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Ebola in Uganda: November 30 - December 17, 2007

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

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

Va. Physician Confronts Ebola, Buries Best Friend


POSTED: 11:59 am EST December 7, 2007
UPDATED: 12:12 pm EST December 7, 2007


<SCRIPT src="/js/13260191/script.js" type=text/javascript></SCRIPT><LINK href="/css/13260803/style.css" type=text/css rel=stylesheet><!--startindex-->KAMPALA, Uganda -- For more than a week, Dr. Scott Myhre didn't take any special precautions when treating the listless patients who were flocking to his hospital in western Uganda.
Only now does the American physician from northern Virginia know the risk he took. The patients were suffering from a new strain of Ebola, a highly contagious disease that has already killed 22 people, including four health workers, among them a doctor Myhre counted as his best friend.
"I'm not in the clear yet but I'm hopeful," Myhre told The Associated Press by telephone from Bundibugyo Hospital, which is at the epicenter of the outbreak. Myhre, who has lived in Uganda for 14 years, must wait 21 days from his last unprotected contact with an Ebola patient to be declared clear of the disease.
For now, he is studiously following the recommended precautions: gowns, gloves, goggles, masks and boots.
Ebola typically kills most of those it strikes through massive blood loss, and has no cure or treatment. It is spread through direct contact with the blood or secretions of an infected person, or objects that have been contaminated with infected secretions.
Friday, the Ministry of Health said there were 101 suspected cases of Ebola in Bundibugyo district and 22 deaths.
Doctors and nurses did not at first know what they were facing, so they failed to protect themselves. Experts say the Ebola subtype that sparked the outbreak is new and the classic Ebola symptoms were not always present, slowing diagnosis. The outbreak began on Aug. 20, but the disease was not confirmed as Ebola until Nov. 29.
Since the confirmation, health workers have fled the job in Bundibugyo.
Hospital officials have been urging staff to return, to little avail. Meanwhile, the 100-bed hospital is trying to discharge all non-emergency patients and is operating very limited services.
"Many of the staff are not coming in but there aren't many patients either," said Myhre, who is from Vienna, Va. "The hospital is pretty much empty except for the isolation ward where the Ebola patients are being treated."
The ward houses 24 patients -- some of whom are on mattresses on the floor -- and is separated from the rest of the hospital by an orange mesh fence. Ebola is not airborne so the fence is designed to stop people wandering in accidentally.
Two teams including infection control doctors from the World Health Organization and the United States' Centers for Disease Control and Prevention, recently arrived in Uganda to help local officials contain the outbreak. In previous Ebola outbreaks, the virus has often spread in health care centers where doctors and nurses are not properly protected.
Everyday operations at Bundibugyo Hospital are difficult at the best of times. The area -- remote even by Ugandan standards -- has no electricity. The hospital owns a powerful generator but the cost of fuel prohibits its use for more than a few hours daily. Solar panels provide lighting, and the wards have concrete floors and paint peeling off the walls.
Doctors attending Ebola patients are now being paid a daily risk allowance of $23, while nurses and auxiliary staff are getting $17 and $12 -- up to twice what they normally receive.
"It is difficult to be with the patients sometimes, there is a lot of emotional pressure and a lot of hard work to be done," said David Kasumba, a nurse who has worked at the hospital for 12 years. "The patients are scared. We try to reassure them but it doesn't always work. They have seen what it can do."

http://www.nbc4.com/print/14798710/detail.html
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Nation on Ebola alert
TABU BUTAGIRA,HUSSEIN BOGERE &JOSEPH MUGISA
Virus spreads to seven more districts
Cabinet approves Shs6 billion for epidemics
Deaths at 22 out of 101 cases, no state of emergency

