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  • #91
    Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

    Still unclear if there is a respiratory component and if the epidemic has been halted.

    Food for thought
    Research of reported signs, not including respiratory, could be several uncommon diseases caused at point source vs. communicable:

    Gastrointestinal Anthrax
    Vibreo vulnificus (if seafood is in diet)
    Tularemia

    Novel disease potential:

    Zoonotic disease transmission to human (perhaps by ingestion of diseased meat) - African Swine Fever - the disease in pigs is similar in signs/symptoms (except a pig can't tell you it has a headache )

    Any ideas?

    Comment


    • #92
      Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

      Excellent find, Treyfish. There are a lot of bloggers among missionaries in Uganda, and I was trying to find such a blog, but I could not. Keep and eye on that one.

      While symptomatically this is the same as Ebola, the Ebola virus itself has been conclusively ruled out, so some other agent is responsible.

      As to above possiblilites, most of the diseases mentioned above do not spread person-to-person; this likely does (the HCW vomitted upon). This looks like some type of hemorrhagic fever, and the known ones have just about been ruled out.

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      • #93
        Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

        An earlier post from the blog Treyfish found:

        http://chasinguganda.blogspot.com/

        Wednesday, December 1, 2010

        Unknown Illnesses and the Help that Hurts


        Disease


        Ebola. One of the most deadly diseases known to man, with in a week 89% of people die. Itís one of the diseases that I learned about in Miss. Hutchisonís 5th grade biology class, one of those things thatís so rare and deadly that 99% of the people in that young class wouldnít be within 1000 miles of a case in their entire lives. So imagine how excited I was to get this email:


        U.S. Embassy Kampala, Uganda
        Warden Message - November 30, 2010


        Outbreak of Unidentified Illness in Northern Uganda


        Ugandan press are reporting an outbreak of an unknown severe illness in three districts of Northern Uganda, characterized by fever, vomiting and diarrhea. The districts identified as being affected are: Abim (specifically Morulem sub-county), Agago (Omiya PíChua, Adilang and Paimoi sub-counties) and Kitgum (Orum, Namokora and Kitgum Town Council).


        While we are seeking to confirm these details, the U.S. Mission in Kampala and the Centers for Disease Control and Prevention (CDC) office in Uganda recommend U.S. citizens residing and traveling in Uganda minimize their travel to these affected areas until further information becomes available. Non-essential U.S. Government official travel to the three affected areas is presently restricted.


        Kitgum is about 50 kilometers awayÖ Word on the street is that itís either Ebola or Dysentery, thatís right, the Dysentery that your character always died from in Oregon Trail. The Center for Disease Control and the US Department of State websites have yet to mention any thing at all so my level of concern is pretty low. But our group is a little on edge nonetheless, we leave Gulu in about 8 days so our level of possible contact is hopefully pretty low. Wonít stop me from keeping my fingers crossed for this next week for this little outbreak to sputter out. The fact that people here actually have to worry about contracting Ebola is mind-boggling. I was talking to my host mother, Jackie, when I was here last, and she mentioned that a few years back there was an outbreak in Gulu. Apparently the Ugandan government sent troops who had been stationed in the Congo, who were showing signs of the virus, to Northern Uganda to keep them away from the favored south. Almost 100 people died. People may question our government in the US sometimes, but sending infected soldiers to a separate region of the country instead of quarantining them? Thatís a whole new low.

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        • #94
          Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

          Originally posted by alert View Post
          The cases do appear slightly more scattered than an H2H spread would produce, and the rate of cases may have slowed or stopped (or reporting may just have).

          It is difficult to imagine that pneumonia is involved, without any mention of cough, breathlessness, chest pain, etc.; perhaps the word "pneumonia" is an errant translation of "plague".

          It does appear that bacteria may be involved in this, as antibiotics seem to help (especially according to the comments by the EAFR moderator).

          If the case in the Kalongo HCW who was vomitted on has been discarded, a wide variety of poisonings might also be suspect.
          You are correct, the diseases listed for consideration would not be communicable. Based on signs/symptoms, possible abrupt halt to the epidemic and information as provided above, it is possible a point source of poisoning or bacterial disease is possible.

