Uganda declares end of Ebola disease outbreak
11 January 2023
Brazzaville/Kampala – Uganda today declared the end of the Ebola disease outbreak caused by Sudan ebolavirus, less than four months after the first case was confirmed in the country’s central Mubende district on 20 September 2022.
“Uganda put a swift end to the Ebola outbreak by ramping up key control measures such as surveillance, contact tracing and infection, prevention and control. While we expanded our efforts to put a strong response in place across the nine affected districts, the magic bullet has been our communities who understood the importance of doing what was needed to end the outbreak, and took action,” said Dr Jane Ruth Aceng Ocero, Uganda’s Minister of Health.
It was the country’s first Sudan ebolavirus outbreak in a decade and its fifth overall for this kind of Ebola. In total there were 164 cases (142 confirmed and 22 probable), 55 confirmed deaths and 87 recovered patients. More than 4000 people who came in contact with confirmed cases were followed up and their health monitored for 21 days. Overall, the case-fatality ratio was 47%. The last patient was released from care on 30 November when the 42-day countdown to the end of the outbreak began.
Health authorities showed strong political commitment and implemented accelerated public health actions. People in the hot-spot communities of Mubende and Kasanda experienced restricted movements.
“I congratulate Uganda for its robust and comprehensive response which has resulted in today’s victory over Ebola,” said Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General. “Uganda has shown that Ebola can be defeated when the whole system works together, from having an alert system in place, to finding and caring for people affected and their contacts, to gaining the full participation of affected communities in the response. Lessons learned and the systems put in place for this outbreak will protect Ugandans and others in the years ahead.”
This Ebola outbreak was caused by the Sudan ebolavirus, one of six species of the Ebola virus against which no therapeutics and vaccines have been approved yet. However, Uganda’s long experience in responding to epidemics allowed the country to rapidly strengthen critical areas of the response and overcome the lack of these key tools.
“With no vaccines and therapeutics, this was one of the most challenging Ebola outbreaks in the past five years, but Uganda stayed the course and continuously fine-tuned its response. Two months ago, it looked as if Ebola would cast a dark shadow over the country well into 2023, as the outbreak reached major cities such as Kampala and Jinja, but this win starts off the year on a note of great hope for Africa,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
Soon after Uganda declared the Sudan ebolavirus outbreak, WHO worked with a large range of partners, including vaccines developers, researchers, donors and the Ugandan health authorities to identify candidate therapeutics and vaccines for inclusion in trials. Three candidate vaccines were identified and over 5000 doses of these arrived in the country with the first batch on 8 December and the last two on 17 December. The speed of this collaboration marks a milestone in the global capacity to respond to rapidly evolving outbreaks and prevent them from becoming larger.
“While these candidate vaccines were not used during this outbreak, they remain the contribution of Uganda and partners to the fight against Ebola. The next time the Sudan ebolavirus strikes we can reignite the robust cooperation between developers, donors and health authorities and dispatch the candidate vaccines,” said Dr Yonas Tegegn Woldemariam, WHO Representative in Uganda.
WHO and partners supported Ugandan health authorities from the outset of the outbreak, deploying experts, providing training in contact tracing, testing and patient care, as well as building isolation and treatment centres and providing laboratory testing kits. Due to the joint efforts, the processing time for Ebola samples dropped from a few days to six hours. WHO helped to protect frontline health workers by organizing a steady supply of personal protective equipment. The Organization provided nearly US$ 6.5 million to Uganda’s response and an additional US$ 3 million to support readiness in six neighbouring countries.
Although the outbreak in Uganda has been declared over, health authorities are maintaining surveillance and are ready to respond quickly to any flare-ups. A follow-up programme has been put in place to support survivors. Neighbouring countries remain on alert and are encouraged to continue strengthening their capacities to detect and respond to infectious disease outbreaks.
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Uganda declares Ebola Virus Disease outbreak (SEBOV) - 20 Sept 2022 - Outbreak is over
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Uganda set to declare end of Ebola outbreak
Issued on: 09/01/2023 - 12:32
Kampala (AFP) – Uganda said on Monday it was expecting to declare an end to an Ebola virus outbreak that emerged late last year and has claimed the lives of at least 56 people.
If no new case is reported by Tuesday, the health ministry said it would formally announce the end of the outbreak on Wednesday.
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Health ministry spokesman Emmanuel Ainebyoona said in an invitation to journalists that the "declaration ceremony" will take place in the central district of Mubende, the epicentre of the outbreak.
Since the Ugandan authorities declared the latest outbreak in Mubende on September 20, the East African nation has registered 142 confirmed cases and 56 deaths, with the disease spreading to the capital Kampala.
