BackgroundEbola haemorrhagic fever (EHF) is infamous for its high case-fatality proportion (CFP) and the ease with which it spreads among contacts of the diseased. We describe the course of the EHF outbreak in Masindi, Uganda, in the year 2000, and report on response activities.MethodsWe analysed surveillance records, hospital statistics, and our own observations during response activities. We used Fisher's exact tests for differences in proportions, t-tests for differences in means, and logistic regression for multivariable analysis.ResultsThe response to the outbreak consisted of surveillance, case management, logistics and public mobilisation. Twenty-six EHF cases (24 laboratory confirmed, two probable) occurred between October 21st and December 22nd, 2000. CFP was 69% (18/26). Nosocomial transmission to the index case occurred in Lacor hospital in Gulu, outside the Ebola ward. After returning home to Masindi district the index case became the origin of a transmission chain within her own extended family (18 further cases), from index family members to health care workers (HCWs, 6 cases), and from HCWs to their household contacts (1 case). Five out of six occupational cases of EHF in HCWs occurred after the introduction of barrier nursing, probably due to breaches of barrier nursing principles. CFP was initially very high (76%) but decreased (20%) due to better case management after reinforcing the response team. The mobilisation of the community for the response efforts was challenging at the beginning, when fear, panic and mistrust had to be countered by the response team.ConclusionsLarge scale transmission in the community beyond the index family was prevented by early case identification and isolation as well as quarantine imposed by the community. The high number of occupational EHF after implementing barrier nursing points at the need to strengthen training and supervision of local HCWs. The difference in CFP before and after reinforcing the response team together with observations on the ward suggest a critical role for intensive supportive treatment. Collecting high quality clinical data is a priority for future outbreaks in order to identify the best possible FHF treatment regime under field conditions.

Interviews were conducted with health workers and community members in Masindi, Uganda on improving the acceptability of infection control measures used during an Ebola outbreak. Measures that promote cultural sensitivity and transparency of control activities were preferred and should be employed in future control efforts. We suggest assessing the practicality of body bags with viewing windows, and face shields with or without chin protectors, in future outbreaks.

2 figures omitted HYPOTHERMIA IS THE UNINTENTIONAL lowering of core body temperature to Ͻ95°F (Ͻ35°C). 1 Core body temperature normally is maintained at 97.7°F (36.5°C). 2 Most hypothermia-related deaths occur during the winter in states that have moderate to severe cold temperatures (e.g., Alaska, Illinois, New York, and Pennsylvania). 3 During 1979-1998, New York had the second highest number of hypothermia-related deaths in the United States. This report presents case reports of four hypothermia-related deaths during January 1999-March 2000 in Suffolk County (1999 population: 1,383,847), the largest county in New York excluding New York City, and summarizes hypothermia-related deaths in the United States during 1979-1998. Such deaths can be prevented by educating health-care providers and the public to identify persons at risk for hypothermia. Case Reports Case 1. On December 15, 1998, an 89-year-old woman with a history of wandering was noticed missing from the adult home facility where she resided and was found shivering in 1 foot of water at the edge of a pond on the property. The temperature that day ranged from 23°F-54°F (−5°C-12.2°C). On admission to a hospital, her rectal temperature was 95°F (35°C). Her