Uganda: Hemorrhagic fever outbreak- Yellow Fever

[Shiloh]

Source: http://www.newvision.co.ug/D/8/12/738335

13 dead, as strange disease spreads
Monday, 15th November, 2010

By David Labeja and Sam Oboke

THIRTEEN people have been reported dead in Abim and Agago districts, following an outbreak of a strange disease in Abim.

Twenty cases have been reported in Abim district, out of whom eight have already died.

In neighouring Agago district, five cases have been reported in the sub counties of Omiya P?Chua and Paimol, which border Abim district.

Emmanuel Okech, an official from Abim district health Office said out of the twenty cases, eight have died, two quarantined and another ten have been discharged after their conditions improved.

According to Okech, the affected persons have high fever, vomit blood, pass bloody stools and also bleed from other openings like the nose and ears.

?The victims usually die between three and five days, and are suspected to be highly contagious,? Okech said.

Last week, a team from the World Health Organization and the Ministry of health went to Abim, and are investigating the disease. According to Okech, samples were taken to Uganda Virus Research Institute but there is still no clue as to what disease is affecting the people there.

?We were suspecting viral hemorrhagic infection, but results from Uganda Virus Research Institute have ruled out Ebola, Marburg and Lassa,? Okech said.

He said samples from the affected persons have now been flown to the Centers for Disease Control in Atlanta...

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

The article above continues:

He said samples from the affected persons have now been flown to the Centers for Disease Control in Atlanta.

On Tuesday, the District health Officer of Agago district Dr Emmanuel Otto announced that five people had died in Paimol and Omiya P?Chua, from infections similar to those reported in Abim.

Dr. Otto said he was also expecting a team of doctors from the World Health Organization and the Health Ministry in Agago, to go to the affected sub counties and conduct tests to ascertain the nature of the disease.

According to Emmanuel Okech, more than 10 percent of patients treated in Abim Hospital are from neighboring Agago district, raising suspicions that the five who died in Agago could have contracted the disease while they went for treatment in Abim Hospital.

Meanwhile authorities in Abim district have put up an isolation center for those suspected to have contracted the disease.

According to Abim district chairman Norman Ochero, the district health sector and its partners have pooled together resources to set up an isolation center in Abim Hospital and Morulem Health Centre.

?We have also advised people to maintain personal hygiene and to desist from handshakes,? said Ochero

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

There have also been at least eight undiagnosed fatalities due to possible hemorrhagic fever in Bundibugyo (about 150 miles away), with Ebola and Marburg excluded there as well:

http://www.flutrackers.com/forum/showthread.php?t=154978

Oddly of note in this outbreak, is that of the 25 reported cases so far, only two are currently ill; the rest have apparently recovered or died. There is no indication in the article the time period involved.

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

http://afludiary.blogspot.com/

Uganda: Unidentified Hemorrhagic Outbreak




5057



In December of 2007 I wrote several blogs about an Ebola outbreak in Bundibugyo, located in western Uganda.



A brief excerpt from one of those posts follows:



Ugandan Nightmare




# 1328

The picture above gives a pretty good indication of how the Ebola virus is spreading in Uganda. Notice the lack of gloves on the attendant's hands, the lack of goggles, and the use of only a simple surgical mask.



Disposables, like gloves, are in very short supply even in the hospitals, and this has led to the deaths of 5 health care workers.



(Continue . . . )




We didn’t realize it at the time, but what they were seeing was a new – previously unidentified strain – of ebola. A strain which would eventually be named Bundibugyo ebolavirus after its place of discovery.



While less deadly (34% Case Fatality Rate) than other strains of ebola (excluding Ebola Reston), the emergence of this new strain was a sober reminder that a year rarely passes when we don’t discover a new zoonotic disease capable of jumping to humans.



A year later (2008) doctors in Zambia and South Africa ran across a mysterious, previously unclassified virus that caused hemorrhagic symptoms in its victims similar to Ebola.