The last confirmed patient was discharged from hospital on November 30, according to health officials.
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WHO Director-General's opening remarks at the media briefing – 4 January 2023
4 January 2023
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Ebola in Uganda has not been detected since 27 November. If this holds and there are no cases by 11 January, the outbreak will be declared over.
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Uganda: Three questions for an MSF (Doctors Without Borders) epidemiologist about the new Ebolavirus variant
December 13, 2022
It has been over two weeks since the last confirmed Ebola case—a stillborn baby of a mother who survived the disease—was reported in Uganda. Doctors Without Borders/Médecins Sans Frontières (MSF) has been responding to the rare outbreak of the Sudan Ebolavirus variant since it was declared on September 20 by building Ebola treatment centers and treatment units, providing support to the Ugandan Ministry of Health for case management in these facilities, and conducting community outreach activities like health promotion and infection protection and control measures in health facilities where known patients went prior to diagnosis.
What is the current trend of the outbreak in Uganda?
In terms of trends, we saw two important peaks in the outbreak. The first one was in September in the Mubende district, which was the first epicenter of this outbreak, and then another in the neighboring district of Kassanda. While cases in these two districts alone represent 80 percent of all cases detected so far in this outbreak, a total of nine districts in the country were affected. Historically, this is the largest geographic spread of Ebola that Uganda has ever faced.
After a steep rise of cases in October (86 cases over 4 weeks), the outbreak slowed in terms of numbers of new confirmed cases in recent weeks (14 cases in 4 weeks in November). However, we are very concerned that we had several Ebola cases that were not linked to any known chains of transmission—this means they had acquired the infection from an unknown source, which means those cases couldn’t be tracked through contact tracing and follow-up. This led to two new districts being affected, Masaka and Jinja.
It’s extremely important to follow up with case contacts. When we identify all the people who were in contact with a confirmed case in time, we can monitor their health and help them to seek care swiftly at the right health facility in case Ebola-related symptoms develop. Yet according to the Ministry of Health data, only around 64 percent of case contacts initially received follow-up, pointing to gaps in this crucial part of the response. While the overall epidemiological trend is now positive, we remain concerned and vigilant about what could still happen.
What are possible future scenarios?
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It has been over two weeks since the last confirmed Ebola case—a stillborn baby of a mother who survived the disease—was reported in
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WHO Director-General's opening remarks at the media briefing – 14 December 2022
14 December 2022
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Likewise, with no new cases in more than two weeks, and no patients being treated at the moment, the countdown to the end of the Ebola outbreak in Uganda has begun.
If no new cases are detected, the outbreak will be declared over on the 10th of January.
With support from WHO and partners, the Government of Uganda is now focusing its efforts on surveillance and monitoring the last few contacts under follow up.
Last week, the first batch of candidate vaccines arrived in Uganda, within 80 days of the declaration of the outbreak – faster than for any previous outbreak.
This was thanks to a remarkable collaboration of partners around the world who have worked together to advance candidate vaccines and ensure their availability to carry out trials.
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Ebola disease caused by Sudan ebolavirus – Uganda
8 December 2022Source: Ministry of Health Uganda and
WHO Situation Reports
*Following a data reconciliation exercise, one case previously classified as ‘dead’ has been re-classified as ‘recovered’
Description of the situation
Since the last Disease Outbreak News published on 24 November, one new confirmed case of Ebola disease caused by the Sudan ebolavirus (SUDV) was reported on 27 November in Kassanda district. According to information shared by the Ministry of Health, the new case was a stillborn baby delivered at 28 weeks of gestation. The mother was infected with SUDV while pregnant and had since recovered and was in good condition at the time of delivery.
Since the outbreak declaration on 20 September, to 5 December 2022, a total of 142 confirmed cases have been reported by the Uganda Ministry of Health. Among them, 55 deaths occurred leading to a CFR of 39%. In addition, 22 probable cases (all are deaths) have been also reported. The number of cases among healthcare workers (HCWs) remains unchanged since the last DON report, with 19 confirmed cases, and seven deaths.
On 2 December, Uganda health authorities announced that all patients have been discharged from Ebola treatment units (ETUs) and that no more cases are currently hospitalized. As of 5 December, there are no active cases.
As of 5 December 2022, out of 2564 contacts listed, 2167 (84.5%), have completed the 21-day follow-up period. There are currently 36 contacts actively being followed up in four districts, with a follow-up rate of 100%.