          Has there been any definitive answer to whether the HCW did in fact become ill after contact with body fluids?

          Comment


          • #95
            Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

            another blog story

            "Good News, It's Plague"

            Sunday, December 5, 2010


            This past week, we began filming interviews with medical staff at the government-run Gulu Referral Hospital. While waiting to meet with the head of the hospital's community outreach program, we were hosted by his office-mate, a very congenial public health officer. He brought us across the hall, into another office, which appeared to function more as storage unit these days. We scavenged for places to sit, and he began asking lots of questions about our film and research projects, in particular he wanted to know the specifics of where we intend to work. "Will you be in Kitgum or Pader?"


            "Not anymore," I replied, " since a few weeks ago, we decided to just keep it simple and limit ourselves to Lira and here."

            "Good, that's very good because you may have heard about the strange disease there now. Been killing people. Since about two weeks ago. They get a fever, start coughing blood, and after a few days they die. 30 people so far. Government's keeping it very quiet. Until they know what it is." Then shaking his head, and with a little, soft laugh, "Or, until it's too late. Like always."

            After processing his cautionary words, John, Meredith, and I immediately began darting our eyes back and forth between each other. We were just 7 kilometers from the hospital that battled the most famous Ebola outbreak ever, and now, we were being warned about some mysterious hemorrhagic fever threatening communities in the neighboring districts. We all started blurting out, "Is it Ebola? Is it Marburg? Lassa?" He simply reassured, "They don't know yet." Then his colleague arrived and greeted us one by one. The public health official got up from his chair, and walked around a desk to shake all of our hands one more time. As he was leaving, he said "It was nice to meet you. Good luck with your work."

            We kept short our meeting with the community outreach leader, and scheduled an on-camera interview with him for the next morning. Then the three of us made our way out of the hospital grounds, which actually feels more like an army barracks than a health facility. It's surrounded by a chain linked fence capped with barbed wire and its front gates are patrolled by an armed guard in military attire. As we reached the outside world, we all professed our mutual anxieties from hearing about some deadly disease being hushed from public ears. Was this guy serious? Does this really happen, a government keeping a deadly outbreak secret?

            Just as we were beginning to evaluate these questions, Akra arrived at the hospital gates with the car. We started driving back to the center of town when we spotted our Italian friend Luca at an intersection. He was trying to give directions to a boda boda driver for some arts and crafts store in the neighborhood. We offered him a lift and he gladly accepted. After he squeezed into the back seat, we promptly barraged the young pediatrician with questions about the rumored lethal illness. He quickly responded, "It's all true. We had two cases brought to our hospital this last week, both died. Nobody knows what it is." When we arrived at Luca's destination, we decided to join him for some souvenir shopping. While perusing shelves of minimally designed earthen clay pots, and surveying walls covered in brightly painted canvases depicting rhythmic scenes of village life, we prodded the Italian for any other details he could provide about the mysterious disease. He really didn't have much more to add, but promised to keep us posted on whatever he learns at the hospital. After we finished wading through the local wares, we dropped Luca off at another motorcycle taxi stage and returned to our hotel to log footage before our next appointment at a local radio station.

            Two hours later, while I'm sifting through the morning's interviews for highlights, my cellphone begins to blare its obnoxious techno-ring. It's Luca. I answer. "My friend, good news! It's plague! Pneumonic plague!" A little unsure of what he was saying, I replied with a confused, "What?" "It's not Ebola, it's plague. Results came back. It's good news, at least we can treat this one." "I see. Great news. Thanks."

            Shortly after getting the brief words of comfort from Luca, we had to leave for our next filming engagement. Our filming journey has helped uncover various informal and formal channels through which the local population is able to voice their right to better medical services. One of the more popular informal routes is the radio.

            snip


            Just about every person that we've interviewed so far has referenced the radio as a main source of health rights education or tool for voicing grievances.

            snip

            He warned us in advance, however, that the radio only broadcasts in Acholi. "The language of the people," he stressed. Despite his concern that we wouldn't understand anything he announced on the microphone, we were able to follow his first news report loud and clear. He began, "Pneumonic plague... Kitgum and Pader."


