Ebola in Uganda: November 30 - December 17, 2007

[Niko]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Personally, I don't see how they expect border control to stop anything.

Kenya is attempting it as well.

Kenya moves to halt Ebola spread

<!-- S BO --> <!-- S IIMA --> <table align="right" border="0" cellpadding="0" cellspacing="0" width="203"> <tbody><tr><td> The Ebola virus is one of the world's most deadly

</td></tr> </tbody></table> <!-- E IIMA --> <!-- S SF --> Kenya has set up screening centres on its borders with Uganda following an outbreak of the Ebola virus which has killed about 20 people. The highly infectious virus has killed two health workers [actually 5 reported by other sources] in western Uganda, where the outbreak was first reported.
Dr James Nyikal, the head of medical services in Kenya, said they are screening people entering the country and all facilities are on alert.


**snipped**
http://news.bbc.co.uk/2/hi/africa/7130654.stm


Kenya on alert for Ebola
06/12/2007 16:30 - (SA)

Nairobi - Kenyan border officials have been warned to be on watch for Ugandans crossing in from a region hit by an Ebola outbreak, the health ministry said on Thursday.
Border guards have been asked to diligently screen Ugandans coming in and hospitals along porous border areas have been warned to keep watch for signs of the disease that has so far killed 22 out of 91 known cases in neighbouring Uganda.
"We are not closing the border but the border posts have been alerted," said Shahnaaz Sherif, senior deputy director of medical services at the Kenyan health ministry.



**snipped**

http://www.news24.com/News24/Africa/News/0,,2-11-1447_2234281,00.html

[sharon sanders]

CDC Outbreak Notice

Outbreak Notice

Ebola Outbreak in the District of Bundibugyo, Uganda
This information is current as of today, December 06, 2007 at 13:16


Updated: December 06, 2007



The U.S. CDC and the Ministry of Health of Uganda have reported an Ebola hemorrhagic fever outbreak in the Bundibugyo district located in the Western part of the country.



The outbreak may have begun as early as August 2007. As of December 3, seventy-five people have become ill; evidence of Ebola virus infection has been confirmed in nine people, and eighteen people have died. Genetic analysis of samples from case-patients indicated that this is a new virus strain distinct from the four known strains of Ebola virus. However, further studies will be needed before this can be verified.
Ebola hemorrhagic fever is a rare, serious viral disease which develops suddenly, with common symptoms of fever, headache, joint and muscle aches, sore throat, and weakness. Diarrhea, vomiting, and stomach pain start after the first symptoms. A skin rash may develop. By the third or fourth day of illness some people with Ebola hemorrhagic fever may develop internal and external bleeding, shock and organ failure.
Ebola is spread through direct contact with blood or other body fluids (e.g., saliva, urine) of infected persons or objects that have been contaminated with infected body fluids. People who have close contact with a nonhuman primate infected with the virus are also at risk.
Recommendations for U.S. Travelers

The World Health Organization (WHO) has reported that there is no need for any travel restrictions to Uganda. Generally, the risk of contracting Ebola virus is low for travelers. CDC recommends that anyone traveling to Uganda take the following steps to prevent Ebola virus infection:

• Avoid contact with Ebola patients and their body fluids.
• Avoid touching used needles or other medical waste.
• Avoid contact with wild animals and bushmeat, including primates.

More Information

For information about the current situation, see the WHO report at www.who.int.
For additional information on Ebola hemorrhagic fever, please see http://www.cdc.gov/ncidod/dvrd/spb/m...ages/ebola.htm.
To learn more about traveling to areas with hemorrhagic fevers, see the Viral Hemorrhagic Fevers section of CDC Health Information for International Travel 2008.

