30 July 2012

Ebola haemorrhagic fever in Uganda

This is an ongoing outbreak

On 29 July 2012, the World Health Organization (WHO) was informed of confirmed cases of Ebola haemorrhagic fever by the Ugandan Ministry of Health [1]. Since the beginning of July 2012, a total of 20 cases including 14 deaths have been reported from Kibaale district in the western part of the country. The diagnosis of Ebola was confirmed by the Uganda Virus Research Institute.

The index case was identified in a family from a single village (Nyanswiga), Nyamarunda sub-county of Kibaale district, where nine of the deaths were reported. The deceased include a clinical officer who attended to a patient, and her four month-old child. Nine of the 14 deaths have occurred in a single household.

The Ugandan Ministry of Health is working with stakeholders and partners including WHO, Médecins Sans Frontières and Centers for Disease Control and Prevention (CDC) in order to control the outbreak. All possible contacts of cases are being identified for active follow up. The necessary supplies and logistics required for supportive management of patients are being mobilized. [1-2].

Ebola is known to occur in Uganda; an outbreak was reported from November 2007 to January 2008 in Bundibugyo district in western Uganda [3-4]. The most recent case was reported in May 2011 in Luwero district, central Uganda. [5].

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 [6].

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

The risk to a traveller of contracting Ebola is very low in the absence of 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. There have been no known imported cases of Ebola in the United Kingdom.

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.

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.

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.

References

1. World Health Organization. Ebola in Uganda. 29 July 2012. [Accessed 30 July 2012]. Available at: http://www.who.int/csr/don/2012_07_29/en/index.html

2. The International Federation of Red Cross and Red Crescent Societies Uganda: Ebola outbreak - Information Bulletin n° 1. 29 July 2012. [Accessed 30 July 2012]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/MIBUG

20120728.pdf

3.  International Federation of Red Cross and Red Crescent Societies. Uganda: Ebola haemorrhagic fever epidemic. 19 May 2011. [Accessed 30 July 2012]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/Full_

Report_741.pdf

4. World Health Organization. Ebola haemorrhagic fever in Uganda – update. 7 December 2007. [Accessed 30 July 2012]. Available at: http://www.who.int/csr/don/2007_12_07/en/index.html

5.  World Health Organization. Ebola in Uganda. 18 May 2011. [Accessed 30 July 2012]. Available at: http://www.who.int/csr/don/2011_05_18/en/index.html

6. 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.

Links

Health Protection Agency

World Health Organization