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Investigating an outbreak of measles in Kamwenge District, Uganda, July 2015

Investigating an outbreak of measles in Kamwenge District, Uganda, July 2015

Alex Riolexus Ario1,2,&, Fred Nsubuga1, Lilian Bulage1, Bao-Ping Zhu3


1Uganda Public Health Fellowship Program, Kampala, Uganda, 2Ministry of Health, Kampala, Uganda, 3US Centers for Disease Control and Prevention, Uganda



&Corresponding author
Alex Riolexus Ario, Uganda Public Health Fellowship Program, Kampala, Uganda




Globalization has opened many fronts for disease outbreaks because of the quick movement of people and porous borders around the world. The emergence of zoonotic diseases and other communicable diseases highlights the need for implementation of the Global Health Security Agenda packages if countries are to achieve compliance with International Health Regulations (IHR 2005). Health workforce development is one of the critical components that must be addressed with utmost urgency if gaps in early disease detection and response are to be addressed. In this regard, this case study is based on a measles outbreak investigation in Uganda simulating a real-life outbreak investigation by field epidemiologists and seeks to demonstrate the principles of applied epidemiology outlining the critical steps in outbreak investigations and generation of evidence for decision making. It aims to shore up the health workforce capacity by providing practical training for field epidemiology students and professionals that builds their skills in outbreak investigation. This case study can be completed in less than three hours.



How to use this case study    Down

General instructions: the participants will read the paragraphs in the participant’s guide in turns as guided by the instructor. One instructor will facilitate the case study for a class of 10 – 15 students/residents. The instructor may ask for group discussion of an answer or direct a question to one particular participant. For questions that require calculations, the instructor will allow each participant to participate to maximize learning. The instructor may ask for a role play as necessary and also split the class into groups to generate brainstorming. The instructor’s guideprovides sufficient background materials to facilitate learning without review of further references.


Audience: residents in Intermediate and Advanced Field Epidemiology Training Programs.


Prerequisites: before using this case study, case study participants should have received lectures in defining outbreaks, conducting basic outbreak investigations, and basic biostatistics. Participants should have a basic science degree or equivalent knowledge of science.


Materials needed: flip chart or white board, markers, laptop with Microsoft Excel and Epi Info™ packages.


Level of training and associated public health activity: intermediate outbreak investigation.


Time required: 2-3 hours


Language: English



Case study material Up    Down



Competing interests Up    Down

The authors declare no competing interests.



Acknowledgments Up    Down

We wish to extend our sincere thanks to African Field Epidemiology Network and Emory University for the funding extended to the successful Case Study Design and Development workshop which enabled us to accomplish this work. We acknowledge Fellows of the Uganda Public Health Fellowship for their contribution to the generation of the dataset whichformed the basis for the development of this case study. We greatly appreciate the technical and practical tips on case study development given by our facilitators – Scott J.N. McNabb, Meeyoung Park, Joseph Asamoah Frimpong, Casey Hall and Shreya Kothari. We cannot forget the encouragement given to us by our CDC colleague Al Forbes. Finally, we would like to acknowledge the following for their peer review during the case study development workshop: Monica Okuga, Kofi Mensah Nyarko, Emmy-Else Ndevaetela, Bernard Sawadogo, Mamadou Sawadogo, Florence Nzilanye Iddrisah, Ernest Konadu Asiedu, Magbagbeola David Dairo and Loveness John Urio.



References Up    Down

  1. Fred Nsubuga, Lilian Bulage, Immaculate Ampeire, Joseph KB Matovu, Simon Kasasa, Patricia Tanifum, Alex Ario Riolexus and Bao-Ping Zhu. Factors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015. BMC Infect Dis. 2018; 18: 21. PubMed | Google Scholar

  2. Uganda Bureau of Statistics. Implementation of the Community Information System (CIS) Abim District socio economic report. CIS summary results. 2011. Google Scholar

  3. David L, Heymann MD, editors. Control of communicable diseases manual. Apha Press. 2015; 20th ed. Google Scholar

  4. WHO/AFRO. Guidelines for Measles Surveillance. December 2004; 1-38. Google Scholar

  5. Centers for Disease Control and Prevention. Principles of Epidemiology in Public Health Practice, Section 2: Steps of an Outbreak Investigation, Atlanta, GA. May 2012; Third Edition. Google Scholar