Nalubega Annet, a 19 years old adult was a case referred to Lacor hospital with severe anaemia, post abortal sepsis, and ruling out peritonitis. She lives in Mocope village, Paridi parish and Adjumani town council – in Adjumani District. She presented to the hospital OPD with history of, per vaginal bleeding, fever, lower abdominal pain, vomiting and difficult breathing on 30/5/2017.
Past surgical and medical history revealed that she was done a tooth extraction mid April 2017 following a dental caries. She got well and later in May 2017 developed fever and lower abdominal pain and managed for Pelvic Inflammatory Disease until her admission in medical ward in Adjumani hospital on 30th May 2017.
She travelled to Adjumani early April 2017 from Kajansi in Mpigi District to pay a visit at the bother in laws / sister. She was normal of any forms of morbidity at arrival in Adjumani; apart from bouts of nasal congestion.
Physical examinations in Adjumani revealed on examination Conjuctival pallor, high fever (39.3 o C), facial puffiness. Per Abdomen she had normal fullness, reduced movement with respiration, guarding, generalised tenderness, no organomegaly, and normal percussion note and bowel sounds. She had a blood pressure of 107/80 mmHg and Tachycardia with normal heart sounds.
The chest was clear with normal breath sounds
Ear nose and throat showed a hyperaemic left posterior nasal turbinate and hypertrophy.
Per Vaginal examinations showed normal vulva and vagina; closed cervical opening and sero aguinous Per Vaginal discharge.
Other examinations were unrevealing
She was later referred to Lacor Hospital for blood transfusion and further management.
Suspected VHF Rumour on social Media
On 2nd June 2017 on social media ( Facebook ) was posted an information that , “LACOR HOSPITAL GULU HAS BEEN PUT ON ALERT AS ONE PERSON IS IN AN ISOLATION UNIT SUSPECTED OF EBOLA, SAMPLE TAKEN TO ENTEBBEE. SHE CAME FROM ADJUMANI, WITH PV BLEEDING AS SHE WAS BEEN MANAGED FOR PV BLEEDING, BLOOD STARTED COMING FROM ALL BODY OPENING (ORIFICE) AND HOSPITAL DOCTORS ALERTED AND THEY SAID THOSE ARE SIGNS OF EBOLA AND INSTRUCTED PATIENT TO BE TAKEN TO ISOLATION UNIT, PRAY FOR EVERYONE IN GULU AND UGANDA MAY GOD SEE US THROUGH AND TAKE CARE”:
Suspected VHF management in Lacor District
An interaction with Lacor hospital management revealed that the patient is been managed for Severe anaemia and septicaemia; but ruling out Viral haemorrhagic fever. Patient was presenting with high grade fever and per vaginal and gum bleeding.
Critical issues, actions taken and additional support required
The team was to establish the VHF prevention strategies to manage the rumour as below;
Formation/reactivation of epidemic case management team in the hospital/district
No case detected in district yet.
Conduct training for 50 health workers in Ebola case management
All health facilities is be issued/distributed Ebola standard case definitions charts
Ebola Supplies and medicines be lobbied and requested from MOH and Partners
Team to ensure quality of care standards are maintained and documentation of relevant information in place- line list, IPD register, fluid chart, admission forms, laboratory register/laboratory request forms.
Adjumani District health educator and Adjumani hospital health educator to head team
To Plan for advocacy, communication and social mobilization activities- IEC materials, meetings with elders, leaders, radio talk shows and radio spot messages
Team up with VHTs and conduct door to door health education on VHF especially in affected homesteads
Team headed by Assistant DHO environment
No Ebola Treatment unit site identified Intensify infection control measures in health facilities – chlorination
Availability of PPEs
To conduct joint inspection of eating places, water points, sanitary facilities, shelters and hygiene in affected communities
Increase the number of hand washing points in hospital
Team to assess/locate an Ebola Treatment unit site in case suspect confirmed positive
Team headed by DSFP, other members include, HSD SFPs, HI, records assistant, VHTs
Contact tracing done
Line listing of cases/ contacts
decontamination for contact house holds
Conduct Active search – patients identified be referred to the treatment centre
Follow up contacts and assess for development of signs,
Listing of contacts and households visited.
DHO/Hospital to allocate/lobby transport for active search and follow-up
The team consists of District Emergency preparedness and response committee
Development /adjustment of the Ebola emergency and response plan.
Develop an Ebola contingency plan
Lobby for transport/fuel/ funding for implementation of activities
Others (meetings, mission, training, other updates etc.)
Consulted with Lacor hospital to verify the rumour – Found out that samples were collected and transported to UVRI for investigation.
Plan of Action:
DHO and surveillance focal person to follow up the sample results at UVRI.
Communication of suspected VHF outbreak to MoH, development partners and implementing partners by DHO
EPR committee meeting at 9:OO am at Adjumani district council board room on 5/6/2017
Implementation of action points for each technical group
Complied by: Olony Paul
Verified by: Manga Godfrey FOR DHO