http://wwwn.cdc.gov/travel/contentEbolaUganda.aspx

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

330 Ugandans monitored as Ebola death toll hits 22: official

1 hour ago
KAMPALA (AFP) ? Some 330 people are being monitored for possible Ebola infection in western Uganda, health authorities announced Thursday, as the national death toll hit 22.
But authorities faced hurdles probing the extent of the outbreak in Bundibugyo district, home to 250,000 people and epicentre of the disease, with many villagers unwilling to cooperate with medical detectives, they said.
"We are monitoring 330 people in the community. These are the people who had contact or were near Ebola patients," said Sam Zaramba, the director of medical services.
"Ninety-three have fitted in the diagnosis of Ebola -- including 22 dead. 38 have been admitted to health centers in Bundibugyo where isolation units have been set up," he told AFP.
Because no one can explain how the disease entered Bundibugyo -- seven years after it killed at least 170 people in northern Uganda -- it is now the job of the US Centers for Disease Control (CDC) to scour the district for clues.
Virologists are convinced that the disease erupted in September, wending its way through the district unnoticed, even though the first cases arrived in ill-equipped hospitals around the same time.
Doctors then misdiagonised it, fostering the outbreak, until samples were flown to the Atlanta-based CDC laboratory, where it was identified as a new Ebola strain with a new set of behaviour and symptoms in late November.
By then, the disease had slipped through the medical chaos, obscured by the absence of its signature haemorrhage, thus affecting isolated groups in the district and perhaps far afield, Zaramba speculated.
"It has taken us three months to diagnose that this was Ebola. It presented itself differently from the known haemorrhagic fevers," Zaramba added.
It was instead characterized by high fever, abdominal pain, diarrhoea vomiting and headache," he told AFP.
Spread by body secretions -- mainly blood -- Ebola can be fatal for up to 90 percent of its victims, often killing them in shock.
The rare disease was named after a small Democratic Republic of Congo river where it was discovered 1976 and in Sudan later the same year. Other outbreaks have been recorded in Ivory Coast, Gabon and Uganda.

http://afp.google.com/article/ALeqM5hSHNQ0JF6KG78Kly7kOY_t-F3omA

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Uganda says suspected Ebola cases rise to 94, 22 dead

Thu Dec 6, 2007 10:43pm IST

By Tim Cocks
KAMPALA (Reuters) - A new strain of the deadly Ebola virus is thought to have infected 94 people and killed at least 22 in Uganda, prompting neighboring Kenya to begin screening at its shared border, officials said on Thursday.
Dr. Sam Zaramba, Uganda's director of health services, told Reuters a doctor had died in Kampala's Mulago Hospital after looking after a patient in its isolation ward. Three other medical staff died after treating infected patients.
Besides the doctor and patient in Mulago, all other cases and deaths had occurred where the outbreak started in Uganda's western Bundibugyo district, bordering the Democratic Republic of Congo, he said.
"We've had one more admission today, someone in Bundibugyo. It is 94, now," Zaramba said.
"Twenty two have died. Out of them, four (are) health workers, one a doctor. He died in Mulago," Zaramba said earlier.
Only 58 cases have so far been confirmed in laboratory tests, Uganda says. But more people falling ill and a rising death toll since the outbreak started in August has caused panic in the east African country.
Neighboring Kenya has been screening travelers entering from Uganda at the Busia crossing -- on the main road out of Kenya's west into east and central Africa -- since last week, health officials said.
"Screening is going on at Busia. People are being asked questions about where they have traveled and their health," Kenya's head of medical services, Dr. James Nyikal, told Reuters.
The Ugandan government confirmed the fever was Ebola a week ago.
"All medical staff dealing with Ebola have been issued with protective gear," Zaramba said.
Genetic analysis of samples taken from some victims shows this virus is a previously unrecorded type of Ebola, making it a fifth strain, U.S. and Ugandan health officials say.
The World Health Organization is concerned about the way the virus keeps mutating.
But Ugandan officials say the unusually low death rate of this type -- at roughly 22 percent when the virus normally kills between half and 90 percent of those infected -- shows it is less lethal than previous epidemics.
Uganda was last hit by Ebola outbreak in 2000, when 425 people caught it and just over half died.
This year, an epidemic broke out in Congo -- where some of the first recorded cases in 1976 gave the virus its name after the country's Ebola river. It killed 187 people and infected up to 264.
(Additional reporting and editing by Bryson Hull)

http://in.reuters.com/article/health/idINL0691704520071206?sp=true

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Friday November 23 is the day Jonah believed himself to have been infected. That was the day he and Scott examined Jeremiah Muhindo. In between two of the times they saw the patient together, Jonah went in alone and arranged a face mask of oxygen onto the dying man, hoping to provide some relief or comfort. He was not wearing gloves because he could not find any at the hospital at that moment, and he felt that his friend needed the oxygen. That was his greatest exposure.

http://paradoxuganda.blogspot.com/2007/12/bundibugyo-where-tears-never-run-dry.html

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

How can new cases increase more than admissions? Well, there were five patients evaluated today by triage who were told to go into the isolation ward but somehow disappeared. Not encouraging for control of the spread .

