Uganda: Hemorrhagic fever outbreak- Yellow Fever

[Shiloh]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Source: http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8BSEPA?OpenDocument

ACT Alliance Alert: Outbreak of Unidentified Disease in Uganda - No. 42/2010

Source: ACT Alliance
Date: 03 Dec 2010


1. Brief description of the emergency...

...2. Impact

The death rates so far are 25 percent in Agago district (ie one in four people with symptoms have died), and in Abim, the death rate has also been about 25%. However, in Kitgum district, eight out of the 10 patients admitted to St. Joseph's Hospital have died. Some connection with animal (domestic and wild) illness and death has been suggested. In Agago especially, links between sick animals and human cases have been examined. It seems to be established that the disease can be spread from human-to-human most likely through body fluids.

Two major factors for spreading the disease at the moment include people trying to move away from affected areas, spreading the disease further, and scared health staff who, without protective clothing, refuse to care for patients. There is need for mobilisation by agencies, sensitisation of population, patient care, patient isolation and proper and safe handling of bodies...

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Tons of information here. It seems possible that a new hemorrhagic fever may have been discovered.

http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8BSEPA?OpenDocument

ACT Alliance Alert: Outbreak of Unidentified Disease in Uganda - No. 42/2010
Source: ACT Alliance

Date: 03 Dec 2010


1. Brief description of the emergency

An unidentified deadly disease broke out in Abim village located in the Karamoja region in northeastern Uganda in late October 2010. Several cases of the disease were reported and several deaths have resulted. The disease then spread from Karamoja to neighbouring districts. On December 1, some cases were also reported in Gulu. The signs and symptoms of the disease indicate that it is most likely not dysentery, as it is sometimes thought to be in the absence of a clear diagnosis. Symptoms point to Ebola but authorities have been unable to confirm that disease. The most common symptoms are headache, fever and vomiting large quantities of blood. Tests have been done in Entebbe (Uganda) and in Atlanta (USA).

Unequipped medical staff are fearful of being infected, leaving their duty stations because they lack personal protective gear. Some refuse to take care of patients. Kitgum district also lacks transport, including ambulances to transport patients. Pader district had one ambulance which no longer functions. People refuse to transport patients for fear of being infected. In villages, residents do not know what to do or how to protect themselves. Some have tried to move out of affected areas, potentially spreading the diseases to new areas. The spread is fairly slow but follows common "travel routes" throughout the region.

The number of affected people is unknown. About 60 cases are known, with at least 20 deaths reported. However, there could be many more cases and deaths that are unreported, and many more carriers. The first six fatalities in Kitgum were one woman, three men, and two male youths. None had any serious previous medical history. One had malaria at the time of death. Death usually occurred within three days of the first symptom. (Sources: Dr. Alex Layoo, Medical Superintendent Kitgum Government Hospital, Dr. Tenywa (World Health Organisation), Medicin Sans Frontiers, Uganda Ministry of Health, and Agago District Local Government).

2. Impact

The death rates so far are 25 percent in Agago district (ie one in four people with symptoms have died), and in Abim, the death rate has also been about 25%. However, in Kitgum district, eight out of the 10 patients admitted to St. Joseph's Hospital have died. Some connection with animal (domestic and wild) illness and death has been suggested. In Agago especially, links between sick animals and human cases have been examined. It seems to be established that the disease can be spread from human-to-human most likely through body fluids.

Two major factors for spreading the disease at the moment include people trying to move away from affected areas, spreading the disease further, and scared health staff who, without protective clothing, refuse to care for patients. There is need for mobilisation by agencies, sensitisation of population, patient care, patient isolation and proper and safe handling of bodies.

3. National and international response

An emergency meeting was held in Kitgum on September 1 bringing together local and international NGOs, governmental institutions, UN agencies and ACT Alliance member LWF. It was agreed that all actors participate in the following coordinated response:

· DHO, KDLF, AVSI, URCS and IRC will work in the surveillance of cases and with epidemiology.

· District Hospitals, MSF and IRC will work on case management.

· CAO, DHO and UNOCHA will work with finances and logistics.

· The District Chairperson and UNOCHA will work with coordination.

· DHE, UNICEF, Care International, CRS, CARITAS, LWF, URCS, IRC, Mercy Corps and WHO will focus on social mobilisation and sensitisation.

The Ministry of Health has responded, together with WHO and NGOs. So far, the focus has been identifying the disease and therefore the appropriate response.

4. ACT Alliance response

ICCO, DanChurchAid, Church of Uganda/PDR (the active members of the Uganda ACT Forum) have approved the Lutheran World Federation proposal to apply for ACT Rapid Response Funds. LWF's primary role at this stage will be community mobilisation and sensitisation to prevent further spread of the disease. Provision of protective gear to village health teams can also be considered so health care workers can move patients and bodies without being exposed to the disease.

5. Planned activities

LWF Uganda, with approval from the ACT Uganda Forum, intends to apply for RRF, with focus on mobilisation/sensitisation of communities and possibly to provide protective gear for village health teams, in order to stop the outbreak and save lives. Discussions in working groups and coordination committees in Kitgum continues. More precise priorities will be set on December 2. Funds will be needed for (preliminary estimates):

· Radio spot messages/production and airing.

