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Uganda: Ebola Sudan identified in 17 deaths, all monitoring completed, outbreak declared over

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Anxiety as Ebola returns





Sunday, 29 July 2012 20:41
Written by SADAB KITATTA KAAYA




grave.jpg
The death toll stands at 14 so far PHOTO: CC BY 2.0


Family of 12 wiped out; death toll at 14 in Kibaale district

Medical authorities in the western district of Kibaale were today investigating more suspected cases of Ebola, as haemorrhagic fever returned, causing anxiety around the country.

Unofficial sources at Kagadi hospital, the main health facility in Kibaale, said more suspected cases were being investigated, but officials would not comment by press time.
By Saturday six people had been admitted with the disease.

Ebola manifests as a haemorrhagic fever, is highly infectious and kills quickly. Signs and symptoms of the disease include fever, vomiting, diarrhoea, abdominal pain, headache, measles-like rash, red eyes, and – sometimes – with bleeding from body openings. People in the district, in Bunyoro sub-region, have been troubled by the mysterious illness, until last Saturday when health authorities confirmed it was Ebola haemorrhagic fever.

By press time, 14 people were known to have died from the fever, including an entire family of 12, in Nyanswiga village, Nyamarunda sub-county. In a statement, Dr Denis Lwamafa, Commissioner National Disease Control in the ministry of Health, said the fever had been confirmed after tests at the Uganda Virus Research Institute in Entebbe.

Lwamafa said the first case was reported on July 6. The dead include a clinical officer and her four-month-old baby, who passed away at Mulago hospital. Yesterday the permanent secretary in the ministry of Health, Dr Asuman Lukwago, sought to assure the country that authorities were doing everything to keep the situation under control.

Speaking on the Kampala-based Radio One, Lukwago said with mass movement of people, as has happened with Congolese refugees who have fled to Uganda because of fighting in their country, diseases can break out. He, however, said authorities were monitoring the situation in western Uganda, while people who recently visited Kibaale would be assisted once they reported to medical authorities.

Twelve of the dead belonged to the family of Yostus Isoke of Nyanswiga village, Nyamarunda sub-county. They include Isoke himself; his five children – Byaruhanga Isoke, Fred Isoke, Roggers Byaruhanga, Doreen Nantongo and an unidentified son. Also among the dead is Lovinsa Kabwimukya, 42, a sub county councilor for people with disabilities in Nyamarunda sub-county council.

The family at first complained of being bewitched and at one stage resorted to visiting witch-doctors. One of the victims is reported to have died in a shrine. Because of the deaths, many people have abandoned the bereaved families for fear of losing lives. Dr Joseph Wamala, a senior epidemiologist in the ministry of health, identified the type of Ebola reported in Kibaale district as Sudan Ebola, which is less deadily than Ebola Zaire.

Other types of Ebola are Ebola Zaire, Ebola Cote d’Ivore, Ebola Bundibugyo and Ebola Reston Ebola can be spread through direct physical contact with body fluids like saliva, blood, stool, vomit, urine and sweat from an infected person and soiled linen used by a patient. One can get it from contact with the body of a person who has died of the disease.
This is the third time a major Ebola outbreak is reported in Uganda in 12 years. In 2000, Ebola killed 224 people, including a prominent physician fighting it, Dr Matthew Lukwiya. In 2007, Ebola struck again, in Bundibugyo district; this time it claimed at least 38 people; they included Dr Jonah Kule and two other medical workers.
Precautionary measures

Dr Lwamafa urged the public to take precautionary measures to avert the spread of the disease. “We have set up a national emergency taskforce to contain the disease from spreading far and wide” Dr Lwamafa said.
He warns against unnecessary contact with suspected people especially during communal funerals and parties. As part of the precautionary measures, he said the ministry of Health has started active and sustained tracing and listing of people that may have been exposed to suspected and confirmed cases since July 6, 2012.