KAMPALA/BUNDIBUGYO
THE government yesterday announced that suspected cases of the lethal Ebola hemorrhagic fever have been reported in seven more districts.
State Minister for Primary Healthcare, Dr Emmanuel Otaala said eight sporadic alert cases have been registered in the districts of Adjumani in West Nile, Mbale in the east, Masaka and Mubende in Buganda region and Kasese, Fort Portal (Kabarole) and Kanungu in western Uganda; implying the whole country is now under Ebola siege. <TABLE cellSpacing=5 cellPadding=0 width=250 align=right border=0><TBODY><TR><TD class=caption>
cover1_4.jpg
CAREFUL: A nurse attends to a patient at Mulago Hospital yesterday. Photo by Samuel Nalwala
</TD></TR></TBODY></TABLE>
The case in Adjumani involves a UPDF soldier who couldn't easily be identified. But Dr Otaala said :"Alert cases do not necessarily mean they are (confirmed) cases of Ebola but they ring a bell in our minds that there is something to investigate," the minister said.
Dr Otaala said reported Ebola infections countrywide since August had surged to 101 while deaths from the virulent disease stagnated at 22.
The Cabinet in an emergency sitting chaired by Prime Minister Apollo Nsibambi yesterday approved Shs6 billion to handle the spate of Ebola, plague, meningococcal meningitis, suspected cholera and yellow fever/Hepatitis A epidemics currently ravaging different parts of the country.
But as Ebola threatens to engulf the whole country, acting government spokesman Dr. James Nsaba Buturo said cabinet threw out pleas by lawmakers on Thursday that a state of emergency be urgently declared to draw international attention to the exploding incurable hemorrhagic fever.
"The work (declaration of) state of emergency is not in our vocabulary because we (government) are on top of things (containing the epidemic)," Dr Buturo said.
But it emerged yesterday that Mr Moses Natukunda, a guard with Delta Security suspected to be ill with Ebola was on Thursday night admitted to Mulago Isolation Ward; the same unit where Kikyo Health centre IV Medical Superintendent Dr. Jonah Kule died of the viral hemorrhagic fever three days ago.
"He (Natukunda) was brought in by his employers, Delta Security, after vomiting and passing out blood," Dr Ayati Omoruto, a community health officer at Mulago Hospital said.
A group of Kyambogo University students who had moved to attend a funeral of a relative in the Ebola hit western Uganda have caused a scare at the campus, forcing Ministry of Health officials to put them under medical observation.
The Director General of Health services, Sam Zaramba said an elaborate surveillance network had been established to trace prior contacts of all victims and now a total of 338 persons are being monitored to establish if they are in gestation period of the contagion.
President Yoweri Museveni, while speaking at the on-going Kampala City of God Crusade at Kololo Airstrip on Thursday warned Ugandans to wave but not shake hands while greeting.
Minister Otaala, himself a medical doctor, told a media briefing yesterday that cabinet had established a new Emergency Fund to be under the docket of the Ministry of Disaster Preparedness to which the Treasury will annually allocate money to cater for epidemic control.
He said the Cabinet had also directed that the risk allowance for health workers battling Ebola, be increased from the Sh20, 000 - 40, 000 to a higher figure that is yet to be established.
Dr Otaala said the government would expedite compensation payment to the families of the six medics who died while treating Ebola patients and ensure full protection for volunteer doctors and nurses in the Ebola zone so that none contracts the killer fever again.
"I am going to write to the Mufti (Sheik Shaban Mubajje) to inform his subjects; the Muslims not to wash dead bodies and the corpses should instead be put in bags and buried immediately by trained health workers," Dr Otaala said.
In Bundibugyo; the epicentre of the epidemic, anxious and panic stricken residents have resorted to using an unnamed local medicinal plant, which they deem to be effective in treating Ebola.
The Ministry of Health says there were a total of 39 admissions of suspected Ebola cases at Bundibugyo hospital and Kikyo health centre IV.
"On a positive note three people who were admitted are ready for discharge. Of the three, two are in Bundibugyo Hospital and one in Kikyo Isolation Unit," the ministry statement said.
The known symptoms of Ebola include; sudden onset of high fever, diarrhoea, vomiting associated with red eyes and a measles-like rash.
The disease is spread through contact with body fluids of infected persons or people who have died of Ebola. Anybody handling suspected cases must use appropriate protective wear including masks, gowns, gumboots and gloves and afterwards wash hands with Jik detergent. Daily Monitor will keep the public informed of any new developments.
In Kampala major hospitals and health centres have taken precautionary measures to stem the spread of Ebola. All major hospitals have set up isolation units from where they can refer cases to Mulago Hospital. Hospital workers and community leaders are also being educated on the early warning practices.
Kampala City Council Health Director Mesach Mubiru says nurses from all the 10 KCC clinics in the five divisions have been trained to identify and handle suspected Ebola cases .
Travelers have been advised to avoid, if possible the western districts of Bundibugyo, Fort Portal and Kasese.
According to the National chairman of the Uganda Taxi Operators and Drivers Association, Mr John Ndyomugyenyi, drivers and passengers alike have been alerted about a possible spread of the epidemic.
But in the city's numerous slums, little effort has been made to educate the people about the epidemic. In Katanga slum, at Wandegeya, residents have not taken any precautionary step against the epidemic.
Even with Katanga?s high concentration of people, the leadership here says the dwellers have not yet received any sensitisation on Ebola. Mr Ssekadebe Karugaba, the LC 1 chairman in Katanga said the biggest problem is in educating the population about the disease and how it is transmitted.
Mr Karugaba says business is still going on as usual and communal drinking of local brew where people share tubes is still practiced.
This kind of drinking exposes people to the disease because Ebola can also be transmitted through fluids like saliva.
Ms Florence Namubiru ,a local brew seller in this slum says the Ebola scare has not yet affected her business because customers are still coming in. "People still come to my bar," she says.
Additional reporting by grace natabaalo, EVELYN LIRRI
& JANE NAFULA


http://www.monitor.co.ug/artman/publish/news/Nation_on_Ebola_alert.shtml
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Healing, or nearly ready for discharge: 4 in Bundibugyo, 2 in Kikyo, plus Dr. Sessanga who has essentially discharged himself from his self-imposed isolation. Scott saw him today and took a lab tech to get his blood sample for the CDC. This is hopeful. People do recover. One of the epidemiologists said she counts only 4 deaths among 18 admissions, which is less than a quarter, similar to the deaths among the confirmed positive lab samples in the original batch that led to the identification of the epidemic (2 of 8).
http://paradoxuganda.blogspot.com/2007/12/ebola-bundibugyo-friday-numbers.html
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Ebola haemorrhagic fever in Uganda - update

7 December 2007

The number of suspected cases of Ebola haemorrhagic fever in the Bundibugyo District of western Uganda has now risen to 93, including 22 fatalities. Laboratory analysis has confirmed the presence of a new species of the virus in 9 of these cases. Four health care workers are among the fatalities. Five sub-counties of Bundibugyo District are affected with a total population of approximately 250,000.

So far, a total of 327 contacts have been identified. Tracing and follow-up of these contacts is being performed with the involvement of Village Health Teams and Community Medicine Distributors.

Specimens from suspected cases are being collected and referred for confirmation as part of intensive surveillance activities. Laboratory experts from the Centers for Disease Control and Prevention (CDC), Atlanta, are providing support to the Uganda Virus Research Institute in diagnosis and analysis of samples.

Isolation wards have been established at hospitals in Kikyo and Bundigugyo, and training provided for health care workers and auxiliary staff in appropriate triage and infection control measures. Teams are being trained in safe burial practices. Additional peer and social support is being offered to staff at the two hospitals.

Agencies in the field, including UNICEF, Médecins Sans Frontières and WHO, are providing support to the health authorities with logistics and provision of drugs and Personal Protection Equipment. The Ministry of Health and IFRC are conducting intensive social mobilization activities, including the use of radio broadcasts and mobile film vans to reach at-risk communities. Fact sheets, brochures and posters are also being distributed.

Ecological studies into the new species of Ebola that has been detected in this outbreak are also being planned.

WHO advises that there is no indication for restrictions on travel or trade with Uganda.

http://www.who.int/csr/don/2007_12_07/en/
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

US Doctor in Uganda Confronts Ebola

By KATY POWNALL

KAMPALA, Uganda (AP) — For more than a week, Dr. Scott Myhre didn't wear a mask or other protective gear when treating the listless patients who were flocking to his hospital in western Uganda.

Only now does the American physician know the risk he took. The patients were suffering from a new strain of Ebola, a highly contagious disease that has already killed 22 people, including four health workers, among them a doctor Myhre counted as his best friend.

"I'm not in the clear yet, but I'm hopeful," Myhre told The Associated Press by telephone from Bundibugyo Hospital, which is at the epicenter of the outbreak. Myhre, who has lived in Uganda for 14 years, must wait 21 days from his last unprotected contact with an Ebola patient to be declared clear of the disease.

For now, he is studiously following the recommended precautions: gowns, gloves, goggles, masks and boots.

Ebola typically kills most of those it strikes through massive blood loss, and has no cure or treatment. It is spread through direct contact with the blood or secretions of an infected person, or objects that have been contaminated with infected secretions.

On Friday, the Ministry of Health said there are 101 suspected cases of Ebola in Bundibugyo district and 22 victims have died.