It appeared to be highly contagious, and was fatal in 4 of the 5 identified victims. Like most other infectious disease bloggers, I covered the story a bit, although the amount of information available then was pretty thin.



WHO Update On South African `Mystery Disease'

South African `Mystery Virus' Identified



On October 13th, 2008 the virus was tentatively identified as a new arenavirus, but since that time more exacting studies have been done. In 2009, this virus was named the Lujo Virus, and detailed in the PloS Pathogens report.



Genetic Detection and Characterization of Lujo Virus, a New Hemorrhagic Fever–Associated Arenavirus from Southern Africa




Today, again from western Uganda, we are seeing reports of a new hemorrhagic disease outbreak – cause unknown – that has reportedly killed 13 people so far.



This report courtesy of Shiloh on FluTrackers, indicates that preliminary testing by the Uganda Virus Research Institute has ruled out Ebola, Marburg, and Lassa. Samples have been sent to the CDC in Atlanta for analysis.





13 dead, as strange disease spreads

Monday, 15th November, 2010



By David Labeja and Sam Oboke
THIRTEEN people have been reported dead in Abim and Agago districts, following an outbreak of a strange disease in Abim.



Twenty cases have been reported in Abim district, out of whom eight have already died.



In neighouring Agago district, five cases have been reported in the sub counties of Omiya P’Chua and Paimol, which border Abim district.


(Continue . . . )




Additional reports will most certainly be posted on this FluTrackers Thread.




Hemorrhagic viruses, while horrific, are usually self-limiting and generally only pose a threat to the area where they emerge.



Most are believed initially contracted by eating (or preparing) bush meat, and are subsequently spread via bodily fluids.



Health care workers – particularly in areas where personal protective equipment is unavailable – are at particularly high risk of contracting the illness.



When we know more about this particular outbreak, I’ll update this story.

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

http://eafr.promedmail.org/direct.php?id=20101117.215285

Published Date: 2010-11-17 08:42:47
Subject:PRO/EAFR> Undiagnosed deaths, human - Uganda: (Agago, Abim) RFI
Archive Number: 20101117.215285


UNDIAGNOSED DEATHS, HUMAN - UGANDA (AGAGO, ABIM) REQUEST FOR INFORMATION
************************************************** **********************


A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: Mon 15 Nov 2010Source: New Vision (Uganda) [edited]http://www.newvision.co.ug/D/8/12/738335

A total of 13 people have been reported dead in Abim and Agago districts, following an outbreak of a strange disease in Abim. 20 cases have been reported in Abim district, out of whom 8 have alreadydied. In neighbouring Agago district, 5 cases have been reported in the sub counties of Omiya P'Chua and Paimol, which border Abim district.

Emmanuel Okech, an official from Abim district health Office, said out of the 20 cases, 8 have died, 2 have been quarantined, and another 10 have been discharged after their conditions improved.

According to Okech, the affected persons have high fever, vomit blood, pass bloody stools, and also bleed from other openings like the nose and ears.

"The victims usually die between 3 and 5 days, and are suspected to be highly contagious," Okech said.

Last week [week ending 14 Nov 2010], a team from the World Health Organization and the Ministry of Health went to Abim, and are investigating the disease. According to Okech, samples were taken toUganda Virus Research Institute but there is still no clue as to what disease is affecting the people there.

"We were suspecting viral hemorrhagic infection, but results from Uganda Virus Research Institute have ruled out Ebola, Marburg, and Lassa," Okech said.

He said samples from the affected persons have now been flown to the Centers for Disease Control in Atlanta.

On [Tue 16 Nov 2010], the District health officer of Agago district, Dr Emmanuel Otto, announced that 5 people had died in Paimol and Omiya P'Chua, from infections similar to those reported in Abim.