            Fortunately, we head south tomorrow for at least a few weeks. Hopefully, this plague will end its course soon with no more casualties. At least, the whole town is aware of it now.
            http://backinuganda.blogspot.com/201...ts-plague.html
            Last edited by sharon sanders; December 9th, 2010, 12:39 PM. Reason: shortened
            CSI:WORLD http://swineflumagazine.blogspot.com/

            treyfish2004@yahoo.com

            Comment


            • #96
              Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

              Apparently, the figures we have are as of the 3rd; more recent numbers have not been released, but the outbreak is ongoing.

              http://www.bloomberg.com/news/2010-1...killed-38.html

              The ministry as ruled out Ebola, Marburg, Rift Valley, typhoid and Congo Crimean fevers as the source of the illness, which was first reported on Nov. 10. The deaths, which took place up to Dec. 3, are among 91 cases recorded in the six districts in the north. More recent figures arenít available, Kakoza said.

              Comment


              • #97
                Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                Originally posted by Treyfish View Post
                another blog story

                "Good News, It's Plague"


                "Good, that's very good because you may have heard about the strange disease there now. Been killing people. Since about two weeks ago. They get a fever, start coughing blood, and after a few days they die. 30 people so far. Government's keeping it very quiet. Until they know what it is." Then shaking his head, and with a little, soft laugh, "Or, until it's too late. Like always."

                [snip]

                . After he squeezed into the back seat, we promptly barraged the young pediatrician with questions about the rumored lethal illness. He quickly responded, "It's all true. We had two cases brought to our hospital this last week, both died. Nobody knows what it is." http://backinuganda.blogspot.com/2010/12/good-news-its-plague.html[/URL]
                So apparently there have been at least two deaths in Gulu (50 km from Kitgum), indicating more efficient spread then one might expect with most hemorrhagic fevers, possibly indicating some other method of spread in addition to contact with bodily fluids from infected patients. And this is the first report of coughing blood, not vomitting blood.

                Very bad sign....

                Comment


                • #98
                  Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                  Originally posted by curiosity View Post
                  You are correct, the diseases listed for consideration would not be communicable. Based on signs/symptoms, possible abrupt halt to the epidemic and information as provided above, it is possible a point source of poisoning or bacterial disease is possible.

                  Has there been any definitive answer to whether the HCW did in fact become ill after contact with body fluids?
                  I don't think there has been a halt to the epidemic (see Treyfish's blog post above); we just haven't gotten current numbers. We have several articles in this thread that indicate that the female HCW did become ill after being vomitted upon.

                  Whatever this is, it seems to be spreading fairly fast.

                  Comment


                  • #99
                    Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                    Uganda: Un-diagnosed Disease Affected Areas & Cases - as of 06 Dec 2010

                    <!--docTitle--><!--Attention ligne utilis&#233;e pour l'impression--><!--Attention ligne utilis&#233;e pour l'impression-->
                    • Date: 08 Dec 2010<!-- date -->
                    • Type: Complex Emergency<!-- map type -->
                    • Keyword(s): Epidemic; Health<!-- keywords -->
                    • <!-- Acrobat Reader link -->
                    <!--border--><img alt="" width="1" height="1">
                    • Source(s):
                      - United Nations Office for the Coordination of Humanitarian Affairs (OCHA)<!-- sources --> <!-- related docs --><!-- related links -->
                    <!--border--><img alt="" width="1" height="1">

                    <!--body--><!--Attention ligne utilis&#233;e pour l'impression-->

                    http://www.reliefweb.int/rw/rwb.nsf/...nt&rc=1&cc=uga

                    http://www.reliefweb.int/rw/fullmaps...df?OpenElement
                    Last edited by sharon sanders; December 9th, 2010, 12:59 PM. Reason: format
                    CSI:WORLD http://swineflumagazine.blogspot.com/

                    treyfish2004@yahoo.com

                    Comment


                    • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                      St Joseph Hospital, Kitgum, WHO IS and WHAT IS DOING video (http://www.avsi.org, to address inquiry or donations).