Precautionary measures to contain Ebola
• Report and immediately take any suspected patient to a nearby health unit
• Avoid direct contact with body fluids of a person suffering from Ebola by using protective materials like gloves and masks
• Disinfect the bedding and clothing of an infected person
• Persons who have died of Ebola must be handled with strong protective wear and buried immediately, avoid feasting and funerals
• Avoid eating dead animals especially monkeys
• Avoid public gathering especially in the affected district
• Burial of suspicious community deaths should be done under close supervision of district health workers
• Report all suspicious deaths to the health workers :tiphat:http://www.observer.ug/index.php?option=com_content&view=article&id=20104:anxiety-as-ebola-returns&catid=34:news&Itemid=114
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Other patients run away from hospital for fear of Ebola




..Patients suffering from other ailments seeking treatment from health centres in Kibaale district have run away for fear of contracting Ebola fever from suspected Ebola patients.

Kibaale district is under attack from a strange disease which government has confirmed as Ebola and has killed close to 20 people, majority of whom are from Nyanswiga village in Nyamarunda Sub County.

The victims suffer from diarrhea, vomiting, and stomach ache and at the time of their death, blood ooze from the nose and mouth...:tiphat:
http://www.ugpulse.com/uganda-news/health/other-patients-run-away-from-hospital-for-fear-of-ebola/26491.aspx
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Deadly Ebola wipes out family of 12 in Kibaale

By Sharon Tibenda
30<SUP>th</SUP> July 2012:
An outbreak of the Ebola virus has killed 14 people in western Uganda this month, health ministry officials said, ending weeks of speculation about an unknown illness that had many people fleeing their homes.
Ugandan officials and a World Health Organisation representative told a news conference in Kampala on Saturday last week that there was “an outbreak of Ebola” in Uganda.
“Laboratory investigations done at the Uganda Virus Research Institute have confirmed that the strange disease reported in Kibaale district is indeed Ebola hemorrhagic fever,” the Ugandan government and WHO said in joint statement.
Officials urged Ugandans to be calm, saying a national emergency taskforce has been set up to contain the disease. In recent weeks, residents of Kibaale had been troubled by what seemed like a mysterious illness. Health officials spent weeks conducting laboratory tests that were at first inconclusive.
Joaquim Saweka, WHO’s representative in Uganda, said the origin of the outbreak had not yet been confirmed. “…A team of experts from the government, WHO and CDC (US Centre for Disease Control) are in the field and following up on all suspected cases and those who got into contact with patients,” he said.
Officials told reporters in Kampala that of the 14 people who have died so far, twelve were from the same family. A total of twenty people have now been confirmed to have Ebola, which causes haemorrhagic fever and internal bleeding... :tiphat:http://www.ugandacorrespondent.com/articles/2012/07/deadly-ebola-wipes-out-family-of-12-kibaale/
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

We seem to have some kind of reporting error. Post #38 indicates that someone died at "Mulago Hospital" in Kampala with Ebola-like symptoms. Post #41 indicates that the four-month-old son of the HCW died at Mulago Hospital. I find it difficult to believe that that infant is the case taken to Kampala after his mother died, especially since we don't yet know where that case supposedly came from.

Are there two Mulago Hospitals? Did the US embassy report mistake the Mulago Hospital in Kibaale for the one in Kampala? Or was there one fatailty in each?

Or is one of these reports using the name of the wrong hospital?
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Kibaale district appears to be fairly isolated

https://maps.google.co.uk/maps?hl=en

Demographic information here

http://www.ifad.org/evaluation/public_html/eksyst/doc/prj/region/pf/uganda/r005ugbe.htm

Kampala is another matter altogether, but hopefully any cases transferred here were heavily quarantined

http://www.newworldencyclopedia.org/entry/Kampala#Demographics
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Alert - the health facility in Kiballe appears to be called Kagadi hospital. I have checked on the maps and there isnt another medical facility, so Mulago hospital references must apply to the one in Kampala.
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Well, there appears to be only one Mulago Hospital, and it is in Kampala:

http://en.wikipedia.org/wiki/Mulago_Hospital

So I think post #41 indicating the infant died in Mulago Hospital is in error. As to the case in post #38, we still don't know enough of his contact history to know whether he ould have contracted Ebola. I don't know whether they would risk medically transferring a suspected case to Kampala; it seems the case in #38 is reported to have travelled to Kampala (from where?) on his own before taking ill.