· Transport/travel costs.

· Posters, Information, Education and Communication (IEC) material.

· Possibly purchasing protective gear for village health teams.

The level of funding is estimated at between 40,000 – US$ 50,000 but this will be confirmed after

coordination meetings when a detailed budget has been worked out.

Any funding indication or pledge should be communicated to Jean-Daniel Birmele, ACT Chief

Finance Officer (jbi@actalliance.org).

Thank you for your attention.

For further information please contact:

ACT Regional Programme Officer, Katherine Ireri (phone +41 22 791 6040)

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

http://www.coastweek.com/3349-32.htm

Strange disease worries northern Uganda

GULU, Uganda (Xinhua) -- A growing concern is spreading in parts of northern Uganda as an Ebola-like disease claimed 26 lives in three districts in the region though the country?s health ministry has ruled out an deadly Ebola outbreak.

According to a medical situation report obtained by Xinhua on Tuesday, eight people have been confirmed dead of the strange disease in Kitgum district, another eight in Agago district and 10 in Abim district.

The health ministry earlier this month said the strange disease was dysentery.

Health workers on the ground, however, said there was no conclusion yet.

The Agago district health officer Emmanuel Otto called for caution among locals saying there was still investigation going on to establish the cause.

"The ministry of health has taken samples from the victims of the disease for analysis and we are yet to get the disease," he noted.

Local leaders revealed that the number of people died of the disease could be higher as some people were not hospitalized and could have died in the village unreported.

The poor sanitation in homesteads of the returning former Internally Displaced Persons (IDPs) remains worrying with a number of homes living with no toilets, local leaders said.

It is reported that a number of animals also died of a strange disease in one village hit by the unknown epidemic.

Residents contracted with the disease commonly present with severe frontal headache that in some cases is associated with pain in the eyes without conjunctivitis.

Some patients have reported dizziness.

This may or may not be followed by low grade fever and general body weakness.

The illness then progresses with patients reporting abdominal pain.

Diarrhea and vomiting that are initially watery and eventually blood-streaked have been reported.

In the near terminal stages, the patient condition changes and is characterized by restlessness, disorientation and mental confusion, aggressive behavior, convulsions, and eventually coma and death.

The duration of illness varies from two to 10 days.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

I think they mean pneumonic plague, not mnemonic plague, confirmed not conformed, and fleas not flees....

I have posted this article as it is, without any edits. I can't find confirmation of this in any other source.

http://www.ugpulse.com/articles/dai...conformed+in+the+Acholi+sub-region++&ID=16924

A previous un identified disease spreading through the Acholi sub-region has been conformed to be the mnemonic plague.
More than ten cases have been reported in Abim, Pader and Kitgum districts.

Bloods samples of the patients were tested at the Uganda virus research institute in Entebbe and come up positive for mnemonic plague.

The ministry of health today said the disease that was earlier feared to be Ebola has been confirmed as mnemonic plague.

Mnemonic plague is contagious disease spread by contact with flees, characterised by coughing fever, headache general body, shortness of breathing and chest pain.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

And another HCW infected, this time in Gulu.

http://www.newvision.co.ug/D/8/16/740073

Three catch strange disease
Friday, 3rd December, 2010 E-mail article Print article

THREE new cases of the mysterious disease that is affecting parts of Acholi sub-region have been registered in the district, bringing the total number to 13.

The district disease surveillance officer, Grace Ogwang, said two of the cases were recorded in Orom sub-county, while another is admitted to St. Joseph’s Hospital.

Evelyn Ayoo and Okeny Denis were admitted to Orom health centre III, while Benon Ogwech was admitted to Kitgum mission hospital.

Medical sources noted that a staff member of Aquatech, Francis Kilama, suspected to be infected by the unknown disease, was also admitted to Lacor Hospital in Gulu.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86092

Archive Number 20101203.4340
Published Date 03-DEC-2010
Subject PRO/EDR> Undiagnosed disease - Uganda (04)


UNDIAGNOSED DISEASE - UGANDA (04)
*********************************
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 3 Dec 2010
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, ACT Alliance, report [summ., edited]
<http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8BSEPA?OpenDocument>


ACT Alliance alert: outbreak of unidentified disease in Uganda
--------------------------------------------------------------
Brief description of the emergency
----------------------------------
An unidentified deadly disease broke out in Abim village located in
the Karamoja region in northeastern Uganda in late October 2010.
Several cases of the disease were reported and several deaths have
resulted. The disease then spread from Karamoja to neighbouring
districts. On Wed 1 Dec 2010, some cases were also reported in Gulu.
The signs and symptoms of the disease indicate that it is most likely
not dysentery, as it is sometimes thought to be in the absence of a
clear diagnosis. Symptoms point to Ebola [haemorrhagic fever] but
authorities have been unable to confirm that disease. The most common
symptoms are headache, fever, and vomiting large quantities of blood.
Tests have been done [presumable in progress] in Entebbe (Uganda) and
in Atlanta (USA).

