Re: Uganda: Hemorrhagic fever outbreak- 45 dead, 127 ill- yellow fever?
Re: Uganda: Hemorrhagic fever outbreak- 45 dead, 127 ill- yellow fever?
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,86341
Archive Number 20101224.4531
Published Date 24-DEC-2010
Subject PRO/AH/EDR> Undiagnosed disease - Uganda (08): yellow fever susp.
UNDIAGNOSED DISEASE - UGANDA (08):
YELLOW FEVER SUSPECTED***********************************************
A ProMED-mail post
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International Society for Infectious Diseases
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[1]
Date: Tue 21 Dec 2010
Source: The Independent [edited]
<http://www.independent.co.ug/index.php/features/features/42-features/3755-strange-killer-of-abim->
A 41-year-old man from Wipolo village, Morulem subcounty in Abim
district was the 1st recorded victim. He complained of headache and
stomach pain on 2 Oct 2010, and by 7 Oct 2010 he was dead. The
epidemiological report from the ministry of Health says his illness
was characterised by vomiting blood, passing bloody stool and general
body weakness. He had attended a party where he reportedly drunk
waragi and later kwete (all locally made brews) before falling ill.
Other people who drunk the same brew at the party did not fall sick.
Five family members who nursed him fell ill, and his 12-year-old son
also died. Other victims of this yet-to-be diagnosed disease have
been presenting similar symptoms.
Samples from suspected cases in Abim were sent to the Uganda Virus
Research Institute Entebbe on 10 Nov 2010, but the Abim Health Office
did not receive results until 14 Nov 2010, 4 days later. The samples
tested negative for Marburg and Ebola [haemorrhagic fevers] among
other haemorrhagic fevers. The disease has since spread to districts
of northern Uganda.
The disease that struck Abim, Kitgum, Agago, and Lamwo districts in
the Acholi sub-region had by early December 2010 claimed 31 lives and
infected at least 96 people. By 2 Dec 2010, of the 15 cases that had
been admitted to St Joseph Hospital in Kitgum, 8 had died, putting
the fatality rate at 53 percent. In Abim, of the 22 cases reported,
10 had died by 24 Nov 2010.
The disease has tentatively been identified as plague according to
Solomon Fisseha, the [spokesperson] at World Health Organisation
(WHO) in Uganda. Fisseha says with plague, the infected persons
usually start with "flu-like" symptoms after an incubation period of
3-7 days. Patients typically experience the sudden onset of fever,
chills, head and body aches and weakness, vomiting and nausea.
Plague, a bacterial disease carried by rodents, spreads to humans by
infected fleas. It infects the lymph glands (bubonic plague), blood
(septicemia plague), and lungs (pneumonic plague). Infections are
spread by bites of infected fleas, direct contact with the tissues or
body fluids of a plague-infected animal; by inhaling infectious
airborne droplets from persons or animals with plague pneumonia; or
by laboratory exposure to plague bacteria. Plague can be a very
severe disease in people, with a case-fatality ratio of 30-60 percent
if left untreated. But an epidemiologist from the Ministry of Health
(MoH) who is on the team investigating the disease told The
Independent that test results are pointing away from plague.
The disease, which was 1st reported in Morulem sub-county Abim
district, has, however, not made as many headlines in the past few
weeks as such attacks usually do. The government response to the
disease remains lukewarm, and the presidential election campaigns
appear to have over-shadowed it. Suspected cases are only isolated
when brought to hospitals, and no quarantine has been imposed on
affected villages.
Issa Makumbi, the Assistant Commissioner in the Ministry of Health,
says they are trying to control the situation at hand by isolating
the affected and that there is no need to alarm people. He says they
encourage people to report to the health centers once they suspect or
get any of the symptoms that have been identified with plague,
because it is contagious. By 10 Dec 2010, there had been no new
reported cases for the last 4 days.
Betty Apio, the District Health Officer of Abim district, says the
challenge at the moment is failure to establish the real disease that
is killing people. She says after the samples sent to the Entebbe
Virus Research Institute tested negative for haemorrhagic fevers,
more samples were sent to the Centers for Disease Control Atlanta,
and to South Africa for further tests. She said that although it had
been indicated earlier that the disease could be bubonic plague, they
are not sure of the disease yet.
