Uganda's widening Ebola outbreak tops 100 cases; more deaths reported
Uganda's health ministry today reported 14 more lab-confirmed Ebola cases, pushing the outbreak total to 109. Health officials also reported 2 more deaths, raising the total to 30. Earlier in the outbreak before the first cases were confirmed, the ministry reported 20 suspected cases, all of them fatal.
At a media briefing today, Uganda Health Minister Jane Ruth Aceng Ocero, MBChB, MPH, said 45 people are being treated for their infections.
The World Health Organization (WHO) African regional office said in its latest weekly health emergencies update that Uganda's outbreak has expanded to two more districts, Kampala and Wakiso, raising the number of affected locations to seven. It warned that further expansion of the outbreak is possible, given that high-risk contacts have been identified for follow-up in five yet-unaffected districts.
Uganda is making progress with case management but needs more isolation units, ambulances, human resources, and funding to battle the outbreak, the WHO said.
Meanwhile, Doctors Without Borders (MSF) said yesterday that it is stepping up its response. It said its teams will expand to help with the response, including medical care, in Kampala.
MSF is currently supporting the treatment of sick people in Mubende, the outbreak's epicenter. One 40-bed treatment facility has been completed there, and another 40-bed unit with the capacity to provide intensive are is under construction in the same area. An 8-bed unit in Madudu is up and running. MSF also said it stands ready to help with clinical trials of vaccines and treatments for the less common Sudan Ebola virus that is fueling the country's outbreak.
Oct 26 Uganda health ministry update
Oct 26 Uganda health ministry tweet
Oct 25 WHO African regional office weekly health emergencies report
Oct 25 MSF update
Alpha, Delta, and Omicron patients may exhale more viruses
A study today from researchers at the University of Maryland determined that patients infected with COVID-19 variants Alpha, Delta, and Omicron—including those fully vaccinated and boosted—shed significantly more viral RNA copies into exhaled breath aerosols than patients infected with ancestral strains and other variants.
The study appears in Clinical Infectious Diseases and adds to evidence of increased transmissibility of the Alpha, Delta, and Omicron variants. The study used 30-minute respiratory samples collected via a Gesundheit-II exhaled breath aerosol sampler from 93 participants who had confirmed COVID-19 infections. Of those, 32 were fully vaccinated and 20 boosted. The participants were tested from June 2020 through March 2022.
According to the authors, 4 Alpha, 3 Delta, and 29 Omicron patients shed significantly more viral RNA copies into exhaled breath aerosols than the 57 people infected with ancestral strains and variants.
The increase in viral shedding may have been at least partly due to participant behavior while in the Gesundheit machine. The authors said Delta and Omicron patients coughed more frequently than those infected with Alpha, ancestral strains, and other variants. Omicron patients also generally reported more upper and lower respiratory symptoms than the other volunteers.
"These data indicate that a characteristic of highly transmissible variants is a high rate of viral shedding into aerosols," the authors concluded. "This evidence for convergent evolution of increased viral aerosol shedding is consistent with a dominant role for airborne transmission (inhalation of viral aerosols regardless of distance that the aerosol traversed) in the spread of COVID-19."
Oct 26 Clin Infect Dis study
Omicron BA.2 subvariant appears to be less severe than other strains
A study yesterday in JAMA Network Open suggests that the SARS-CoV-2 Omicron BA.2 subvariant carries a significantly lower risk of death than that of Delta and the original Omicron strain, B.1.1.529.
Led by researchers at Massachusetts General Hospital and Harvard Medical School, the study involved 102,315 COVID-19 cases in adults and children in New England diagnosed from Mar 3, 2020, to Jun 20, 2022. Average patient age was 44.2 years, 62% were women, 76.4% were White, and 20.3% of the cases were Delta, 51.4% were Omicron, and 28.3% were BA.2.
Amid Delta, 48.5% of patients had received a primary COVID-19 vaccine series, and 44.7% were unvaccinated, while during Omicron predominance, 65.9% had received a booster dose. Also, fewer people had previous infections during the Delta wave (1.8%) than in the Omicron (6.4%) and BA.2 (5.3%) surges.
COVID-19 30-day death rates were 0.7% for Delta, 0.4% for Omicron, and 0.3% for Omicron BA.2. The adjusted odds ratio (aOR) of death from Delta relative to BA.2 was 2.07 (95% confidence interval [CI], 1.04 to 4.10), and for Omicron it was 2.20 (95% CI, 1.56 to 3.11).
The risk of hospitalization with Delta was significantly greater than that of BA.2 (aOR, 3.84; 95% CI, 2.93 to 5.02). Omicron was also more likely to lead to hospitalization than BA.2 (OR, 2.71; 95% CI, 2.42 to 3.02).
Likewise, intensive care unit admission was six times higher with a Delta infection than with BA.2 (OR, 6.12; 95% CI, 2.57 to 14.5), and with Omicron it was triple (OR, 3.06; 95% CI, 2.28 to 4.10). The relative risk of invasive ventilation was more than quadruple and triple, respectively, with Delta (OR, 4.36; 95% CI, 2.56 to 7.41) and Omicron (OR, 3.55; 95% CI, 2.61 to 4.84).
"After having accounted for a variety of confounding factors associated with SARS-CoV-2 outcomes, the Omicron BA.2 subvariant was found to be intrinsically less severe than both the Delta and Omicron variants," the study authors wrote.
Oct 25 JAMA Netw Open study