Dr. Otto said he was also expecting a team of doctors from the World Health Organization and the Health Ministry in Agago, to go to the affected sub counties and conduct tests to ascertain the nature of the disease.

According to Emmanuel Okech, more than 10 percent of patients treated in Abim Hospital are from neighboring Agago district, raising suspicions that the 5 who died in Agago could have contracted the disease while they went for treatment in Abim Hospital.

Meanwhile authorities in Abim district have put up an isolation center for those suspected to have contracted the disease.

According to Abim district chairman, Norman Ochero, the district health sector and its partners have pooled together resources to set up an isolation center in Abim Hospital and Morulem Health Centre.

"We have also advised people to maintain personal hygiene and to desist from handshakes," said Ochero

[Byline: David Labeja, Sam Oboke]

--Communicated by:ProMED-EAFR
[This undiagnosed illness in North Eastern Uganda has a clinical presentation that suggests viral hemorrhagic fever. However tests done at the Uganda Virus Research Institute have ruled out Ebola,Marburg and Lassa fevers. The differential diagnosis is wide and includes other viral infections particularly arbovirus infections; bacterial infections such as typhoid fever and shigellosis;rickettsial diseases; and parasitic infections such as malaria. This cluster definitely warrants a comprehensive epidemiological investigation and further information on the cause of this evolvingoutbreak will be appreciated.

A map showing Abim and Agago districts in North Eastern Uganda can be seen athttp://en.wikipedia.org/wiki/Districts_of_Uganda and the HealthMap/ProMED-mail interactive map of the country can be seen athttp://healthmap.org/r/0gge. - Mod JFW]

[sharon sanders]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

We also submitted to ProMED:

From: FluTrackers <flutrackers@earthlink.net>
To: ProMed <promed@promedmail.org>
Subject: Uganda - 13 dead of hemorrhagic fever
Date: Nov 16, 2010 9:25 AM

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

At least no new cases or deaths seem to have been reported in the past two days.

http://www.newvision.co.ug/D/8/13/738552

Tough rules set over Abim disease
Wednesday, 17th November, 2010 E-mail article Print article

By Conan Businge
and David Labeja

HEALTH officials have warned residents of Abim and Agago districts in north-eastern Uganda against the washing of the dead, eating wild meat and the communal washing of hands, following an outbreak of a strange disease that has so far killed 13 people.

The Agago district health officer, Dr. Emmanuel Otto, said the new measures should be upheld until the health ministry ascertains the disease.

About 20 cases have been reported in Abim district.

In neighbouring Agago district, five cases have been reported in the sub-counties of Omiya P’Chua and Paimol, which border Abim district.
The victims develop high fever, vomit blood, pass bloody stool and also bleed from other openings like the nose and ears.

“We do not know the disease we are dealing with, so we must respect the new measures which have been put in place,” Otto said.

“Communal hand washing and eating wild rats may spread the disease. Cultural practices such as washing dead bodies must be stopped immediately.”

Otto said a taskforce had been constituted to handle burials until new precautionary measures have been put in place.

He said the decision was reached in a meeting between the district and health ministry officials yesterday.

Last week, a team from the World Health Organisation and the health ministry went to Abim, and is still investigating the disease.

“We hope to get the results of the samples taken soon. We will then be able to know what to do next,” Otto said.

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

http://www.promedmail.org/pls/apex/f?p=2400:1001:3134403529197808::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85882

Archive Number 20101117.4172
Published Date 17-NOV-2010
Subject PRO/EDR> Undiagnosed deaths - Uganda: (AO, AI) RFI


UNDIAGNOSED DEATHS - UGANDA (AGAGO, ABIM), REQUEST FOR INFORMATION
************************************************** ****************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 15 Nov 2010
Source: New Vision (Uganda) [edited]
<http://www.newvision.co.ug/D/8/12/738335>


A total of 13 people have been reported dead in Abim and Agago
districts, following an outbreak of a strange disease in Abim. 20
cases have been reported in Abim district, out of whom 8 have already
died. In neighbouring Agago district, 5 cases have been reported in
the sub counties of Omiya P'Chua and Paimol, which border Abim
district. Emmanuel Okech, an official from the Abim district health
office, said out of the 20 cases, 8 have died, 2 have been
quarantined, and another 10 have been discharged after their
conditions improved.