Whereas the 1st victim of the disease died on 7 Oct 2010, Abim
district health office knew about the disease on 8 Nov 2010 after 3
more people from Morulem subcounty had died in a similar manner. By
12 Nov 2010, when the disease spread to Agago, Lamwo and Kitgum
districts, a team of investigators from the Ministry of Health
reported that there was an epizootic that needed specialised
investigations as of 15 Nov 2010.
Ten days later, a multi-department team of health investigators from
the Ministry of Health, WHO, CDC, AFENET, Ministry of Agriculture,
Makerere University Faculty of Veterinary Medicine and School of
Public Health arrived in Agago to "facilitate the extended
investigations and initiation of preliminary control measures." The
investigators later visited Kitgum and Abim.
Apio says with support from the MoH and WHO, Abim has set up an
emergency centre to handle cases that arise in the area at Morulem
Health Centre III. The Ministry is still involved in an active search
for victims, putting them in isolation centers, community social
mobilisation, providing protective gear and drugs to control the
infections, and it has engaged with the Ministry of Agriculture and
Animal Husbandry who are on the ground in Abim district to ascertain
whether the undiagnosed disease is linked to the wild animals they eat.
Delay in diagnosing the disease has led to speculation that politics
could be at play. It is election time. President Yoweri Museveni,
while campaigning in Karamoja, told voters that previous regimes
failed to fight disease. Polio is a UPC disease, he has told them.
His opponents have countered with accusations that President
Museveni's regime has failed in that people are dying of jiggers and
plague, a disease that reveals a lot about people's hygiene taking
its toll in northern Uganda. With over 30 people dead and more than
96 cases admitted to health centres, some critical voices say
government response to the disease has been slow as compared to the
time when the hemorrhagic Ebola fever broke out in Bundibugyo in 2007.
Ebola left at least 37 people dead including a doctor who had put his
life on the line treating his people who suffered from a then
undiagnosed disease. Many are recalling that Ebola broke out at a
time when Uganda was days to hosting the Commonwealth Heads of
Government Meeting (CHOGM) and the reporting about the disease was
very muted. Journalists who wanted to report it were getting sketchy
answers. CHOGM was held from 22-25 Nov 2007. Before it was held, the
story was: "No Ebola in Uganda - health official" in The New Vision.
The 12 Sep 2007 story quoted Dr Sam Okware, the Commissioner of
Community Health. "Strange viral disease kills 20 in Bundibugyo,"
reported the Daily Monitor on 14 Nov 2007 and "Strange Disease Kills
One More," the New Vision on 26 Nov 2007. At that point, 16 people had died.
By 30 Nov 2007, just 5 days after CHOGM, the story was: "New Ebola
strain found in Uganda". Why was it so difficult to diagnose the
disease before CHOGM and so easy after?
Dr Sam Zaramba, the Director General of Health Services, denied
reports that the government had known about the deadly epidemic
outbreak weeks earlier but concealed it in order not to scare away
foreign dignitaries who were to attend CHOGM. "It would be unethical
for me to keep quiet (about an epidemic outbreak). It is true we knew
there was a strange disease in western Uganda but had not got the
conclusive confirmation," he said.
It is an unusual but common enough case that when there is a disease
outbreak, governments try to downplay it to avoid bad publicity and
panic. This was the case when the deadly severe acute respiratory
syndrome (SARS) broke out in Hong Kong. Some 800 people had been
infected, and 20 died, but authorities in Hong Kong kept claiming the
disease was under control as more and more people were infected and
refused to impose a travel quarantine to badly hit areas. The US
government has also been accused of hiding information about the
outbreak of mad cow disease for a period of 8 years.
In Uganda's case, Assistant Commissioner in the Ministry of Health
Makumbi says they have warned people against eating wild animals
after the initial samples showed that some people had plague, though
they are not sure whether the plague was contracted from animals.
Every patient is being treated for plague, and some patients are
recovering while others are still receiving treatment.
Fisseha also says there is still need to do further investigation,
and WHO is working closely with the MOH and partners to ascertain the
cause and institute appropriate control measures.
[Byline: Mubatsi Asinja Habati, Rukiya Makuma]
--
Communicated by:
Thomas James Allen <tjallen@pipeline.com>
*****
[2]
Date: 23 Dec 2010
Source: Uganda Health News [edited]
<http://www.ugpulse.com/articles/daily/news.asp?about=Yellow+fever+kills+40+in+northern+Uganda+&ID=17241>
The Ministry of Health has confirmed that the disease that has killed
over 40 people in Northern Uganda since last month [November 2010] is
yellow fever.
