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  • #16
    Re: Uganda: Hemorrhagic fever outbreak- 13 dead

    I think this source and the one above it may be inaccurate sources (neither is based in Uganda, and both contradict Dr. Malinga in post #9). The statement in bold below is impossible to know; there is not sufficient lab facilities in Uganda (nor the time) to exclude all known agents. I think it is a poor paraphrasing of Dr. Okech's quote (from post #1) that Ebola, Marburg, and Lassa, the three most well-known VHF agents, were excluded.

    I think both sources are quoting the source at (http://www.globalpost.com/dispatch/a...disease-uganda).

    http://pidnews.com/?p=7830

    New hemorrhagic disease emerges in Africa
    According to Emmanuel Okech, an official from the Abim District Health Office, test results are in, and the mystery illness is NOT caused by any known agent. Samples have been flown to the CDC in Atlanta. — PID

    KAMPALA, Uganda (GLOBAL POST) — Thirteen people have died in northeastern Uganda from a mysterious disease.

    The World Health Organization and the Centers for Disease Control are investigating the outbreak of the disease that appears to be similar to the Ebola and Marburg hemorrhagic viruses.

    via Ebola virus

    Comment


    • #17
      Re: Uganda: Unidentified outbreak- 13 dead - Amoebic dysentery suspected

      It is possible that the original symptomatic description was slightly off, as the illness may have been similiar enough to VHF (fever, bloody diarrhea, high fatality rate), that other symptoms may have been reported (bleeding out other orifices, etc.) by people who suspected the outbreak might be due to Ebola. It is mildly unusual that Ebola and Marburg were tested for and excluded before many more common illnesses. Also of note is we have no idea the time frame of this outbreak. The case counts might still be incorrect, as we have reports of about a 40% CFR in Abim, but reports only inidicate the five fatal cases in Agago.

      We will see what else develops; the New Vision source (www.newvision.co.ug) that has had the three most informative articles went to press today without mention of this outbreak.

      http://eafr.promedmail.org/

      Published Date: 2010-11-19 11:36:44
      Subject: PRO/EAFR> Undiagnosed deaths, human - Uganda (03): dysentery susp.
      Archive Number: 20101119.215350

      UNDIAGNOSED DEATHS, HUMAN - UGANDA (03): (AGAGO, ABIM) DYSENTERY SUSPECTED
      ************************************************** ************************




      Date: Thu 18 Nov 2010
      Source: New Vision (Uganda) [edited]
      http://www.newvision.co.ug/D/8/13/738633


      Abim deaths due to dysentery
      ----------------------------
      Preliminary laboratory tests done by the Ministry of Health have revealed that the disease that killed 13 people in northeastern Uganda is dysentery.

      "We have been investigating the deaths and we now know that this is amoebic dysentery. We are continuing with more tests," the ministry publicist, Paul Kaggwa, told New Vision. "We are carrying out 'culture and sensitivity tests' to know more about the disease we are dealing with," he added.

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

      Dysentery, formerly known as bloody flux, is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhoea containing mucus and blood. Exposed individuals may
      experience either mild, severe, or even no symptoms. In extreme cases, doctors say, dysentery patients may pass over a litre of fluid an hour. More often, individuals will complain of nausea, abdominal pain, rectal pain, and fever. Dysentery patients sometimes also experience vomiting, rapid weight loss, and generalised muscle aches.

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

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

      The health minister, Stephen Mallinga, said the ministry would do its best to control the spread of the disease. "It is containable. We just need to sensitise the people about hygiene, like using
      latrines," he added.

      Official figures show that latrine coverage in Karamoja is at 4 percent, implying that 96 percent of the Karimojong ease themselves in the bush.

      More so, only 3 out of 10 families have access to safe water, and that about 82 percent of Karimojong live below the poverty line.

      When the disease broke out, it created fear and anxiety in the districts of Agago and Abim because the health ministry could not ascertain that it was dysentery.

      Reports from both districts show that no more people have contracted the disease. Only 2 patients were still isolated.

      [Byline: Conan Businge]

      --
      Communicated by:
      ProMED-EAFR


      [Amoebiasis is an infection caused by the protozoal organism
      _Entamoeba histolytica_, which can cause colitis and other extraintestinal manifestations, including liver abscess (most common) and pleuropulmonary, cardiac, and cerebral dissemination. _E
      histolytica_ is transmitted primarily through the fecal-oral route. Infective cysts can be found in fecally contaminated food and water supplies and contaminated hands of food handlers. Sexual transmission is possible, especially in the setting of oral-anal practices
      .

