H5N1

Ebola virus disease in Uganda - Situation Report #01 (12 June 2019)

Mabalako not shown on Google Maps. Distance from Beni to Butembo is just under 60 km.

Via ReliefWeb, the government of Uganda has published Ebola Virus Disease in Uganda - Situation Report #01 (12 June 2019).

On 11th June 2019, the Minister of Health, Hon Dr Jane Aceng, made an official statement of an Ebola Virus Disease (EVD) outbreak in Kasese District, South West Uganda.  

The index case was a 5-year-old male who travelled from the Democratic Republic of Congo (DRC) with his mother on 9th June 2019 after attending a burial of the grandfather who had succumbed to EVD. The grandfather was a pastor who lived in Mabalako health zone in Aloya health area about 30 km from Beni. 

The mother was of Congolese origin but married to a Ugandan and residing in Kasese District. However, she had travelled back to DRC to nurse her father who succumbed to Ebola. The health authorities in Beni identified 12 suspect cases from the same family and put them in isolation for monitoring. However, 6 of the 12 suspect cases escaped and crossed over to Uganda. Of the 6 who crossed to Uganda 4 were children and 2 adults with 81 contacts in Kasindi and 40 contacts in Mutwanga, areas bordering Uganda in the DRC.  

One of the people who crossed over was the wife of the deceased pastor – grandmother to the index case. Three of the people who crossed were of Congolese origin. 

The child and his family entered the country through the market at Mpondwe, bypassing the official border post. On 10th June, the mother sought medical care for the child at Kagando hospital as the child was not feeling well by the time they came into Uganda. The child presented with the following symptoms: vomiting blood, bloody diarrhea, muscle pain, headache, fatigue and abdominal pain. 

On suspicion of EVD, the clinicians transferred him to Bwera ETU where a sample was collected and shipped to Uganda Virus Research Institute (UVRI) on 10th June 2019 for confirmatory testing. The grandmother and 3-year-old brother who had also started showing signs of EVD were isolated at the same ETU and their samples collected on the 11th June 2019. The 5-year old’s results were confirmed positive for Ebola Zaire by PCR on the evening of 11th June 2019 and he later succumbed to EVD at about 9.45 pm. 

Today, the samples of the 50-year-old grandmother and 3-year-old brother to the index case tested positive for Ebola Zaire by PCR. The grandmother has also succumbed to EVD. Twenty-seven contacts have been line listed for follow up so far.

WHO: Ebola virus disease – Republic of Uganda

WHO has published Ebola virus disease – Republic of Uganda. Excerpt from the risk assessment section:

All three confirmed cases are imported from DRC and belong to the same family who travelled together from Mabalako Health Zone, an area currently affected by Ebola outbreak in North Kivu, DRC. To date, they remain as a single episode of EVD in Uganda, and the geographical spread in Uganda appears to be limited to one district near DRC border. Further investigations are ongoing both in Uganda and DRC to assess the full extent of the outbreak. 

Since the beginning of the Ebola outbreak in DRC in August 2018, WHO has advised neighbouring countries (Priority 1 countries: Uganda, Rwanda, South Sudan, and Burundi / Priority 2 countries: Angola, Zambia, Tanzania, Central African Republic and Republic of Congo) to reinforce their preparedness measures. 

Considering that to date i) the EVD cases confirmed in Uganda were epidemiologically linked to the DRC; ii) all three cases belong to single family cluster with a common high-risk exposure to a confirmed case, iii) the level of preparedness and the proven experience of Ugandan authorities to manage previous EVD outbreaks, and iv) the rapidity of the detection and a limited geographical area affected (Kasese district), the overall level of risk at national level is assessed as moderate. 

Moreover, given that there is no evidence of local transmission of EVD in Uganda and the location of the outbreak being close to the DRC border, the overall risk posed at regional level by the Ugandan outbreak is considered low. However, the overall regional risk posed by the outbreak in DRC remains very high. The overall risk at international level remains low.  

The Director-General will convene a third meeting of the Emergency Committee under the International Health Regulations (IHR 2005) following the most recent risk assessment which noted a cross-border spread of Ebola from DRC to Uganda. WHO has convened the emergency committee under International Health Regulations (IHR 2005) twice (October 2018 and April 2019) since the outbreak in DRC was announced in August. The committee will discuss whether the event constitute a public health emergency of international concern (PHEIC).