According to Okech, the affected persons have high fever, vomit blood,
pass bloody stools, and also bleed from other openings like the nose
and ears. "The victims usually die between 3 and 5 days and are
suspected to be highly contagious," Okech said.

Last week [week ending 14 Nov 2010], a team from the World Health
Organization and the Ministry of Health went to Abim and are
investigating the disease. According to Okech, samples were taken to
the Uganda Virus Research Institute, but there is still no clue as to
what disease is affecting the people there.

"We were suspecting viral hemorrhagic infection, but results from the
Uganda Virus Research Institute have ruled out Ebola, Marburg, and
Lassa," Okech said. He said samples from the affected persons have now
been flown to the Centers for Disease Control & Prevention (CDC) in
Atlanta.

On [Tue 16 Nov 2010], the district health officer of Agago district,
Dr Emmanuel Otto, announced that 5 people had died in Paimol and Omiya
P'Chua from infections similar to those reported in Abim. Dr. Otto
said he was also expecting a team of doctors from the World Health
Organization and the Health Ministry in Agago to go to the affected
sub-counties and conduct tests to ascertain the nature of the disease.

According to Emmanuel Okech, more than 10 percent of patients treated
in Abim Hospital are from neighboring Agago district, raising
suspicions that the 5 who died in Agago could have contracted the
disease while they went for treatment in Abim Hospital. Meanwhile,
authorities in Abim district have put up an isolation center for those
suspected to have contracted the disease.

According to Abim district chairman Norman Ochero, the district health
sector and its partners have pooled resources to set up an isolation
center in Abim Hospital and Morulem Health Centre. "We have also
advised people to maintain personal hygiene and to desist from
handshakes," said Ochero [but see last comment below].

[Byline: David Labeja, Sam Oboke]

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[This undiagnosed illness in northeastern Uganda has a clinical
presentation that suggests viral hemorrhagic fever. However, tests
done at the Uganda Virus Research Institute have ruled out Ebola,
Marburg and Lassa fevers. The differential diagnosis is wide and
includes other viral infections, particularly arbovirus infections;
bacterial infections such as typhoid fever and shigellosis;
rickettsial diseases; and parasitic infections such as malaria. This
cluster definitely warrants a comprehensive epidemiological
investigation, and further information on the cause of this evolving
outbreak will be appreciated.

A map showing Abim and Agago districts in northeastern Uganda can be
seen at <http://en.wikipedia.org/wiki/Districts_of_Uganda>, and the
HealthMap/ProMED-mail interactive map of the country can be seen at
<http://healthmap.org/r/0gge>. - Mod JFW]

[In 2008, Lujo virus (LUJV), a new member of the family _Arenaviridae_
responsible for a severe haemorrhagic fever, was isolated in South
Africa during an outbreak of human disease characterized by nosocomial
transmission and an unprecedented high case fatality rate of 80
percent (4/5 cases). This virus was characterised molecularly and
found to be an arenavirus distinct from previously known Old World
arenaviruses (such as Lassa fever virus).

