的高死亡率、严重和长期发病率相关，这些病例通过 PCR 得到确认。应制定一健康综合干预措施，以改善环境和牲畜监测、预防感染、及时发现疫情和改善患者预后。