Doctors and nurses did not at first know what they were facing, so failed to protect themselves. Experts say the Ebola subtype that sparked the outbreak is new and the classic Ebola symptoms were not always present, slowing diagnosis. The outbreak began on Aug. 20, but the disease was not confirmed as Ebola until Nov. 29.

Since the confirmation, health workers have fled their jobs in Bundibugyo.

Hospital officials have been urging staff to return, to little avail. Meanwhile, the 100-bed hospital is trying to discharge all non-emergency patients and is operating very limited services.

"Many of the staff are not coming in but there aren't many patients either," said Myhre, of Vienna, Va. "The hospital is pretty much empty except for the isolation ward where the Ebola patients are being treated."

The ward houses 24 patients — some of whom are on mattresses on the floor — and is separated from the rest of the hospital by an orange mesh fence. Ebola is not airborne so the fence is designed to stop people from wandering in accidentally.

Two teams, including infection control doctors from the World Health Organization and the United States' Centers for Disease Control and Prevention, recently arrived in Uganda to help local officials contain the outbreak. In previous Ebola outbreaks, the virus has often spread in health care centers where doctors and nurses are not properly protected.

Everyday operations at Bundibugyo Hospital are difficult at the best of times. The area — remote even by Ugandan standards — has no electricity. The hospital owns a powerful generator but the cost of fuel prohibits its use for more than a few hours daily. Solar panels provide lighting, and the wards have concrete floors and paint peeling off the walls.

Doctors attending Ebola patients are now being paid a daily risk allowance of $23, while nurses and auxiliary staff are getting $17 and $12 respectively — up to twice what they normally receive.

"It is difficult to be with the patients sometimes, there is a lot of emotional pressure and a lot of hard work to be done," said David Kasumba, a nurse who has worked at the hospital for 12 years. "The patients are scared. We try to reassure them, but it doesn't always work. They have seen what it can do."

http://ap.google.com/article/ALeqM5h8nLHUlhDiLlgAafCb9-w_9Nki5QD8TCPQK80
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

EBOLA HEMORRHAGIC FEVER - UGANDA (07): (BUNDIBUGYO), WHO
*******************************************************
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: Fri 7 Dec 2007
Source: World Health Organisation (WHO), CSR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2007_12_07/en/index.html>


Ebola haemorrhagic fever in Uganda - WHO Update
---------------------------------------------------------
As of Fri 7 Dec 3007, the number of suspected cases of Ebola
haemorrhagic fever in the Bundibugyo District of western Uganda has
now risen to 93, including 22 fatalities. Laboratory analysis has
confirmed the presence of a new species [see comment below] of the
virus in 9 of these cases. A total of 4 health care workers are among
the fatalities. A total of 5 sub-counties of Bundibugyo District are
affected with a total population of approximately 250 000.

So far, a total of 327 contacts have been identified. Tracing and
follow-up of these contacts is being performed with the involvement
of Village Health Teams and Community Medicine Distributors.
Specimens from suspected cases are being collected and referred for
confirmation as part of intensive surveillance activities. Laboratory
experts from the Centers for Disease Control and Prevention (CDC),
Atlanta, are providing support to the Uganda Virus Research Institute
in diagnosis and analysis of samples.

Isolation wards have been established at hospitals in Kikyo and
Bundibugyo, and training provided for health care workers and
auxiliary staff in appropriate triage and infection control measures.
Teams are being trained in safe burial practices. Additional peer and
social support is being offered to staff at the 2 hospitals. Agencies
in the field, including UNICEF, Medecins Sans Frontieres and WHO, are
providing support to the health authorities with logistics and
provision of drugs and Personal Protection Equipment. The Ministry of
Health and IFRC are conducting intensive social mobilization
activities, including the use of radio broadcasts and mobile film
vans to reach at-risk communities. Fact sheets, brochures and posters
are also being distributed.

Ecological studies into the new species of Ebola [virus] that has
been detected in this outbreak are also being planned.
WHO advises that there is no indication for restrictions on travel or
trade with Uganda.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[The numbers of confirmed cases and fatalities are similar to those
reported in the previous report from Uganda dated Thu 6 Dec 2007.

The ranking of this new Ebola virus as a new virus species (rather
than as a new strain or new subtype) is premature. A decision on the
taxonomic status of the Ebola virus responsible for the current
outbreak in Uganda must await further characterization and
determination of the complete genome sequence.

ProMED-mail thanks Coulibaly Sidi for provision of the same report. - Mod.CP]
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Ebola toll in Uganda rises to 23: health official


KAMPALA (AFP) — An Ebola patient died in western Uganda on Friday, bringing the toll to 23, an official said, amid fears that the virulent strain had spread to the eastern part of the country.

The patient died in Bundibugyo district, the outbreak's epicentre where hundreds are under observation for possible infection, said Sam Okware, a health ministry official heading the battle against the disease.

"So far the strain has infected 104, of which 23 have died," Okware said, adding that signs of the deadly microbe, which first surfaced in Bundibugyo in September, had appeared near Lake Victoria and the near the Kenyan border in the country's eastern region.

"We are investigating cases in Mbale (near the Kenyan border), where one man has died and in Masaka (near Lake Victoria), where two fishermen have symptoms similar to those of Ebola," he added.

The health ministry said teams were also probing cases in western Kanungu and Kasese districts and northwestern Adjuman district for possible Ebola infections.

Spread by body fluids, the blood-borne disease, Ebola 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.

In the previous outbreaks, the disease struck with initial ferocity causing massive fatalities then faded away months later without a leaving hint where it came from.

Because of its scanty history, scientists have concluded that the strain is somewhat containable because it kills its victims faster that it can spread to new hosts.

http://afp.google.com/article/ALeqM5j7CeRa2i9clq58rvQ1fm88Ka8Rxw
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Ebola - Country On High Alert


The Monitor (Kampala)

NEWS
8 December 2007 </B>
Posted to the web 7 December 2007

By Isaac Mufumba, David Mafabi, Alfred Tumushabe, Joseph Mugisa, Francis Mugerwa, Samuel O. Egadu & Felix Warom