Figure 1. Number of confirmed and probable cases of Ebola disease caused by SUDV by date of symptom onset, with 3-day moving average, as of 5 December 2022. Source: Ebola Virus Disease in Uganda Situation Report - 69
Table 1. Number of cases and deaths (confirmed and probable) of Ebola disease caused by SUDV, by district, as of 5 December.
Figure 2. Map of confirmed cases and deaths of Ebola disease caused by SUDV, by district, as of 5 December 2022.
Public health response
For further information on the public health response in Uganda by the Ministry of Health, WHO and partners, see the latest situation reports jointly published by the Ministry of Health and the WHO Regional Office for Africa: https://www.afro.who.int/countries/p...ns?country=879.
Following a Global Outbreak Alert and Response Network (GOARN) Request for Assistance, as of 7 December, there have been 66 offers of support received from 23 partner institutions. Five experts are currently deployed through GOARN in the functions of case management, infection prevention and control and Go.Data implementation. Additional offers of support have been received for the functions of water, sanitation and hygiene (WaSH), epidemiology and surveillance, partner coordination and laboratory capacities. In addition to the GOARN Request for Assistance, partners continue to support the Ministry of Health led response across multiple areas.
WHO held expert consultations to identify candidate therapeutics and vaccines for inclusion in trials throughout October and November 2022 and developed clinical trial protocols for both vaccine and therapeutic candidates against Sudan ebolavirus. The experts recommended that three candidate vaccines should be included in the planned ring vaccination trial: VSV-SUDV from Merck/IAVI, ChAd3-SUDV from the Sabin Institute, and biEBOV from Oxford University/Jenner Institute. On 8 December, 1200 doses of one of these candidate vaccines arrived in the country and will be evaluated in a clinical trial.
WHO is working closely with partners on the ‘accelerated campaign’ in Kampala, carrying out Risk Communication and Community Engagement (RCCE) activities. A festive season RCCE plan was developed to orient RCCE activities in Uganda and prevention in neighboring countries during this period.
WHO continues to support the Uganda MoH and collaborate with partners to implement Infection Prevention and Control (IPC) measures in health facilities to prevent onward transmission including development of a national IPC strategy for SUDV response, implementation of screening, isolation and notification of suspect cases and health worker trainings. The IPC ring approach has been implemented and remains in place to support facilities and communities in the event of a confirmed case is reported.
Preparedness and operational readiness in neighboring countries
WHO has revised the prioritization of the surrounding countries after conducting a risk assessment. In addition to the six surrounding countries (Burundi, Democratic Republic of the Congo, Kenya, South Sudan, Rwanda and Tanzania) that were assessed to be at-risk, five additional countries, with important population movements to and from Uganda, have been included, namely Central African Republic, Djibouti, Ethiopia, Somalia, and Sudan.
The Ministries of Health, WHO, in-country and international partners, are supporting SUDV preparedness and operational readiness activities in these countries.
Summary of the country’s preparedness and operational readiness activities (no new updates for Djibouti, Somalia and Sudan):- Burundi continues to strengthen its surveillance at points of entry and is prepositioning infection prevention and control materials at the district level. The MoH has also received international experts in the areas of case management and IPC. Efforts to scale up the functionalities of points of entry and Ebola treatment centers continue as well as public communication and sensitizations.
- Central African Republic is conducting screening and all alerts are being investigated. The national Emergency Operation Center has been activated, and the national Strategic Preparedness and Response Plan is being finalized.
- Democratic Republic of the Congo continue to conduct screenings at 42 points of entry including airports, seaports, and ground crossings. Samples have been collected from suspect cases and resulted negative for SVD. The MoH is conducting surveillance, case management and IPC trainings of all staff deployed to at-risk health zones.
- Ethiopia has been on alert mode since September 2022. The MoH is in the process of conducting the SUDV readiness assessment to identify challenges and gaps to increase its readiness capacities. At international airport, screening activities continue.
- Kenya is planning on participating in a simulation exercise. In addition, a training course was held on case management at national and subnational levels. The MoH has also completed the SUDV readiness assessment and reports gained capacities in response and will continue scaling up its efforts to address challenges and gaps.
- Rwanda continues to conduct screenings and investigating all alerts. There are no reports of SUDV cases in the country. The MoH is coordinating readiness activities at national and subnational levels. A trainer-of-trainers workshop will be conducted in the coming week on digitalized community-based surveillance for community health workers. As well, trainings on case management and safe and dignified burial will be in mid-December in high-risk districts.
- South Sudan reports having conducted screening in Juba and Nimule. All 28 alerts have been investigated and all are negative for SVD. Rapid response teams and health care workers in laboratory procedures are being trained in Juba and Yambio next week.