      Amoebic colitis presents with bloody diarrhea of gradual onset, abdominal pain, and tenderness spanning several weeks' duration. Fever occurs in 10-30 percent of the patients. The disease is more
      common in children especially those who are undernourished.

      The cases in Abim and Agago have been reported to have high grade fever, vomit blood, pass bloody stools, and bleed from other openings with rapid progression to death in 3 to 5 days if no treatment is given. This rapid progression of the illness is not typical of amoebic dysentery. It would be interesting to determine the age-group affected in this outbreak as children are more predisposed to the severe and fatal types of amoebic dysentery. Due to the high burden of infectious diseases in developing countries, it is common to have mixed infections among diseased individuals. It is therefore important that extended investigations are conducted to identify other possible causes of the current outbreak since the case presentation here seems to suggest other co-infections in addition to amoebiasis.

      The clinical presentation including bleeding from other orifices is unusual in amoebic dysentery. Given the environment in which this outbreak is located, it would be important to also investigate for other causes of dysentery - Mod. BE]

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

      Comment


      • #18
        Re: Uganda: Hemorrhagic fever outbreak- 13 dead

        Originally posted by sharon sanders View Post
        From: FluTrackers <flutrackers@earthlink.net></flutrackers@earthlink.net>
        To: ProMed

        Subject: Uganda - 13 Abim deaths due to dysentery
        Date: Nov 19, 2010 12:21 PM

        I have taken the site off daylight savings time. None of the time stamps were corresponding. lol



        </promed@promedmail.org>
        "May the long time sun
        Shine upon you,
        All love surround you,
        And the pure light within you
        Guide your way on."

        "Where your talents and the needs of the world cross, lies your calling."
        Aristotle

        “In a gentle way, you can shake the world.”
        Mohandas Gandhi

        Be the light that is within.

        Comment


        • #19
          Re: Uganda: Suspected amoebic dysentery outbreak- 13 dead

          For the fourth consecutive day, no mention of this outbreak in Ugandan press, but we do have this article about poor water quality issues in the area, and a visit from the President of the country to combat this problem. That would seem unlikely with an unknown VHF going around, but makes snese if people are dying of waterborne amoebic dysentery.

          http://www.newvision.co.ug/D/8/12/739046

          Museveni orders Karamoja water probe
          Monday, 22nd November, 2010 E-mail article Print article


          President Yoweri Museveni and his wife Janet arrive at Abim Priamry School for a public rally


          By Cyprian Musoke and Olandason Wanyama

          PRESIDENT Yoweri Museveni has instructed the state minister for Karamoja, Janet Museveni, to probe how the money sent to the region to sink boreholes was used, and report to him.

          Addressing his first rally in Karamoja at Abim Primary School in Abim district yesterday, Museveni said the Government sends a lot of money to the district for water, yet people were still complaining of lack of water.

          Museveni, who is being accompanied in Karamoja by the First Lady, who is also the Ruhaama MP, said he sends an average of sh600m for water to the region annually

          Using sh500m, he added, one can construct 30 boreholes per year at a cost of sh15m per borehole.

          He gave the directive after he invited the chief administrative officer (CAO), Bruno Mwaita, and the RDC to explain how the money was used.

          The CAO endeavored to explain that the district used half a billion shillings sent last year on a gravity scheme that is still under construction in Lotuke, but he was booed by the people, who said they wanted boreholes urgently since their water needs could not wait for the scheme.

          Museveni explained that from the 2009/10 financial year to date, the Government has sent close to sh1.9b to the district for water.

          “My question to the CAO is where are the boreholes? The CAO answered that I shouldn’t kill him, the money is in Lotuke gravity scheme. So you don’t have to worry because Lotuke is not on the moon. The minister for Karamoja is here. After her nomination in Ruhaama, she will find out where that programme is,” Museveni said to thunderous applause.

          Museveni, who arrived in Abim at about 2:00pm in the company of Kampala mayor Nasser Sebaggala and former UPC vice-chairman Badru Wegulo, urged the people not to develop high blood pressure over the water issue, saying he had records of money he had sent, and would cross-check what is on the ground after the elections.

          “If the work on the ground is not adequate, we shall cut off someone’s neck,” he said.

          The President addressed a second rally at Lomukura Primary School in Kotido and appealed to the people to vote for the NRM and all its flag-bearers so that they can continue fulfilling NRM programmes and consolidate the peace they brought.

          The army, he added, had liberated Karamoja from Kony rebels and had now stemmed cattle rustling through the disarmament programme.

          He warned the people against lying politicians, saying they should shun them because NRM rid the country of polio, which other parties that ruled the country before, failed to do.