Health workers across the country have been put on high alert as the government struggles to contain the spread of the deadly Ebola epidemic.
The disease was officially first reported in the western border district of Bundibugyo a week ago.
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</TD></TR></TBODY></TABLE>​
With suspected cases of Ebola reported in the eastern district of Mbale, medical authorities across the country are taking precautionary measures to stem the epidemic.
Eastern:
According to district health officials from Jinja, Kamuli, Iganga, Mayuge the major hospitals in those districts have neither equipment nor facilities to handle an Ebola outbreak. Already, there is a suspect death in Mbale.
Dr Benon Wanume, the Medical Superintendent of Jinja Hospital, told Daily Monitor that the facility is not equipped to handle an outbreak. "We have some protective gear, but we cannot say that we are prepared for an outbreak. We have put in a request to the national task force so that we have some more protective gear and detergents," he said.
The plan, according to Dr Wanume, is to either turn the outpatients department or a tent into an isolation ward if there is any outbreak. ,Jinja District authorities are set to meet up with officials from the health department and the hospital to map out a strategy of dealing with a possible outbreak.
Iganga's situation is even more saddening. The district, according to its Director for Health Services, Dr David Muwanguzi, does not only lack the requisite protective gear but also updated information on Ebola.
"We are just sensitising people about the disease," he said "using old films that were used in the past". The Ministry of Health was expected to have delivered protective gear and detergents, by yesterday, although the district has no isolation unit.
In the neighbouring Bugiri District, plans are underway to sensitise the public on Ebola, according to Dr Stephen Kirya, the district's Director for Health Services.Protective gear will be requested for, Dr Kirya said, when the Ebola problem arises.
Just like the other districts in the region, Kamuli neither has enough protected gear nor an isolation ward. "We have only started an awareness campaign to update health workers and the community about the virus," Dr Bakari Tigawalan, the DDHS said.
In Mayuge, the DDHS, Dr Isiko indicated that although protective equipment and detergents like JIK are available, the district is yet to carry out sensitisation campaigns and to identify an area that can be turned into an isolation centre.
However in Mbale where a suspected fatal case has been reported pending confirmation, plans have been put in place at the regional referral hospital. "We have informed staff at all our inlets; Out Patients Clinic, Acute Care Unit [children ward] and labour ward to begin wearing protective gear like gum boots, surgical gloves, head protectors [masks] when treating any patient," the Hospital Principal Administartor, Mr Henry Lwigale said.
He said they are also taking notes of the history of the patient, which palces they have been to in the last one week.
The Mbale District Health Officer, Dr Francis Obwaimo, when contacted for a comment, seemed unaware of what was taking place in the region.
"About readiness on Ebola, I don't know, I have no update maybe ring me next week," aid Dr Obwaimo.
In Manafwa District, the DHO, Dr Gideon Wamasebu, was already in a meeting with the district sectoral committee on health to map out ways of forming the district epidemic rapid response team, identify sources of funding to sensitize the public on the Ebola virus.
"The district epidemic rapid response team would also be charged with the responsibility of lobbying for resources to ensure that protective wear like gum boots, surgical gloves and masks and medicine are procured within the shortest time possible to keep the district ready to battle the Ebola virus," said Wamasebu.
Western
Whereas the Eastern region is waiting to engage the Ministry of Health in case of an Ebola outbreak, those in western Uganda have decided to take the initiative, probanly borne out of the presence of the Ebola virus in the region.
Reports from the region show that the districts near the diseased Bundibugyo hastily formed preparedness committees to lobby for and mobilize resources, and carry out education and sensitization on the disease.
Medics, civil and religious leaders have joined hands through task forces in various districts. Among their activities are relying Ebola spread means and preventive measures. They are carrying out public sensitization through FM radio talk shows, announcements, brochures and public address systems.
Though there are no cases reported in some of the western districts, most hospitals and health centres have been put on the ready to handle Ebola patients. In Kabarole District, an isolation ward has been set up at Kicwamba health centre 3.
The DDHS, Dr Joel Oketch, said a preparedness committee headed by the RDC had been formed. "Ministry of Health has already given us some money and materials. We have received protective materials for those who might treat Ebola patients although they are not enough for every body," Oketch said.
The Kasese DDHS, Dr Peter Mukubi, said sensitisation is on going. He said apart from forming a task force headed by the RDiC and comprised of the CAO and LC5 chairman, the district has mobilised Shs12 million to deal with any out break.
Dr Mukubi said NGOs, political leaders and health workers are busy carrying out sanitisation programmes.
In Bushenyi, however, which is not very far from Bundibugyo, there is not much readiness to avert Ebola. "Although Bundibugyo is just a stone's throw away, I don't want to deceive you. We have not formed a task force. We have not earmarked any funds. But we have Kitagata hospital staff, they are on alert 24 hours," LC5 Longino Ishanga said.
Kamwenge, on the other hand has a district preparedness team. Its DDHS, Dr Sarah Kasewa, said they have protective gear, as well as a film van expected to help with the sensitization programme.
A crusade that was being organized by Catholic diocese scheduled to take place in the district this week has been postponed. It was feared that the coming in of people from the Rwenzori region could escalate the spread of the disease.
In Mbarara, a taskforce has also been formed. District health workers teamed with Mbarara Regional Referral Hospital medical staff and the civil leaders. The team is headed by RDC Clement Kandole while the clinical team is headed by Dr Medard Bitekyerezo.
At the isolation ward, medical workers and cleaners ware preparing and fumigating the place in readiness for the patients. Dr Bitekyerezo said everything to handle Ebola patients is now in place.
In Hoima, a district Ebola task force has been formed headed by DDHS, Dr Joseph Ruyonga. Dr Ruyonga said they are carrying out public sensitisation through radio Hoima and other local FM stations. Although they have no case of Ebola, he said they have already received treatment kits from the MOH.
In Kibaale, Dr Dan Kyamanwa, the DDHS and head of the task force said links with Bundibugyo have been cutoff. The task force he leads conducts talk shows on radios highlighting Ebola preventive and spreading measures.
Northern
The district health authorities in northern Uganda are on standby one in case of any outbreak of the hemorrhagic fever. The district authorities yesterday said they were on the look out for any suspected cases.
Pader and Gulu districts do not want to be caught offside by the fever; they have already formed health rapid response teams and isolation centres to handle any emergency.
The Gulu Regional Referral Hospital, Pader, Kitgum and other hospitals in the region have been stocked with medical supplies for any eventualities.
The Pader District Director of Health Services, Dr Janet Oola said, "We are closely monitoring. We do not want to be caught offside by the epidemic. We are on high alert."
The Gulu Referral Hospital medical superintendent, Dr Tom Otim, said they are on thelook out as they have alerted all the medical staff in the district to be on high alert incase of the epidemic.
"The Ministry of Health informed us to be on high look out," Dr Otim said. "We have alerted all our staff about the epidemic (Ebola) in western Uganda. We are on high alert. The supplies are available incase of any outbreak," he said.
"We have got an isolation ward that we shall use for screening and treatment of suspected Ebola patients incase of any outbreak of the fever," Dr. Otim said. In Lira, the medial workers were yesterday reportedly meeting to mop up ways to handle any emergency.
And in West Nile, district health officers in Arua, Koboko, and Nebbi have already formed task force committees that are preparing to handle eventualities. However, they are limited by financial resources. "As districts, we don't have enough resources. The government and international agencies like WHO should mobilise resources for us," Arua District Director of Health Services said.

http://allafrica.com/stories/printable/200712070971.html
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Commentary

Fleeing Patients Complicate Uganda Ebola Control
Recombinomics Commentary
December 7, 2007

Twenty two people have so far died of the fever.