http://paradoxuganda.blogspot.com/2007/12/ebola-bundibugyo-thursday-night-numbers_06.html

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

...told Scott that in the first family to be affected, four brothers all died. There must have been someone who survived, because the story later came out that they had eaten a monkey together.

http://paradoxuganda.blogspot.com/2007/12/ebola-bundibugyo-thursday-night-numbers_06.html

[sharon sanders]

MSF Dr. Fabiansen Video Describing Congo 2007 Ebola Outbreak

<table border="0" cellpadding="5" cellspacing="0" width="100&#37;"><tbody><tr><td align="left">
</td> <td align="right" nowrap="nowrap" valign="top">Information dated 19.10.2007</td> </tr> <tr> <td colspan="2" width="90%"> VIDEO: Working at an Ebola outbreak in the DRC with Dr Fabiansen
</td> </tr> <tr> <td colspan="2"> Dr Christan Fabiansen has been working at the Ebola outbreak in the Democratic Republic of Congo and explains some of the working systems
used in combatting the highly contagious and deadly disease.

http://www.msf.org/msfinternational/invoke.cfm?component=article&objectid=B796F29F-15C5-F00A-2554B7CC855E4C13&method=full_html

</td></tr></tbody></table>

[sharon sanders]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Heros. All of them.

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Commentary at

http://www.recombinomics.com/News/12060702/Ebola_Uganda_Spread_Confirmed.html

[hawkeye]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

latest from the blog:
* Cummulative Cases: 101
* Deaths: 22
* New admissions: 1 in Kikyo and 0 in Bundibugyo

[hawkeye]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

I can not imagine being faced with this decision:

From the blog:

But consider this dilemma. Someone comes to triage. She has a low grade fever and mild diarrhea. 10 days ago she stood in a known patient?s presence and prayed for them. She claims to have not touched the patient. Is she a contact? Is she a suspect case? If she is lying and she really did touch the patient she?d be a definite contact, and a contact with a fever and symptoms should be admitted. But she says she didn?t touch, so then she?s not a contact, just a person with diarrhea who happened to be in the room of an Ebola patient once. Yet if you are making the decisions and you take this lady?s denial of contact at face value ( in a culture where truth is very fluid and relative) then you might be condemning others to die as she gets sicker and spreads the virus. On the other hand, if she really didn?t touch the patient and she has some mild crud that is not in any way related to Ebola, yet you admit her to the isolation ward, she?ll probably get Ebola from the patients already there, and she might die. That is very very tough.

[hawkeye]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

quote from the blog:

They seem suspect about the lack of cases?

Another Hmmmm. . . . Where are all the sick people? Hiding at home.

[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Uganda: Union tells doctors to leave Ebola zone