In September and October 2008, 5 cases of this previously undiagnosed
haemorrhagic fever, 4 of them fatal, were treated in South Africa
after transfer of a critically ill index case from Zambia. This highly
lethal virus has not been recorded subsequently elsewhere in Africa,
but Lujo virus should be considered as a possible etiologic agent in
the current outbreak of undiagnosed haemorrhagic fever in Uganda. That
apart, the methodology of unbiased high throughput pyrosequencing
(see:
<http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000455>) developed by Ian Likkin and colleagues for the initial characterisation of the highly lethal Lujo virus could be applied with profit in the current disease situation in Uganda. -
Mod.CP]

[Hemorrhagic fevers are spread by arthropods or contact with body
fluids or excreta of infected humans and animals, not by handshake. -
Mod.JW]

[alert]

Re: Uganda: Unidentified outbreak- 13 dead - Amoebic dysentery suspected

http://www.newvision.co.ug/D/8/13/738633

Abim deaths due to dysentery – Mallinga
Thursday, 18th November, 2010 E-mail article Print article

By Conan Businge

PRELIMINARY laboratory tests done by the Ministry of Health have revealed that the disease that killed 13 people in north eastern Uganda is dysentery.

“We have been investigating the deaths and we now know that this is amoebic dysentery. We are continuing with more tests,” the ministry publicist, Paul Kaggwa, told New Vision.

“We are carrying out ‘culture and sensitivity tests’ to know more about the disease we are dealing with,” he added.

Kaggwa explained that several samples must be obtained because the amoeba changes daily. Blood tests can also be used to measure abnormalities in the levels of essential minerals and salts.

Dysentery, formerly known as bloody flux, is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhoea containing mucus and blood.

Exposed individuals may experience either mild, severe, or even no symptoms.

In extreme cases, doctors say, dysentery patients may pass over a litre of fluid an hour. More often, individuals will complain of nausea, abdominal pain, rectal pain, and fever.

Vomiting, rapid weight loss, and generalised muscle aches are sometimes also experienced by dysentery patients.

If not treated, dysentery can be fatal, the district health officer of Abim, Dr. Emmanuel Otto, said.

Otto explained that dysentery is transmitted through contaminated food and water.

The health minister, Stephen Mallinga, said the ministry would do its best to control the spread of the disease.

“It is containable. We just need to sensitise the people about hygiene, like using latrines,” he added.

Official figures show that latrine coverage in Karamoja is at 4&#37;, implying that 96% of the Karimojong ease themselves in the bush.

More so, only three out of 10 families have access to safe water, and that about 82% of Karimojong live below the poverty line.

When the disease broke out, it created fear and anxiety in the districts of Agago and Abim because the health ministry could not ascertain that it was dysentery.
Reports from both districts show that no more people have contracted the disease. Only two patients were still isolated.

[alert]

Re: Uganda: Unidentified outbreak- 13 dead - Amoebic dysentery or alcohol poisoning?

The previous source seems to be a higher quality source (as the case counts below have been muddied), but as preposterous as this one sounds, this too is possible, and has happened elsewhere in Africa (here is an incident from Angola http://www.flutrackers.com/forum/showthread.php?t=91951).

The above article is also more recent than this one.

We don't know the timeframe on this outbreak, but either of the two diagnoses in the last two posts would likely have occurred within a short period of time, a few days to a couple weeks. A VHF outbreak would likely have required a couple months of transmission to produce this many cases.

http://www.ugpulse.com/articles/daily/news.asp?about=Ministry+of+Health+dismisses+claims+of+Ebola+reports+in+Abim+district+&ID=16679

The ministry of health has confirmed that a strange disease that had earlier been reported in Abim district in northern Uganda was not Ebola as earlier speculated but it was being caused by intoxicated alcohol.

The disease that characterised by vomiting, bleeding from all body opening has killed over 13 people with 20 cases undergoing serious treatment.

The Acting Permanent Secretary in the Ministry of Health Asuman Lukwago says the ministry is also investigating earlier reports that the disease could have been caused by residents eating half cooked rats, monkeys, and cats.

He says people should not be alarmed of any Ebola outbreak as a team from the Ministry of Health has confirmed there is no outbreak of Ebola.

