Refugee Settlements and Cholera Risks in Uganda, 2016–2019

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  • 1 Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda;
  • 2 College of Health Sciences, Makerere University, Kampala, Uganda;
  • 3 Emergencies Programme, UNICEF, Kampala, Uganda;
  • 4 Department of Health, Isingiro District Local Government, Isingiro, Uganda;
  • 5 Emergency Operational Centre, Ministry of Health, Kampala, Uganda;
  • 6 Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia;
  • 7 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016–2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case–control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.

Author Notes

Address correspondence to David A. Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205. E-mail: dsack1@jhu.edu

Disclaimer: The funding agencies had no role in collecting, analyzing, or interpreting the results. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or other participating agencies.

Financial support: Funding for the study was provided by the Bill & Melinda Gates Foundation (OPP1148763), which provided financial support through the Johns Hopkins University Delivery of Oral Cholera Vaccine Effectively (DOVE) project and from a grant from the National institute of Allergy and Infectious Disease (5R01AI123422).

Authors’ addresses: Godfrey Bwire, Freda Loy Aceng, Sam Emmanuel Arianitwe, and Allan Muruta, Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda, E-mails: cddmoh@yahoo.com, faceng@musph.ac.ug, emmaxsam@gmail.com, and allan.muruta@gmail.com. Christopher Garimoi Orach, Makerere University School of Public Health, Kampala, Uganda, E-mail: cgorach@musph.ac.ug. David Matseketse, Emergency Programme, UNICEF, Kampala, Uganda, E-mail: dmatseketse@unicef.org. Edson Tumusherure, Department of Health, Isingiro District Local Government, Isingiro, Uganda, E-mail: etumusherure@gmail.com. Makumbi Issa, Emergency Operational Centre, Ministry of Health, Kampala, Uganda, E-mail: issamakumbi@gmail.com. Rebecca D. Merrill, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: xdf6@cdc.gov. Amanda Debes, Mohammad Ali, and David A. Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Heath, Baltimore, MD, E-mails: adebes1@jhu.edu, mali25@jhu.edu, and dsack1@jhu.edu.

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