Review of Uganda’s high-risk Ebola preparedness activities enabling prompt control of imported Ebola Virus Outbreak from the Democratic Republic of Congo, June 2019

Introduction: On 1 August 2018, the Democratic Republic of Congo declared its tenth Ebola Virus Disease (EVD) outbreak in North-Kivu province, 100 km from the Uganda border. Uganda immediately initiated activities to prepare for possible importation of cases. The capacity developed through these interventions was tested when three EVD cases entered Uganda through Kasese District on 10 June 2019. We describe how heightened preparedness efforts enabled prompt detection and control of the imported EVD cases within Uganda. Methods: To prepare for the spillover of EVD cases, Uganda Ministry of Health activated coordination mechanisms, conducted readiness assessments and a field simulation exercise, developed an EVD preparedness and response plan, enhanced surveillance, point of entry screening, trained health workers and community on detection, conducted laboratory investigations, established treatment units and vaccinated health care workers in high-risk Ugandan districts. EVD operational readiness was monitored regularly using the WHO checklist. We conducted desk reviews of all preparedness and response documentation. Results: During the preparedness period, 3 imported EVD cases were identified at a hospital in Kasese District on 10 June 2019 after entering Uganda through an undesignated border crossing near Mpondwe, Kasese District. All three patients died within a few days. Between 11-15 June 2019, 114 contacts were identified and followed up for 21 days. Of these, 78 (68%) were vaccinated with the Ebola rVSV-ZEBOV vaccine, and none developed EVD symptoms. The Ministry of Health declared the outbreak over in Uganda 42 days after the death of the last confirmed case. Conclusion: Preparedness activities in a high-risk district in Uganda enabled early detection, effective isolation, infection prevention and control, and efficient response coordination following importation of EVD cases into Uganda from DRC, resulting in its full containment and preventing further spread throughout the country. Preparedness activities implemented systematically could enable effective and efficient response to similar high-risk situations in the future.