Evaluation of SARS-CoV-2 Transmission and Cross-Border Transmission Risk Factors among Fishing Communities in Kyotera District, Uganda: May-June, 2020

  • Public health surveillance
  • Vaccine preventable diseases
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Background:
Incoming travelers from neighboring countries were the primary source of early COVID-19 cases in Uganda. Travelers crossed at multiple land and lake borders, including Kasensero and Nangoma fishing communities on Lake Victoria. In April 2020, persons in these communities migrated inland following flooding of Lake Victoria, leading to concern about introduction and spread of COVID-19. We evaluated these communities for SARS-CoV-2 infection and border-community-associated risk factors during May-June.

Methods:
We conveniently sampled persons from Kasensero (population: 6,793) and Nangoma (population: 2,949) regardless of symptoms. A confirmed case was positive SARS-CoV-2 RT-PCR from a nasopharyngeal or oropharyngeal swab. Confirmed case-patients were isolated. We interviewed confirmed case-patients to identify potential high-risk person-to-person exposures.

Results:
In total, 4,602 individuals [3,344 (88%) from Kasensero and 441 (12%) from Nangoma] were tested May 19-June 27, 2020. Fifty-six percent were males and 80% were aged 16-45 years. We identified 26 case-patients during May 25-June 3, including 15 (0.5%) in Kasensero and 11 (2.5%) in Nangoma; 15 (58%) were asymptomatic. Reported interactions between female case-persons and foreigners included sexual activity, bar service, or fish trading, while interactions between male case-persons and foreigners comprised cross-border movements or fishing-related interactions. Six (23%) case-patients had travelled to neighbouring countries (road or lake travel) in the past 14 days. Among 228 contacts, 172 (75%) were locatable; two (1.2%) (symptomatic) tested positive. Contacts were monitored for face mask use and social distancing. Testing of 1,454 additional community members from June 4-June 28, 2020 yielded no cases.

Conclusions:
We identified SARS-CoV-2 community transmission in Ugandan fishing communities bordering Tanzania. Infections among women may have been acquired from sexual, social, or business interactions with foreigners while those among men may have occurred during travel or fish-handling activities. Similar border communities should be individually assessed early during outbreaks to identify and intervene to reduce high-risk exposures.

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