At least 31 children in India killed by toxin in lychees

Via The Guardian: At least 31 children in India killed by toxin in lychees. Excerpt:

At least 31 children have died in northern India in the past 10 days from a brain disease believed to be linked to a toxic substance found in lychee fruit, health officials have said. 

The deaths were reported by two hospitals in Muzaffarpur in Bihar state, famed for it lush lychee orchards, officials said. 

The children all showed symptoms of acute encephalitis syndrome (AES), senior health official Ashok Kumar Singh said, adding most had suffered a sudden loss of glucose in their blood. 

At least 40 other children complaining of similar symptoms were being treated at intensive care units. 

“We are trying our best to save them,” said S P Singh, the chief medical officer of Sri Krishna medical college and hospital.

The outbreaks of the disease have happened annually during summer months in Muzaffarpur and neighbouring districts since 1995, typically coinciding with the lychee season. 

“The health department has already issued an advisory for people to take care of their children during the hot summer when day temperature is above 40 degrees,” Ashok Kumar Singh said.

High rate of transmission in a pulmonary tuberculosis outbreak in a primary school, north-eastern Italy, 2019

Eurosurveillance has published High rate of transmission in a pulmonary tuberculosis outbreak in a primary school, north-eastern Italy, 2019. The abstract:

Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. 

The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. 

Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.

Uganda: Second person dies of Ebola in Kasese as cases rise to 10

The isolation centre set up in Bwera, Kasese District where the five-year-old boy who tested positive for Ebola died from. Photo by Joel Kaguta

Via the Daily Monitor in Kampala: Second person dies of Ebola in Kasese as cases rise to 10.

The grandmother of a five year old boy who died of Ebola yesterday has also passed on. 

The late reportedly died at around 6pm at Bwera General Hospital where an isolation facility was established for Ebola patients to be treated.  

“She will be buried tomorrow by our team after identifying a place," a source among the Ministry of Health team which travelled to Kasese today told Daily Monitor. He however declined to be named because they are not authorized to speak to the press. 

Health Ministry Spokesperson Mr Emmanuel Ainebyoona was hesitant to comment on the matter while Dr Jane Ruth Aceng the Health Minister did not pick our calls to confirm the case.  

The Ebola outbreak which has ravaged the neighbouring DRC for the last one year was Tuesday confirmed in Uganda in the western border district of Kasese. 

The first case to be confirmed on Tuesday was that of a five-year-old boy, who tested positive and later died. The others cases include the deceased three-year-old young brother, who also tested positive and were admitted at the isolation facility that was established at Bwera General Hospital.

Health Minister Dr Jane Ruth Aceng said there are more seven suspects, including two men, two women and a six-months-old baby, who came from the DR Congo. All the cases are at the isolation facility.

DRC Ebola: 13 new cases, 9 deaths (7 in community) and a destroyed family

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Wednesday, June 12, 2019. Apart from being a bad day, June 11 was aggravated by the cases in a Congolese-Ugandan family that managed to cross the border back into Uganda. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Wednesday, June 12, 2019  

The epidemiological situation of the Ebola Virus Disease dated 11 June 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,084, including 1,990 confirmed and 94 probable. In total, there were 1,405 deaths (1,311 confirmed and 94 probable) and 579 people healed. 

• 339 suspected cases under investigation; 

• 13 new confirmed cases, including 7 in Mabalako, 4 in Beni, 1 in Kalunguta and 1 in Komanda; 

• 9 new confirmed case deaths:  

 º 7 community deaths, including 5 in Mabalako, 1 in Kalunguta and 1 in Komanda; 

º 2 deaths at CTE, including 1 in Katwa and 1 in Butembo; 

• 4 new cures out of ETCs, 2 in Beni and 2 in Butembo. 

INFO: All family members of the Ebola case in Uganda are not yet included in the caseload. The confirmed cases of the family, both on the Ugandan and Congolese side, will be officially added in the epidemiological situation that will be published this Thursday, June 13, 2019.

  

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS   

Case of Ebola Virus Disease in Uganda 

• The first confirmed case of Ebola in Uganda, a five-year-old boy, passed away on the morning of Wednesday, June 12, 2019. His dignified and safe burial will be on Thursday, June 13, 2019 in Kasese, the district where he resided with his parents.  

