Fourteen deaths reported in Uganda Ebola outbreak

Lisa Schnirring

Jul 30, 2012 (CIDRAP News) – An Ebola outbreak in Uganda that has killed 14 people has mobilized global efforts to contain the disease, the World Health Organization (WHO) said yesterday.

Among the dead are a healthcare worker and several members of the same family, and Ebola cases, including the fatal ones, have now reached 20, the agency said.

The outbreak is centered in Kibaale district, in the western part of the country. Nine of the deaths occurred in a family from Nyanswiga village, the WHO said. Other fatalities include a clinical officer who treated a patient and the woman's 4-month-old child. The outbreak area is about 136 miles west of Kampala, Uganda's capital and second-largest city.

The Uganda Virus Research Institute in Entebbe confirmed the Ebola virus findings in patient samples.

Of the 20 patients, 2 are hospitalized in stable condition: a 38-year-old woman who cared for her sister—the clinical officer who died—and a 30-year-old woman who helped bury the index patient, according to the WHO. Both women were hospitalized on Jul 23 with fever, vomiting, diarrhea, and abdominal pain, but so far no bleeding that is often seen in viral hemorrhagic fever (VHF).

Stephen Byaruhanga, health secretary of Kibaale district, told the Associate Press (AP) today that six more suspected patients have been admitted to the hospital, raising fears that the outbreak could involve more villages.

The Ebola virus is highly contagious, and infections carry a high fatality rate, ranging from about 50% to 90%. Initial symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain, according to the US Centers for Disease Control and Prevention (CDC). Hallmarks of Ebola infection include internal and external bleeding, and there is no vaccine or specific treatment for the disease.

Uganda's health ministry and its partners are finalizing national and district response plans, and the ministry has reactivated a national taskforce to address the Ebola outbreak. Meanwhile, a district task force in Kibaale has been formed and is coordinating the field response, as bordering districts raise their alert level and increase surveillance for new infections.

WHO and CDC experts are in Kibaale to assist with response activities, the WHO reported. Medical teams are identifying all contacts who may have been exposed to confirmed or suspected patients since Jul 6 for follow-up, and the groups are mobilizing supplies and logistics to help treat patients.

The hospital in Kibaale has set up a temporary isolation ward for suspected, probable, and confirmed cases, and Doctors Without Borders is assisting with the set-up. Though the health ministry and Mulago Hospital in Kampala has helped staff the isolation center, the WHO said more workers are urgently needed.

A reporter from a local radio station said some of the hospital's staff had fled the facility but are returning now that authorities have provided them with protective gear, Reuters reported today.

The WHO said in a Twitter post today that one of the patients died at Mulago Hospital after transferring from the district hospital, but that no infections have occurred in Kampala. According to the Reuters report, the transferred patient who died there was a local health worker.

Identification of the disease in many cases may have been delayed, because doctors initially thought the patients' symptoms weren't typical for Ebola, and some people put off medical care because they thought the infections were caused by "evil spirits," Reuters reported.

The health ministry has urged the public to take precautions to curb the spread of the disease, and today Uganda's president Yoweri Museveni issued a public statement urging people to avoid shaking hands, having casual sex, and participating in burials, according to the Reuters report.

The WHO said in its Twitter posts that Ebola outbreaks are normally very localized, and the risk of international spread is very small. It does not recommend any travel or trade restrictions.

Previous Uganda cases
Uganda's last reported Ebola case occurred in May 2011, in a 12-year-old girl from Luwero district who died from the disease and whose illness and lab findings were described in a Jul 27 report in Emerging Infectious Diseases (EID) by CDC researchers and their partners in Uganda.

Prior to that, a 2007 Ebola outbreak in Uganda killed 37 people. That outbreak was the first to involve the newly discovered Bundibugyo subtype. A 2000 Uganda outbreak involved 425 cases, 224 of them fatal.

The 2011 investigation into the girl's death found evidence the Sudan Ebola subtype, which has been linked with large hemorrhagic fever outbreaks in Africa. Follow-up of 25 close contacts of the girl found no other infections, but blood tests on a juvenile relative found evidence of a past Ebola infection, which didn't appear to be temporally related to the girl's infection.

Several species of bats were found in vacant houses and in several classrooms of the village schoolhouse that the girl attended, and testing the bats for Ebola virus is ongoing, according to the EID report.

The authors wrote that the girl's exposure was probably zoonotic and occurred near her residence, given her relatives' reports that the girl did not travel and that another family member had serologic evidence of infection that wasn't related to the girl's case.

The report said rapid detection, high clinical suspicion, and appropriate use of isolation by hospital staff probably limited the size of the outbreak in the girl's case. The authors noted that the CDC Viral Special Pathogens Branch and the Uganda Virus Research Institute have established a permanent high-containment lab that can test for filoviruses and other causes of VHF in the country.

National VHF surveillance systems and rapid diagnostic capacity can limit the extent of disease outbreaks, and more efforts are needed to build and maintain VHF networks across Africa, the group concluded.