"Cumulatively, we have got 101 cases of Ebola -- those who fit the case definition," Kabwa said, adding that all were in western Uganda's Bundibugyo district, except for two in Kampala, including a doctor who died.

He said 39 had been admitted to hospital in serious condition and 350 others suspected of having been exposed to the virus were being urged to stay at home.

"They are being observed because they are possible contacts with Ebola cases," Kabwa said. "They are not being confined."

The outbreak, which started in August, has sparked panic amongst officials, health workers and the public.

"A bigger Ebola bomb could explode, claiming many more lives," Bundibugyo district chairman Jackson Bambalira was quoted as saying in the state-owned New Vision daily on Friday.

The above comments provide an update on the Ebola cases in Uganda. However, these numbers are incomplete and easily misinterpreted by the popular press. Some media reports have cited a 22% case fatality rate based on the 22 deaths out of 101 diagnosed patients. However, this calculation is incorrect. It assumes that all cases that have not died will not die, and there is no data to support such an assumption. There is no cure for Ebola, so many of the recently diagnosed patients will not recover.

The above comments cite 39 patients admitted in serious condition. However, the report does not say how many diagnosed patients have fled. As the hospitals empty because of patients requesting discharge and staff absenteeism, the number of diagnosed patients who are admitted also declines because patients fear infections from the hospitals. This fear is based in part on fatal infections in health care workers. Thus, many of the diagnosed patients have no outcome (death or discharge), and have instead chosen not to be admitted. Moreover, new suspect cases are being identified across southern Uganda (see satellite map), which creates additional tracking problems.

Therefore, the case fatality rate will be a very soft number until more outcomes are known, and these outcomes may not include fleeing patients, or contacts of fleeing patients.

Without details of outcomes, publication of case fatality rates is misleading.


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

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

Commentary

Ebola Super Spreaders in Uganda?

Recombinomics Commentary
December 7, 2007

Admitted at Bundibugyo: 15, including Dr. Sessanga whose sister just came to our house looking for Scott because he?s no longer responsive; the matron (head nurse); the nurse who was working in the isolation unit Fred; a clinical officer named Joshua Kule; and an ophthalmic assistant. Among the other patients are six direct contacts (mother, brother, wife, daughter and two friends) of Muhindo Jeremiah who died just over a week ago.

one death this morning 5 am, another contact of Jeremiah Muhindo, who seems to have been very infectious.

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.

The above comments are from a blog of two physicians in Uganda here, here, and here. The repeated mention of the same patient, Jeremiah Muhundo, in association with multiple suspect / confirmed cases, raises the possibility of a super-spreader. Several of the above cases, including four health care workers, died within 24 hours of each other, raising concerns that they were infected by a common source.

The repeated mention of the same patient raises concerns that he was a super spreader, leading to infection of multiple contacts. More information on the direct contacts would be useful.

Super spreaders were implicated in the transmission of SARS coronavirus, and the above linkages raise questions about the new strain of Ebola, which is likely to be a recombinant. In the SARS outbreak, sequences of isolates from the same super spreader suggested co-infections and recombination contributed to the multiple linked infections. Although the case fatality rate of this new Ebola strain may be lower than that of prior strains, confirmed or alert cases throughout Uganda (see satellite map), suggest that transmission may be more efficient than seen for prior strains, resulting in a large geographical reach.


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

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

If the co-infection were HIV, would that produce that type of super spreader?

Would it be similar to speculation about BF/HIV super spreaders? If so, could that be responsible for the Ebola mutations, as suggested for BF/HIV co-infections?

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

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

If the co-infection were HIV, would that produce that type of super spreader?

Would it be similar to speculation about BF/HIV super spreaders? If so, could that be responsible for the Ebola mutations, as suggested for BF/HIV co-infections?

.
Co-infections with multiple strains of Ebola = super spreader
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

SARS unanswered questions .

....(snipped)

Scientists are also still puzzled about why some SARS-infected individuals are able to infect tens or hundreds of other people. The answer does not lie in the genome, said the experts. "There is no unique genetic sequence for super spreaders," said Holmes.

Instead, super spreaders may be co-infected with another disease that makes them more contagious. In cows, dual infection with a coronavirus and flu leads to a longer period of shedding and increased fecal shedding as well as prolonged fever and respiratory disease.

David Ho, an HIV researcher at the Aaron Diamond AIDS Research Center, thinks super spreading is due not just to the spreader but also to something about the immune systems of the people the super spreader infects. He thinks the spreading has a strong genetic component. "Why else would everyone in the family succumb?" he asked.

.....

http://www.vetscite.org/publish/items/001251/index.html
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

Map of Districts (Administrative level 1) in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region w:st="on"><st1:place w:st="on">Uganda</st1:place></st1:country-region> with reported or suspected cases of Ebola. The highest number of cases has been concentrated in the Bundibugyo District. See attached image at bottom of post.

The map based on:
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
1. Niman’s Google Maps data: http://maps.google.com/maps/ms?ie=U...6,31.992188&spn=9.10699,17.29248&t=h&z=6&om=0
2. MoMosMom case compilation in thread: https://www.singtomeohmuse.com/viewtopic.php?t=1965&postdays=0&postorder=asc&start=15
<o:p></o:p>
December 7

Adjumani District - reported cases no #s
Mbarara District - 1 case ADM 12/1 - Deceased 12/1
Kabarole District - reported cases
Kasese - 12/5 - suspect case teacher from Bundibugyo
12/7 1 suspect case admitted to hospital
Fort Portal
12/2 - 1 suspect case 13M - deceased 12/4
12/5 - 1 suspect cases - woman vomiting blood flees hospital
12/7 - 2 suspect cases in isolation
Kabarole Village
Kanunga District{I've seen this district as Kabarole as well}
12/2 Kanyantorobo Sub-County - 1 suspect case - Moses Kanyarutokye - casual laborer
Mubende District - reported cases in Buganda region no #s
Mbale District
Mbale- 12/6 1 suspect case dead - Olive Esther Mukite - Sironko District Info Officer. had just returned from a trip to Kisoro district - may or may not be significant. She was pregnant.