It is normal from previous Ebola outbreaks to have reports of quite a few suspected cases that are not actually infected. They cast a wide net in looking to isolate suspects to avoid missing a case and allowing a new cluster to occur.

----------------

Apparently, Mulago Hospital is being used as a base for co-ordinating the response:

http://www.nation.co.ke/News/High+a...ls+14++/-/1056/1465798/-/i6ex7tz/-/index.html

[snip]

According to the Health ministry, a national taskforce to be based at Mulago National Referral Hospital has been activated.
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

It is the second report of a death at kampala:tiphat:http://www.flutrackers.com/forum/showpost.php?p=462273&postcount=20post #20

...At this time, the cases appear to be centered in Nyamarunda Sub County, Kibaale district, although one suspected victim is reported to have traveled to Kampala for treatment at Mulago Hospital where he subsequently died on July 22, 2012.
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

typoEbola patients were being treated at the only major hospital in Kibaale, said Stephen Byaruhanga, the district's health secretary:tiphat:http://www.flutrackers.com/forum/showpost.php?p=462295&postcount=25


killed 13 family members and a clinical officer in Kagadi Hospital who was attending to the patients.
World Health Organisation, Centers for Disease Control, Mulago and Laco hospitals, mainly those who handle Ebola outbreaks has already camped in Kibaale District :tiphat:http://www.flutrackers.com/forum/showpost.php?p=462297&postcount=26

so they got people from a few different hospitals. 1 person suspected went to Kampala, prolly on his own. They would know who they were and where they came from, but didn't know it was Ebola till yesterday.
 
Last edited by a moderator:
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Ebola Death Toll Rises in Kibaale District

Posted by Uganda News Picks on July 30, 2012

Kibaale district was last week hit by a strange disease which the health experts from World Health Organization (WHO) have confirmed to be Ebola.
The disease has spread to most areas in the district and reports indicate that it has so far killed 18 people out of the 20 admitted at Kagadi hospital.
More patients are being admitted each day and among them include a health worker identified as Margret Asaba who was working at Muhorro Health Centre III.
Most of the patients admitted have signs which include fever, vomiting, diarrhea, abdominal pain, headache, rash, red eyes and bleeding.:tiphat:http://www.ugandapicks.com/2012/07/ebola-death-toll-rises-in-kibaale-district-49991.html
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Monday 30 July 2012
South Sudan alert after Ebola outbreak in Uganda

July 30, 2012 (JUBA) - The Republic of South Sudan remains alert after a confirmed Ebola outbreak in neighbouring Uganda reportedly killed 13 people, with at least 20 cases reported by the country?s health officials.



An outbreak of the deadly disease, according to local media reports, were confirmed in the Western Ugandan district of Kibaale, located about 200km from the country?s capital, Kampala. The district reportedly has a total population of about 646,700 people.

An official from South Sudan health ministry, speaking on condition of anonymity, told Sudan Tribune on Monday that the new nation, being a neighbour to Uganda, will ?not take chances? at all on the disease.
?Ebola, as you know is a deadly disease and the rate at which it spreads from one person to another is very rapid. We need to take precaution as a country especially with the massive influx of Ugandans coming into South Sudan,? the official warned... :tiphat:http://www.sudantribune.com/South-Sudan-alert-after-Ebola,43398
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

The HCW infections are the most difficult/worrying as these individuals will have been infectious during the incubation period (anything from 2 - 21 days). Contact with skin secretions of an infected person is a potential mode of transmission, which means that an infected HCW may have seen many patients before becoming symptomatic themselves. This is especially true of a health centre as opposed to a hospital; these centers carry out routine anti-natal work, immunisations etc.

http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/qa.htm

Given that this outbreak has become quite well established before being identified [as it did not present with the 'usual' disease pattern] suggests that WHO and health authorities have an enormous contact tracing mission ahead of them over a wide geographical area.