Unequipped medical staff are fearful of being infected, leaving their
duty stations because they lack personal protective gear. Some refuse
to take care of patients. Kitgum district also lacks transport,
including ambulances to transport patients. Pader district had one
ambulance which no longer functions. People refuse to transport
patients for fear of being infected. In villages, residents do not
know what to do or how to protect themselves. Some have tried to move
out of affected areas, potentially spreading the diseases to new
areas. The spread is fairly slow but follows common "travel routes"
throughout the region.

The number of affected people is unknown. About 60 cases are known,
with at least 20 deaths reported. However, there could be many more
cases and deaths that are unreported, and many more carriers. The 1st
6 fatalities in Kitgum were one woman, 3 men, and 2 male youths. None
had any serious previous medical history. One had malaria at the time
of death. Death usually occurred within 3 days of the 1st symptom.
(Sources: Dr Alex Layoo, medical superintendent Kitgum Government
Hospital, Dr Tenywa (World Health Organisation), Medecins Sans
Frontieres, Uganda Ministry of Health, and Agago District Local
Government).

Impact
------
The death rates so far are 25 percent in Agago district (that is, one
in 4 people with symptoms have died), and in Abim, the death rate has
also been about 25 percent. However, in Kitgum district, 8 out of the
10 patients admitted to St Joseph's Hospital have died. Some
connection with animal (domestic and wild) illness and death has been
suggested. In Agago especially, links between sick animals and human
cases have been examined. It seems to be established that the disease
can be spread from human-to-human most likely through body fluids.

Two major factors for spreading the disease at the moment include
people trying to move away from affected areas, spreading the disease
further, and scared health staff who, without protective clothing,
refuse to care for patients. There is need for mobilisation by
agencies, sensitisation of population, patient care, patient
isolation, and proper and safe handling of bodies.

National and international response
-----------------------------------
An emergency meeting was held in Kitgum on 1 Sep 2010 bringing
together local and international NGOs, governmental institutions, UN
agencies, and ACT Alliance member LWF [Lutheran World Federation]. It
was agreed that all actors participate in the following coordinated
response: [Curious as the 1st cases were reported in October 2010.
[Interested readers should refer to the original document via the URL
at the head of this posting for a list of the participating
organisations. - Mod.CP]

ACT Alliance response
---------------------
ICCO [Interchurch Organisation for Development Cooperation],
DanChurchAid [Danish humanitarian NGO], Church of Uganda/PDR
[Planning, Development, and Rehabilitation] (the active members of the
Uganda ACT Forum) have approved the Lutheran World Federation proposal
to apply for ACT Rapid Response Funds [RRF]. LWF's primary role at
this stage will be community mobilisation and sensitisation to prevent
further spread of the disease. Provision of protective gear to village
health teams can also be considered so health care workers can move
patients and bodies without being exposed to the disease.

Planned activities
------------------
LWF Uganda, with approval from the ACT Uganda Forum, intends to apply
for RRF, with focus on mobilisation/sensitisation of communities and
possibly to provide protective gear for village health teams, in order
to stop the outbreak and save lives. Discussions in working groups and
coordination committees in Kitgum continues. More precise priorities
would be set on 2 Dec 2010. [The funds listed in detail in the
document can be viewed by accessing the original text. - Mod.CP]

For further information please contact: ACT regional programme
officer, Katherine Ireri (phone +41 22 791 6040).

--
Communicated by:
Charles Ortleb
<rubiconmedia@yahoo.com>

[The ACT Alliance document identifies 60 cases and 20 fatalities and
suggests that the number of victims may be considerably more. Some
involvement of sick animals (domestic and wild) is rumoured, but it is
believed that person-to-person transmission has been responsible for
the rapid spread of the outbreak from village to village. According to
local sources death has occurred within 3 days of appearance of
symptoms. The infectious agent has not yet been identified, but the
disease resembles a severe dysentery rather than a haemorrhagic fever.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

And another HCW infected, this time in Gulu.

http://www.newvision.co.ug/D/8/16/740073

Three catch strange disease
Friday, 3rd December, 2010 E-mail article Print article

THREE new cases of the mysterious disease that is affecting parts of Acholi sub-region have been registered in the district, bringing the total number to 13.

The district disease surveillance officer, Grace Ogwang, said two of the cases were recorded in Orom sub-county, while another is admitted to St. Joseph?s Hospital.

Evelyn Ayoo and Okeny Denis were admitted to Orom health centre III, while Benon Ogwech was admitted to Kitgum mission hospital.

Medical sources noted that a staff member of Aquatech, Francis Kilama, suspected to be infected by the unknown disease, was also admitted to Lacor Hospital in Gulu.

There may be an important timing clue here: If the first cases in Gulu had onset around the 1st, if an HCW has already been infected there, the incubation period may be only 1-2 days.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

http://www.monitor.co.ug/News/National/-/688334/1065984/-/ckk0u1z/-/index.html

Gulu District bans transportation of the dead, patients

By David Livingstone Okumu & James Eriku

Posted Saturday, December 4 2010 at 00:00

Gulu

Authorities in Gulu have banned the transportation of bodies in the district. The move is aimed at curbing the spread of a strange disease that broke out in the region about a month ago.

The disease which first started in Abim in November has now spread to other nearby districts of Kitgum, Pader and Agago, killing 19 people and infecting over 30 others. At least eight people have so far died of the strange infectious disease in Pader district, nine in Agago district, and another in Kitgum.

