Uganda: Nodding disease (Situation as of 14 February, 2012)

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A total of 3097 suspected cases and 170 death (CFR: 5.4%) were reported from three districts

Event description

The Uganda Ministry of Health reported a mysterious disease condition, referred to as "Nodding Syndrome", being reported in the Northern Uganda districts of Kitgum, Pader and Lamwo. The condition was first noticed in Kitgum district in 2003, and described as a progressive disease characterized by nodding of the head, mental retardation and stunted growth. The investigations revealed that the disease was a new type of epilepsy that was reported to have affected at least 3,000 children in the districts of Kitgum, Lamwo and Pader in Northern Uganda. As of February 14, it is estimated that a total to 3,094 suspected cases with 170 deaths have occurred.

The disease is mainly affecting children aged 5 to 15 years, with 54% of the affected children being males. Most of the affected children (93%) live in areas where Onchocerciasis (River Blindness) is prevalent.  The disease presentation suggests that this is possibly a new type of epilepsy that is characterized by head nodding episodes that consist of repetitive dropping forward of the head. There is deterioration of brain function in some of the victims, and malnutrition with growth retardation; many children have dropped out of school.

Actions taken

The Ministry of Health with support from WHO, CDC and other partners conducted epidemiological investigations in 2009 and 2010.  These investigations enabled exclusion of possible etiological agents such as infectious, toxic, or nutritional factors; however the cause of the illness remains unclear.   The association between Onchocerciasis and Nodding Syndrome requires further investigation.  A modest deficiency of vitamin B6 and deficiencies of other micronutrients (Vitamin A, Seleniun and Zinc) was found in most cases. Investigations to date reveal that Nodding Syndrome is not transmissible person to person. The patients can be effectively treated with anti-epileptic drugs; however, further investigations into the cause of the disease and pathogenesis are planned.   The MOH and partners developed a response plan to Nodding Syndrome which includes:  case management to prevent deterioration of the cases, bi-annual mass treatment of Onchocerciasis, strengthening surveillance, and multivitamin and multi-nutrient supplementation.  In response to the request to WHO AFRO for technical and financial support, an epidemiologist from the regional office has been deployed to provide additional support to MoH to improve monitoring of nodding disease cases through strengthening surveillance. The epidemiologist will also support training of health workers on case management in the affected districts and work with the nodding disease research sub-committee in identifying additional research priorities and contribute to finalisation of the existing protocols . Seed funds were provided by AFRO to support some of the key activities

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