If cases start appearing at random in the Kampala area [which has an international airport at Entebbe, 45 kms out of Kampala ] should the authorities be considering immediate movement bans out of Uganda now to prevent international spread?
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Uganda Red Cross responding to Ebola outbreak in Western Uganda
Report
http://reliefweb.int/organization/ifrc
Nairobi/Geneva - 29 July 2012 - A deadly outbreak of hemorrhagic fever Ebola has been confirmed in Kibaale district, Western Uganda by the Ministry of Health of Uganda. So far, 13 people have died and 7 more cases have been diagnosed. Kibaale district has a total population of about 646,700 people and is located at around 200 kilometres west of the Ugandan capital Kampala, and around 50 kilometres from the border with Democratic Republic of Congo.


The Uganda Red Cross is part of the National Emergency Taskforce that has been set up by the Ministry of Health to stop the disease from spreading more widely. The Red Cross has mobilized volunteers and staff who are ready to support with case tracking and community awareness.

'This outbreak is occurring in the same area where the Red Cross is already responding to the growing crisis caused by the influx of Congolese refugees fleeing violence in their country? said Charlie Musoka, Regional Operations Coordinator in Nairobi for the International Federation of the Red Cross who is preparing to travel to the affected region.
There is no treatment or vaccine against Ebola, one of the most virulent viral diseases known to humankind. It is transmitted by close personal contact and, depending on the strain, kills up to 90 percent of those who contract the virus.
There have been several Ebola outbreaks recorded in Uganda since the first one in 2000, leaving many people killed and much more traumatized. Symptoms include sudden onset of fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain.
The government of Uganda is coordinating needs assessments and response efforts aimed at containing the outbreak. A team composed of a medical doctor and a Disaster Management specialist from the International Federation of Red Cross is being dispatched from Nairobi to immediately support Uganda Red Cross efforts.
For further information, please contact:
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Summary Information on the Sudan strain

http://en.wikipedia.org/wiki/Sudan_virus

Ebola virus pathogenesis

It seems that a typical infection runs its course over 14 - 21 days but I am not clear if this time range is from the date of onset of symptoms, but I would guess it must be.

As the incubation period is anything from 2 - 21 days, it would suggest that the monitoring period will need to be 6 weeks clear from the last detection of a case before this can be declared contained or 'over'.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC224575/
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

The HCW infections are the most difficult/worrying as these individuals will have been infectious during the incubation period (anything from 2 - 21 days). Contact with skin secretions of an infected person is a potential mode of transmission, which means that an infected HCW may have seen many patients before becoming symptomatic themselves. This is especially true of a health centre as opposed to a hospital; these centers carry out routine anti-natal work, immunisations etc.

http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/qa.htm

Given that this outbreak has become quite well established before being identified [as it did not present with the 'usual' disease pattern] suggests that WHO and health authorities have an enormous contact tracing mission ahead of them over a wide geographical area.

If cases start appearing at random in the Kampala area [which has an international airport at Entebbe, 45 kms out of Kampala ] should the authorities be considering immediate movement bans out of Uganda now to prevent international spread?

WHO said in its statement specifically that does not recommend any travel or trade restrictions to Uganda.

Any suspected case has to be quarantined in hospital as happened in the past. For example in Italy several nuns were put into isolation for three weeks after being exposed to infected people in a hospital (it was 1995 Kikwit Ebola outbreak. A story about the nuns who died in Zaire is available in Italian at http://www.istitutopalazzolo.it/site/?page_id=21 . For the survivors, another story is here: http://archiviostorico.corriere.it/1995/maggio/22/Noi_scampate_Ebola__co_0_9505224759.shtml ).
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

It is typical in the reporting to get a lot of suspect cases that are not actually infected with Ebola, and have no contact history, but whose symptoms look enough like Ebola that they must be isolated as a precaution.

