Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018-January 2019.
Sporadic outbreaks of crimean-congo haemorrhagic fever in Uganda, July 2018-January 2019.
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2018年7月至2019年1月乌干达零星爆发克里米亚-刚果出血热。
DOI：
10.1371/journal.pntd.0009213
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Ario AR
中科院分区：
文献类型：
--
作者：
Mirembe BB;Musewa A;Kadobera D;Kisaakye E;Birungi D;Eurien D;Nyakarahuka L;Balinandi S;Tumusiime A;Kyondo J;Mulei SM;Baluku J;Kwesiga B;Kabwama SN;Zhu BP;Harris JR;Lutwama JJ;Ario AR
克里米亚-刚果出血热（CCHF）是一种蜱传的人畜共患病毒性疾病，可引起出血症状。尽管在2013年至2017年期间有8起确认的疫情，都在乌干达的“牛群走廊”内，但乌干达没有针对性的蜱虫控制计划来预防疾病。在2018年7月至2019年1月的7个月期间，卫生部确认了多起独立的CCHF疫情。我们进行了调查，以确定风险因素，并建议干预措施，以防止未来的爆发。我们将确诊病例定义为2018年7月1日至2019年1月30日期间通过RT-PCR检测克里米亚-刚果出血热病毒（CCHFv）呈阳性的受影响地区居民突然发热（≥37.5 ℃），伴有≥4种以下体征和症状：厌食、呕吐、腹泻、头痛、腹痛、关节痛或突然不明原因出血。我们回顾了医疗记录，并进行了积极的病例调查。我们进行了一项病例对照研究，并比较了病例患者与年龄、性别和县以下匹配的对照人群（1：4）的暴露情况。我们从西部和中部地区的11个县确定了14例确诊病例（64%为男性），5例死亡（病死率：36%）。其中，8例（73%）病例患者居住在乌干达的“养牛场”。一次暴发涉及两名病例，其余涉及一名病例。所有病例均有发热，93%有不明原因出血。病例-患者年龄为6-36岁，20-44岁的患者（AR：7.2/1，000，000）比≤19岁的患者（2.0/1，000，000）受影响更大，p = 0.015。大多数（93%）病例患者在症状出现前≤2周与牲畜接触。12只（86%）的动物居住地距离放牧场不到1公里，而对照组为27只（48（ORM-H = 18，95%CI = 3.2-∞），14例病例患者中有10例（71%）在症状发作前≤2周发现蜱虫附着在其身体上，56例对照者中有15例（27%）发现蜱虫附着在其身体上（ORM-H = 9.3，95%CI = 1.9-46）。2018-2019年期间，在乌干达的“牛走廊”地区内外零星发生了CCHF疫情。大多数病例与蜱虫接触有关。卫生部应与农业、畜牧业和渔业部合作，通过“一个健康”的方法，共同制定全国性的蜱虫控制联合方案和战略。自2013年首次确诊克里米亚-刚果出血热疫情以来，乌干达已发生多起疫情。我们的研究已将蜱暴露确定为主要风险因素，这一发现与乌干达暴发期间进行的其他研究相似。然而，乌干达仍然缺乏国家蜱虫控制指南，广泛观察到滥用杀螨剂（专门用于蜱虫的农药）。这已被引用影响蜱对杀螨剂的抗性增加。我们的研究可能无法表明蜱虫对杀螨剂的耐药性是否增加了乌干达的蜱虫种群，但在预防和控制CCHF暴发的努力中必须考虑蜱虫控制。因此，我们建议通过对杀螨剂分配和使用的国家法规，制定战略以减少该国蜱虫对杀螨剂的耐药性，以及在牲畜管理中更多地参与蜱虫控制，来改善乌干达的蜱虫控制。
Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne, zoonotic viral disease that causes haemorrhagic symptoms. Despite having eight confirmed outbreaks between 2013 and 2017, all within Uganda’s ‘cattle corridor’, no targeted tick control programs exist in Uganda to prevent disease. During a seven-month-period from July 2018-January 2019, the Ministry of Health confirmed multiple independent CCHF outbreaks. We investigated to identify risk factors and recommend interventions to prevent future outbreaks. We defined a confirmed case as sudden onset of fever (≥37.5°C) with ≥4 of the following signs and symptoms: anorexia, vomiting, diarrhoea, headache, abdominal pain, joint pain, or sudden unexplained bleeding in a resident of the affected districts who tested positive for Crimean-Congo haemorrhagic fever virus (CCHFv) by RT-PCR from 1 July 2018–30 January 2019. We reviewed medical records and performed active case-finding. We conducted a case-control study and compared exposures of case-patients with age-, sex-, and sub-county-matched control-persons (1:4). We identified 14 confirmed cases (64% males) with five deaths (case-fatality rate: 36%) from 11 districts in western and central region. Of