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TABU BUTAGIRA, HUSSEIN BOGERE & JOSEPH MUGISA
- State of emergency looming
- Suspect death in Mbale
BUNDIBUGYO/KAMPALA - The Uganda Medical Workers Union, an umbrella association of about 20, 000 health workers, has asked under-resourced and unprotected medics attending to Ebola patients in the worst hit western district of Bundibugyo to leave immediately.
"All (health) workers who are not provided with protective gear should not work on suspected Ebola cases and (should) leave straight away," the Union chairman Dr Apollo Nyangasi said yesterday.
The recall comes a day after Dr Jonah Kule, a medical officer at Bundibugyo Hospital, his junior Joshua Kule, a senior clinical officer, Ms Rose Bulimpikya, a matron at the same hospital and another unnamed nurse, who all contracted the hemorrhagic fever from patients they were treating, died on Tuesday and Wednesday.
Their deaths bring the toll to 18 of medics killed by Ebola since it broke out in Gulu in 2000 - in which at least 14 nurses died on duty alongside Dr Mathew Lukwiya, the then medical superintendent of Lacor hospital. Dr Lukwiya has since been declared a national hero.
"Losing one health worker," Dr Nyangasi said, "means endangering the lives of over 15,000 people since the ratio of health workers to the population is 1: 15,000. We call upon the government to be proactive in cases of epidemics; not reactionary like now".
Early this week, overstretched nurses at Bundibugyo hospital momentarily halted work over delayed payment of risk allowances prompting local leaders to offer part payment of Sh30,000, Sh20,000 and Sh10,000 to each doctor, nurse and other support staff respectively for the daily allowance.
The workers' body now says the government should immediately increase the risk allowances to Sh50,000 per day for all cadres of health workers.
"Those (medical staff) who have no protective gear and are not sure of their risk allowance being paid should leave straight away," Dr Nyangasi insisted.
The Uganda Red Cross Society (URCS) yesterday delivered an assortment of gloves, facemasks, gumboots and Jik detergent among other supplies to help salvage the deplorable situation of health workers at the Ebola centers in Bundibugyo hospital and Kikyo health centre IV.
"There has been lack of protective gear among nurses working on Ebola cases posing a health risk," Ms Catherine Ntabadde, the URCS publicist said in a statement.
Dr Nyangasi had said public health workers hold a right to pull out from highly hazardous working environments under provisions of the Occupational Safety and Health Act, 2006.
Section 37 of the said legislation provides thus: "A (health) worker who removes him or herself from a situation which he or she has reasonable justification to believe presents an imminent and serious danger to his or her life or health shall not be punished or subjected to undue consequences, provided the danger is confirmed by the commissioner (of labour)".
Workers MP Dr Sam Lyomoki, who is also the secretary general of the Medical Workers Union had earlier expressed concern over the ill treatment of medics by the government but said withdrawal of medical services to desperate Ebola victims would amount to "treason".
But Dr Nyangasi said "serious measures" had to be taken to re-awaken the government to the raging plight of the few qualified medical personnel who sacrifice a lot to serve the community.
Asked if the directive to the health workers to quit Bundibugyo does not contravene ethics of medical practice, Dr Nyangasi said, "Medical ethics only operate when one is alive. The right to life is absolute and superior and carries higher priority than professional etiquette".
Dr Sam Zaramba, the director general for health services said the recall of devoted medics in Bundibugyo was "demoralising and unfortunate".
"We do not force any health worker to work in the isolation ward (for Ebola patients). It is quite unfortunate that he (Nyangasi) is giving the instructions (of withdrawal) without discussing it with us (the Ministry of health)".
Yesterday, a section of doctors working at Mulago hospital voiced displeasure at reports that top Health officials are scheduled for an expensive retreat at the luxurious Mweya Safari Lodge in Queen Elizabeth National Park in Kasese next week largely to review work methods and discuss new targets instead of advancing those funds for handling Ebola management.
In an independent assessment, Dr Christopher Orach, the head of community health and behavioural sciences at the Makerere University Institute of Public Health yesterday challenged the Health officials to intensify surveillance because they could be countless unreported or hidden Ebola cases in the countryside.
"Community mobilisers should be trained and empowered to reach out to all areas. They should follow up all those who came into contact with (Ebola victims) for 21 days. Effective clinical case management should also be put in place and health facilities or hospitals should have isolated treatment centres and camps," said Dr Orach.
DR Congo acts
As the Ministry of health reported yesterday that the unfolding Ebola epidemic had killed a total of 22 people out of 93 suspected cases, authorities in the DR Congo slapped a travel embargo at the common border with Bundibugyo district; the epicentre of Ebola.
Sambire Wamukoka, the chief of Watalinga territory in the DRC issued the directive on Wednesday and put soldiers on standby to ensure that no Ugandan uses the Buranga/Busunga border posts to enters Congo and no Congolese crosses over to Butogo and Mahuka markets on the Ugandan side.
Ministry officials said there were a total of 38 patients admitted at medical facilities; 23 at Bundibugyo hospital and 15 at Kikyo health centre.
Mbale suspect
By press time, a team of epidemiologists from Kampala was reported to be heading to eastern Uganda to investigate reports that Ms Olive Mukite, the district information officer of Sironko died yesterday of suspected Ebola infection at Mbale referral hospital.
This follows reports of alert cases in Mbarara, Kabarole, Mubende and Kanungu; where 20-year-old Ivan Asimwe died yesterday.
Earlier, Dr Zaramba said he had drafted a memorandum highlighting the key issues and Shs6b budget details and Prime minister Apollo Nsibambi is scheduled to chair a special cabinet meeting today to address the exploding epidemic. Additional reporting by AGNES NANDUTU

http://www.reliefweb.int/rw/RWB.NSF/db900SID/SHES-79MSVF?OpenDocument

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[HenryN]

Re: New Ebola Strain in Uganda Spreading - Death toll rising

Commentary at

http://www.recombinomics.com/News/12060703/Ebola_Uganda_Spread_East.html