Article Category:
Research Article

Identification of Anthrax as the Cause of a Cluster of Unexplained Deaths, Uganda, 2023: The Role of Metagenomic Next-Generation Sequencing and Postmortem Specimens

Nicholas Bbosa MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;
Uganda Virus Research Institute, Entebbe, Uganda;
Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;

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Deogratius Ssemwanga MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;
Uganda Virus Research Institute, Entebbe, Uganda;

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Sonja L. Weiss Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;
Abbott Diagnostics, Abbott Park, Illinois;

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Sam Kalungi Pathology Department, Mulago National Referral Hospital, Kampala, Uganda;
Ministry of Health, Kampala, Uganda;

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Anatoli Mawanda Pathology Department, Mulago National Referral Hospital, Kampala, Uganda;

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Richard Ssentudde Pathology Department, Mulago National Referral Hospital, Kampala, Uganda;

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Emmanuel Ssekyeru Kalisizo General Hospital, Kalisizo, Uganda;

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Alfred Ssekagiri Uganda Virus Research Institute, Entebbe, Uganda;

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Ronald Kiiza MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;

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Cleophous Rwankindo Uganda Virus Research Institute, Entebbe, Uganda;

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Joshua Buule Uganda Virus Research Institute, Entebbe, Uganda;

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Hamidah Suubi Namagembe MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;

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Stella Nabirye Uganda Virus Research Institute, Entebbe, Uganda;

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Justine Priscilla Nassolo Uganda Virus Research Institute, Entebbe, Uganda;

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Robert Downing Uganda Virus Research Institute, Entebbe, Uganda;
Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;

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Julius Lutwama Uganda Virus Research Institute, Entebbe, Uganda;

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Tom Lutalo Uganda Virus Research Institute, Entebbe, Uganda;

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Henry Kyobe Bosa Ministry of Health, Kampala, Uganda;
Uganda Peoples Defence Forces, Kampala, Uganda;
Makerere University Lung Institute, Kampala, Uganda

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Michael G. Berg Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;
Abbott Diagnostics, Abbott Park, Illinois;

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Mary A. Rodgers Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;
Abbott Diagnostics, Abbott Park, Illinois;

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Francisco Averhoff Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;
Abbott Diagnostics, Abbott Park, Illinois;

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Gavin A. Cloherty Abbott Pandemic Defense Coalition (APDC), Abbott Park, Illinois;
Abbott Diagnostics, Abbott Park, Illinois;

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Pontiano Kaleebu MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda;
Uganda Virus Research Institute, Entebbe, Uganda;

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DOI:
https://doi.org/10.4269/ajtmh.24-0489
Volume/Issue:
Ahead of Print
Open access
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Between April and November 2023, 27 unexplained human deaths that presented with swelling of the arms, skin sores with black centers, difficulty in breathing, obstructed swallowing, headaches, and other body aches were reported in Kyotera District, Uganda by the Public Health Emergency Operations Center. Subsequently, the death of cattle on farms and the consumption of carcass meat by some residents were also reported. Field response teams collected clinical/epidemiological data and autopsy samples to determine the cause of deaths. Metagenomic next-generation sequencing (mNGS) and target enrichment sequencing conducted on postmortem samples confirmed Bacillus anthracis, the etiological agent of anthrax disease, as the cause of the deaths. Applying mNGS to autopsy specimens is useful as a retrospective tool for identifying high-consequence pathogens during suspected outbreaks of unknown etiology.

Author Notes

Financial support: This study was supported by the Abbott Pandemic Defense Coalition.

Disclosures: The study was approved by the Uganda Virus Research Institute Research Ethics Committee (Reference no. GC/127/908) and the Uganda National Council of Science and Technology (reference no. HS2543ES). S. L. Weiss, M. G. Berg, M. A. Rodgers, and G. A. Cloherty are all employees and shareholders of Abbott Laboratories. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Authors’ contributions: N. Bbosa, D. Ssemwanga, G. A. Cloherty, and P. Kaleebu conceptualized the study. N. Bbosa, S. L. Weiss, and A. Ssekagiri performed data curation. N. Bbosa, S. L. Weiss, A. Ssekagiri, M. G. Berg, and F. Averhoff performed formal analysis. N. Bbosa, S. Kalungi, A. Mawanda, R. Ssentudde, E. Ssekyeru, M. G. Berg, M. A. Rodgers, and F. Averhoff performed the investigation. N. Bbosa, A. Ssekagiri, R. Kiiza, H. S. Namagembe, S. Nabirye, and M. G. Berg contributed to the methodology. C. Rwankindo, J. Buule, and T. Lutalo performed project administration. D. Ssemwanga, J. P. Nassolo, J. Lutwama, H. K. Bosa, G. A. Cloherty, and P. Kaleebu contributed resources. N. Bbosa, S. L. Weiss, A. Ssekagiri, and M. G. Berg contributed software. N. Bbosa wrote the original draft. D. Ssemwanga, S. Kalungi, R. Downing, H. K. Bosa, M. G. Berg, M. A. Rodgers, F. Averhoff, and P. Kaleebu reviewed and edited the manuscript.

Current contact information: Nicholas Bbosa, Deogratius Ssemwanga, and Pontiano Kaleebu, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda and Uganda Virus Research Institute, Entebbe, Uganda, E-mails: nicholas.bbosa@mrcuganda.org, deogratius.ssemwanga@mrcuganda.org, and pontiano.kaleebu@mrcuganda.org. Ronald Kiiza and Hamidah Suubi Namagembe, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda, E-mails: ronald.kiiza@mrcuganda.org and hamidah.namagembe@mrcuganda.org. Alfred Ssekagiri, Cleophous Rwankindo, Joshua Buule, Stella Nabirye, Justine Priscilla Nassolo, Robert Downing, Julius Lutwama, and Tom Lutalo, Uganda Virus Research Institute, Entebbe, Uganda, E-mails: assekagiri@gmail.com, cleorwankind093@gmail.com, buulej@yahoo.com, stellanabirye@gmail.com, justine.priscilla@gmail.com, downingrg@gmail.com, jjlutwama03@yahoo.com, and tomlutalo@gmail.com. Sonja L. Weiss, Michael G. Berg, Mary A. Rodgers, Francisco Averhoff, and Gavin A. Cloherty, Abbott Pandemic Defense Coalition, Abbott Park, Illinois, USA and Abbott Diagnostics, Abbott Park, Illinois, USA, E-mails: sonja.weiss@abbott.com, michael.berg@abbott.com, mary.rodgers@abbott.com, francisco.averhoff@abbott.com, and gavin.cloherty@abbott.com. Sam Kalungi, Anatoli Mawanda, and Richard Ssentudde, Mulago National Referral Hospital, Pathology Department, Kampala, Uganda and Ministry of Health, Kampala, Uganda, E-mails: skalungi@amail.com, mawandaanatoli37@amail.com, and sentudder@amail.com. Emmanuel Ssekveru, Kalisizo General Hospital, Kalisizo, Uganda, E-mail: ssekyemma@gmail.com. Henry Kyobe Bosa, Uganda Peoples Defence Forces, Kampala, Uganda and Makerere University Lung Institute, Kampala, Uganda, E-mail: hskyobe@gmail.com.

Address correspondence to Nicholas Bbosa, Uganda Virus Research Institute, PO Box 49, Plot 51-59 Nakiwogo Rd., Entebbe, Uganda. E-mail: nicholas.bbosa@mrcuganda.org
Copyright:
© The author(s) 2025
Received:
19 Jul 2024
|
Accepted:
21 Oct 2024
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Published Online:
07 Jan 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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