The disease, which presents with fever, headache, abdominal pains,
vomiting and diarrhea, left 45 people dead and 127 in serious
condition in November [2010].
Districts that were affected by the disease include Abim, Agago,
Lamwo, Kitgum, Pader, Gulu, Arua, Kaabong and Lira.
The Director General of Health Services, Dr Nathan Kenya-Mugisha,
[stated that] yellow fever is a viral disease that is transmitted by
mosquito bites, and its signs, among others, are fever, muscle pains,
shivering, yellow eyes, and vomiting.
Dr. Mugisha advised members of the public to destroy mosquito
breeding places around their homes and sleep under a mosquito net.
He says maximum vaccination is going to be carried out in the
affected areas and urged any person who experiences unfamiliar health
symptoms to immediately report to the nearest health centre.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
*****
[3]
Date: Fri 24 Dec 2010
Source: The Monitor [edited]
<http://www.monitor.co.ug/News/National/-/688334/1078030/-/cjvl6uz/-/index>
The Ministry of Health yesterday [23 Nov 2010] confirmed that the
strange disease that has been devastating parts of northern Uganda is
yellow fever. The disease that has plagued the region since November
2010 has so far killed 45 people. Most of its victims suffer fever,
headache, abdominal pain, vomiting, and diarrhea.
Another 174 people have also been reported infected, according to the
ministry of health. Yellow fever is a viral disease that is
transmitted by mosquito bites. Its symptoms are headache, fever,
muscle and back pain, shivering, loss of appetite and vomiting.
Some patients, according to health experts, also develop yellow eyes,
abdominal pain, and bleeding from the eyes, ears and nose. Ministry
of Health officials said experts from the Uganda Virus Research
Institute, the US Centers for Disease Control and the World Health
Organisation have for the past one month been investigating the
disease in the districts of Abim, Arua, Kaabong, Lira, Agago, Lamwo,
Kitgum, Pader and Gulu.
Dr Kenya Mugisha, the acting director of health services, said mass
vaccination will be carried out in the affected areas to control the
spread of the disease.
He, however, advised people in the affected areas to sleep under
mosquito nets and destroy all mosquito breeding places, like stagnant
water around their homes.
Uganda, particularly the northern region, is not new to epidemic
outbreaks. In recent years, the region has been hit by a string of
epidemics, including hepatitis E, Ebola, meningitis, cholera and
bubonic plague in West Nile.
[Byline: Evelyn Lirri]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The 1st of the above reports give a more coherent account of the
origin and progress of the outbreak than previously available.
However, the etiology and homogeneity of the outbreak remains
problematic despite the number of organisations apparently involved
in the investigation, although a diagnosis of plague is still
favoured. It seems unlikely, however, that political interference is
a relevant factor.
The 2nd and 3rd reports state that yellow fever virus is the
etiologic agent.
The evidence for this diagnosis is not revealed, but
the nature of the disease is compatible with the limited clinical
information so far available.
According to the WHO
(<
http://www.who.int/mediacentre/factsheets/fs100/en/index.html >),
yellow fever infection is difficult to diagnose, especially during
the early stages. It can be confused with malaria, typhoid, dengue,
hepatitis and other diseases, as well as poisoning. Blood tests can
detect yellow fever antibodies produced in response to the infection.
Several other techniques are used to identify the virus in blood
specimens or liver tissue collected after death. These tests require
highly trained laboratory staff and specialized equipment and materials.
Yellow fever is an acute viral haemorrhagic disease transmitted by
infected mosquitoes. The 1st, "acute," phase usually causes fever,
muscle pain with prominent backache, headache, shivers, loss of
appetite, and nausea or vomiting. Most patients improve, and their
symptoms disappear after 3 to 4 days. However, 15 percent of patients
enter a 2nd, more toxic phase within 24 hours of the initial
remission. High fever returns, and several body systems are affected.
The patient rapidly develops jaundice and complains of abdominal pain
with vomiting. Bleeding can occur from the mouth, nose, eyes or
stomach. Once this happens, blood appears in the vomit and faeces.
Kidney function deteriorates. Half of the patients who enter the
toxic phase die within 10 to 14 days, the rest recover without
significant organ damage.
Further information on the basis for the diagnosis of yellow fever is
awaited before this explanation can be regarded as conclusive. - Mod.CP]