[alert]

Re: Uganda: Unidentified outbreak- 13 dead - Amoebic dysentery suspected

This is EAFR post #2. Can someone send post #9 of this thread to ProMED that this outbreak may be due to amoebic dysentery?

http://eafr.promedmail.org/

Published Date: 2010-11-18 11:45:54
Subject: PRO/EAFR> Undiagnosed deaths, human - Uganda (02): (Agago, Abim)
Archive Number: 20101118.215329

UNDIAGNOSED DEATHS, HUMAN - UGANDA (02): (AGAGO, ABIM)
************************************************** ****



Date: Wed 17 Nov 2010
Source: New Vision (Uganda) [edited]

http://www.newvision.co.ug/D/8/13/738552

Health officials have warned residents of Abim and Agago districts in northeastern Uganda against the washing of the dead, eating wild meat, and the communal washing of hands, following an outbreak of a strange disease that has so far killed 13 people.

The Agago district health officer, Dr Emmanuel Otto, said the new measures should be upheld until the health ministry ascertains the disease.

About 20 cases have been reported in Abim district. In neighbouring Agago district, 5 cases have been reported in the sub-counties of Omiya P'Chua, and Paimol, which border Abim district.

The victims develop high fever, vomit blood, pass bloody stool, and also bleed from other openings like the nose and ears.

"We do not know the disease we are dealing with, so we must respect the new measures which have been put in place," Otto said. "Communal hand washing and eating wild rats may spread the disease. Cultural practices such as washing dead bodies must be stopped immediately."

Otto said a taskforce had been constituted to handle burials until new precautionary measures have been put in place. He said the decision was reached in a meeting between the district and health
ministry officials yesterday [16 Nov 2010].

Last week [week ending 14 Nov 2010], a team from the World Health Organisation and the health ministry went to Abim, and is still investigating the disease.

"We hope to get the results of the samples taken soon. We will then be able to know what to do next," Otto said.

[Byline: Conan Businge, David Labeja]

--
Communicated by:
ProMED-EAFR


[The investigations into this evolving outbreak continue but officials have moved in fast to caution the public against getting into contact with cases as a measure for curtailing transmission.

A map showing Abim and Agago districts in northeastern Uganda can be seen athttp://en.wikipedia.org/wiki/Districts_of_Uganda and the HealthMap/ProMED-mail interactive map of the country can be seen athttp://healthmap.org/r/0gge. - Mod.JFW]

[sharon sanders]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

Ok. I will.

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

Ok. I will.

Thank you, Sharon, as always. I'm not sure what the name of this thread should be now...

[sharon sanders]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

From: FluTrackers <flutrackers@earthlink.net>
To: ProMed <promed@promedmail.org>
Subject: Uganda - 13 Abim deaths due to dysentery
Date: Nov 19, 2010 12:21 PM

[Treyfish]

Re: Uganda: Hemorrhagic fever outbreak- 13 dead

Mystery disease kills 13 in Uganda

Health officials investigate deadly fever that appears similar to Ebola

Posted Nov 19, 2010, 9:52 am
Gregory Branch Special to GlobalPost
KAMPALA, Uganda — Thirteen people have died in northeastern Uganda from a mysterious disease.

snip


Of the 20 cases in Abim, eight have died, two are quarantined and another 10 have been discharged after their conditions improved, according to Emmanuel Okech, a health official in Abim. Five more died in the neighboring Agago district.
"The victims usually die between three and five days, and are suspected to be highly contagious," Okech told GlobalPost.
Symptoms include high fever, vomiting blood, passing bloody stool, convulsions and bleeding from openings like the nose and ears.
"We do not know what we are dealing with, we do not know what is happening, so we must respect the new measures which have been put in place," said Dr. Emmanuel Otto, a health officer in Agago district, which has also been affected by the disease.
Health officials warn against communal hand washing, eating bush meat (meat from wild animals, especially monkeys and other primates) and discourage people from the local cultural practice of washing dead bodies before burial.

more at..

.http://www.tucsonsentinel.com/nation...uganda_disease