Bundibugyo District - located in <st1:place w:st="on">West Nile</st1:place>
12/7 Kikyo village - 16 patients. 2 placed in recovering almost ready to go home category
12/7 Bundibugyo village - 24 patients. 5 recovering includes Dr. Sessenga
12/7 5 AWOL patients from 12/6. 1 in Kasese village. 4 in Bundibugyo village
11 villages listed with suspect patients no #s
Masaka District in Buganda region
Kampala District
Kampala City
Dr. Kule ADM 11/30. Deceased 12/4 - Mulago Hospital
Moses Natukunda ADM 12/7 - Mulago Hospital
Masaka District
Masaka - 12/7 2 suspect cases – fisherman<o:p></o:p>
3. Kyenjojo District – post #31 above.
<o:p></o:p>
4. Kasese District - post #94 and #157 above.
 

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

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

Good overview/summation - not much new information for those who have followed this outbreak

Cabinet meets over Ebola epidemic Publication date: Friday, 7th December, 2007
1197049145Zulu.jpg

Nursing interns who refused to work without protective gear at Mulago Hospital following the death of a doctor who had been admitted with ebola.
By Vision team

PRESIDENT Yoweri Museveni has urged all Ugandans to stop shaking hands until the Ebola pandemic is completely contained, including people in places where the disease has not been reported.

?Ebola spreads through contact. For the time being, people should resort to jambo (waving). If I don?t shake your hand, it doesn?t mean I don?t like you,? Museveni said.

Addressing Christians on Thursday night during the Kampala City of God Prayer campaign at Kololo Airstrip, the President said the Government was doing everything possible to contain the Ebola pandemic across the country.

?You have been hearing that there is an outbreak of Ebola. It started in Bundibugyo. Some people survive it, but the mortality rate is quite high. I would encourage every one to stop shaking hands,? Museveni said.
He added: ?The country has already lost a few people including medics. Although we don?t think there is a problem in Kampala yet, we have to take precaution.?

Ebola is spread through direct physical contact with a patient?s body fluids like blood, saliva, stool, vomit and urine, or items contaminated by such secretions. It is prevented through avoiding contact with the patients, contaminated materials, as well as disinfecting any items that come into contact with the patient.

Over 90 suspected cases have been reported, of whom at least 24 have died. The disease broke out in August but was only confirmed as ebola on November 29. Another 350 people who made contact with ebola victims are being closely monitored.

Yesterday morning, the Cabinet held a special meeting on Ebola and the Prime Minister, Apolo Nsibambi, was due to announce decisions taken on how to deal with the emergency.

Mulago panics

At Mulago Hospital, where Dr. Jonah Kule, a medic from Bundibugyo, died of suspected Ebola on Tuesday night, some sections were paralysed yesterday as health workers feared to handle patients without appropriate protective gear. In the casualty ward, Saturday Vision saw empty glove boxes and plastic containers meant to carry disinfectants. By about 11:00am, a crowd of patients was outside the casualty ward waiting in vain to be called in, while others went home frustrated. In emergency ward 3B, some workers wore masks, white gumboots and gloves, while others did not. Meanwhile, in the out-patient department in Old Mulago, work was going on normally except for the low turn up of patients compared to other days. The hospital director could not be reached for comment as he was in marathon meetings.

How Dr. Kule died

According to a diary written by Dr. Kule?s mentor, Dr. Scott Myhre, the medic contracted ebola after treating his friend without gloves, days before the epidemic was confirmed. A patient was dying and there were no gloves at the hospital.

On Sunday, November 25, Jonah travelled to Kampala. On Wednesday November 28, he began to notice a headache and suspected malaria. The following day ebola was confirmed in Bundibugyo as Dr. Kule?s became more ill. He picked up his oldest daughter, Masika, from a boarding school in Kampala. He then took a malaria test at a private clinic, before a doctor friend encouraged him to be admitted at Mulago, where he was put in an isolation tent.

His family would see him through a tent window. The Mulago doctor assigned to his care supposedly fled, but MSF Spain doctors checked him a couple of times a day. His young brother sometimes entered the tent to care for him when no nurse or other medical person was available. He was alone much of the time.

Quarantine calls

The Uganda Medical Workers? Union asked the Government to put in place quarantine measures to stop further spread of the deadly Ebola. Addressing a press conference at Christ the King hall yesterday, the union wondered why victims from the Ebola stricken districts were still moving freely to other districts in the country.

?In Rwanda, there is a checkpoint. But here, people are just moving anyhow, without being stopped. And you think we are safe?? asked Mary Irene Kabole, the vice-chairperson, of the National Organisation of Trade Unions (NOTU).

Referring to the fallen Dr. Jonah Kule, Nassuna added: ?He (Kule) travelled to Kampala to pick his children from school, went to his brother in Kyebando, to a clinic in Kamyokya, another clinic in Wandegeya, before jumping on a bodaboda to rush to Mulago Hospital. Don?t you see the risk of all these people he interacted with??

?This is negligence. The outbreak in 2000 should have acted as an eye opener. Someone should have a policy to make sure that all health workers have protective gear,? she said.

Kabarole

Two more suspected Ebola patients have been identified and admitted to the isolation centre in Kichwamba 10km from Fort-Portal town. The two were first admitted to Kabarole Hospital before they were transferred to the isolation centre. This brings to four, the number of patients who reported to hospitals in Kabarole with signs associated with Ebola. The first, a 13-year-old boy, has died and the second, a woman, fled the hospital.

Doctors in Fort-Portal said yesterday that panic-stricken people had been calling from different parts of Kabarole district to report suspected cases. Some of them turn out to be false alarms. By 9:00am yesterday, the doctors and the District health team were going for a meeting to chart out how to trace the SOS calls and pick the suspected patients.

Hotels and bars in Fort-Portal Municipality have reported a decline in business as the Ebola scare escalates. George Kaahwa, proprietor of Hotel Cornerstone, said people who made bookings for Christmas months in advance, have cancelled.

Kanungu

Another suspected case has been reported in Kanyantorobo Sub-County. The 20-year old man exhibited signs of the Ebola and was admitted to Kihihi health centre IV on Tuesday.

Kanungu District Medical Officer, Dr. Stephen Sebudde said that a blood sample was got from the man for testing. ?We cannot rule out Ebola until the tests say otherwise. We have put him in isolated ward and we take precautions to ensure the disease does not spread if it is Ebola.?

