Background In June 2019, surveillance data from the Uganda’s District Health Information System revealed an outbreak of malaria in Kole District. Analysis revealed that cases had exceeded the outbreak threshold from January 2019. The Ministry of Health deployed our team to investigate the areas and people affected, identify risk factors for disease transmission, and recommend control and prevention measures. Methods We conducted an outbreak investigation involving a matched case-control study. We defined a confirmed case as a positive malaria test in a resident of Aboke, Akalo, Alito, and Bala sub-counties of Kole District January–June 2019. We identified cases by reviewing outpatient health records. Exposures were assessed in a 1:1 matched case-control study (n = 282) in Aboke sub-county. We selected cases systematically from 10 villages using probability proportionate to size and identified age- and village-matched controls. We conducted entomological and environmental assessments to identify mosquito breeding sites. We plotted epidemic curves and overlaid rainfall, and indoor residual spraying (IRS). Case-control exposures were combined into: breeding site near house, proximity to swamp and breeding site, and proximity to swamp; these were compared to no exposure in a logistic regression analysis. Results Of 18,737 confirmed case-patients (AR = 68/1,000), Aboke sub-county residents (AR = 180/1,000), children < 5 years (AR = 94/1,000), and females (AR = 90/1,000) were most affected. Longitudinal analysis of surveillance data showed decline in cases after an IRS campaign in 2017 but an increase after IRS cessation in 2018–2019. Overlay of rainfall and case data showed two malaria upsurges during 2019, occurring 35–42 days after rainfall increases. Among 141 case-patients and 141 controls, the combination of having mosquito breeding sites near the house and proximity to swamps increased the odds of malaria 6-fold (OR = 6.6, 95% CI = 2.24–19.7) compared to no exposures. Among 84 abandoned containers found near case-patients’ and controls’ houses, 14 (17%) had mosquito larvae. Adult Anopheles mosquitoes, larvae, pupae, and pupal exuviae were identified near affected houses. Conclusion Stagnant water formed by increased rainfall likely provided increased breeding sites that drove this outbreak. Cessation of IRS preceded the malaria upsurges. We recommend re-introduction of IRS and removal of mosquito breeding sites in Kole District.
Background: Tracking adverse events helps to assess vaccine safety. Uganda rolled out the AstraZeneca vaccination in March 2021 primarily targeting teachers, health workers, security personnel, and older persons. However, information about adverse events following the nationwide rollout of the AstraZeneca vaccination in Uganda is limited. We, therefore, assessed the prevalence and factors associated with adverse events following AstraZeneca vaccination among adults in the Greater Kampala region in Uganda. Methods: We used routinely collected data about AstraZeneca vaccination to identify persons who received ≥1 dose of the vaccine. Data were collected between March 10 and April 30, 2021, through telephone interviews with a random sample of vaccinated individuals. We defined adverse events as any untoward medical occurrence after vaccination and serious adverse events as any event leading to hospitalization, persistent disability ˃28 days, death, or congenital anomaly. We summarized data descriptively, performed bivariate analysis, and determined the factors independently associated with adverse events using multivariable logistic regression, expressed as adjusted odds ratio (AOR) and 95% confidence interval (CI). Results: We studied 374 participants aged 20-85 years and found 235 (62.8%) had received only the first dose of the Astra-Zeneca vaccine while 139 (37.2%) received two doses of the vaccine. The prevalence of adverse events was 76.5% and the common adverse events included injection site redness, pain, itching, and headache but no serious adverse event was reported. Participants aged 20–29 years (AOR 4.58; 95% CI: 1.92–10.95), 30-39 years (AOR 3.69; 95% CI: 1.81–7.51) and 40-49 years (AOR 2.78; 95% CI 1.26–4.90) were more likely to develop adverse events compared to those aged ≥50 years. Conclusion: Adverse events are prevalent among persons vaccinated with the Astra-Zeneca vaccine, largely among those below 50 years old. However, serious adverse events are rare. Persons <50 years old should be targeted for surveillance of adverse events and receive appropriate health education and counseling.
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