Health Professionals

Clinical Updates

6 August 2012

Ebola haemorrhagic fever: Uganda

This updates the Clinical update of 30 July, 2012

The Ebola outbreak, in Kibaale district in the western part of Uganda, is ongoing. As of 3 August 2012, a total of 53 suspected cases including 16 deaths had been reported to the World Health Organization (WHO); of these five have been laboratory confirmed.  As of 3 August, 32 cases are admitted to Kagadi Government Hospital, Kibaale district and are being nursed in isolation. A total of 312 contacts have been identified of which 253 are being closely followed up. These include seven healthcare workers who attended the case who was transferred to and died in Mulago hospital in Kampala; none of these have shown symptoms so far. So far samples from other districts have tested negative for Ebola indicating that the outbreak has not spread outside of Kibaale district [1].

The Ugandan Ministry of Health has activated a National and local task force to co-ordinate the response to this outbreak.  Experts from international organisations including WHO, Centers for Disease Control and Prevention (CDC) and specialised Non Governmental Organisations, including Médecins Sans Frontières and the Ugandan Red cross, are supporting this response [1,2]. In addition to contact tracing, disease surveillance and infection control measures are being enhanced. Because the incubation period can be up to 21 days, it is likely that additional cases will be identified in the coming weeks in Uganda [2].

Ebola is known to occur in Uganda; an outbreak was reported from November 2007 to January 2008 in Bundibugyo district in western Uganda [3]. The most recent case was reported in May 2011 in Luwero district, central Uganda. [4].

Ebola haemorrhagic fever

Ebola haemorrhagic fever is a severe disease caused by a virus of the Filoviridae family. The natural reservoir for Ebola is not known, but non-human primates can become ill with Ebola [5].

Following an incubation period of four to 10 days (range two to 21 days) illness presents with the sudden onset of fever, headache, joint and muscle aches, and weakness. As the infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion, and haemorrhage can occur.

This can lead to multi-organ failure, shock, and death. Ebola is transmitted via direct contact with the bodily fluids of an infected person. Ebola has also been reported following contact with the tissues of infected animals.

Advice for travellers

There have been no known imported cases of Ebola in the United Kingdom [6].

The European Centre for Disease Prevention and Control advises that the risk to travellers (including tourists and those visiting friends and relatives [VFR]) and EU residents living in Uganda is extremely low, even for those who have visited the outbreak area [2].

Transmission of Ebola can only occur when there is direct contact with the blood or body fluids of an infected person, animal, or objects, such as needles, that have been contaminated with blood or body fluids. Travellers should avoid all contact with infected patients.

Those who are providing medical care or are involved in the evaluation of an outbreak should observe strict barrier precautions. Guidance for healthcare workers who will be working with VHF patients in African healthcare settings has been written by the CDC in conjunction with WHO.

Travellers who have been potentially exposed to Ebola virus should seek medical attention immediately if they experience any symptoms consistent with Ebola within the first 21 days of return to the UK.

United Kingdom guidance on the management and control of viral haemorrhagic fevers (VHF) has been written by the Advisory Committee on Dangerous Pathogens.

References

1. World Health Organization. Global Outbreak Response (GAR). Ebola in Uganda: update 3 August 2012. [Accessed 6 August, 2012]. Available at: http://www.who.int/csr/don/2012_08_03/en/index.html

2. European Centres for Disease Prevention and Control. Rapid Risk Assessment. Outbreak of Ebola Haemorrhagic Fever in Uganda 2 August, 2012. [Accessed 6 August, 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/TER-020812-RRA-Ebola-Uganda.pdf

3. World Health Organization. Ebola haemorrhagic fever in Uganda – update. 7 December 2007. [Accessed 6 August, 2012]. Available at: http://www.who.int/csr/don/2007_12_07/en/index.html

4. World Health Organization. Ebola in Uganda. 18 May 2011. [Accessed 6 August, 2012]. Available at: http://www.who.int/csr/don/2011_05_18/en/index.html

5. Beeching NJ, Fletcher TE, Hill DR, Thomson GL. Travellers and viral haemorrhagic fevers: what are the risks? Int J Anti Micro Agents 36:S26-S35, 2010.

6. Health Protection Agency. Ebola. [Accessed 6 August, 2012]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/Infections

AZ/Ebola/

 

Links

Health Protection Agency: Ebola

World Health Organization: Ebola haemorrhagic fever