          “When David Pulkol (former ESO chief) comes here with his lies, tell him to take his polio away because most of you, who are NRM children, have no polio,” Museveni said.

          Abim regional NRM chairperson Janet Okoromoi said unlike other areas, no one in her area had crossed to another party because they are all NRM, as it has been for sometime.

          Museveni said he made Abim a district so that residents could speak their own language, adding that he used to sleep in meetings as they translated from Karimojong, Labwor and Pokot.

          Museveni added that the Prosperity for All programme aimed at increasing household income and that he had remodeled NAADS for that purpose.

          He also added that the Government introduced UPE and USE in 1997, but reminded parents of their responsibility to provide packed lunch and exercise books for their children.

          The people stunned Museveni when he asked them whether they would provide lunch for their children and they responded that it is World Food Programme (WFP) that should continue doing so.

          He asked what they would do if WFP wound up and they told him that he would help them.

          Museveni said he would only do so during drought like the one they are facing.

          “WFP will provide food as long as there is drought. Now that you have got peace, you should be able to give lunch to your children,” he said.

          Museveni promised to construct roads in Karamoja, take electricity there, rehabilitate schools and build health centres at every sub-county.

          Comment


          • #20
            Re: Uganda: Hemorrhagic fever outbreak- 13 dead

            Maybe two outbreaks? Note also the increased death toll, and also the variant/errant spelling "Abima" as the district name.

            Kanungu is in the southwest of the country, near the DRC border, but the possible hemorrhagic outbreaks in Abim and Agago are in the northeast, hundreds of miles away, closer to the Sudan and Kenya borders.

            Also, note that only the first article in this thread indicates that Ebola was excluded. The most recent articles such as the one below don't mention that fact, possibly suggesting that it is incorrect.

            If this article is correct that the death toll has increased from 13 to 16 over the past week, it means that ths timing on this outbreak is likely several weeks or longer, making VHF more likely.

            http://www.ugpulse.com/articles/dail...da+++&ID=16734

            By Mugisa Mathias

            An outbreak of dysentery has been reported in the western district of Kanungu where many people are reported to be affected.
            The disease has been discovered in 12 patients in the sub counties Kihhihi,Ishasha. The kanungu district medical officer Florence Nabahima says is a result of contaminated major water sources in the district.

            Nabahima also suspects the disease could come in from democratic republic of Congo and she says no death has yet been registered yet.

            Menawhile, an outbreak of diseases that looks like that is Ebola has been reported in the northern districts of Agago and Abima.

            The medical workers say victims pass blood stool, vomiting, high temperatures and blood discharge from the nose and other parts of the body and over 16 people have so far been killed by this disease.


            But the Ministry of health is yet to confirm the nature of the disease outbreak.

            Comment


            • #21
              Re: Uganda: Hemorrhagic fever outbreak- 13 dead

              One other fact to keep in mind:

              Uganda's national lab in Kampala is testing for Ebola using kits obtained from the United States CDC. There are at least three known strains of Ebola that could be responsible for this outbreak (Bundibugyo, Zaire, Sudan) given its location. It may be possible that the Kampala lab cannot detect all of them. Alternatively, it may also be possible that the local testing is not good; no Ebola or Marburg cases have ever been confirmed (as far as I am aware) by that lab outside of an externally confirmed outbreak, and no Ebola or Marburg cases with onset later than January 1, 2009 have been confirmed anywhere in the world.

              The situation remains very unclear.

              Comment


              • #22
                Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                This report brings Agago to 10 cases with seven deaths, although if this is dysentery, these would just be the msot severe cases.

                Note that the two fatalities here are not the two quarantined cases from post #1, as those cases were in Abim, and these two are in Agago.



                http://www.newvision.co.ug/D/8/16/739215

                Dysentery kills 2 more in Agago
                Wednesday, 24th November, 2010 E-mail article Print article

                By David Labeja

                TWO more people in Agago district have died of dysentery. This brings the number of people who have died of the disease since the outbreak last month to 15.

                Three other people have been quarantined at Kalongo after presenting symptoms of the disease.

                The district health officer, Dr Emmanuel Otto, said the two people, who had been quarantined at Dr Ambrossoli Hospital in Kalongo town council, died over the weekend.

                “All the five victims are from Paimol sub-county, which borders Abim district,” Otto said.

                Last week, 13 people died of the disease, five from Paimol and Omiya P’Chua sub-counties in Agago district and eight from the neighbouring Abim district, where the disease is said to have originated.

                The health ministry spokesman, Paul Kaggwa, recently said preliminary laboratory tests revealed that the disease was dysentery.