- United Republic of Tanzania has increased its readiness activities in the past two weeks by strengthening its call centers, and increasing screenings at points of entry. All alerts have been investigated and are negative for SVD.
On 6 December, WHO Regional Office for Africa in partnership with Africa Centres for Disease Control and Prevention, West African Health Organization, United States Centers for Disease Control and Prevention, UK Health Security Agency, Robert Koch Institute and the Bill and Melinda Gates Foundation, implemented a two-day public health emergency operation centre (PHEOC) simulation exercise with 36 countries in the WHO African Region, to improve readiness to respond to public health emergencies.
WHO risk assessment
On 4 November 2022, WHO revised the rapid risk assessment for this event from high to very high at the national level, and from low to high at the regional level, while the risk remained low at the global level. As of 8 December 2022, WHO’s assessment of risk remains unchanged.
The risk will be continuously assessed based on available and shared information.
WHO advice
Successful SUDV disease outbreak control relies on applying a package of interventions, including case management, community engagement, surveillance and contact tracing, strengthening laboratory capacity, safe and dignified burials.
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. Implementation of IPC measures in health care (e.g., hand hygiene, training of health workers, adequate personal protective equipment (PPE) supplies, waste management, environmental cleaning, and disinfection etc.) with ongoing monitoring and supervision for implementation is required to reduce risks of health care facilities amplifying the outbreak.
Ensuring the provision of safe and dignified burials, supporting IPC in community settings (including adequate WASH facilities, hand hygiene capacity and safe waste management) and community engagement and social mobilization are essential to prevent and mitigate ongoing transmission.
Upon case identification, early diagnosis and early initiation of supportive treatment has been shown to significantly improve survival. There are currently no proven therapeutics for SUDV but candidate therapeutics are available and due to be used in randomized controlled trials. Care of SUDV patients should occur in safely designed isolation and treatment/care centers with trained health workers.
Establishing active surveillance at points of entry is an essential component of the outbreak response to mitigate the risk of international spread due to the high cross-border mobility between Uganda and neighbouring countries.
There are no licensed vaccines for SUDV, but there are candidate vaccines which are going be used in trials.
WHO advises against any restrictions on travel and/or trade to Uganda based on available information for the current outbreak.
Further information- WHO AFRO: Uganda declares Ebola Virus Disease outbreak
- WHO AFRO. Ebola Virus Disease in Uganda SitReps
- WHO. Ebola, Uganda, 2022
- WHO Emergency Appeal: Ebola Disease Outbreak in Uganda
- Archive of Disease Outbreak News on Ebola disease caused by Sudan ebolavirus – Uganda
- Ministry of Health of the Republic of Uganda
- WHO AFRO. Bolstering Africa’s health emergency readiness and response
- WHO AFRO. Rapid response teams bolster Uganda’s Ebola fight
- WHO Vaccine Prioritization Working Group. Summary of the evaluations and recommendations on the three Sudan ebolavirus vaccines that are candidates for inclusion in the planned ring vaccination trial in Uganda (Tokomeza Ebola)
- Sudan Ebolavirus – Experts deliberations. Candidate treatments prioritization and trial design discussions
- WHO steps up support to Uganda’s evolving Ebola outbreak as hope for vaccines increases
- Ebola virus disease fact sheet
- Optimized Supportive Care for Ebola Virus Disease. Clinical management standard operating procedures. WHO. 2019.
- Personal protective equipment for use in a filovirus disease outbreak: rapid advice guideline
- World Health Organization. (2021). Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the national level. World Health Organization. https://apps.who.int/iris/handle/10665/345251. License: CC BY-NC-SA 3.0 IGO
- Global health agencies outline plan to support Ugandan government-led response to outbreak of ebola virus disease
- ICD-11 2022 release
- Kuhn JH, Adachi T, Adhikari NKJ, et al. New filovirus disease classification and nomenclature. Nat Rev Microbiol. 2019;17(5):261-263. doi:10.1038/s41579-019-0187-4
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Uganda’s disappearing Ebola outbreak challenges vaccine testing
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5 DEC 202212:15 PM BYJON COHEN
Last week, Uganda announced uplifting news about the Ebola outbreak that surfaced there in mid-September: The last known patient had recovered and been discharged from a hospital. Health officials hope that signals the spread of the virus has slowed dramatically, if not stopped altogether. Yet the aggressive containment efforts that led to the waning of the outbreak also means a quickly arranged trial of experimental ebolavirus vaccines faces formidable hurdles. The goal of the so-called ring trial is to test the efficacy of the vaccines by giving them to contacts of known cases. But the number of potential participants is dwindling fast.
