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Tracking the 2022 Ebola Outbreak in Uganda
Uganda declared an outbreak of Ebola on Tuesday, September 20th after a case caused by the Sudan ebolavirus strain was confirmed in the Mubende district. The virus was detected in a 24-year-old male who presented with a high fever, diarrhea, abdominal pain, and vomiting blood and later died. This 2022 case is Uganda’s first death from Ebola since 2019 (Zaire ebolavirus strain) and the first time in over a decade that the relatively rare Sudan ebolavirus strain has been recorded in Uganda. Here are links to review Ebola’s emergence and a timeline of past outbreaks.
According to the World Health Organization (WHO data from the Uganda Ministry of Health Situation Report 38), as of October 29th, there have been 149 cases (128 confirmed), including 34 confirmed and 21 probable deaths, across 7 districts: Mubende, Kyegegwa, Kassanda, Kagadi, Bunyangabu, Wakiso, and Kampala. We are early in the outbreak and the Global.health curation team will continue to track cases through the first 100 days to provide situational awareness during a critical time [open access line-list database under CC BY 4.0 license]. We discussed challenges in curation in a recent blog post; the same themes we observed for monkeypox are recurring (e.g. reporting delays; inconsistent, aggregated, or missing case information; assumptions). Our curation team also struggled with access to official information; the sooner data can be made publicly available, the more good researchers can do to support response.
WHO assessed the risk of spread to neighboring countries as high due to cross border movements for trade, social, and cultural connections, and a large refugee population. The Ugandan health authorities and the WHO are working quickly to respond to the outbreak by increasing surveillance and implementing infection prevention and control (IPC) initiatives. With cases increasing, on October 15th, the President of Uganda imposed a 21-day lockdown on Mubende (current epicenter of the outbreak) and Kassanda districts to contain the outbreak.
Community attitudes and behaviors can also affect spread. A man who was exposed to the virus in Mubende district fled and spread the disease to Kampala, the capital city. Uganda’s MOH and the WHO have made investments to deepen and sustain risk communication and community engagement in affected and high-risk districts by sharing Ebola information, education, and communication materials. It is important to raise awareness without raising fear and stigma. Ebola is a scary disease; many sick people die – currently, the overall case fatality ratio for this outbreak is 37%.
Healthcare workers (HCW) are at increased risk for morbidity and mortality from Ebola. They are more likely to be exposed to the virus during an outbreak and require adequate IPC measures and protective equipment. Loss of this skill set and workforce can destabilize an already fragile, under-resourced healthcare system. In this current outbreak, eighteen HCW have been affected, including seven deaths. The Global.health schema includes a variable for occupation and specifically identifies HCW; users can quickly identify these fatalities in our tracker.
The source of this outbreak is currently unknown, but Ebola outbreaks typically start when a person encounters an infected animal (i.e. spillover event); the virus later spreads from person to person through direct contact with blood or other bodily secretions or materials contaminated with those fluids. Early in this outbreak, transmission chains and contacts were being thoroughly identified. Many cases reported outside of the Mubende District had either sought care at the Mubende Regional Referral Hospital or participated in burials of confirmed or probable cases in the Mubende District. Traditional burial practices, including the washing and anointing of corpses, have contributed significantly to the spread of Ebola in previous outbreaks. The WHO has since announced that investigations into more recent cases indicated that they do not have any known links to current patients, raising concerns that there may be more transmission chains and possibility for spread than previously suspected.
Treatment for infection is supportive care. It is unknown if the Ervebo vaccine, which was approved by the U.S. Food and Drug Administration in December 2020 and has proven effective in controlling outbreaks of Zaire ebolavirus, will also protect against the Sudan strain. Two vaccines currently under development for the Sudan strain may soon start clinical trials in Uganda, pending approval from the Ugandan government. Without a vaccination campaign as part of the outbreak response strategy, prompt identification, isolation, and treatment of cases will be crucial.
Our mission is to enable rapid sharing of trusted and open public health data to advance the response to infectious diseases and to cultivate a global community invested in improving health outcomes for all. Ebola is a high-consequence biological event, identified as a Category A priority pathogen by the U.S. National Institute of Allergy and Infectious Diseases; there is a moral imperative to act to protect the world from this health security threat. Every line-list that we build – COVID-19, monkeypox, Ebola, and beyond – is a step towards mitigating pandemic threats.
Until the next post,
The G.h Team