                      <object height="390" width="640">


                      <embed src="http://www.youtube.com/v/99nQykOqx-A&hl=it_IT&feature=player_embedded&version=3" type="application/x-shockwave-flash" allowfullscreen="true" allowscriptaccess="always" height="390" width="640"></object>

                      Comment


                      • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                        One report cited that they had come up with an effective treatment. Can we keep an eye out for any mentions of what they are attempting to treat this with? That may provide some answers..

                        Comment


                        • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                          Originally posted by Vibrant62 View Post
                          One report cited that they had come up with an effective treatment. Can we keep an eye out for any mentions of what they are attempting to treat this with? That may provide some answers..
                          Apparently they are treating this with antibiotics, which might suggest a bacterial cause:

                          http://eafr.promedmail.org/

                          Additionally and from reliable information, people who presented early to health facilities in the affected areas recovered and were sent home after treatment with quinolones and aminoglycoside antibiotics an indication of the bacterial rather than viral nature of the disease. - Mod BE

                          Comment


                          • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                            I suggest interested people may ask for further information to the field NGO:

                            Medici con l'Africa Cuamm

                            via S. Francesco 126
                            35121 Padova

                            Phone:
                            0039 049 8751279
                            0039 049 8751649
                            fax 0039 049 8754738
                            cuamm@cuamm.org

                            The site is owned by Missionary Physician for Africa (CUAMM) a renowned organization based in Padua, present in the region with several missions.

                            Comment


                            • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                              As of December 6th, Kitgum was apparently at 20 cases, 9 deaths (2 new cases since the 2nd), Abim is 27 cases, 12 deaths, and Agago is 37 cases, 10 deaths, for a total of 84 cases and 31 deaths in those three districts. The rest of the deaths are apparently in Gulu, Pader, and Lamwo (not shown on map). So two of the worst affected regions did not report a new case during the four-day period (and Abim, at 27 cases, has apparently only had seven new cases since the November 15th report). No clue as to how many of the non-fatal cases were still ill.

                              There is also a symptom frequency that indicates that things like convulsions, dizziness, and other neurological symptoms mentioned above have been relatively rare. The most common symptoms are headache, fever, and various forms of bleeding (vomitting blood, bloody diarrhea, nosebleed, hemorrhage). In particular, 100&#37; of the cases in Kitgum have had some kind of hemorrhage.

                              http://www.reliefweb.int/rw/fullmaps...df?OpenElement

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                              • Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill- officials say pneumonic plague or pneumonia

                                The WHO Representative to Uganda is Dr Joaquim Saweka

                                Uganda
                                The WHO Representative
                                Plot 4, Nile Avenue
                                PO Box 24578 Kampala
                                Tel: (256) 414 335500 / 31 262071
                                Fax: (256) 414 335569 /41 34 40 59
                                E-mail:<SCRIPT language=JavaScript type=text/javascript>/*<![CDATA[*/var prefix='&#109;a'+'i&#108;'+'&#116;o';var path='hr'+'ef'+'=';var addy3348='r&#101;g&#97;fr&#111;'+'&#64;';addy3348= addy3348+'&#97;fr&#111;'+'&#46;'+'wh&#111;'+'&#46; '+'&#105;nt';document.write('<a '+path+'\''+prefix+':'+addy3348+'\'>');document.wr ite(addy3348);document.write('<\/a>');/*]]>*/</SCRIPT>
                                regafro@afro.who.int<SCRIPT language=JavaScript type=text/javascript>/*<![CDATA[*/document.write('<span style=\'display: none;\'>');/*]]>*/</SCRIPT> This e-mail address is being protected from spambots. You need JavaScript enabled to view it<SCRIPT language=JavaScript type=text/javascript>/*<![CDATA[*/document.write('</');document.write('span>');/*]]>*/</SCRIPT> http://www.afro.who.int/en/uganda/contacts.html
                                CSI:WORLD http://swineflumagazine.blogspot.com/

                                treyfish2004@yahoo.com

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