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According to the World Health Organization (WHO), as of 25 November, Uganda had 141 confirmed cases, 55 of whom had died. WHO tallies include another 22 deaths as likely due to the virus, which had spread, alarmingly, to Kampala, the heavily populated capital.
The last confirmed case was diagnosed on 13 November, save for a stillborn baby on 27 November whose mother had already recovered. After 42 days have passed without a case, the outbreak officially will have ended. But epidemiologist Mike Ryan, director of WHO’s Health Emergencies Programme, cautioned at a press conference last week that there were still “significant gaps in tracing some of the chains of transmission,” which means new cases and their contacts may soon surface. “Ebola always has a sting in its tail,” he said.
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Dr. Diana Atwine@DianaAtwine
As of now we have no Ebola patient admitted in our ETU . I can confidently say we have defeated Ebola . Thank you all who believed in the capacity Uganda has and worked with us to not only protect our citizens but our Neighbors
Dr. Diana Atwine@DianaAtwine
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9h
Happy to announce that we discharged the past Ebola patient . We are sorry for those who predicted doom for Uganda . God has seen us though this epidemic . We continue to follow up actively the remaining contacts till they complete 21 days
Mubende Ebola unit now empty as last four patients are discharged
9:34 AM · Dec 2, 2022
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Mubende Ebola unit now empty as last four patients are discharged
Thursday, December 01, 2022
By BARBARA NALWEYISO
Reporter
Daily Monitor
The health team at Mubende Ebola treatment Unit can now breathe a sigh of relief after discharging their last patients.
The last batch of four patients including three women and a one-year-old baby, received their discharge letters on Wednesday evening and are now free to reunite with their families.
Dr Paskar Apiyo, a consultant physician attached to Gulu Regional Referral Hospital, but currently heading the Mubende Ebola Treatment team, described the discharging of patients as a milestone that has given them a great experience that they will always share.
"We had a total of 111 patients where 62 of them recovered and 49 died, some of them came very late, but with the grace of God, we have managed to save their lives,” she said.
"With the experience we have attained here in Mubende, I think if there is another Ebola outbreak in Uganda, more people are going to survive. We are going to write what has been here and it will change the story about Ebola," she added.
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EBOLA OUTBREAK STATISTICS 2022
NEW CASES 1
CUMULATIVE CONFIRMED CASES 142
CONFIRMED DEATHS 56
RECOVERIES 80
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Ministry of Health- Uganda @MinofHealthUG
The positive #Ebola case today, 28 Nov 2022,is a 28-week male stillborn to an Ebola survivor mother.The mother, is a 23 year old resident of Kikandwa,Kasanda district who had stillbirth.She was attended to during delivery by an appropriately donned midwife & is in good condition
8:00 AM · Nov 28, 2022·Twitter for iPhone
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Source: https://www.who.int/emergencies/dise...em/2022-DON425
Ebola disease caused by Sudan ebolavirus – Uganda
24 November 2022
Source: Ministry of Health Uganda and WHO Situation Reports
Description of the situation
Since the outbreak declaration on 20 September, a total of 141 confirmed cases and 55 confirmed deaths (CFR 39%) from Ebola disease caused by the Sudan ebolavirus (SUDV) have been reported by the Uganda Ministry of Health as of 21 November. In addition, 22 probable cases (all are deaths) have been reported since the beginning of the outbreak. Overall, 19 cases with seven deaths occurred among healthcare workers (HCWs).
The weekly number of confirmed cases reported has decreased for the third consecutive week (Figure 1) after the peak observed in the week 17-23 October. During the week commencing 7 November, five confirmed and one probable case was reported, including one confirmed case and one probable death from a newly affected district (Jinja), in the Eastern Region of Uganda, which is 80 km distant from Kampala. The most recent confirmed case was reported by the Uganda MoH on 14 November, from Kampala district.
Figure 1. Number of confirmed and probable cases of Ebola disease caused by SUDV by date of symptom onset, with 3-day moving average, as of 21 November 2022. Source: Ebola Virus Disease in Uganda Situation Report - 57
A higher proportion of cases are male (57.5%), and the most affected age group is represented by those aged 20-29 years, followed by those aged 30-39 years (Figure 2). Around 25% of cases are reported among children under 10 years old, indicating potential household transmission.
Figure 2. Age and sex distribution of confirmed and probable cases of Ebola disease caused by SUDV, as of 21 November 2022. Source: Ebola Virus Disease in Uganda Situation Report - 57
Since the last DON published on 10 November, one newly affected district has been reported (Jinja), leading to a total of nine districts that have reported confirmed SVD cases. The most affected district remains Mubende with 64 (45%) confirmed cases and 29 (53%) confirmed deaths, followed by Kassanda with 48 (34%) confirmed cases and 20 (36%) confirmed deaths. Two districts, Bunyangabu and Kagadi, have not reported cases for more than 42 days.