We know that someone died on the 22nd in Mulago Hospital in Kampala of a hemorrhagic illness. We do NOT know that he had any contact with any confirmed/probable Ebola case, and we do NOT even know for sure that he had been in Kibaale (all we know is that he travelled to Kampala; we do not know his origin).

We also know that a woman named Margaret Asaba who worked in Muhorro Health Center (which I think is in Kibaale, at least according to http://allafrica.com/stories/201109281268.html) has been isolated and is ill. She certainly could have had contact with a missed case as she is in the right area, but we don't have any report of any suspected cases at Muhorro other than her.

Both of these remain in the "suspected" category for now.

We also have one unconfirmed report that the four-month-old infant son of the first HCW at Kagadi (who we know has died) was transferred to Mulago Hospital in Kampala. Personally, that seems unlikely, but we will see. If other HCW at Mulago start taking ill, then we have a problem.
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Again, no clue as to the epidemiological links here:

http://www.usatoday.com/news/world/story/2012-07-30/uganda-ebola-outbreak/56585196/1

6 more Ugandans admitted with possible Ebola

Sponsored LinksKAMPALA, Uganda (AP) ? A Ugandan health official says six more patients suspected to have Ebola have been admitted to the hospital days after investigators confirmed an outbreak of the highly infectious disease in a remote corner of western Uganda.

Stephen Bayaruhanga, health secretary of the affected Kibaale district, said Monday that possible cases of Ebola, at first concentrated in a single village, are now being reported in more villages.

But many sick people with suspected Ebola are unwilling to be taken to the hospital, he said, because they are terrified of contracting the disease if Ebola is not what they have.

If the six new cases are confirmed as Ebola, it would bring to 26 the number of Ugandans infected with the virus this month. At least 14 people have died.
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Ouch. Looks like two cases from Kibaale really did go to Kampala. Not good.

http://www.iol.co.za/news/africa/ebola-virus-reported-in-kampala-1.1352055


Ebola virus reported in Kampala
July 30 2012 at 12:52pm

AFP

Uganda's president on Monday banned all physical contact after a victim of a deadly outbreak of the Ebola virus was reported in the capital Kampala for the first time.

“The Ministry of Health are tracing all the people who have had contact with the victims,” Yoweri Museveni said in a state broadcast, adding that 14 people had died in total since Ebola broke out in western Uganda three weeks ago.

Two cases have since been reported in the capital, with one victim reported dead in Kampala's Mulago Hospital, he said, calling on people not to shake hands to avoid the spread of the killer virus.

“Ebola spreads by contact when you contact each other physically... avoid shaking of hands that can cause contact through sweat, which can cause problems,” Museveni said.

“Do not take on burying somebody who has died from symptoms that look like Ebola -- instead call health workers because they know how to do it...avoid promiscuity because this sickness can also go through sex,” he added.

Seven doctors and 13 health workers at Mulago hospital are in quarantine after “at least one or two cases” were taken there, with one later dying from the virus.

The latest outbreak started in Uganda's western Kibaale district, around 200 kilometres west of the Kampala, and around 50 kilometres from the border with Democratic Republic of Congo.

The rare haemorrhagic disease, named after a small river in DR Congo, killed 37 people in western Uganda in 2007 and claimed the lives of at least 170 people in the north of the country in 2000.

“I wish you good luck, and may God rest the souls of those who died in eternal peace,” Museveni added. - AFP
 
Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

Re: Uganda: Ebola Sudan identified in 13-17 deaths including Healthcare worker in Kibaale out of 20 total suspected cases

What we are missing here are timelines.

Dates of cofirmed cases presenting to health facilities, dates of disease onset etc. i.e how long a gap was there between presentation for treatment and confirmation this was Ebola?

The second factor we dont know is the onset and progression of symptoms - given that reports have already stated that at least some cases were atypical and therefore could be missed/ misdiagnosed.
 
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