                “We are collecting samples from victims and their relatives. We want to get the facts on the ground,” Otto said.

                He said the ministry, together with officials from the World Health Organisation, was closely monitoring the conditions of the quarantined patients.

                Otto said they had also taken blood samples from people close to the patients.

                The district health team has urged residents to desist from congregating for funerals and ensure a speedy burial of the victims.

                Residents have also been warned against eating wild game.

                Traditionally, communities of Paimol and Omiya P’Chua sub-counties are hunters since they live close to mountain ranges with a variety of wild animals.
                Last edited by sharon sanders; December 2nd, 2010, 10:40 PM. Reason: edit

                Comment


                • #23
                  Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                  A bit about the hospital where the three ill patients in Agago are quarantined:

                  http://www.viasarfatti25.unibocconi....php?PassRub=12

                  The hospital, now a private non-profit organization, was founded in 1957 by Father Joseph Ambrosoli surgeon and Comboni missionary who devoted himself to the care of the Ugandan population. Kalongo is located in northern Uganda, the Acholi tribe's territory, an extremely poor, with few roads and no developed centers. The hospital now provides health care to about 50,000 people each year, of which almost half of them children under the age of 5 years, and has 345 beds and 7 units (including maternity, paediatrics, malnutrition, tuberculosis and AIDS). Was formed in 1998 by the Comboni Missionaries and the family of Father Joseph Ambrosoli the Foundation Dr. Ambrosoli Memorial Hospital , which supports the hospital and the St. Mary's School of Midwifery Kalongo.

                  Comment


                  • #24
                    Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                    Transmission to HCW is a bad sign, and spread to Kitgum as well is not good either. November 8th is finally given as the start date of the outbreak, which is a bit more recent than I would have guessed (and may only be the start of the outbreak in Agago - the disease may have hit Abim earlier).

                    The numbers do not quite add up (32 cases so far is only an increase of 2 cases sinces the last report, but the number in isolation has increased to 19 from 3), but that is to be expected at this point (and if the 32 cases are only those in Agago, then it is an increase of 22 cases).

                    Headache is a new reported symptom.

                    http://www.monitor.co.ug/News/Nation...0/-/ckm7v9z/-/

                    Strange disease breaks out in Acholi

                    Posted Monday, November 29 2010 at 14:52

                    A strange disease has hit Kitgum, Abim and Agago districts killing 8 people and infecting dozen others since November 8. A Health Situation Report of November 26, puts accumulative cases of the disease to 32.

                    The disease, which some sources suspect to be the deadly Ebola was reported in Balang Village in Agago District early this month.

                    Other cases were found in Odiyo Village while other cases were reported in in Patongo, in the same district.
                    The National Professional Officer of the World Health Organizationbased in Gulu District, Dr Emmanuel Tenywa said 19 people are currently admitted in an isolation ward at Kalongo Hospital.

                    He said those admitted experience acute diarrhea, vomiting and severe headache.

                    Dr Tenywa said in the report that a health worker at Kolongo Hospital contracted the disease after a suspected patient vomited on her.
                    Last edited by sharon sanders; December 2nd, 2010, 10:41 PM. Reason: edit

                    Comment


                    • #25
                      Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                      Submitted to ProMed again.
                      "May the long time sun
                      Shine upon you,
                      All love surround you,
                      And the pure light within you
                      Guide your way on."

                      "Where your talents and the needs of the world cross, lies your calling."
                      Aristotle

                      “In a gentle way, you can shake the world.”
                      Mohandas Gandhi

                      Be the light that is within.

                      Comment


                      • #26
                        Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                        Google news gives the following description on the following feed, supporting the case counts above, but I can't find the full article.

                        http://epaper.monitor.co.ug/DM/DM/RSSFeed/News.xml

                        The strange disease that broke out in the newly-created Agago District has now killed up to seven people and infecting 18 others in a week

                        ---------

                        The link below has a picture of the article. The text is as much of it as I can make out:

                        http://epaper.monitor.co.ug/DM/DM/20...&ArtId=008_005

                        The strange disease that broke out in the newly-created Agago District has now killed up to seven people and infecting 18 others in a week. The areas most affected by the strange disease that has bloody [illegible] and headache as its signs include Paimol and [illegible] sub-counties, while Kalongo Town Council has also started registering some cases. The infected people have been admitted to Ambrosoli Hospital, Kalongo, and Paimol Health Centre. Stool specimens of the patients is now at the government hospital in Entebbe.

                        Comment


                        • #27
                          Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                          Google maps puts Acholi and Kitgum about 10 miles north of Agago, and about 20 miles northwest of Abim.

                          The latest reports indicate that Agago seems to be the center of the outbreak.