Table 1. Number of cases and deaths (confirmed and probable) of Ebola disease caused by SUDV, by district, as of 21 November.
Figure 3. Map of confirmed cases and deaths of Ebola disease caused by SUDV, by district, as of 21 November 2022.
Although there is significant improvement in surveillance activities in most affected districts, contact tracing gaps have been reported in newly affected districts. The suboptimal performance could be attributed to different factors, such as the non-reporting of probable cases, high population mobility including the movement of non-listed and/or missing contacts, and initial gaps in human and material resources. Surveillance strengthening plans have been put in place in newly affected districts.
Since the beginning of the outbreak, 4652 contacts have been registered, of which 3599 (78%) have completed the 21-day follow-up period.
As of 21 November, a total of 700 contacts in five districts (Jinja, Kampala, Kassanda, Masaka, and Mubende) were under active surveillance. In the week commencing 14 November, the average follow-up rate was 65%, representing a decrease of 26% in the follow-up rate as compared to 91% the previous week. Follow-up rates have been particularly low in Jinja and Masaka, at an average of 42% and 53%.
Figure 4. Weekly average number of contacts under active follow-up and follow-up rate, as of 21 November 2022. Graph re-produced using data reported in the Ministry of Health Uganda and WHO Situation Reports
The daily number of alerts received has not been regularly reported to WHO since 7 November, however, the number of alerts verified has been reported. During the week commencing 14 November, at least 953 alerts were verified (daily average 159), of which 335 (35%) met the definition of a suspected case.
Public health response
For further information on the public health response in Uganda by the Ministry of Health, WHO and partners, see the latest situation reports jointly published by the Ministry of Health and the WHO Regional Office for Africa: https://www.afro.who.int/countries/p...ns?country=879.
In addition to responding to this outbreak, the MoH and WHO are also responding to an ongoing outbreak of Crimean Congo Hemorrhagic Fever (CCHF) in Uganda, supporting clinical management and facilitating a referral pathway for the effective isolation and treatment of suspected and confirmed cases of CCHF and SUDV disease.
Following a Global Outbreak Alert and Response Network (GOARN) Request for Assistance, as of 22 November, there have been 52 offers of support received from 21 partner institutions. Six experts are currently deployed through GOARN in the functions of case management, partner coordination and infection prevention and control. Additional offers of support have been received for the functions of water, sanitation and hygiene (WaSH), epidemiology and surveillance, and laboratory capacities. In addition to the GOARN Request for Assistance, partners continue to support the Ministry of Health-led response across multiple areas.
WHO held expert consultations to identify candidate therapeutics and vaccines for inclusion in trials throughout October and November 2022 and to draft clinical trial protocols for both vaccine and therapeutic candidates against Sudan ebolavirus. WHO also requested the existing COVID-19 Vaccine Prioritisation Working Group (WG) to extend its COVID-19 remit to rapidly evaluate the suitability of candidate SUDV vaccines for inclusion in the planned trial in Uganda using similar considerations on safety, potential efficacy and logistic issues relating to availability and implementation. The experts recommended that three candidate vaccines should be included in the planned ring vaccination trial: VSV-SUDV from Merck/IAVI, ChAd3-SUDV from the Sabin Institute, and biEBOV from Oxford University/Jenner Institute. The first doses of one of these vaccine candidates are expected to arrive in the country soon.
Preparedness and operational readiness in neighboring countries
WHO has revised the prioritization of the surrounding countries after conducting a risk assessment. In addition to the six surrounding countries that were assessed to be at-risk, five additional countries are being included, namely Central African Republic, Ethiopia, Somalia, Sudan and Djibouti. These countries have important population movements to and from Uganda. WHO has started to engage with these countries and will report their readiness activities in the next DON report.