The district?s Acting LCV chairman, Mr Kitara Makmot, issued the directive to have all the dead buried immediately. He also stopped the transportation of bodies and patients from one district to another. He was speaking during the commemoration of the international world Aids in Lakwana Sub-county, Gulu on Wednesday. ?We need to take precautionary measures to avoid further spread of the disease in areas where it is not yet there? Mr Kitara said.

Mr Makmot, however, said the ban is only temporary as experts from the government laboratories have the final analysis of the specimens sent to them two weeks ago. ?Even if I die here now, the law of nature should prevail which allows my dead body to be buried immediately?. He said the ban on transportation of the dead and patients was agreed upon in a security meeting also attended by officials from the WHO and district health office.

In the meeting, the committee also set up a task force to help follow up the trend of the disease.

 

[alert]

Re: Uganda: Unidentfied outbreak- 16 dead - Plague suspected

Re: Uganda: Unidentfied outbreak- 16 dead - Plague suspected

And now we have a second source suspecting plague. It really doesn't even have to be pneumonic plague; the plague bacteria could spread person-to-person through direct contact with fluids of infected people. Had it gone pneumonic, I might expect many more cases in the same location ("superspreaders"), and more respiratory symptoms.

http://www.sundayvision.co.ug/detail.php?mainNewsCategoryId=7&newsCategoryId=128&newsId=740159

Strange disease could be plague

By Wokorach-Oboi

THE mysterious disease that has devastated parts of Acholi and Karamoja sub-regions for close to a month could be human plague.

Kitgum district LC5 chairman, John Komakech Ogwok, quoting sources from the World Health Organisation, said on Friday evening that preliminary tests point at the plague.

“Information from the World Health Organisation says that the strange disease that has been disturbing us seems to be plague.

But the tests have ruled out Ebola or Marbug as has been widely suspected by people here,” he said.

Speaking during a book launch at the district council hall, Ogwok said further tests were still being carried out to ascertain which of the three types of the plague disease could be infecting the people.

Human plague is transmitted by fleas that move on rats and other rodents.

The symptoms are said to be similar to the ones associated to a strange disease that broke out in Abim about a month ago and has now spread to Agago, Kitgum, Lamwo and Pader districts.

Those infected manifest symptoms of headache, stomach-ache, bloody vomiting and diarrhoea and also cases of blood sipping through most of the openings in the body.

The last known report of the human plague disease in Uganda was reported in Arua District in 2004 and Nebbi in 2006.

Meanwhile, one more person in Kitgum, a 70-year-old Benon Ongwen died on Thursday at St Joseph’s Hospital from the mysterious disease, bringing to nine the total number of people who have died due to the disease and a total of 16 people infected by the disease as of Friday.

 

[Shiloh]

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Re: Uganda: Hemorrhagic fever outbreak- 16 dead

Source: http://www.monitor.co.ug/News/National/-/688334/1066262/-/ckjh2vz/-/

Strange disease kills 38
Posted Sunday, December 5 2010 at 00:00

The death toll from a strange disease that is devastating parts of northern Uganda has now reached 38. Another 91 people are also reported to be infected and suffering from the unknown disease, which scientists from the Uganda Virus Research Institute are trying to establish.

A team of health experts has already been dispatched to northern Uganda to monitor the situation, but also try and establish the cause of the disease.

Ministry of Health officials said yesterday that preliminary laboratory tests conducted by local and international researchers have tested negative for the deadly Ebola, Marburg, Congo Crimean fever, Rift Valley fever and Typhoid.

?Further tests are being run to identify the disease,? said Dr Kenya Mugisha, the director general of health services in the health ministry.

Dr Mugisha said the yet-to-be- established disease has since November 10, been reported in the districts of Agago, Pader, Abim, Lamwo, and Gulu.

According to the ministry of Health, the affected patients complain of severe headache, dizziness, and a mild fever at the onset and then progress with pain in the abdomen together with diarrhoea and vomiting.
The general public has now been urged to avoid eating sick and dead domestic animals, observe personal hygiene including hand washing and report suspected cases to the nearest health facility.

 

[Giuseppe]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

An Italian military hospital is currently operating in the epidemic area (see the related piece of news, in Italian: http://www.rainews24.it/it/news.php?newsid=148033 ).

Doctors of the hospital are involved in the quest of search for the causative agent.

A reference summary could be useful for readers: (compiled by a medical officer of the mission)

Source: AVSI, http://www.avsi.org/documenti/8Salandini.pdf


REFERENCES:

1. Maurice King: ?Primary Surgery? volume One : Non-Trauma. - Oxford Medical Publications.
2. Maurice King: ?Primary Surgery? volume Two: Trauma. - Oxford Medical Publications.
3. Maurice King: ?Primary Anaesthesia" - Oxford Medical Publications.
4. Maurice King: ? A Medical laboratory for Developing Countries". - Oxford Medical Publications.
5. Maurice King: ?Medical care in Developing Countries. A Symposium from Makerere" - Oxford University
Press.1966.
6. ?UGANDA CLINICAL GUIDELINES? - Uganda Ministry of Health
7. ? Formul?rio Nacional de Medicamentos? - Mo?ambique, Ministerio da Sa?de
8. A. Adeloye: ?Davey?s Companion to Surgery in Africa? - Churchill Livingstone
9. B. Leppard:? An Atlas of AFRICAN Dermatology? - Radcliffe Medical Press.
10. O. Canizares:? Clinical Tropical Dermatology? - Blackwell Scientifica Publications.
11. R.M. Coupland: "War Wounds of Limbs surgical management". - I.C.R.C. Editions, Geneva.
12. R.M. Coupland: "Amputations for War Wounds? - I.C.R.C. Editions, Geneva.
13. D.I.Rowley: ?War Wounds with fractures: a Guide to Surgical management? - I.C.R.C. Editions, Geneva.
14. S.Renzo-C.Panciera: ? Early Surgery for Hansen Neuritis? - Assoc. It. ?Amici R. Follereau? Organizzaz.Cooper.
Sanitaria Internaz. (OCSI)
15. Proceedings of the International Congress on ?Medical and social Rehabilitation of the disabled in the Third
World Countries with emphasis to the rehabilitation of the leprosy Patient? - Assoc. It. ?Amici R. Follereau?
Organizzaz.Cooper. Sanitaria Internaz. (OCSI)
16. L.Belli: ?Ultrasound in The Tropics? a practical guide. - Ediz. AVSI
17. E. Eriksson. ?Illustrated Handbookin Local Anaesthesia? - Schultz Forlag-Copenhagen (Verduci)
18. J.O. Oluwasanmi:? Plastic Surgery in the Tropics? - Macmillan Intern.College Editions.
19. I.Husain.: ?Tropical Urology and Renal Diseases? - Churchill Livingstone
20. W. Peters, G.Pasvol: ?Tropical Medicine and parasitology? - Elsevier Limited /Flammarion.
21. S.Pampiglione: ?Guida Sanitaria per i Tropici? - Istituto Italo-Africano
22. V.Beltrami, S. Galvagno, G. Meo: ?Chirurgia Tropicale? - Centro Scientifico Torinese.
23. Dion R. Bell. ?Lecture Notes on Tropical Medicine? - Blackwell Science.
24. ?Tropical Doctor? quarterly review. - Royal Society of Medicine Press.
25. R.Casadei, V.Frigerio, G. Rizzardini et al.: ?Gli occhi di Irene? - Guerini e Associati.
26. R. Guest: ? The Shackled Continent: Africa?s past, present & future? - Pan Books.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

I believe the discrepancies in counts indicated by the moderator below are the result of reporting a total death toll versus the death toll in an individual district. There have been 9 deaths in Kitgum (as below), 10 in Abim, at least 8 in Agago, and we don't know how many in the other districts, but the total appears to be at least 38 (Shiloh's post above).

Perhaps we should replace "hemorrhagic fever" with "undiagnosed disease" in our thread title as ProMED is using as all the known hemorrhagic fevers seem to be excluded.

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86112

Archive Number 20101205.4354
Published Date 05-DEC-2010
Subject PRO/EDR> Undiagnosed disease - Uganda (05)


UNDIAGNOSED DISEASE - UGANDA (05)
**********************************
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: Sun 5 De 2010
Source: Sunday Vision [edited]
<http://www.sundayvision.co.ug/detail.php?mainNewsCategoryId=7&newsCategoryId=128&newsId=740159>


The mysterious disease that has devastated parts of Acholi and
Karamoja sub-regions for close to a month could be human plague.
Kitgum district LC5 chairman, John Komakech Ogwok, quoting sources
from the World Health Organisation, said on Friday evening [3 Dec
2010] that preliminary tests point at the plague. "Information from
the World Health Organisation (WHO) says that the strange disease
that has been disturbing us seems to be plague. But the tests have
ruled out Ebola or Marburg [haemorrhagic fevers] as had been widely
suspected by people here," he said.

Speaking during a book launch at the district council hall, Ogwok
said further tests were still being carried out to ascertain which of
the 3 types of plague [bubonic plague, septicemic plague, and
pneumonic plague] could be infecting the people. Human plague is
transmitted by fleas that move on rats and other rodents. The
symptoms are said to be similar to the ones associated with a strange
disease that broke out in Abim about a month ago and has now spread
to Agago, Kitgum, Lamwo and Pader districts. Those infected manifest
symptoms of headache, stomach-ache, bloody vomiting and diarrhoea and
also cases of blood seeping through most of the openings in the body.
The last known report of the human plague disease in Uganda was
reported in Arua District in 2004 and Nebbi in 2006.

Meanwhile, one more person in Kitgum, a 70-year-old man, died on
Thursday [2 Dec 2010] at St Joseph's Hospital from the mysterious
disease, bringing to 9 the total number of people who have died due
to the disease, and a total of 16 people infected, as of Friday [3 Dec 2010].

[Byline: Wokorach-Oboi]

--
[The number of fatalities attributed to this still undiagnosed
disease has fluctuated from 36 on 29 Nov 2010, to 8 (approximately)
on 1 Dec 2010, 20 on 3 Dec 2010, and now 9 in the current report. The
only certainty at present is that this is not an outbreak of
Ebola/Marburg-like haemorrhagic fever. A previous suggestion that
amoebic dysentery was responsible appears to have been discarded and
replaced by information attributed to WHO suggesting that the disease
is plague, which has not been seen in Uganda since 2006.