these, eight (73%) case-patients resided in Uganda’s ‘cattle corridor’. One outbreak involved two case-patients and the remainder involved one. All case-patients had fever and 93% had unexplained bleeding. Case-patients were aged 6–36 years, with persons aged 20–44 years more affected (AR: 7.2/1,000,000) than persons ≤19 years (2.0/1,000,000), p = 0.015. Most (93%) case-patients had contact with livestock ≤2 weeks before symptom onset. Twelve (86%) lived <1 km from grazing fields compared with 27 (48%) controls (ORM-H = 18, 95% CI = 3.2-∞) and 10 (71%) of 14 case-patients found ticks attached to their bodies ≤2 weeks before symptom onset, compared to 15 (27%) of 56 control-persons (ORM-H = 9.3, 95%CI = 1.9–46). CCHF outbreaks occurred sporadically during 2018–2019, both within and outside ‘cattle corridor’ districts of Uganda. Most cases were associated with tick exposure. The Ministry of Health should partner with the Ministry of Agriculture, Animal Industry and Fisheries to develop joint nationwide tick control programs and strategies with shared responsibilities through a One Health approach. Uganda has had multiple Crimean-Congo haemorrhagic fever outbreaks since 2013 when the first outbreak was confirmed. Tick exposure has been identified as the major risk factor by our study and this finding was similar with other studies done during outbreaks in Uganda. However, Uganda still lacks national tick control guidelines and indiscriminate use of acaricides (pesticides specially for ticks) has been observed widely. This has been cited to influence increased tick resistance to acaricides. Our study might not indicate whether tick resistance to acaricides has increased tick populations in Uganda however it is imperative that tick control is considered in efforts of prevention and control of CCHF outbreaks. We therefore recommend improved tick control in Uganda through national regulations on acaricide distribution and use, development of strategies to reduce tick resistance to acaricides in the country, and more community-based engagement of tick control in livestock management.
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影响因子：
33.9
作者：
Kizito, Susan;Okello, Paul E.;Zhu, Bao-Ping
通讯作者：
Zhu, Bao-Ping
DOI：
10.4269/ajtmh.2012.12-0337
发表时间：
2013-03-01
影响因子：
3.3
作者：
Naderi, HamidReza;Sheybani, Fereshte;Mostafavi, Irandokht
通讯作者：
Mostafavi, Irandokht
影响因子：
12.7
作者：
Yagci-Caglayik, Dilek;Korukluoglu, Gulay;Uyar, Yavuz
通讯作者：
Uyar, Yavuz
DOI：
10.1093/trstmh/trv050
发表时间：
2015-08
影响因子：
2.2
作者：
Messina JP;Pigott DM;Golding N;Duda KA;Brownstein JS;Weiss DJ;Gibson H;Robinson TP;Gilbert M;William Wint GR;Nuttall PA;Gething PW;Myers MF;George DB;Hay SI
通讯作者：
Hay SI
影响因子：
11.8
作者：
Karti SS;Odabasi Z;Korten V;Yilmaz M;Sonmez M;Caylan R;Akdogan E;Eren N;Koksal I;Ovali E;Erickson BR;Vincent MJ;Nichol ST;Comer JA;Rollin PE;Ksiazek TG
通讯作者：
Ksiazek TG