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Research article - Peer-reviewed, 2022

Clinical and Molecular Epidemiology of Crimean-Congo Hemorrhagic Fever in Humans in Uganda, 2013-2019

Balinandi, Stephen; Whitmer, Shannon; Mulei, Sophia; Nyakarahuka, Luke; Tumusiime, Alex; Kyondo, Jackson; Baluku, Jimmy; Mutyaba, Joseph; Mugisha, Lawrence; Malmberg, Maja; Lutwama, Julius; Shoemaker, Trevor R.; Klena, John D.

Abstract

Crimean-Congo Hemorrhagic Fever (CCHF) is endemic in Uganda, yet its epidemiology remains largely uncharacterized. To better understand its occurrence within Uganda, case reports of patients hospitalized with CCHF between 2013 and 2019 were reviewed. Further, genome sequences of CCHF-positive RNA obtained during this period were determined for phylogenetic comparisons. We found that a total of 32 cases (75% males; CFR, 31.2%), aged between 9 to 68 years, were reported during the study period. Most cases were detected during July to December of each outbreak year (81.2%; P < 0.01) and were located along the "cattle corridor" (68.7%, P = 0.03). The most common presenting symptoms were fever (93.8%), hemorrhage (81.3%), headache (78.1 %), fatigue (68.8%), vomiting (68.8%), and myalgia (65.6%). In five patients for whom hematological data were available, varied abnormalities were observed including thrombocytopenia, leukopenia, anemia, lymphopenia, lymphocytosis, polycythemia, and microcytosis. About 56.3% (P = 0.47) of patients reported tick bites or exposure to livestock as their potential source of infection. Person-to-person transmission was suspected for two cases. Using unbiased metagenomics, we found that the viral S- and L- segments have remained conserved in Africa 2 Glade since the 1950s. In contrast, the M segment split into two geographically interspersed Glades; one that belongs to Africa 2 and another that is ancestral to Africa 1 and 2. Overall, this data summarizes information on the history and clinical presentation of human CCHF in Uganda. Importantly, it identifies vulnerable populations as well as temporal and geographic regions in Uganda where surveillance and control interventions could be focused.

Published in

American Journal of Tropical Medicine and Hygiene
2022, volume: 106, number: 1, pages: 88-98
Publisher: AMER SOC TROP MED AND HYGIENE

Authors' information

Balinandi, Stephen
Uganda Virus Research Institute
Balinandi, Stephen
Makerere University
Whitmer, Shannon
Centers for Disease Control and Prevention - USA
Mulei, Sophia
Uganda Virus Research Institute
Nyakarahuka, Luke
Makerere University
Nyakarahuka, Luke
Uganda Virus Research Institute
Tumusiime, Alex
Uganda Virus Research Institute
Kyondo, Jackson
Uganda Virus Research Institute
Baluku, Jimmy
Uganda Virus Research Institute
Mutyaba, Joseph
Uganda Virus Research Institute
Mugisha, Lawrence
Makerere University
Swedish University of Agricultural Sciences, Department of Animal Breeding and Genetics
Lutwama, Julius
Uganda Virus Research Institute
Shoemaker, Trevor R.
Centers for Disease Control and Prevention - USA
Klena, John D.
Centers for Disease Control and Prevention - USA

UKÄ Subject classification

Infectious Medicine
Public Health, Global Health, Social Medicine and Epidemiology

Publication Identifiers

DOI: https://doi.org/10.4269/ajtmh.21-0685

URI (permanent link to this page)

https://res.slu.se/id/publ/116200