On the basis of the limited descriptions of the disease so far
available, plague would seem an unlikely cause and a book launch a
curious venue to communicate the information. The plague that kills
is pneumonic, and there has been no description about cough
hemoptysis, etc. There is also no mention of buboes in others. For
these reasons, we will continue to carry this thread as undiagnosed
disease until there is official and verifiable confirmation of a diagnosis.

The districts in the Northern Region of Uganda affected by the
outbreak can be located using the map at
<http://en.wikipedia.org/wiki/Districts_of_Uganda>. The
HealthMap/ProMED-mail interactive map of Uganda can be accessed at
<http://healthmap.org/r/0089>. - Mods.CP/DK]

 

[sharon sanders]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

"Bloody vomiting" is hemorrhagic and offers the more probative value over "undiagnosed disease" I think.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

http://afludiary.blogspot.com/

Sunday, December 05, 2010
Updating Uganda?s Mystery Outbreak

# 5116

More than a month after it began, doctors appear no closer to determining the cause of a fatal disease outbreak in northern Uganda, where the death toll reportedly stands at 38.

I last reported on this outbreak three weeks ago in Uganda: Unidentified Hemorrhagic Outbreak.

Health Ministry officials have stated that laboratory tests have come back negative for the usual suspects from that part of the world; Ebola, Marburg, Congo Crimean fever, Rift Valley fever and Typhoid.

Additional testing is ongoing.

There are reportedly more than 90 people currently reporting symptoms of the disease, which includes severe headache, dizziness, and a mild fever to start - followed by abdominal pain with diarrhea and vomiting.

Some hemorrhagic symptoms have been reported in early media reports as well, although it is unclear whether this is really a hemorrhagic disease.

Chen Qi has a report from the Ugandan Sunday Monitor with more on this story.


Strange disease kills 38
By Evelyn Lirri


While I won?t speculate on the cause of this particular outbreak, Africa continues to be the place of origin of newly identified ? often zoonotic ? diseases.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

http://eafr.promedmail.org/

[snip]

So far, this outbreak remains undiagnosed and spreading to other parts of Uganda a worrying trend indeed. The fact that both domestic and wild animals are also affected points to a zoonotic nature of the outbreak which requires further aggressive investigations, management and eventually control. It puzzles one to note that the diagnosis remains ellussive even by the most well equipped laboratories in Uganda and the US. -Mod. BE

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 80 deaths

Re: Uganda: Hemorrhagic fever outbreak- 80 deaths

Please send this to ProMED. Yikes.

80 deaths so far indicates that things are getting rapidly worse, perhaps faster than a normal VHF outbreak. Although if only 17 of the deaths are in Kitgum and Agago, not much new is happening there (Kitgum was at 16 cases, 9 deaths, and Agago was at 32 cases, 8 deaths several days ago, so all that would have happened there was the discarding of one case), and the increase in deaths might be the result of reporting coming in from the other areas.

http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8BVGS7?OpenDocument

Uganda: ACT Alliance Rapid Response Payment Request No. 17/2010 - Unidentified Disease
Source: ACT Alliance

Date: 06 Dec 2010


Full_Report (pdf* format - 147.2 Kbytes)

Funds Sent To: - Lutheran World Federation (LWF) Uganda

Amount Sent: - USD 35,500

Date: - 6 December 2010

An unidentified deadly disease broke out in Abim, located in the Karamoja region, in northeastern Uganda in late October 2010. Several cases of the disease were reported and several deaths have resulted. The disease then spread from Karamoja to neighboring districts. On December 1, some cases were also reported in Gulu. To date 80 deaths have been reported from north and northeast Uganda.

The signs and symptoms of the disease indicate that it is most likely not dysentery, as it has been thought to be in the absence of a clear diagnosis. Symptoms point to Ebola but authorities have been unable to confirm this. The most common symptoms are headache, fever and vomiting large quantities of black blood. Tests have been done in Entebbe (Uganda) and in Atlanta (USA). Several other diseases are under investigation, including Lassa, Marburg, Rift Valley Fever, Bubonic Plague, Kala Azar – but so far no definite diagnosis has been possible. Ebola and Bubonic Plague are the two most often mentioned at the moment, but until there is a confirmed diagnosis we are unable to state the disease.

Unequipped medical staffs are fearful of being infected, leaving their duty stations because they lack personal protective gear. Staffs on leave have made themselves unavailable so as not to be called in for duty. Kitgum district lacks transport, including ambulances to transport patients. Pader district had one ambulance which no longer functions. People refuse to transport patients for fear of being infected. In villages, residents do not know what to do or how to protect themselves. Some have tried to move out of affected areas, potentially spreading the diseases to new areas. The spread is fairly slow but follows common "travel routes" throughout the region.

