Cholera in Uganda could be genetically spread

By Nelson Kiva

Cholera, an acute diarrheal disease, essentially eliminated in the western world many decades ago, has continued to cause many deaths in sub-Saharan Africa, South America and Asia.

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Prof. Christopher Garimoi (right), congratulating Dr.Bwire after he was conferred his doctorate at Makerere recently


A study by the Ministry of Health and Makerere University School of Public Health (MUSPH), has ruled out water sources being possible reservoirs of cholera causing bacteria.

The findings hint at the genetic spread of cholera in Uganda, East and Central African regions.

“Our study discovered that water sources were possibly not reservoirs for the epidemic vibrio cholera, a bacteria that causes cholera,” Dr.Godfrey Bwire, the lead researcher said.

The study found that cholera outbreaks in Uganda were due to three genetically related vibrio cholerae types or clones.

The clones, according to Bwire, showed that transmission was within Uganda, East, and Central African regions,” he added.

Bwire studied molecular characterization and rapid detection of vibrio cholerae bacteria in Uganda; the relationship between human pathogens and aquatic environment, as his doctorate programme at MUSPH. He was among many who graduated at Makerere University recently.

He is also a principal medical officer in charge of controlling diarrheal diseases at the health ministry.

Cholera, an acute diarrheal disease, essentially eliminated in the western world many decades ago, has continued to cause many deaths in sub-Saharan Africa, South America and Asia.

It is widely known to be caused by eating food or drinking water contaminated with vibrio cholera bacteria or in simple terms poor sanitation.

Cholera has inflicted a heavy financial burden on the governments in terms of treatment and prevention efforts.

 “Our aim was to determine the genetic relatedness and spread of strains responsible for cholera outbreaks in Uganda,” Bwire said.

The latest outbreak in Uganda was recently reported in Busia Municipality, leaving over 31 people hospitalized.

The disease for years has attacked the districts on the different borderlines of Uganda.

They include Nebbi, Hoima, Ntoroko, Kasese, Namayingo, Busia, Moyo, Arua, Zombo, Pakwach and Buliisa.

In 2018, it broke out in Kampala and a total of 53 cases were registered mostly in Kabowa- Sembule II and Kironde zone in Rubaga Division.

The study was jointly funded by the Ministry of Health and Bill and Melinda Gates Foundation (USA) and supervised by Prof. Christopher Garimoi Orach (MUSPH) and Prof. David Allen Sack (John Hopkins University, USA).

Prof. Christopher Grimoi Orach, the head of the department of community and behavior sciences at MUSPH said, the conclusions in the study, are drawn from the tests conducted on 63 samples collected from outbreaks in Uganda between 2014 and 2016.

“We tested using multiplex polymerase chain reaction (PCR), a multi-locus variable number of tandem repeat analysis (MLVA) and whole-genome sequencing (WGS) to arrive at our findings,” Grimoi said.

Cholera diagnosis in most countries in sub-Saharan Africa, including Uganda, Grimoi said, is by stool culture, serology and biochemical methods.

These testing methods, he claims are unable to establish the relatedness, virulence, and spread of Vibrio cholerae in the region.

“These findings provide a valuable baseline and help define the context for directing control measures and technologies for cholera prevention in East Africa,” he said.

According to the health ministry, Uganda has registered significant strides in the fight against cholera.

Emmanuel Ainebyoona, a senior public relations officer at the ministry, told New Vision that, over 1million people have since been vaccinated against vibrio cholera in the six hot spot districts in the first and second phase of the campaign that target 11 districts.

They include; Hoima, Buliisa, Pakwach, Zombo, Nebbi, and Bududa. The third phase and the last will include Busia, Namayingo, Kasese, Ntoroko, Arua and Moyo before the end of June, this year.

“Currently we are doing active surveillance in the districts before we rollout immunization in the districts,” Ainebyoona said.

 He added, over 3.6 million doses have been planned for the immunization in all the 11 districts and Sh2b is already in the budget to support cholera fight this year.