According to the Kanungu Chief Administrative Officer, Moses Kanyarutokye, the patient, is a casual labourer in Kanyatorogo. Sebudde said a team of doctors from Kambuga hospital had gone to Kihihi to help out.

Bundibugyo

In Bundibugyo, the Medical Superintendent, Dr. Richard Ssessanga was reported to be improving but that he was still very weak. Ssessanga?s colleague, Dr. Jonah Kule and four other health workers have died of Ebola. Four other health workers there who were admitted with Ebola were said to be in a critical condition yesterday.

Kasese
One man was admitted to hospital and movement of a number of others was restricted for monitoring. A mass wedding scheduled for December 7, has been suspended.

The Kamaiba church pastor asked the more than 20 intending couples to be patient until the Ebola threat blows over. A Catholic priest on the Kasese Ebola Task Force, Fr. Kasenyankwe, announced that the church would restrict the people attending weddings to five. He said big parties will not be allowed.

The Task Force has also banned night prayers and crusades by born again churches as well as any public gatherings, including discotheques and video hall gatherings. A piece of land in Bwera has been identified for burial of any Ebola victims in Kasese.

Bushenyi

Bushenyi woman MP, Mary Karooro Okurut has appealed to residents there to restrict their movements in order to minimise chances of contracting Ebola. ?Since we are approaching Christmas , people should travel when it is absolutely necessary.? She advised that those with relatives in Kasese and Bundibugyo should suspend visits there.

Meanwhile, residents have expressed fear that teachers exported to Bundibugyo district might carry the disease back home when schools break off for holiday. A big number of teachers from Bushenyi are working in Bundibugyo.

Mbale

Fear has gripped the town and neighbouring districts after Sironko district information officer, Olive Mukiite died of an ebola-like illness. Mukiite, who was expectant, died at Mbale regional referral hospital on Thursday afternoon. A week earlier she had returned from Kabale and Kisoro, where Sironko district officials and political leaders had gone on a study tour.

The hospital superintendent, Dr. Vincent Ojome, said the actual cause of the death had not been established. ?Samples taken from her are yet to be taken to Kampala for analysis. It will only be on Saturday that the actual cause of the death would be established,? Ojome said. The nurse who attended to her has been confined.

By Anne Mugisa, Flavia Nakagwa, Carol Natukunda, Bizimungu Kisakye, Chris Ahimbisibwe, Chris Ocowun, Nathan Etengu and Colombus Tusiime/b>
This article can be found on-line at: http://www.newvision.co.ug/D/8/12/600922

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

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

Doctor Loses Life to Ebola in Outbreak

In Treating Ebola, Doctor Exposed Himself to Deadly Virus

By JOHN SPANGLER, M.D.

Dec. 8, 2007 ?

"Dr. Jonah Kule died this evening, Tuesday 4 December, at Mulago Hospital [of Ebola hemorrhagic fever] ...
"Ebola is horrific. There are no words to express our grief. And this makes the whole epidemic even more frightening, if that were possible."
So writes Dr. Jennifer Myhre, a medical missionary, who, along with her husband, Dr. Scott Myhre, has lived in Bundibugyo District in remote western Uganda for 14 years serving the poorest of the poor.
"We have lost one of our best friends," she continues.
The Myhres -- Scott, a family physician, and Jennifer, a pediatrician, knew Kule since they began work in this virtually unknown corner of the world.
Bundibugyo is a place that rarely makes the news -- that is until a week ago when the deadly Ebola virus erupted with vengeance into a ghastly epidemic.
Native to Africa, Ebola is not well known in the United States. But in central and eastern parts of Africa, where it periodically explodes into fatal, bloody outbreaks, the mere mention of the word sparks dread and panic.

The Horror of Ebola

According to the Centers for Disease Control and Prevention (CDC), Ebola hemorrhagic fever (Ebola HF) is a relentless, frequently lethal disease in humans, gorillas, monkeys and other nonhuman primates. It has appeared sporadically since its initial recognition in 1976.
Scientists conjecture that outbreaks initially occur by exposure of humans to infected animals. Symptoms include fever, vomiting, diarrhea and, commonly, bleeding from all body orifices. Patients usually die of shock or respiratory failure, likely as a result of massive bleeding, including bleeding into the lungs.
Epidemics spread through contact with the blood or body fluids of the ill.
Kule, who grew up in Bundibugyo, had recently returned to this deprived rural district after completing medical school in the capital city of Kampala.
Kule passed up lucrative career opportunities in Kampala and other large Ugandan cities to work among his tribesmen in a place where few Ugandan doctors venture, and even then, venture only when assigned as part of government service.
Kule was one of the few from Bundibugyo to ever attend medical school.
"He refused to charge patients extra fees for his services, even though that is widely practiced in government hospitals," writes Jennifer Myhre. "He was completely trustworthy with his responsibilities and resources.
<!-- page -->"He [believed] that God was the one who provided his opportunities," she continues. "A person who stands against corruption meets obstacles here. He struggled. But we always thought he would eventually prevail."
He did not. In treating the poor he came to serve, he died a horrible death.
"I have seen [Ebola] patients die, and I know that I am dying," he said the morning of his death.
According to Myhre, moments before he died he said, "I am going to die now. And I pray that no one should ever have to die of this disease again."