                          Comment


                          • #28
                            Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                            http://www.promedmail.org/pls/apex/f..._ID:1000,86040

                            Archive Number 20101129.4297
                            Published Date 29-NOV-2010
                            Subject PRO/EDR> Undiagnosed disease - Uganda: Acholi, RFI


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

                            Date: Mon 29 Nov 2010
                            Source: The Monitor, via allAfrica.com [edited]
                            <http://allafrica.com/stories/201011291952.html>


                            A strange disease has hit Kitgum, Abim, and Agago districts, killing 8
                            people and infecting a dozen others since Mon 8 Nov 2010. A Health
                            Situation Report of Fri 26 Nov 2010 puts the cumulative number of cases of
                            the disease [at] 32.

                            The disease, which some sources suspect to be the deadly Ebola [hemorrhagic
                            fever], was reported in Balang Village in Agago District early this month
                            [November 2010]. Other cases were found in Odiyo Village, while other cases
                            were reported in Patongo, in the same district.

                            The national professional officer of the World Health Organization based in
                            Gulu District, Dr Emmanuel Tenywa, said 19 people are currently admitted in
                            an isolation ward at Kalongo Hospital. He said those admitted experience
                            acute diarrhea, vomiting, and severe headache.

                            Dr Tenywa said in the report that a health worker at Kolongo Hospital
                            contracted the disease after a suspected patient vomited on her.

                            [byline: Sam Lawino]

                            --
                            communicated by:
                            Thomas James Allen <tjallen@pipeline.com>

                            [The districts of Kitgum, Abim and Agago in the Northern Region of Uganda
                            can be located in the map at
                            <http://en.wikipedia.org/wiki/Districts_of_Uganda>. This region of Uganda
                            is populated mainly by people of the Achol ethnic group and has suffered
                            frequent incursions of refugees from Sudan in the north.

                            In 2008, the region suffered an extensive outbreak of hepatitis E virus
                            infection causing some fatalities (see the ProMED-mail archived reports
                            below). The characteristics of the disease described in the current report
                            are poorly defined but not dissimilar from those experienced by patients in
                            the hepatitis E outbreak. Ebola hemorrhagic fever has been suggested as a
                            possible cause of the outbreak. While not implausible, hemorrhage as a
                            feature of the disease is not mentioned in the press report. Precise
                            information from the region would be welcomed
                            .

                            The HealthMap/ProMED-mail interactive map of Uganda can be accessed at
                            <http://healthmap.org/r/0089>. - Mod.CP]

                            Comment


                            • #29
                              Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                              Not good. Spread to other districts as well.

                              http://www.newvision.co.ug/D/8/13/739715

                              Strange disease spreads to Kitgum
                              Monday, 29th November, 2010 E-mail article Print article

                              By Wokorach-Oboi
                              Anne Mugisa and
                              David Labeja

                              THE mysterious disease affecting Agago and Abim districts has reportedly spread to Kitgum.

                              The health ministry yesterday said the disease had not been identified yet, but medical officers had been giving people “supportive treatment”.

                              Dr. Issa Makumbi, the ministry’s head of disease surveillance, said Entebbe-based Centre for Disease Control was today expected to release results from samples received last week.


                              In the middle of this month, ministry officials, quoting preliminary laboratory results, identified the disease as amoebic dysentery. Yesterday, the ministry put the death toll in Kitgum at five.

                              But Sr. Grace Ogwang, the Kitgum district disease surveillance officer, said eight people died of the disease in Kitgum.

                              This brings the death toll in the three districts to 36.

                              The disease has also reportedly spread to Pader.


                              The Kitgum victims included Robert Salongo, a mechanic.

                              Salongo was hurriedly buried at the Kitgum Hospital cemetery on Sunday under the strict supervision of medical personnel from the World Health Organisation.

                              Ogwang said Salongo travelled to Wol in Agago district a week before his death. He is suspected to have contracted the disease there. Ogwang warned people against getting into contact with the bodies of victims and to avoid handshakes, communal handwashing and sharing of food.
                              Last edited by sharon sanders; December 2nd, 2010, 10:43 PM. Reason: edit

                              Comment


                              • #30
                                Re: Uganda: Hemorrhagic fever outbreak- 16 dead

                                Sent to ProMED again.
                                "May the long time sun
                                Shine upon you,
                                All love surround you,
                                And the pure light within you
                                Guide your way on."

                                "Where your talents and the needs of the world cross, lies your calling."
                                Aristotle

                                “In a gentle way, you can shake the world.”
                                Mohandas Gandhi

                                Be the light that is within.

                                Comment

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