The Ministries of Health of the six neighboring countries (Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, South Sudan, and the United Republic of Tanzania), in-country and international partners, and WHO are supporting SUDV readiness actions.- Burundi is scaling up its operational readiness by coordinating with provinces and districts on upcoming activities such as the reinforcement of points of entry bordering Tanzania and Rwanda. In addition, training of community health workers and health care workers have been on going to enhance surveillance activities. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
- Democratic Republic of the Congo has been focusing their readiness efforts on training staff at points of entry. As of 21 November, 98% of travelers at airports are being screened. In addition, the health zones have been strengthening their capacities in laboratory and case management. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
- Kenya is strengthening their capacities in case management through conducting trainer-of-trainers and holding a comprehensive simulation exercise with WHO’s support. Points of entry at high-risk counties have been conducting screenings as well. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
- Rwanda is updating its contingency plan to guide the efforts in scaling up its readiness capabilities. Specifically, there are advancements in the establishment of Ebola Treatment Units (ETUs). The Ministry of Health is also reinforcing its core capacities in infection prevention and control and case management. Specifically, WHO is developing and implementing a training package in case management. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
- South Sudan has been enhancing its capacities in the areas of surveillance, case management and infection prevention and control. Health care workers at the subnational level have been undergoing trainings on SUDV management at health facilities. In addition, this past week, sensitization trainings for SUDV stakeholders have been completed. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
- United Republic of Tanzania has conducted training in the areas of IPC including safe and dignified burials. Health promoters have completed trainings in risk communication and community engagement and in mental health and psychosocial support. As of 21 November, all alerts have been investigated and resulted negative for SUDV.
WHO risk assessment
On 4 November 2022, WHO revised the risk assessment for this event from high to very high at the national level, and from low to high at the regional level, while the risk remained low at the global level.
The risk will be continuously assessed based on available and shared information.
WHO advice
Successful SUDV disease outbreak control relies on applying a package of interventions, including case management, community engagement, surveillance and contact tracing, strengthening laboratory capacity, safe and dignified burials.
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. Implementation of IPC measures in health care (e.g., hand hygiene, training of health workers, adequate personal protective equipment (PPE) supplies, waste management, environmental cleaning, and disinfection etc.) with ongoing monitoring and supervision for implementation is required to reduce risks of health care facilities amplifying the outbreak.
Ensuring the provision of safe and dignified burials, supporting IPC in community settings (including adequate WASH facilities, hand hygiene capacity and safe waste management) and community engagement and social mobilization are essential to prevent and mitigate ongoing transmission.
Upon case identification, early initiation of supportive treatment has been shown to significantly improve survival.
Establishing active surveillance at points of entry is an essential component of the outbreak response to mitigate the risk of international spread due to the high cross-border mobility between Uganda and neighbouring countries.
There are no licensed vaccines for SUDV, but there are candidate vaccines which are due to be used in trials.
WHO advises against any restrictions on travel and/or trade to Uganda based on available information for the current outbreak.
Further information- WHO AFRO: Uganda declares Ebola Virus Disease outbreak
- WHO AFRO. Ebola Virus Disease in Uganda SitReps
- WHO. Ebola, Uganda, 2022
- WHO Emergency Appeal: Ebola Disease Outbreak in Uganda
- Archive of Disease Outbreak News on Ebola disease caused by Sudan ebolavirus – Uganda
- Ministry of Health of the Republic of Uganda
- WHO Vaccine Prioritization Working Group. Summary of the evaluations and recommendations on the three Sudan ebolavirus vaccines that are candidates for inclusion in the planned ring vaccination trial in Uganda (“Tokomeza Ebola)
- Sudan Ebolavirus – Experts deliberations. Candidate treatments prioritization and trial design discussions
- WHO steps up support to Uganda’s evolving Ebola outbreak as hope for vaccines increases
- Ebola virus disease fact sheet
- Optimized Supportive Care for Ebola Virus Disease. Clinical management standard operating procedures. WHO. 2019.
- Personal protective equipment for use in a filovirus disease outbreak: rapid advice guideline
- World Health Organization. (2021). Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the national level. World Health Organization. https://apps.who.int/iris/handle/10665/345251. License: CC BY-NC-SA 3.0 IGO
- Global health agencies outline plan to support Ugandan government-led response to outbreak of ebola virus disease
- ICD-11 2022 release
- Kuhn JH, Adachi T, Adhikari NKJ, et al. New filovirus disease classification and nomenclature. Nat Rev Microbiol. 2019;17(5):261-263. doi:10.1038/s41579-019-0187-4
See all DONs related to this event
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Govt accused of double standards in Ebola fight
Tuesday, November 22, 2022
..Citizens have raised concerns in regard to the government’s commitment to the fight against Ebola.
This follows the MTN-Uganda marathon that was organised on Sunday....
One of the concerned citizens, Mr Jeje Odea, tweeted after the marathon: “Schools are closing two weeks earlier because of Ebola, yet adults are converging in thousands to sweat, one of the easiest ways of spreading the disease. How do you convince one that the Ebola card is not a gig to attract international sympathy and hence foreign donations.”...
.Ever since the Education ministry announced the shortening of third term, several music concerts have been organised, including the one of Edrisa Musuuza, aka Eddy Kenzo that pulled an estimated 30,000 revellers.
In a press statement issued yesterday in defence of the big crowds around the city, the Health ministry reasoned that the MTN-Uganda marathon did not pose any risk of transmission or spread of Ebola.
..that the event posed no risk of Ebola transmission among the participants,” read the ministry’s statement.
“Unlike Covid-19, the risk of Ebola Virus Disease (EVD) transmission and spread is highest when people are symptomatic (presenting with signs and symptoms). With the screening measures in place at the MTN Kampala Marathon, no participant presented with any other symptom,” the statement added.
But another concerned citizen said: “Are you trying to lie that all participants in the marathon were screened?! Additionally, we would like to know how exactly this Ebola risk assessment is conducted.” ...https://www.monitor.co.ug/uganda/new...
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...Airport restrictions
The Health ministry has also eased the restrictions previously imposed on Entebbe airport. According to a statement from the Uganda Civil Aviation Authority, the country’s body that manages air travel, the restrictions, which had previously caused inconveniences at Entebbe, the country’s only international airport, have been removed.
“Following communication from the Ministry of Health, the requirement for inbound and outbound passengers through Entebbe Airport to fill in a digital health declaration/locator form has been temporarily suspended until further notice,” the statement stated....https://www-theeastafrican-co-ke.tra..._x_tr_pto=wapp
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UNICEF Uganda Situation Report No. 3 (Ebola Virus Disease) - 21 November 2022
Format Situation Report SourcePosted21 Nov 2022 Originally published21 Nov 2022Attachments
Highlights- 21 November marked 66 days of responding to the Ebola outbreak since confirmation of the first case on 19 September. New cases continue to be reported, and spreading into a new district (Jinja).
- 48 children, adolescents and care givers accessed community based Mental Health and Psychosocial support (MHPSS) in the affected districts.
- During this reporting period, 127,665 people were engaged in community dialogues to raise awareness for Sudan Virus Disease (SVD) prevention and control.
- 1,518 teachers and non teaching staff oriented on SVD prevention, early treatment seeking and notification.
- UNICEF supported Government efforts to safely evacuate 549 (249 girls, 300 boys) school children from Mubende and Kassanda across the country after their exams.
- The UNICEF SVD response plan is costed at US$18.2 million and has a funding gap of 56 per cent.
Situation overview and humanitarian needs
According to Ministry of Health (MoH) reports, 21 November marked 66 days of responding to the Ebola outbreak since the confirmation of the first case on 19 September and declaration of an outbreak on 20 September. 1 A total of 141 confirmed Ebola cases2 with 55 confirmed deaths3 of which 11 children4 and seven health workers5 are among the confirmed deaths and 79 recoveries had been reported as of 19 November. Ebola infections are confirmed in nine districts: Jinja, Masaka, Kampala, Wakiso, Kagadi, Mubende, Kyegegwa, Kassanda and Bunyangabu. MoH attributes the spread of the virus to movements of contacts and symptomatic individuals to new areas. Bunyangabu and Kagadi districts have been dropped from the follow up list because they have completed 42 days, which is two incubation cycles of the disease without a case.
UNICEF is scaling up risk communication and community engagement to reinforce early reporting and treatment seeking and adherence to case management and infection prevention protocols such as isolation. Further focus on mental health and psychosocial support is critical for preventing and addressing stigma against families affected by Ebola and for the reintegration of survivors within the communities. The Ministry of Health, with support from partners has established an Ebola Survivor’s programme that aims to provide integrated health, psychosocial care and other services to survivors.
There are presently four operational Ebola Treatment Units (ETUs) - three in Mubende and one in Entebbe with two isolation units in Madudu and Mulago established in response to the outbreak. ETU construction in Kassanda District is on going.
The President addressed the nation on the situation of Ebola outbreak for the fourth time on 15 November 2022.The public health and social measures announced by the President of Uganda in mid October to curb Ebola transmission, will continue with intensified sensitization of the population by MoH and Local Government leaders. These include prohibition of movements into and out of Mubende and Kassanda districts, curfew (07:00pm-06:00am) and a restriction on the movement of public transport, private transport, trucks carrying logs and boda-bodas for a period of 21 days, starting 16 October 2022. All traditional healers and witch doctors were prohibited from carrying out their activities during the outbreak. The MoH issued a directive stating that all contacts to confirmed cases are not allowed to travel locally or internationally for 21 days. On 14 November 2022, Government of Uganda issued a directive for all travelers at both departure and arrival points to fill out the online digital health declaration form.
https://reliefweb.int/report/uganda/...
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