At the End of the Road, a Killer

The road, such as it is, ends in Bundibugyo. You cannot travel farther without leaving Uganda and crossing into the Congo.
Winding through the steep terrain, one descends from Fort Portal to Bundibugyo, Uganda, passing through spectacularly beautiful jungle and savannah, with views to the west of the snow-capped equatorial Rwenzori mountains.
Margherita Peak towers in the misty distance at 16,795 feet; it is the third highest peak in Africa after mounts Kilimanjaro and Kenya. In the Semliki Valley below, hot springs attract tourists, lured here by the beauty of the incredibly rare and varied topography.
This is where Sir Henry Morton Stanley found Dr. David Livingstone in 1889, purportedly uttering the words, "Dr. Livingstone, I presume." Stanley was the first European to discover this mountain range, which he dubbed "mountains of the moon."
Along the Bundibugyo road, perched on the steep Rwenzori slopes, lies the village of Kikyo.
"This epidemic began in Kikyo, which is about 14 kilometers from Bundibugyo town and above the Semiliki National Forest and hot springs," noted Dr. Scott Myhre. "There has been confirmation that the first family afflicted were hunters who ate a monkey."
Kule was the first to investigate this Ebola outbreak sometime in October. There had been rumors of a mysterious illness with fever, abdominal pain, vomiting, diarrhea, and, inexplicably, rapid death.
"I remember well the day he [Kule] came into the pediatric ward and told us about it," Jennifer Myhre continued. "I gave him gloves and my bottle of alcohol hand gel -- pitifully inadequate measures [as I look back on it] now."
In the beginning, the Myhres suspected a cholera outbreak. Kule promptly planned an excursion to learn more.
"I remember him slinging his backpack on, and getting on his motorcycle, saying 'If I die, I die,'" she writes.
<!-- page -->Kule returned to Bundibugyo later that day. "He guessed typhoid fever, due to the prominent abdominal pain and even what seemed to be two cases with intestinal perforation," Jennifer Myhre writes.
He held community meetings to emphasize hygiene, and dispelled rumors of witchcraft or poison.
Ominously, back in Bundibugyo, Kule cared for an older gentleman who had also recently returned from Kikyo, having visited many of the sick there. Within a week, this gentleman died. Ebola still was not yet suspected.
On Nov. 29, results of blood samples that had been sent to the CDC in Atlanta came back.
"It was a bombshell -- Ebola, a new strain," remembered Jennifer Myhre.
The finding made international news immediately. Concerned, the Myrhes called Kule in Kampala where he had traveled to attend to personal business.
"That [Thursday on which] we talked to Jonah, he had a headache he said, maybe early malaria, he'd watch," recalled Jennifer Myhre. "By Friday morning he found it prudent to admit himself to Mulago hospital. That was his last act of bravery and wisdom. We talked on the phone [Friday and] he sounded so normal, so himself."
From Friday through the weekend, things seemed hopeful for Kule. He was walking and talking.
But his urine output was diminishing, and malaria seemed less and less likely.
"Still, Jonah was a strong man, healthy, smart," Myhre said she thought at the time. "He was in the country's main hospital, not out here in Bundibugyo. He was getting lab tests. He had a team of doctors, including [Doctors without Borders from Spain]. We had hope.
"Then suddenly [Tuesday] night they called back. He had died. Maybe there was bleeding, involving his kidneys and lungs..."
She trails off, not knowing how to complete the story.
"To my surprise, the Bundibugyo Ebola epidemic is not what I imagined Ebola would look like," writes Scott Myhre. "I imagined blood oozing from every orifice. A sort of melting or gelatinizing of the human body. The reality is a much more nonspecific 'viral syndrome': fever, vomiting and diarrhea, [although] we are seeing bleeding symptoms (blood in the urine, vomit, or stool) in about one-quarter of patients."
According to the Myhres, at the time they wrote their correspondence the cumulative count of infected in the district was 93, and the death count was 21.

Continuing the Fight

<!-- page -->Scott Myhre, along with Doctors without Borders, continues to see patients at Bundibugyo Hospital.
"The protocol now to see a patient involves changing into surgical scrubs in a clean changing area and then donning the hot zone suit (every centimeter of skin covered plus goggles). You are sprayed with chlorine solution after emerging," he writes.
Still, the stark, understaffed hospital remains nearly empty except for those with Ebola, out of fear of contact with the disease.
One of the main concerns now is contact with the dead bodies, discovered to be a risk factor for acquiring Ebola during this epidemic. A few brave health care workers soldier on, placing themselves at risk to care for their sick compatriots.
"On average," Scott Myhre explained, "the incubation period for Ebola is between five and 10 days, the duration of symptoms is two to three weeks, and if the patient dies, the time between onset of symptoms and death is about a week."
The Myhres are forbidden to leave the Bundibugyo District until a symptom-free three-week interval has passed since their last contact with a known case.
Their children, and their missionary colleagues, left earlier this week. Jennifer Myhre has been prohibited by World Harvest Mission, for whom the Myhres work, from seeing patients so that she may reunite with her children as soon as her three weeks are up.
But to the Myhres, this story is clearly not about themselves.
It is about Dr. Jonah Kule.
"Tomorrow his body will arrive," writes Jennifer Myhre, "having been carefully decontaminated (as far as possible) and enclosed. Whenever we speak of him again to someone who cared about him, the tears come freely. We have seen some men here cry like we never saw men cry before.
"I think Jonah was perceived as a resource, a gift, to the whole district," she continues.
"Everyone feels bereaved and robbed of their man, their doctor, the one they could trust and count on. When we see his family, we will have the complication that they are now [Ebola] contacts, too like we are, and we should not be touching each other. So we have to go to the burial of our dear friend without any hugging, comfort his wife and children without touch.
"That feels harsh."
Dr. John Spangler is a professor of family medicine at Wake Forest University School of Medicine.

http://abcnews.go.com/print?id=3970795
 
Re: New Ebola Strain in Uganda Spreading - Death toll rising

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

New Ebola fatalities push Uganda toll to 25

1 hour ago
KAMPALA (AFP) ? A dreaded Ebola outbreak has killed two people, bringing the toll to 25 in western Uganda, an official said Saturday, as health teams battled to contain the virulent strain in the region.
Health authorities continued to monitor hundreds of quarantined people who had contacts with the Ebola victims in Bundibugyo district, home to 250,000 people and the outbreak's epicentre.
"Two people died last night in Bundibugyo, bringing the death toll to 25," said Sam Okware, a health ministry official heading the battle against the disease.
The mysterious strain has so far infected 104 people -- including the 25 dead -- some of them medical workers who treated patients without latex gloves and respirator gowns.
Experts from the US Centers for Disease Control and Prevention (CDC) were studying new blood and tissue samples from western Kanungu and Kasese districts and northwestern Adjuman district for possible Ebola infections.
The health ministry said the previously unknown Ebola virus hit the region in September, simmered unnoticed while obscured by chaos and spurred other infections with similar symptoms, until it was identified in late November.
Unlike other Ebola strains, which kill after signature non-stop haemorrhage, the new strain takes life after provoking mainly high fever, diarrhoea and vomiting.
Although containing the strain is the priority, epidemiologists are also scouring the area to search for the source of the virus, seven years after it killed at least 170 people in northern Uganda, in a bid to stall future outbreaks.
Spread by body secretions, the blood-borne disease, Ebola was named after a small DRC river where it was discovered in 1976. It re-emerged in Sudan later the same year. Other outbreaks have been recorded in Ivory Coast, Gabon and Uganda.
In the previous outbreaks, the disease struck with initial ferocity causing massive fatalities, then faded away months later without leaving a hint where it came from. Experts are still seeking its footprints, if any.
Because of its scanty history, scientists have concluded that the strain is somewhat containable because it kills its victims faster than it can spread to new hosts.

http://afp.google.com/article/ALeqM5iDYKgzt4Q97d5sICbpFpxzp4kkUA
 
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