An outbreak of Ebola in Uganda

Abstract

Summary An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterized by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot‐Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts. Response measures included surveillance, community mobilization, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow‐up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism and international relations. The international response was coordinated by the World Health Organization (WHO) under the umbrella organization of the Global Outbreak and Alert Response Network. A WHO/CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the ‘alert’, ‘suspected’, ‘probable’ and ‘confirmed cases’. Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC). For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2.5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community‐based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably.

Serosurvey on Household Contacts of Marburg Hemorrhagic Fever Patients

“…Our secondary attack risk estimate of 21% is within the range reported for Ebola outbreaks for comparable types of contacts: Ebola-Zaire, Kikwit, 1995, household contacts 16% ( 5 ); Yambuku, 1976, close relatives, 20% ( 9 ); Ebola-Sudan, Nzara, 1979, family members with physical contact including nursing 31% ( 10 ) Our estimate is much higher than the 2.5% reported for Ebola-Sudan, Uganda, 2000 ( 11 ); however, the Ugandan estimate may have included persons who merely stayed in the same house as a patient without reporting physical contact. The secondary and tertiary attack risks in our study were found to be virtually identical, 21% and 19%, respectively; thus no evidence suggested that Marburg virus loses infectivity by repeated passages through humans.…”

Post-exposure treatments for Ebola and Marburg virus infections

“…Although this syndrome was noted in survivors of past filovirus outbreaks [223][224][225] , the magnitude of the 2013-2016 epidemic resulted in a large number of survivors. This syndrome draws attention to the importance of identifying, developing and optimizing drugs that can reach immune-privileged tissues such as the central nervous system and reproductive organs.…”

Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014–2015

“…The largest prior EVD outbreak, in Uganda, resulted in 425 cases. 1,2 In less than 18 months, arising from a single index case, Sierra Leone, Liberia and Guinea recorded an estimated 11,147 direct deaths from EVD, including 507 deaths in healthcare workers, with many more deaths secondary to the breakdown and fear of healthcare services; for a time the epidemic threatened the region and potentially the continent. 3,4 The high mortality and the panic this outbreak induced additionally had a major effect on health systems and economies, driving people further into poverty.…”