• Laboratory tests have confirmed that of the six family members who have crossed the border, two others are also infected with Ebola. This is the 50 year old grandmother and the 3 year old brother of the deceased boy. Of the six family members left in Kasindi and transferred to the Beni Ebola Treatment Center, five were tested positive. Around this family, about 50 contacts were listed in Kasese on the Ugandan side and 80 contacts in Kasindi on the Congolese side. Kasindi's vaccination ring was opened on Wednesday. 

• On Wednesday, June 12, 2019, the Congolese and Ugandan health authorities also held a meeting in Kasese, about 140 kilometers from Beni, to discuss mechanisms for cross-border collaboration. The Ugandan Minister of Health, Dr Jane Ruth Aceng, led the Ugandan delegation while the Congolese side was led by Dr. Gaston Tshapenda, coordinator of Beni. 

• The main decisions taken are: 

º Strengthen surveillance at ports of entry, especially secondary roads; 

º Maintain continuous information sharing in real time between the two countries; 

º Start vaccinating the contacts as soon as possible. The DRC has already donated 400 doses of rVSV-ZEBOV vaccine to Uganda. The DRC is willing to send vaccination teams to Uganda to vaccinate all contacts more quickly if needed; 

º Repatriate all family members in the DRC after obtaining their informed consent. Since the father of the deceased child was Ugandan, the family was free to choose the place of hospitalization. Living family members have all agreed to return to the DRC for further medical treatment and 21-day follow-up. The advantage of continuing medical treatment in the DRC is the possibility of benefiting from new therapeutic molecules that are not yet available in Uganda; 

º Finalize the Memorandum of Understanding between Uganda and the DRC that will define the procedures for in-depth health collaboration between the two countries.

FIGURES OF THE RESPONSE

132,679 people vaccinated

• 415 people vaccinated on 11/06/2019.

• Of those vaccinated, 36,595 are high-risk contacts (CHRs), 65,944 are contacts of contacts (CC), and 30,140 are front-line providers (PPLs).

• Persons vaccinated by health zone: 33,990 in Katwa, 25,890 in Beni, 18,234 in Butembo, 11,387 in Mabalako, 6,443 in Mandima, 4,619 in Kalunguta, 3,329 in Goma, 3,048 in Komanda, 2,835 in Musienene, 2,569 in Oicha, 2,351 in Masereka , 2,045 to Vuhovi, 1,998 to Lubero, 1,980 to Kayna, 1,888 to Kyondo, 1,487 to Bunia, 1,040 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 666 to Rwampara (Ituri), 596 to Mangurujipa, 527 to Nyankunde, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Health checkpoints

65,448,742 people under control

• 80 entry points (PoE) and operational health checkpoints (PoC).

Infected healthcare workers

115 contaminated health workers

• Two Mabalako health workers, unvaccinated, are among the new confirmed cases. One of the health workers died in the health center where he was working (community death).

• The cumulative number of confirmed / probable cases among health workers is 115 (5.5% of all confirmed / probable cases), including 38 deaths.

Five-year-old dies of Ebola as outbreak crosses Congo border

Thanks to Mary Marshall for sending the link to this Associated Press report in the Daily Mail: 5-year-old dies of Ebola as outbreak crosses Congo border. Excerpt:

KASINDI, Congo (AP) - A 5-year-old boy vomiting blood became the first cross-border victim of Ebola in the current outbreak on Wednesday, while two more people in Uganda tested positive for the highly contagious disease that has killed nearly 1,400 in Congo. 

The boy, part of a Congolese family who crossed into Uganda earlier in the week, died overnight, the World Health Organization said. Ugandan authorities said the two new cases are his 3-year-old brother and 50-year-old grandmother, who have been isolated at a hospital near the border. Uganda now has three confirmed Ebola cases. 

Authorities tried to determine how the family, exposed to the virus via a sick relative in Congo, managed to cross a border where health officials have been screening millions of travelers for months.  

This has become the second-deadliest Ebola outbreak in history since the first cases were declared in August. A WHO expert committee has been alerted for a possible meeting on whether to declare a global health emergency now that the outbreak has crossed the border, a spokesman said.  

Experts have long feared Ebola could spread to neighboring countries because of rebel attacks and community resistance hampering virus containment work in eastern Congo, one of the world's most turbulent regions. The virus can spread quickly via close contact with bodily fluids of those infected and can be fatal in up to 90% of cases. 

Congo's health ministry said a dozen members of the boy's family had showed symptoms of Ebola. They were not placed in isolation and instead were told to remain where they were staying until transport was found to an Ebola treatment unit in Beni, Dr. Dominique Kabongo, coordinator of Ebola response teams in Kasindi, told The Associated Press.

