Application of 7-1-7 framework in prototypical anthrax outbreak: Identifying missed opportunities for early detection in Southwestern Uganda, September 2024

IntroductionUganda responded to 37 anthrax outbreaks during 2014-2024. In 2021, the country adopted the 7-1-7 framework, which stipulates detection of outbreaks within seven days, notification completed in one day, and completion of early response actions initiated within seven days. However, the application of the 7-1-7 timeliness evaluation for prototypical zoonotic infections, such as anthrax, is unclear. We assessed the timeliness of response to the 2021 Anthrax outbreak in a rural border district in Uganda. MethodsWe reviewed human and animal health surveillance records to document key dates of emergence, detection, notification, and completion of early response actions. We used the 7-1-7 metrics to evaluate the timeliness of these milestones. Through discussions with district leadership, health workers, and residents, we verified key dates and facts, identified bottlenecks and enablers, and confirmed the accuracy of information. Qualitative data were organized into themes to capture bottlenecks and enablers. ResultsThe disease in animals was detected after 87 days, and notification was made in one day. In humans, detection took 83 days, and notification took one day. Early response actions were jointly initiated five days after notification and completed within 10 days. The outbreak involved 111 animal deaths and 90 cases of human anthrax, including 6 (6.7%) deaths. The enablers included the presence of a real-time One Health communication platform, partner support, presence of Village Health Teams (VHTs), and training of animal health workers on detection. Bottlenecks included weak zoonotic disease surveillance, characterized by understaffing, a low suspicion index, misdiagnosis, and weak coordination with private health facilities. ConclusionOverall, there were delays in detection and completion of early response in an anthrax outbreak in humans and animals, highlighting the need for cross-sectoral coordination to ensure coordinated surveillance and response in a One Health approach. Strengthening animal health surveillance, building private sector engagement, and training frontline workers to recognise zoonoses early could improve future outbreak responsiveness and mitigate potential cross-border spills.