CDC Director’s debut visit to Uganda for GHSA ministerial meeting

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CDC Director Brenda Fitzgerald, MD, recently made her debut visit to Africa to attend the fourth Global Health Security Agenda (GHSA) high-level Ministerial Meeting from October 25-27, 2017 in Kampala, Uganda. She was accompanied by HHS Office of Global Affairs (OGA) Director Garrett Grigsby, Counsellor Margaret Wynne; OGA Africa Bureau Director Samuel Adenyi-Jones, MD, PhD; CGH Director Rebecca Martin, MD, PhD; NCEZID Director Rima Khabbaz, MD; and other officials for the week-long working visit. While there the team visited various CDC-supported program sites to see firsthand how the agency is supporting the Uganda Ministry of Health to improve its public health capabilities.

Strengthening in-country Capacity to Combat Threats

Dr. Fitzgerald and the team visited Zika Forest and Uganda Virus Research Institute (UVRI) to learn about CDC’s work in Uganda to address emerging and re-emerging disease threats such as yellow fever, malaria, and hemorrhagic fevers like Ebola and Marburg Virus Diseases.

At Zika Forest, they saw how mosquitoes are trapped and collected. They learned about the different species of mosquitoes in the forest, noting how they may present in populations across the world, including the Aedes aegypti mosquito that transmits Zika virus disease. The team was taken through the different infection cycles of the yellow fever virus – between the African Region (Forest–Rural–Urban) and South American region (Forest–Urban) – and how the infection is controlled in Uganda. They also heard about the many disease agents that have been discovered and named after places in Uganda, including the Zika virus (1947) and West Nile virus (1937).

Enhancing Diagnostic Capacity

From Zika Forest, the visiting team went to UVRI, which provides highly specialized expertise the country needs to prevent, detect, and respond to epidemic threats. Uganda is a “hot zone” for infectious diseases such as viral hemorrhagic fevers (like Ebola and yellow fever), cholera, meningitis, plague, and anthrax. While at UVRI, the visitors saw how mosquitoes trapped at Zika Forest were transferred to the UVRI arbovirus laboratory for species characterization. In the early days of UVRI, several new viruses capable of causing severe acute febrile illnesses were discovered there in addition to Zika and West Nile viruses: O’nyong Nyong virus 1959, Orungo virus 1959, Kamese virus 1967, among others.

With support from CDC, UVRI established a comprehensive viral hemorrhagic fever (VHF) program that serves as national and regional reference laboratory and coordinates national VHF surveillance, diagnostic testing, and outbreak response. UVRI has played an important role as a national reference laboratory, helping to isolate Marburg virus in Uganda-dwelling Egyptian fruit bats in 2009 as well as Sosuga virus (2012), a novel virus found in the same bats. A new strain of Ebola virus (Ebola Bundibugyo) causing human disease was also discovered with assistance from UVRI in 2007.

All alert samples coming from any part of the country are first tested at UVRI’s VHF laboratory. Samples that test negative to VHF are then systematically tested for arboviruses. Quick and accurate laboratory testing allows public health experts to move faster to respond and stop outbreaks from spreading. With laboratory and technical support from CDC, UVRI has reduced time between initial report of a suspected outbreak and laboratory confirmation from several weeks to less than three days. In 2010, it took more than a month to confirm a yellow fever outbreak, six years later the time dropped to 10 days. Now it takes less than three days to get the results of a suspect yellow fever sample.

During the high level delegation visit and the GHSA Ministerial Meeting, Uganda was working to contain a Marburg virus disease outbreak. [CNN feature on Marburg]. Dr. Fitzgerald and the team had another opportunity to see up-close how CDC’s global health security work is supporting Uganda to build its capabilities to prevent, detect, respond to and contain health threats within their borders and stop outbreaks at their source.

Providing HIV services to high prevalence populations

Dr. Fitzgerald and the team also visited Kigungu fishermen’s landing site to appreciate the vulnerability of fishing communities to HIV infection. The AIDS Support Organization (TASO), a local CDC partner under PEPFAR, provides HIV care and treatment services to the highly mobile population of fisher folk, fish traders, boat owners, bar attendants, sex workers, and residents of the lakeshores—populations with the highest HIV prevalence in Uganda. These services include health education/sensitization, HIV testing, provision of ARVs, and voluntary medical male circumcision using a differentiated service delivery approach that meets the needs of this mobile population.