The number of affected people is unknown. There are several deaths that have not yet been investigated. In Kitgum and Agago there are 47 confirmed cases and 17 confirmed deaths (36% death rate). However, there are many more cases and deaths that are unreported, still being investigated or reported but not confirmed to be this disease. The first six fatalities in Kitgum were one woman, three men, and two male youths. None had any serious previous medical history. Death usually occurred within three days of the first symptoms. (Sources: Dr. Alex Layoo, Medical Superintendent Kitgum Government Hospital, World Health Organisation, Medicin Sans Frontiers, Uganda Ministry of Health, and Agago District Local Government

--------

http://dispatch.ug/2010/12/06/press...break-of-an-unknown-cause-in-northern-uganda/

PRESS RELEASE: A disease outbreak of an unknown cause in Northern Uganda
Posted on06 December 2010. Tags: illness, medical, uganda

The Ministry of Health would like to inform the general public that there is an outbreak of illnesss of unknown cause which has been reported in the districts of Agago, Pader, Abim, Lamwo, and Gulu since November 10, 2010. The preliminary results from tests done at the Central Public Health Laboratories (CPHL), Uganda Virus Research Institute (UVRI), USAID CDC Atlanta USA and WHO on specimens obtained from patients are NEGATIVE for Ebola, Marburg, Congo Crimean Fever, Rift Valley and Typhoid. Further tests are being run to identify the cause of the illness.

As of December 3, 2010, there were 91 patients and 38 deaths have occurred most of them in the community.
The affected patients complain of severe headache, dizziness, and a mild fever at the onset and then progress with pain in the abdomen together with diarrhea and vomiting. The substances vomited and diarrhea are initially watery but eventually contain dark blood. The duration of illness varies from 2 to 10 days.

The Ministry of Health has put all Health Facilities in affected districts on ALERT and supported them to handle all cases. Current information available indicate that full recovery is possible if affected persons report to the Health facility for treatment as soon as the illness begins

The Ministry has sent a multiple disciplinary team of experts to support the investigation and response in the affected districts.

In the mean time, the public is urged to avoid eating sick and dead domestic and wild animals, observe personal hygiene like hand washing and report any suspected case to the nearest Health Facility.

All individuals presenting with the above symptoms should therefore report to the nearest health facility for proper investigations and management.

The Ministry of Health therefore would like to assure the general public that everything possible is being done to contain the disease and will be updating the public as investigations continue.

For more information please contact The Epidemiology and Surveillance Division, Ministry of Health Room C204, Tel: 256- 414 345108, 0772 513 315, 0772 587 567 or email esd@health.go.ug

Dr. Nathan Kenya Mugisha

For: Director General Health Services

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86130

Archive Number 20101206.4365
Published Date 06-DEC-2010
Subject PRO/EDR> Undiagnosed disease - Uganda (06)


UNDIAGNOSED DISEASE - UGANDA (06)
*********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:

[1] Case count rising
[2] Comment

******
[1] Case count rising
Date: Sun 5 Dec 2010
Source: Daily Monitor [edited]
<http://www.monitor.co.ug/News/National/-/688334/1066262/-/ckjh2vz/-/index.html>


The death toll from a strange disease that is devastating parts of
northern Uganda has now reached 38. Another 91 people are also
reported to be infected and suffering from the unknown disease, which
scientists from the Uganda Virus Research Institute are trying to
establish. A team of health experts has already been dispatched to
northern Uganda to monitor the situation, but also try and establish
the cause of the disease.

Ministry of Health officials said yesterday [4 Dec 2010] that
preliminary laboratory tests conducted by local and international
researchers have tested negative for the deadly Ebola, Marburg,
Crimean-Congo fever, Rift Valley fever and typhoid. "Further tests
are being run to identify the disease," said Dr Kenya Mugisha, the
director general of health services in the health ministry.

Dr Mugisha said the yet-to-be-established disease has, since 10 Nov
2010, been reported in the districts of Agago, Pader, Abim, Lamwo,
and Gulu. According to the Ministry of Health, the affected patients
complain of severe headache, dizziness, and a mild fever at the onset
and then progress with pain in the abdomen together with diarrhoea
and vomiting.

The general public has now been urged to avoid eating sick and dead
domestic animals, to observe personal hygiene including hand washing,
and to report suspected cases to the nearest health facility.

[Byline: Evelyn Lirri]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2] Comment
Date: Sun 5 Dec 2010
From: Manfred Peters <tropenpeters_hamburg@yahoo.com>


Comment
------------
There are discrepancies in the reports about the new undiagnosed
disease in Uganda. The disease was 1st recognized in Northern Uganda
in Kitgum district. Now I read about the help of scientists from
Tanzania. This is strange, because Tanzania has a border with Uganda
in the south, not in the north. The next border in the north is
Southern Sudan. Here you can see that there are too many rumors in
Uganda. The high death rate in Kitgum is a fact.

--
Dr. Manfred Peters
Tropical Medicine
Medecins Sans Frontieres
<tropenpeters_hamburg@yahoo.com>

[ProMED-mail thanks Dr Manfred Peters for this comment. The number of
cases and fatalities continues to rise, but confusion remains about
the cause and nature of the outbreak. The suggested diagnosis of
plague contained in the preceding report from the region is no longer
mentioned. Clarification of the situation in Northern Uganda is still
awaited. Forthwith, ProMED-mail will only post new reports from the
region when greater consistency is apparent.

 

[alert]

Re: Uganda: Unidentified outbreak- 80 deaths? - Plague confirmed?

Re: Uganda: Unidentified outbreak- 80 deaths? - Plague confirmed?

