title: Epidemiological and laboratory characterization of a yellow fever outbreak in northern Uganda, October 2010-January 2011.
abstract: BACKGROUND
  In November 2010, following reports of an outbreak of a fatal, febrile, hemorrhagic illness in northern Uganda, the Uganda Ministry of Health established multisector teams to respond to the outbreak.
  
  
  METHODS
  This was a case-series investigation in which the response teams conducted epidemiological and laboratory investigations on suspect cases. The cases identified were line-listed and a data analysis was undertaken regularly to guide the outbreak response.
  
  
  RESULTS
  Overall, 181 cases met the yellow fever (YF) suspected case definition; there were 45 deaths (case fatality rate 24.9%). Only 13 (7.5%) of the suspected YF cases were laboratory confirmed, and molecular sequencing revealed 92% homology to the YF virus strain Couma (Ethiopia), East African genotype. Suspected YF cases had fever (100%) and unexplained bleeding (97.8%), but jaundice was rare (11.6%). The overall attack rate was 13 cases/100000 population, and the attack rate was higher for males than females and increased with age. The index clusters were linked to economic activities undertaken by males around forests.
  
  
  CONCLUSIONS
  This was the largest YF outbreak ever reported in Uganda. The wide geographical case dispersion as well as the male and older age preponderance suggests transmission during the outbreak was largely sylvatic and related to occupational activities around forests.
authors.affiliation: Ministry of Health, Plot 6 Lourdel Road, PO Box 7272, Kampala, Uganda. j_wamala@yahoo.com
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Wamala
authors.forename: Mugagga
authors.initials: M
authors.lastname: Malimbo
authors.forename: Charles L
authors.initials: CL
authors.lastname: Okot
authors.forename: Ann D
authors.initials: AD
authors.lastname: Atai-Omoruto
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tenywa
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Miller
authors.forename: Stephen
authors.initials: S
authors.lastname: Balinandi
authors.forename: Trevor
authors.initials: T
authors.lastname: Shoemaker
authors.forename: Charles
authors.initials: C
authors.lastname: Oyoo
authors.forename: Emmanuel O
authors.initials: EO
authors.lastname: Omony
authors.forename: Atek
authors.initials: A
authors.lastname: Kagirita
authors.forename: Monica M
authors.initials: MM
authors.lastname: Musenero
authors.forename: Issa
authors.initials: I
authors.lastname: Makumbi
authors.forename: Miriam
authors.initials: M
authors.lastname: Nanyunja
authors.forename: Julius J
authors.initials: JJ
authors.lastname: Lutwama
authors.forename: Robert
authors.initials: R
authors.lastname: Downing
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mbonye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D001769:Blood / Q000821:virology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016133:Polymerase Chain Reaction; D014454:Uganda / Q000453:epidemiology; D015004:Yellow Fever / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000635:transmission; D015005:Yellow fever virus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral