Uganda confirms cases of Marburg virus

[tetano]

Uganda has confirmed one case of Marburg virus, a highly infectious hemorrhagic fever similar to Ebola, the health minister said on Thursday.
Jane Aceng told reporters at a news conference in capital Kampala that the case, which led to a fatality, had been confirmed after a series of tests were carried out.
The East African nation last suffered a Marburg outbreak, which has a high mortality rate, in 2014. Marburg is from the same family of viruses as Ebola, which killed thousands in West Africa in 2014.
The minister said the victim, a 50-year old woman, died on Oct. 11 at a hospital in eastern Uganda after ?she presented with signs and symptoms suggestive of viral hemorrhagic fevers.

http://punchng.com/uganda-confirms-one-case-of-ebola-like-marburg-virus/

[Ronan Kelly]

Ebola-like Marburg virus kills two in Uganda: Official
FRIDAY OCTOBER 20 2017

By AFP
KAMPALA

Two people have died from the Marburg virus in eastern Uganda, in the country's first outbreak of the deadly Ebola-like pathogen in three years, the health ministry said.

"Blood samples were taken from two people who have since died and were found positive for Marburg", Uganda's health ministry permanent secretary, Dr. Diana Atwine said.

She said a team of experts had been sent to Kween district, near the Kenyan border, to contain the virus.
...
One individual was a male hunter who died on September 25. His 50-year-old sister died on October 11.
...

http://www.nation.co.ke/news/africa/Ebola-like-Marburg-virus-kills-2-in-Uganda/1066-4147806-137he6lz/index.html

[Shiloh]

Source: http://www.who.int/csr/don/25-octobe...urg-uganda/en/

Marburg virus disease ? Uganda Disease outbreak news
25 October 2017

On 17 October 2017, the Ugandan Ministry of Health notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017.
As of 24 October, five cases have been reported ? one confirmed case, one probable case with an epidemiological link to the confirmed case, and three suspected cases including two health workers.
Chronologically, the first case-patient (probable case) reported was a male in his 30s, who worked as a game hunter and lived near a cave with a heavy presence of bats. On 20 September, he was admitted to a local health centre with high fever, vomiting and diarrhoea, and did not respond to antimalarial treatment. As his condition deteriorated, he was transferred to the referral hospital in the neighbouring district, where he died the same day. No samples were collected. He was given a traditional burial, which was attended by an estimated 200 people.
The sister (confirmed case) of the first case-patient nursed him and participated in the burial rituals. She became ill and was admitted to the same health centre on 5 October 2017 with fever and bleeding manifestations. She was subsequently transferred to the same referral hospital, where she died. She was given a traditional burial. Posthumous samples were collected and sent to the Uganda Virus Research Institute (UVRI). On 17 October, Marburg virus infection was confirmed at UVRI by RT-PCR and it was immediately notified to the Ministry of Health.
The third case-patient (suspected case) is the brother of the first two cases. He assisted in the transport of his sister to the hospital, and subsequently became symptomatic. He refused to be admitted to hospital, and returned to the community. His whereabouts are currently not known though there is an ongoing effort to find him.
Two health workers who were in contact with the confirmed case have developed symptoms consistent with Marburg virus disease and are under investigation (suspected cases). Laboratory results to rule out Marburg virus disease are pending.
Contact tracing and follow-up activities have been initiated. As of 23 October, 155 contacts including 66 who had contact with the first case and 89 who had contact with the second case-patient have been listed in the two affected districts, including 44 health care workers. The number of family and community contacts is still being investigated.
Public health response

• The Ugandan Ministry of Health has rapidly responded to the outbreak, with support from WHO and partners. A rapid response field team was deployed to the two affected districts within 24 hours of the confirmation.
• To coordinate response activities, the National Task Force has convened, an Incident Management System (IMS) framework implemented with an Incident Manager appointed, a District Task Force has been established, and an emergency rapid response plan has been developed.
• Marburg virus disease response activities have been initiated, including surveillance, active case search, contact tracing and follow-up, as well as monitoring within affected communities and healthcare centres.
• Personal protective equipment has been deployed in the affected districts. Healthcare workers have been put on high alert and training sessions are planned, including a thorough review of infection prevention and control (IPC) protocols and capacity. An isolation facility is being prepared at the health centre and the hospital.
• Training of teams for safe and dignified burials has been conducted in affected districts.
• Community engagement and awareness campaigns are ongoing to reduce stigma, encourage reporting and early healthcare seeking behaviours, and acceptance of prevention measures. Information, education and communication materials and messages have been updated and are being produced.
• International partners and stakeholders have been engaged at country level, and internationally to provide support and technical assistance for the response as needed. WHO has deployed additional staff, and six viral haemorrhagic fever (VHF) kits. Funding has been provided from the WHO Contingency Fund for Emergencies to ensure immediate support and scale up the response. WHO has alerted partners in the Global Outbreak Alert and Response Network (GOARN), and is coordinating international support for the response.
• UNICEF is assisting with communication activities, and community engagement.
• M?decins Sans Fronti?res has deployed to support setting up of treatment centres.

WHO risk assessment

Marburg virus disease is an emerging and highly virulent epidemic-prone disease associated with high case fatality rates (case fatality rate: 23?90%). Marburg virus disease outbreaks are rare. The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).
Candidate experimental treatments and vaccine are being reviewed for potential clinical trials.
Uganda has previous experience in managing recurring viral haemorrhagic fever outbreaks including Marburg virus disease. Cases have historically been reported among miners and travellers who visited caves inhabited by bat colonies in Uganda. Marburg virus disease outbreaks have been documented during:

• 2007 ? 4 cases, including 2 deaths in Ibanda District, Western Uganda;
• 2008 ? 2 unrelated cases in travellers returning to the Netherlands and USA, respectively after visiting caves in Western Uganda;
• 2012 ? 15 cases, including 4 deaths in Ibanda and Kabale districts, Western Uganda; and
• 2014 ? 1 case in healthcare professional from Mpigi District, Central Uganda.

As of 24 October, five cases have been identified ? one confirmed case, one probable case, and three suspected cases, and the outbreak remains localised. Ugandan health authorities have responded rapidly to this event, and measures are being rapidly implemented to control the outbreak. The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies is a challenge for the response. In addition, hospitalised cases were handled in general wards without strict infection control precautions, and one probable case refused to be hospitalised for a period of time.
The affected districts are in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The Mount Elgon caves are a major tourist attraction, and are host to large colonies of cave-dwelling fruit bats, known to transmit the Marburg virus. The close proximity of the affected area to the Kenyan border, and cross-border movement between the affected district and Kenya and the potential transmission of the virus between colonies and to humans, increases the risk of cross-border spread.
These factors suggest a high risk at national and regional level, requiring an immediate, coordinated response with support from international partners. Tourism to Mount Elgon including the caves and surrounding areas should be noted and appropriate advice given and precautions taken. The risk associated with the event at the global level is low.
WHO advice

Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and body fluids, and Marburg virus transmission associated with provision of health care has been reported when appropriate infection control measures have not been observed.
Health-care workers caring for patients with suspected or confirmed Marburg virus should apply infection control precautions to avoid any exposure to blood and body fluids, and unprotected contact with possibly contaminated environment.
Surveillance activities, including contact tracing and active case search must be strengthened within all affected health zones.
Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key measures to reduce human infections and deaths. Key public health communication messages include:

• Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bats colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home.
• Communities affected by Marburg should make efforts to ensure that the population is well informed, both about the nature of the disease itself to avoid community stigmatization, and encourage early presentation to treatment centres and other necessary outbreak containment measures, including burial of the dead. People who have died from Marburg should be promptly and safely buried.

WHO advises against the application of any travel or trade restrictions on Uganda or the affected area based on the current information available on this event. Travellers to the Mount Elgon bat caves are advised to avoid exposure to bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks .
For further information on Marburg virus disease and prevention and control measures is available in the WHO Marburg virus disease factsheet.

• WHO Marburg virus disease factsheet

[Pathfinder]

Marburg virus disease Uganda

6 Cases
3 Deaths
CFR 50%

EVENT DESCRIPTION

The outbreak of Marburg virus disease (MVD) in Uganda continues to evolve. Since
our last report on 20 October 2017 (Weekly Bulletin 42), one new confirmed case
of MVD has been reported in Kween District. As of 29 October 2017, a total of six
cases (2 confirmed, 1 probable and 3 suspected) have been reported in Kween and
Kapchorwa Districts. Three of the six cases have died, giving an overall case fatality
rate of 50%. The deaths occurred in the two confirmed cases and one probable
case, which was epidemiologically linked to one of the confirmed cases. All the three
deaths were from one family in Kween District.

The outbreak of MVD in Uganda was confirmed on 17 October 2017 and officially
declared by the Ministry for Health on 19 October 2017. Chronologically, the first
case (probable) was a male game hunter in his 30s who died on 25 September
2017. No laboratory specimens were collected for testing. His sister (the index and
confirmed case) was a 50-year-old female who nursed him and participated in the
burial rituals. She became ill on 5 October 2017 with similar symptoms and died
on 13 October 2017. Marburg virus infection was confirmed at the Uganda Virus
Research Institute (UVRI) by reverse transcriptase polymerase chain reaction (RTPCR)
on 17 October 2017.

The third case-patient (confirmed) is the brother of the first two cases. He
transported his sister to the hospital on 10 September 2017 and subsequently
became symptomatic. He initially refused to be admitted to hospital and returned
to the community. While in the community, he reportedly consulted two traditional
healers: one in Bukwo District and another in Kitale District in western Kenya (the
health authorities in Kenya have been informed accordingly). On 24 October 2017,
he was eventually admitted to the treatment centre in Kween District, where he died
on 25 October 2017. The specimens collected from the case-patient confirmed
Marburg virus infection by RT-PCR.

...
Read the weekly bulletin on outbreaks and other emergencies - Week 43: 21 - 27 October 2017

http://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates

[Pathfinder]

Marburg virus disease – Uganda and Kenya

Disease outbreak news
7 November 2017

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017.

As of 3 November, the three cases that have been previously reported (two confirmed and one probable case, the latter being the index case) have died, thus, resulting in an overall case-fatality rate of 100%. The cases were epidemiologically linked and come from one family.

The second confirmed case travelled to Kenya, prior to his death. Contact tracing and active case search is ongoing in Kween in Kapchorwa district in Uganda, as well as in Kitale district and West Pokot in Kenya. On 4 November a high risk contact of the second confirmed case, a health care worker in Kween developed symptoms and was admitted to the treatment facility in Kween. Additionally, one close contact of the second confirmed case has been reported to have travelled to Kampala. The Kampala City Authority has sent a team to the village she is reported to be visiting to trace this contact and continue 21 days follow-up.

Public health response

• The Ugandan Ministry of Health continues to proactively respond to the outbreak with support from WHO and partners.
• Contact tracing is ongoing, as well as active case search in health facilities and at community level. Reported deaths are also investigated for Marburg before burial and suspicious deaths accorded safe and dignified burials.
• An isolation and treatment unit was set-up in Kapchorwa with logistical support from WHO, UNICEF, and MSF. A complete triage protocol has been implemented.
• Social mobilization and risk communication are ongoing. With the support from Red Cross volunteers, UNICEF and WHO communication experts, over 4,000 community members have received information on MVD.
• Psychosocial support specialists have been deployed to Kween and counselling sessions are being conducted for family members of the deceased Marburg cases, health workers, and other community members.
• Guided tours of the Marburg treatment units in Kapchorwa and Kween were organized in order to dispel fear of the treatment center and rumours of wrong practices by healthcare workers that cause death of admitted patients.
• A cross-border meeting between Uganda and Kenya health authorities is scheduled for 7th November 2017 in Kapchorwa, and cross-border surveillance activities are ongoing.
• Kenya Marburg virus disease outbreak contingency plan and the public health EOC have been activated and preparedness measures have started.
• 2000 Personal Protective Equipment sets have been dispatched by WHO and shipped to Trans Nzoia County, Kenya.
• Blood specimens were collected and have been dispatched to Nairobi’s KEMRI Laboratory
• A temporary treatment center (Kaisangat Health center) has been identified and the Kenya Red Cross Society is recruiting and re-orienting nurses to manage the MVD treatment centre.
• UNICEF is assisting with communication activities, and community engagement.
• MSF-France has deployed to support setting up of treatment centres in Uganda (Kapchorwa and Kaproron) and Kenya (Kaisangat).

WHO risk assessment

Marburg virus disease is an emerging and highly virulent epidemic-prone disease associated with high case fatality rates (case fatality rate: 23–90%). Marburg virus disease outbreaks are rare. The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).
Candidate experimental treatments and vaccine are being reviewed for potential clinical trials.
Uganda has previous experience in managing recurring Ebola and Marburg virus (MVD) disease outbreaks. MVD cases have historically been reported among miners and travellers who visited caves inhabited by bat colonies in Uganda. Marburg virus disease outbreaks have been documented during:

• 2007 – 4 cases, including 2 deaths in Ibanda District, Western Uganda;
• 2008 – 2 unrelated cases in travellers returning to the Netherlands and USA, respectively after visiting caves in Western Uganda;
• 2012 – 15 cases, including 4 deaths in Ibanda and Kabale districts, Western Uganda; and
• 2014 – 1 case in healthcare professional from Mpigi District, Central Uganda.

Currently, three cases have been identified; two confirmed and one probable case. The second confirmed case travelled to Kenya prior to his death, but so far no human-to-human transmission has been confirmed outside of Uganda. Ugandan health authorities have responded rapidly to this event, and measures are being rapidly implemented to control the outbreak. Kenyan health authorities have activated the contingency plan and the public health EOC and have started preparedness measures. The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies is a challenge for the response.

The affected districts are in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The Mount Elgon caves are a major tourist attraction, and are host to large colonies of cave-dwelling fruit bats, known to transmit the Marburg virus. The close proximity of the affected area to the Kenyan border, and cross-border movement between the affected district and Kenya and the potential transmission of the virus between colonies and to humans, increases the risk of cross-border spread.

These factors suggest a high risk at national and regional level, requiring an immediate, coordinated response with support from international partners. Tourism to Mount Elgon including the caves and surrounding areas should be noted and appropriate advice given and precautions taken. The risk associated with the event at the global level is low.

WHO advice

Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and body fluids of infected symptomatic persons, and Marburg virus transmission associated with provision of health care has been reported when appropriate infection control measures have not been observed.
Health-care workers caring for patients with suspected or confirmed Marburg virus should apply infection control precautions to avoid any exposure to blood and body fluids, and unprotected contact with possibly contaminated environment.

Surveillance activities, including contact tracing and active case search must be strengthened within all affected health zones.

Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key measures to reduce human infections and deaths. Key public health communication messages include:

• Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bats colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home.
• Communities affected by Marburg should make efforts to ensure that the population is well informed, both about the nature of the disease itself to avoid community stigmatization, and encourage early presentation to treatment centres and other necessary outbreak containment measures, including burial of the dead. People who have died from Marburg should be promptly and safely buried.

WHO advises against the application of any travel or trade restrictions on Uganda or the affected area based on the current information available on this event. Travelers to the Mount Elgon bat caves are advised to avoid exposure to fruit bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks.
...
http://www.who.int/csr/don/7-november-2017-marburg/en/

[Pathfinder]

Uganda and Kenya Hold Cross Border Meeting on Marburg Virus Disease

Kapchorwa 10th November 2017- Political leaders, civil servants, health workers and security officers from Kenya and Uganda have agreed to establish mechanisms to share disease surveillance data across districts and borders in order to prevent or control disease outbreaks.

Participants in the one-day meeting held in Kapchorwa district also agreed to operationalize the surveillance and response zonal committees and to develop common epidemic preparedness and response plans. They resolved to establish local community based trans-boundary disease surveillance mechanisms using community structures such as Village Health Teams (VHTs).

To achieve the above, participant highlighted the importance of across border training sessions on surveillance and to address attitudes of the local community through risk communication. This will go hand in hand with strengthening surveillance in institutions of learning through existing structures in the districts.

Other activities agreed to include setting aside and ring fencing funds for disease outbreak response in the districts; strengthen regional and district level laboratories to be able to investigate and confirm some of the disease outbreaks so as to save time and improve timely response; setting up a permanent structure and human resources to deal with disasters or disease outbreaks; and organizing regular rotational cross border meetings.

Regional surveillance platforms in Busia, Uganda and Kitale in Kenya will be strengthened and local focal persons such as District Resident Commissioners and Local Council Five Chairmen in Uganda; and County Commissioners and Governors in Kenya respectively will be supported logistically and technically to work on disaster or disease outbreak issues. The media, in both countries, will also be involved in the detection and control of outbreaks.

?Infectious diseases don?t know borders and a disease across the border is a disease on your border,? said Dr Issah Makumbi the head of Uganda?s Emergency Operations Centre in the Ministry of Health. Dr Makumbi, therefore, presented the Institutional Framework for Cross-border Integrated Disease Surveillance and Response that should be used by the six Member States to address Public Health Events.

Security officers at the meeting advised health workers to always treat disease outbreaks as national security issues. ?Governments can fall, economies can collapse and social order disorganized because of disease outbreaks which makes it a matter of security concern,? said Mr Kennedy Adhola Otiti, the RDC for Kween.

The meeting was necessitated by fact that Uganda and Kenya share a long porous border through which people move easily and frequently and the communities along the border are closely related. In the current MVD outbreak, a suspect case, who was later confirmed, moved between Uganda and Kenya seeking for care from traditional healers. In the process, several people in the Kenyan towns of Alale and Kitale got in close contact with him.

In view of the above, the meeting aimed at establishing a sensitive cross-border disease surveillance system for timely detection and response to public health events with special focus on Marburg.

Participants were therefore oriented on priority diseases reporting and investigation. They were updated on International Health Regulation (2005) and relevant articles on public health event notification, surveillance and response, as well as WHO recommendations on travel and trade restrictions. They were also updated on the current Marburg response strategy, progress made so far and challenges.

They later discussed the critical areas of collaboration including social mobilization, surveillance and contact tracing. Finally, they generated consensus on the national and collaborative activities to be undertaken to strengthen cross-border surveillance and overall outbreak response.
...

http://www.afro.who.int/news/uganda-and-kenya-hold-cross-border-meeting-marburg-virus-disease

[Pathfinder]

Marburg virus disease ? Uganda and Kenya

Disease outbreak news
15 November 2017

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg Virus Disease in Kween District, Eastern Uganda. The MoH officially declared the outbreak on 19 October 2017. As of 14 November, three cases have been reported including two confirmed cases, and one probable case. All three cases have died, resulting in a case fatality rate of 100%. The cases were epidemiologically linked and all belong to the same family.
Chronologically, the first case (probable) was a 35-years-old herdsman who frequently hunted near the area of Kaptum, known for its bat-infested caves. He was admitted to hospital on 20 September with Marburg-like symptoms and died five days later. The first confirmed case was the sister and caretaker of the first case. The second confirmed case was the brother of the first two cases, who died on 26 October 2017 and had a safe and dignified burial on the same day.
Prior to his death, the second confirmed case travelled to Kenya where he visited his relatives in West Pokot County, as well as a traditional healer in Trans Nzoia County. On 29 October 2017, the Ugandan MoH notified WHO and the Kenyan MoH of these high-risk contacts. The traditional healer tested negative for Marburg virus disease on repeated blood specimen analyses performed at the Kenyan Medical Research Institute (KEMRI) in Nairobi. She and her family were monitored for 21 days. The two relatives from West Pokot, as well as other contacts in the same county, also completed their 21 days of follow up.
Active case search, death surveillance, safe and dignified burials and community mobilization are ongoing in Kween and Kapchorwa districts. In Uganda, of the 339 contacts listed, 283 have completed 21 days of follow-up and 56 are still being monitored. Contact follow-up is ongoing in Kween for the 56 contacts, while In Kapchorwa District, all the listed contacts have completed the 21 days follow-up period. All remaining contacts are expected to complete 21 days of follow up on 16 November 2017. Enhanced surveillance activities will continue until 7 December 2017.
Public health response

• The Ugandan MoH continues to proactively respond to the outbreak with support from WHO and partners.
• Contact tracing and active case search in health facilities and at the community level are ongoing. On 14 November 2017, 56 contacts were still under follow up. Reported deaths are also investigated for Marburg before burial and suspicious deaths are buried according to safe and dignified burial protocols.
• Two Marburg treatment centers have been set up in Kapchorwa hospital and Kaproron with logistical support from M?decins Sans Fronti?res (MSF) France, UNICEF and WHO.
• Social mobilization and risk communication are ongoing. Over 12 000 community members have received information on Marburg virus disease with the support from Red Cross volunteers, UNICEF and WHO communication experts.
• Psychosocial support specialists have been deployed to Kween and counselling sessions are being conducted for family members of the deceased Marburg cases, health workers, and other community members.
• Guided tours of the Marburg treatment units in Kapchorwa and Kaproron were organized in order to dispel fear of the treatment centers and rumours of wrong practices by healthcare workers that cause deaths among admitted patients.
• On 7 November 2017, a cross-border meeting between Uganda and Kenya health authorities was organized to strengthen cross-border surveillance in Kapchorwa, and cross-border surveillance activities are ongoing.
• The Kenyan Marburg virus disease outbreak contingency plan and the public health Emergency Operations Center have been activated and preparedness measures have started.
• Two thousand Personal Protective Equipment (PPE) kits have been dispatched by WHO and shipped to Trans Nzoia County, Kenya.
• A temporary treatment center (Kaisangat Health center) has been identified and the Kenya Red Cross Society is recruiting and re-orienting nurses to manage the Marburg Virus Disease treatment centre.
• UNICEF is assisting with communication activities and community engagement.

WHO risk assessment

Marburg virus disease is an emerging and highly virulent epidemic-prone disease associated with high case fatality rates (CFR: 23 to 90%). Marburg virus disease outbreaks are rare. The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).
Candidate experimental therapeutics are being reviewed for potential clinical trials.
As of 15 November, the current outbreak has affected three cases, all of whom have died. One of the confirmed cases travelled to Kenya prior to his death. However, so far no secondary case has been confirmed outside of Uganda.
Uganda has previous experience in managing recurring Ebola and Marburg virus disease outbreaks. Cases have historically been reported among miners and travellers who visited caves inhabited by bat colonies in Uganda. Kenya on the other hand has limited experience and has been facing a healthcare worker strike which could delay any public health response. Cross-border population movement and community mixing between Uganda and Kenya may increase the risk of cross-border spread.
Ugandan health authorities have responded quickly to this event, and measures are being rapidly implemented to control the outbreak. Kenyan health authorities have activated the contingency plan and the public health EOC and have started preparedness measures. The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies was a challenge for the response.
The affected districts are in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The Mount Elgon caves are a major tourist attraction, and are host to large colonies of cave-dwelling fruit bats, known to transmit the Marburg virus. The close proximity of the affected area to the Kenyan border, and cross-border movement between the affected district and Kenya and the potential transmission of the virus between bat colonies and to humans, increases the risk of cross-border spread.
These factors suggest a high risk at national and regional level, requiring an immediate, coordinated response with support from international partners. Tourism to Mount Elgon, including to the caves and surrounding areas, should be considered as part of the response, and appropriate advice provided, and precautions taken. The risk associated with the event at the global level is low.
WHO advice

Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and body fluids, of infected symptomatic persons, and Marburg virus transmission associated with provision of health care has been reported when appropriate infection control measures have not been observed.
Health-care workers caring for patients with suspected or confirmed Marburg virus should apply infection control precautions to avoid any exposure to blood and body fluids, and unprotected contact with possibly contaminated environment.
Surveillance activities, including contact tracing and active case search must be strengthened within all affected health zones.
Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key measures to reduce human infections and deaths. Key public health communication messages include:

• Reducing the risk of bat-to-human transmission arising from exposure to mines or caves inhabited by fruit bats colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home.
• Communities affected by a Marburg outbreak should make efforts to ensure that the population is well informed about the nature of the disease , both to avoid community stigmatization, and to encourage early presentation to treatment centres and to support other necessary outbreak containment measures, including burial of the dead. People who have died from Marburg virus disease should be buried promptly, safely, and with dignity.

Restrictions of international travel

WHO advises against the application of any travel or trade restrictions on Uganda or the affected area based on the current information available on this event. Travelers to the Mount Elgon bat caves are advised to avoid exposure to fruit bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks.
A media signal about quarantine measures being implemented by Kenya on the border with the affected areas in Uganda was verified; the signal was not confirmed by the health authorities in Kenya.

• Kenya on high alert after a suspected Marburg case near Uganda border

No other signals were detected in relation to travel measures against Uganda or Kenya due to the current Marburg virus disease outbreak.
For further information on Marburg virus disease and prevention and control measures is available on the WHO website Marburg virus and in the WHO Marburg virus disease factsheet.

• Website on Marburg virus disease
• Fact sheet on Marburg virus disease

http://www.who.int/csr/don/15-november-2017-marburg-uganda-kenya/en/

[Shiloh]

Source: http://www.who.int/mediacentre/news/...us-disease/en/
Uganda ends Marburg virus disease outbreak

News release

8 December 2017 | Geneva - Uganda has successfully controlled an outbreak of Marburg virus disease and prevented its spread only weeks after it was first detected, the World Health Organization said on Friday (December 8).
?Uganda has led an exemplary response. Health authorities and partners, with the support of WHO, were able to detect and control the spread of Marburg virus disease within a matter of weeks,? said Dr Matshidiso Moeti, WHO Regional Director for Africa.
The Ugandan Ministry of Health notified WHO of the outbreak on October 17, after laboratory tests confirmed that the death of a 50-year-old woman was due to infection with the Marburg virus. A Public Health Emergency Operations Centre was immediately activated and a national taskforce led the response.
Three people died over the course of the outbreak which affected two districts in eastern Uganda near the Kenyan border, Kween and Kapchorwa. Health workers followed up with a total 316 close contacts of the patients in Uganda and Kenya to ensure that they had not acquired the illness.
The MVD outbreak was declared contained by the Ministry of Health after the contacts of the last confirmed patient completed 21 days of follow up (to account for the 21-day incubation period of the virus) and an additional 21 days of intensive surveillance was completed in affected districts.
?As evidenced by the quick and robust response to the Marburg virus disease outbreak, we are committed to protecting people by ensuring that all measures are in place for early detection and immediate response to all viral haemorrhagic fever outbreaks,? said Ugandan Minister of Health Sarah Opendi.
Within 24 hours of being informed by Ugandan health authorities in early October, WHO deployed a rapid response team to the remote mountainous area. The Organization also released US$623,000 from its Contingency Fund for Emergencies (CFE) to finance immediate support and scale up of the response in Uganda and Kenya.
In subsequent weeks, WHO and partners supported laboratory testing and surveillance, the search for new cases and their contacts, establishing infection prevention measures in health facilities, managing and treating cases, and engaging with communities.
Surveillance and contact tracing on the Kenyan side of the border by the Kenyan Ministry of Health and partners also prevented cross-border spread of the disease.
?The response to the Marburg virus disease outbreak demonstrates how early alert and response, community engagement, strong surveillance and coordinated efforts can stop an outbreak in its tracks before it ravages communities,? said Dr. Peter Salama, Executive Director of the WHO Health Emergencies Programme. ?This was Uganda?s fifth MVD outbreak in ten years. We need to be prepared for the next one.?
WHO will continue to support health authorities in both countries to upgrade their surveillance and response capabilities ? including infection prevention and control measures, and case management.
Note to editors

The response to the Marburg virus disease outbreak was led by health authorities in Uganda and Kenya in coordination with the World Health Organization (WHO), the Global Outbreak Alert and Response Network (GOARN), the US Centers for Disease Control and Prevention (CDC), the African Field Epidemiology Network (AFENET), UNICEF, M?decins Sans Fronti?res (MSF), the International Federation of Red Cross and Red Crescent Societies (IFRC), the International Committee of the Red Cross (ICRC), the Uganda Red Cross Society, the European Union Commission?s Civil Protection Mechanism and the Emergency Response Coordination Centre (ECHO-ERCC), the Bernhard Nocht Institute for Tropical Medicine and Marburg University in Germany, the European Union Mobile Lab Consortium and the Alliance for International Medical Action (ALIMA), the Uganda Virus Research Institute (UVRI), the Joint Mobile Emerging Diseases Intervention Clinical Capability (JMEDICC), the Infectious Diseases Institute of Makarere University (IDI), the Kenya Red Cross Society, and the Kenya Medical Research Institute (KEMRI).

• Marburg virus disease fact sheet

For more information, please contact:

Fadela Chaib
Communications Officer
World Health Organization
Tel: +41 22 791 3228
Mobile: +41 79 475 5556
Email: chaibf@who.int