I think this article is saying three cases have been confirmed as plague by the CDC. As no plague cases have been reported in Uganda in four years, even one confirmed case strongly implicates that agent. Plague does spread easier than a VHF, both through respiratory droplets of pneumonic cases, as well as possible extensive spread in animals.

If this really is plague, it would make containment of the disease considerably easier as antibiotic could be used as a preventative for those who have been exposed. Perhaps local sources/witnesses confused coughing up blood for vomitting it?

Please send this to ProMED.

http://www.newvision.co.ug/D/8/13/740385

Mysterious Acholi disease is plague
Monday, 6th December, 2010 E-mail article Print article

By Conan Businge
and Chris Ocowun

PLAGUE, a disease that affects rodents but can be spread to humans and other animals by infected fleas, has hit the northern Ugandan district of Kitgum, the health ministry has confirmed.

The ministry said they had confirmed that the strange sickness was plague, not a hemorrhagic fever as earlier thought.
“It is controllable, though fatal. We have sent another team to beef up the one we already had on the ground,” it added.
The disease surveillance officer in Kitgum district, Sr. Grace Agwang, said preliminary results from the Centre for Disease Control in Atlanta showed that it was plague.

In humans, plague has three forms, bubonic plague (infection of the lymph glands), septicemia plague (infection of the blood) and pheumonic plague (infection of the lungs). Pneumonic plague is the most contagious form, because it is airborne.

The disease, according to the World Health Organisation report, hit Acholi sub-region on December 3. One person has been admitted in Kitgum at St. Joseph Hospital, two others at Kalongo Hospital in Pader.

The report adds that Kitgum district has so far had 18 cases, while one of the infected people died at St. Joseph Hospital on December 3. Nine other people have so far died, according to the report.

Medical personnel in Kitgum have set up an isolation unit at Kitgum Hospital. Health workers are also being trained by Medecin San Frontieres from Holland to handle the disease.

“At Kalongo Hospital, 24 people had been admitted by December 3. The WHO suggested that a community-based surveillance system needs to be reactivated in the affected districts.

Medical officers said there was need for an adequate isolation unit, with a 24-hour ambulance service.
They also want to be stocked with the essential medicines, and to set up a burial team.

How do people contract plague?


•Bites of infected fleas.


•Direct contact with the tissues or body fluids of a plague-infected animal.


•Inhaling infectious airborne droplets from persons or animals, especially cats, with plague pneumonia


•Laboratory exposure to plague bacteria.


What are the signs and symptoms of plague?

•Swollen lymph nodes causing the painful lumps that are characteristic of bubonic plague.

•Other symptoms are fever, headache, chills, and extreme tiredness. Some people have gastrointestinal symptoms.


•If bubonic plague goes untreated can produce severe blood infection. Signs and symptoms are fever, chills, tiredness, abdominal pain, shock, and bleeding into the skin and other organs. Untreated septicemia plague is usually fatal.


•People with plague pneumonia have high fever, chills, difficulty breathing, a cough, and bloody sputum.


•Plague pneumonia is considered a public health emergency because a cough can quickly spread the disease to others. Untreated pneumonic plague is usually fatal.


How soon after exposure do symptoms appear?
Symptoms usually begin within 2 to 6 days after exposure to the plague bacteria.

How can plague be prevented?

•Eliminate food and shelter for rodents around homes, work places, and recreation areas.

•Remove brush, rock piles, junk, and food sources, including pet food.


•Allow health authorities to use appropriate and licensed insecticides to kill fleas during plague outbreaks in wild animals.


•Treat pets (cats and dogs) for flea control regularly.


•Avoid sick or dead animals, and report such animals to the health department.


•Preventive treatment with antibiotics is recommended.

 

[curiosity]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

The ministry also previously stated the illness via "preliminary" results as being ameobic dysentery.

Pneumonic Plague, untreated is over 75% fatal. The CFR does not seem as high.

 

[alert]

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

Re: Uganda: Hemorrhagic fever outbreak- 38 dead, 91 ill

The ministry also previously stated the illness via "preliminary" results as being ameobic dysentery.

Pneumonic Plague, untreated is over 75% fatal. The CFR does not seem as high.

We don't know that it is untreated; they may have started giving antibiotics to suspected cases as soon as rumor that the illness was plague started. If the plague was pneumonic and untreated, the fatality rate would be essentially 100%. There is an article (I can't find it now) that indicates that 1910 pneumonic plague outbreak in China (before the discovery of antibiotics) had about 60.000 cases and 6 survivors.

Also, the CFR reports are misleading; few if any cases have been discharged after recovery - most of the non-fatal cases are still ill, and some of them may die. Kitgum, for example, appears to have had 10 deaths in 18 cases, and at least some of the survivors are still in isolation at St. Joseph's hospital. At Kalongo, there have been 8-9 deaths, but no apparent discharges yet.

The drugs that would be used to treat plague are available enough and safe enough (and there is likely no treatment for novel VHF anyway) that it is reasonable to treat these patients with anitbiotics at this point.

The last article explicitly claims three patients that have reportedly tested positive for plague by the US CDC, not just speculation within the Ugandan ministry of health. Nevertheless, the situation remains unclear.