On September 21, Uganda’s Health Ministry announced a latest outbreak of the deadly Ebola virus. Uganda has had at least six previous episodes of Ebola in 2000 that killed 224, 37 people died in 2007, one person in 2011, in 2012 the country experienced two episodes of an outbreak that both saw a total of 21 people dead and in 2019 4 people died.
Four health workers have so far been pronounced dead in the latest outbreak that has so far claimed 9 lives with 43 cases according to the Health ministry. Health Minister Jane Ruth Aceng on Wednesday announced the death of Margaret Nabisubi, an anaesthetic officer. “The 58-year-old succumbed to Ebola at 4.33am this morning at Fort Portal Hospital (JMedic) after battling the disease for 17 days,” Dr Aceng said in a tweet, adding: “The late Margaret is the 4th health worker we have lost in the current Ebola outbreak after the probable case of the midwife, Dr Mohammed Ali and the health assistant in Kagadi District. May their souls rest in eternal peace.”
In an address to the nation last week President Yoweri Museveni said the disease is easy to contain. He ruled out imposing a lockdown to combat the Ebola virus that has been detected in Uganda, saying the country has the capacity to contain the outbreak.
According to the Health Ministry, the virus is transmitted through contact with the blood, stool or fluids of an infected person and objects that have been contaminated with body fluids from an infected person. One can also contract the disease from infected animals such as fruit bats and other wild animals. The known symptoms of Ebola include fever, fatigue, chest pain, diarrhoea, vomiting, yellowing of the eyes and unexplained bleeding. Bleeding is usually a late presentation after the above symptoms, according to the Health Ministry.
The recently confirmed outbreak is of the less deadly Sudan strain, which has a lower case fatality rate than the Zaire strain, which broke out in DRC and parts of Uganda in 2018.
Abdhalah Ziraba, a public health researcher explains that the Ebola virus is highly infectious and mainly transmitted through contact with body fluid of infected persons. “The risk to the public is real as the first documented case could have exposed family members and also members of the public in close contact. The next few days are critical to identify any secondary cases and their potential contacts.”
Ziraba further explains that Ebola tends to have a high case fatality rate – out of those infected a high proportion end up dying. In the 2000 outbreak in northern Uganda, more than half (53%) of all those infected with the virus succumbed to it.
Depending on the strain of the virus and public health response in place, the fatality rate can range anywhere between 25% and 90% of those infected. The 2000 outbreak resulted in 224 deaths out of 425 cases that were reported countrywide.
Owing to Uganda’s proximity to the Democratic Republic of Congo which has suffered numerous outbreaks of Ebola, and Uganda itself having experienced several outbreaks in the past, the government has developed a functional surveillance system to flag and confirm suspicious cases early.
Ziraba says Uganda’s viral haemorrhagic fever surveillance programme was established in 2010 in collaboration with the viral special pathogens branch of the US Centers for Disease Control and Prevention (CDC). “The surveillance programme has a diagnostic laboratory, staff, supplies and sentinel surveillance centres for the rapid detection of outbreaks. In the current outbreak, the turnaround time (24-48 hours) for laboratory testing was short and done at a laboratory located within the country.”
According to him, delayed action, poor health education messaging and slow behavioural change helped spur the outbreaks in West Africa in 2014-2016 and eastern DRC in 2019. “Uganda has drawn lessons from these and its own large outbreak in 2000 and it is not taking chances,” he states, adding: “Public health messaging is critical and has worked well for Uganda in past outbreaks. Health education campaigns carry messages on prevention practices, manifestation of symptoms and what to do in case of contact or infection.”
Another critical factor, according to the researcher, is having rapid response teams on standby and Uganda has developed this capability.
Ziraba outlines other strategies that the country has in place to control the spread:
“Just as important is the need for a strong surveillance system to pick up suspicious cases early. Front-line health care workers have been trained to be able to pick out suspected cases, which in turn get isolated. Suspected cases are given supportive treatment, reported and specimens collected and sent to the reference lab for analysis. Once a case is confirmed efforts are made to manage cases and prevent further transmission. The Ministry of Health and partners also provide the capacity to evaluate and care for a markedly increased volume of patients.”
“Uganda has local laboratory capacity at the Uganda Virus Research Institute at Entebbe. The laboratory has the capacity to test and confirm whether suspect cases are indeed Ebola virus disease cases. Timely confirmation is important to trigger the rapid response required. This includes contact tracing, health education and care for those who are infected.”
“Uganda has also learnt the value of sounding the international alarm at the earliest opportunity. It did so this time round, alerting the WHO within hours of detecting the first suspected case.”
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