Outbreak simulation exercise

In recent years, Uganda has had a history of high-profile disease outbreaks. CDC continues to support the Ministry of Health’s efforts to build capacity to respond to infectious disease threats and elevate global health security as a national priority. To test Uganda’s preparedness for disease threats, the visiting team witnessed a ‘real-time outbreak’ simulation exercise staged by the Public Health Emergency Operations Center in collaboration with UVRI, the Field Epidemiology Training Program (FETP) and the Zoonotic Disease Coordination Office.

The exercise was based on a real recent outbreak of Crimean Congo Hemorrhagic Fever (CCHF) that occurred in Central Uganda in 2017. The simulation was planned and coordinated by the Emergency Operations Center (EOC) field investigation team, UVRI, and other subject matter experts, including CDC-trained disease detectives, who assisted in managing the actual outbreak.

Dr. Fitzgerald and her team witnessed the core elements of an outbreak field investigation, from the gathering of the necessary information on a suspect case to how appropriate actions and relevant recommendations are made to treat patients and limit chances of spreading the suspected pathogen. They were also taken through the post-outbreak follow-up process, shown the protection equipment used, and briefed on associated challenges and opportunities in outbreak response.

The simulation exercise was complemented by poster presentations—showcasing how the CDC-supported EOC has been able to effectively track and enhance Uganda’s progress towards elimination of mother-to-child transmission of HIV, to counter the burden of multidrug-resistant tuberculosis and antimicrobial resistance, to respond to five Ebola outbreaks since the year 2000, as well as outbreaks of typhoid, yellow fever, anthrax, and CCHF.

Witnessing the Miracle of ART

To end their tour, the visitors stopped at Reach Out Mbuya (ROM) in order to understand the impact of a faith-based organization supported by CDC under PEPFAR. Here, they interacted with the first-ever client who was started on antiretroviral drugs thanks to PEPFAR. The client shared his experience and showed his good health for which he thanked the USG for its support to HIV programs in the world.

For 16 years now, ROM has delivered a holistic HIV care model that emphasizes social, psychosocial and economic empowerment support through community approaches in providing services to HIV infected or affected poor communities in Uganda’s capital-Kampala and surrounding districts. ROM has grown from 14 clients in 2001 to 9,000 individuals (769children) in 2017, with 98% of its clients on ART.

CDC HQ staff also interacted with other CDC partners implementing HIV and health security-related activities. Through poster presentations, they discussed:

  • Factors contributing to girls’ vulnerability to HIV infection and the PEPFAR DREAMS program (Mildmay Uganda).
  • Strategies to retain monitoring and evaluation focal points, increasing capacity of districts through district led programming, improving health information systems and scale up of electronic medical records in facilities (Makerere University Monitoring and Evaluation Technical Support [METS] program).
  • Managing pediatric HIV infections and the race towards zero mother to child HIV transmission (Baylor College of Medicine Children’s Foundation-Uganda).
  • Caring, empowering and involving people living with HIV through client-centered models of service provision (TASO).
  • Supporting the MoH to improve its capacity to public health systems through better staffing (African Field Epidemiology Network).
  • And how research activities are helping to improve service delivery and other comprehensive programs in Uganda including refugee health (Infectious Diseases Institute).

“CDC Uganda has diverse programs. The majority fall under the DGHT but we also have DGHP, GID, and NCEZID programs in-country, besides our cross collaborations with NIH and HRSA. We were extremely privileged to showcase them during our director’s first visit to Africa,” says CDC Country Director Lisa Nelson, MD, MPH.

Thank you:

“…such good work for such a good cause by such good people…Your dedication and passion make a difference in the world,” Fitzgerald said while meeting over 100 CDC staff at their offices in Entebbe. “CDC boasts of highly dedicated staff, but I’m happy to see first-hand what many of you are doing in our field offices and that we are trying to advance the goal of ‘One CDC’ in global health. I see a lot of best practices in Uganda that can be shared with other countries.” End…