Investigation of a COVID-19 Outbreak at Moroto Prison, Northern Uganda, September 2020

Respiratory Diseases

Background: A COVID-19 outbreak occurred at Moroto Prison, northern Uganda in September 2020. We investigated factors associated with the introduction and spread of COVID-19 in the prison.
Methods: A case was PCR-confirmed SARS-CoV-2 infection in a inmate/staff at Moroto Prison during August–September 2020. We reviewed prison medical records to identify case-patients and interviewed prison staff to understand possible infection mechanisms for the index case-patient. In a retrospective cohort study, we interviewed all inmates and staff to identify risk factors. Data were analyzed using log-binomial regression.
Results: On September 1, 2020, a recently-hospitalized inmate with unrecognized SARS-CoV-2 infection was admitted to Moroto Prison quarantine. He had become infected while sharing a hospital ward with a subsequently-diagnosed COVID-19 patient. A sample taken from the hospitalized inmate on August 20 tested positive on September 3. Mass reactive testing at the prison on September 6, 14, and 15, revealed infection among 202/692 inmates and 8/90 staff (overall attack rate=27%). One prison staff and 1 inmate who cared for the sick inmate while at the hospital re-entered the main prison without quarantining. Both tested positive on September 6. Using facemasks >50% of the time (aRR=0.26; 95% CI=0.13–0.54), or in combination with handwashing after touching surfaces (aRR=0.25; 95% CI=0.14–0.46) were protective. Prisoners recently transferring from other facilities to Moroto Prison had an increased risk of infection (aRR=1.50; 95% CI=1.02–2.22).
Conclusions: COVID-19 was likely introduced into Moroto Prison quarantine by a inmate with hospital-acquired infection and delayed test results, and/or by caretakers who were not quarantined after hospital exposures. Facemasks and handwashing were protective. Reduced test turnaround time for the hospitalized inmate could have averted this outbreak. Testing incoming inmates for SARS-CoV-2 before quarantine, providing unrestricted soap/water for handwashing, and universal facemask use in prisons could mitigate risk of future outbreaks.

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