Volume 93, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered.


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  1. Bhattacharya S, Black R, Bourgeois L, Clemens J, Cravioto A, Deen JL, Dougan G, Glass R, Grais RF, Greco M, Gust I, Holmgren J, Kariuki S, Lambert PH, Liu MA, Longini I, Nair GB, Norrby R, Nossal GJ, Ogra P, Sansonetti P, von Seidlein L, Songane F, Svennerholm AM, Steele D, Walker R, , 2009. Public health. The cholera crisis in Africa. Science 324: 885.[Crossref] [Google Scholar]
  2. Gaffga NH, Tauxe RV, Mintz ED, , 2007. Cholera: a new homeland in Africa? Am J Trop Med Hyg 77: 705713. [Google Scholar]
  3. Glass RI, Claeson M, Blake PA, Waldman RJ, Pierce NF, , 1991. Cholera in Africa: lessons on transmission and control for Latin America. Lancet 338: 791795.[Crossref] [Google Scholar]
  4. Naidoo A, Patric K, , 2002. Cholera: a continuous epidemic in Africa. J R Soc Promot Health 122: 8994.[Crossref] [Google Scholar]
  5. Nkoko D, Giraudoux P, Plisnier P-D, Tinda A, Piarroux M, Sudre B, Horion S, Tamfum JJ, Ilunga BK, Piarroux R, , 2011. Dynamics of cholera outbreaks in Great Lakes region of Africa, 1978–2008. Emerg Infect Dis 17: 20262034.[Crossref] [Google Scholar]
  6. Mintz ED, Tauxe RV, , 2013. Cholera in Africa: a closer look and a time for action. J Infect Dis 208 (Suppl 1): S4S7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24101644. Accessed August 25, 2014.[Crossref] [Google Scholar]
  7. World Health Organization, 2014. Cholera, 2013. Wkly Epidemiol Rec 89: 345356. Available at: http://www.who.int/wer/en/. Accessed August 25, 2014. [Google Scholar]
  8. Alajo SO, Nakavuma J, Erume J, , 2006. Cholera in endemic districts in Uganda during El Niño rains: 2002–2003. Afr Health Sci 6: 9397. [Google Scholar]
  9. Andrawa M, Anguzu P, Anguaku A, Nalwadda C, Namusisi O, Tweheyo R, , 2010. Risk factors for repeated cholera outbreak in Arua municipal council, north-western Uganda. Int J Infect Dis 14: e65.[Crossref] [Google Scholar]
  10. Bwire G, Malimbo M, Maskery B, Kim YE, Mogasale V, Levin A, , 2013. The burden of cholera in Uganda. PLoS Negl Trop Dis 7: e2545.[Crossref] [Google Scholar]
  11. Bwire G, Malimbo M, Makumbi I, Kagirita A, Wamala JF, Kalyebi P, Bingi A, Gitta S, Mukanga D, Mengel M, Dahlke M, , 2013. Cholera surveillance in Uganda: an analysis of notifications for the years 2007–2011. J Infect Dis 208 (Suppl 1): S78S85. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24101649.[Crossref] [Google Scholar]
  12. Cummings MJ, Wamala JF, Eyura M, Malimbo M, Omeke ME, Mayer D, Lukwago L, , 2012. A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions. Epidemiol Infect 140: 13761385.[Crossref] [Google Scholar]
  13. Health Service Commission (Uganda), 2009. Health Service Commission Annual Report F/Y 2008/2009. Available at: http://www.hsc.go.ug/content/hsc-annual-report-20082009. [Google Scholar]
  14. Ball L, , 2009. Cholera and the pump on Broad Street: the life and legacy of John Snow. History Teacher 43: 105119. [Google Scholar]
  15. UNICEF, 2013. UNICEF Cholera Toolkit 2013, 251255. Available at: http://www.unicef.org/cholera/Cholera-Toolkit-2013.pdf. [Google Scholar]
  16. World Health Organization, 2015. Prevention and Control of Cholera Outbreaks: WHO Policy and Recommendations, 56. Available at: http://www.who.int/cholera/prevention_control/recommendations/en/#. [Google Scholar]
  17. World Health Organization, 2002. Prevention of Hospital-Acquired Infections: A Practical Guide, 2nd edition. Available at: http://www.who.int/csr/resources/publications/WHO_CDS_CSR_EPH_2002_12/en/. [Google Scholar]
  18. Cliff JL, Zinkin P, Martelli A, , 1986. A hospital outbreak of cholera in Maputo, Mozambique. Trans R Soc Trop Med Hyg 80: 473476.[Crossref] [Google Scholar]
  19. Goh KT, Teo SH, Lam SLM, , 1990. Person-to-person transmission of cholera in a psychiatric hospital. J Infect 20: 193200. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2341728.[Crossref] [Google Scholar]
  20. Mhalu FD, Mtango FSEMA, , 1984. Hospital outbreak of cholera transmitted through close person-to-person contact. Lancet 2: 8283.[Crossref] [Google Scholar]
  21. Guévart E, Solle J, Noeske J, Amougou G, Mouangue A, Fouda AB, , 2005. Mass antibiotic prophylaxis against cholera in the New Bell central prison in Douala during the 2004 epidemic. Sante 15: 225227. [Google Scholar]
  22. Vo TH, Le NH, Nuorti JP, Phan LT, Nhu N, Minh T, , 2010. A cluster of cholera among patients in a Vietnamese district hospital in 2010. J Infect Dev Ctries 7: 910913. [Google Scholar]
  23. Daniels NA, Simons SL, Rodrigues A, Gunnlaugsson G, Forster TS, Wells JG, Wells JG, Hutwagner L, Tauxe RV, Mintz ED, , 1999. First do no harm: making oral rehydration solution safer in a cholera epidemic. Am J Trop Med Hyg 60: 10511055. [Google Scholar]
  24. Routh JA, Loharikar A, Fouché M-DB, Cartwright EJ, Roy SL, Ailes E, Archer WR, Tappero JW, Roels TH, Dahourou G, Quick RE, , 2011. Rapid assessment of cholera-related deaths, Artibonite Department, Haiti, 2010. Emerg Infect Dis 17: 21392142.[Crossref] [Google Scholar]
  25. Ivers LC, Walton DA, , 2012. The “first” case of cholera in Haiti: lessons for global health. Am J Trop Med Hyg 86: 3638. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3247106&tool=pmcentrez&rendertype=abstract. Accessed July 3, 2014.[Crossref] [Google Scholar]
  26. UNICEF, 2012. Guidance Note on the Use of Oral Cholera Vaccines for UNICEF Guidance, 209218. Available at: http://www.unicef.org/immunization/files/UNICEF_OCV_Guidance_20_July2012_final.pdf. [Google Scholar]

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  • Received : 19 Nov 2014
  • Accepted : 12 May 2015
  • Published online : 02 Sep 2015

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