Instead half of the family quietly crossed into Uganda, while five of those who remained have tested positive for Ebola since being taken to Beni, the health ministry said.  

"Many people are evading (border) customs and using small footpaths and it is difficult for us to follow the contacts," Kabongo said.

Branswell: Uganda confirms first Ebola case outside outbreak in DR Congo

Via STAT, Helen Branswell wraps up a bad day: Uganda confirms first Ebola case outside outbreak in DRC. Excerpt:

Uganda on Tuesday confirmed a child there has been diagnosed with Ebola, the first cross-border case from the Democratic Republic of the Congo, where a large outbreak has raged for the last 10 months.  

Five family members traveling with the child, a 5-year-old, are also ill and have been tested for Ebola, Ugandan Health Minister Dr. Jane Ruth Aceng said. Those test results are pending.  

The news will likely increase pressure on the World Health Organization to declare the outbreak a public health emergency of international concern. The agency’s director-general, Tedros Adhanom Ghebreyesus, told STAT he will convene an advisory body — called an emergency committee — as quickly as possible to review the situation and decide whether the outbreak now poses a global health threat.

Dr. Mike Ryan, who heads the WHO’s emergencies program, said the meeting will likely occur within the next day or two, after the agency consults with the governments of Uganda and DRC. 

Ryan said Uganda and partners have been working for months to protect the border area against just this type of event. “It’s never good news to have Ebola,” he said, but suggested the preparatory work should help contain the threat.  

The infected child crossed into Uganda with his family in Bwera, near the Congolese city of Butembo. The Congolese Health Ministry said the family was traveling from Mabalako. Both Mabalako and Butembo have experienced intense Ebola transmission of late.

The boy’s mother is Congolese but his father is Ugandan; they live in Uganda, near the border. The family had traveled to DRC to see the woman’s father. He died from Ebola in late May. 

A group of 14 family members set off to return to Uganda, arriving at a village called Kasindi near the border on June 10. Of the group, seven are children, ranging in age from 7 months to 12 years of age. 

When they arrived at Kasindi, 12 members of the group were experiencing symptoms, and they stopped there at a health facility. They were directed to an isolation center, but then six members of the family fled the facility, crossing into Uganda, said the Congolese Health Ministry, which alerted Ugandan authorities of the family’s movements. The group that crossed the border included the boy, his mother, and four others.  

The WHO’s country office for Uganda said that after crossing the border, the group sought care at a hospital in Kagando, where health workers recognized the boy was likely infected with Ebola. 

The boy was transferred to an Ebola treatment center at Bwera, one of the facilities Uganda has set up in anticipation of the possibility of seeing cases imported from DRC. He was tested for the virus there. 

For months, DRC’s neighbors have been preparing for the possibility that a case arising from the outbreak in DRC could spill into their territories, with Uganda, South Sudan, and Rwanda vaccinating health workers in health facilities near their borders with DRC. Vaccination of health workers in parts of Burundi is also planned. 

Uganda has vaccinated nearly 5,000 health workers at 165 health facilities, including both the one where the boy is being treated, and the one at Kagando where his family first stopped for care.

DRC - Ministry of Health communication on first case of Ebola virus disease detected in Uganda

Google Maps

The Ministry of Health has published EBOLA DRC - Ministry of Health Communication on First Case of Ebola Virus Disease Detected in Uganda. It is quite a story. The Google translation:

Ministry of Health Communication on First Case of Ebola Virus Disease Detected in Uganda   

Kinshasa, June 11, 2019  - The Ministry of Health of the Republic of Uganda has announced the presence of the first patient with Ebola Virus Disease in Uganda since the beginning of the Ebola outbreak in the provinces of North Kivu and Ituri. This is a five-year-old child who crossed the border with five members of his family on the evening of Monday, June 10, 2019.

The mother of the child is a woman of Congolese origin married to a Ugandan man and they reside in Kasese District in Uganda. She had traveled to the Democratic Republic of Congo in May 2019 to take care of her father, who unfortunately died of Ebola on May 27, 2019 in Cantine-Aloya, in the health zone of Mabalako.   

On June 10, 2019, 14 members of this family, 12 of whom were already symptomatic, arrived in Kasindi, a town on the border with Uganda. They were listed as contacts of a confirmed Ebola case who died on May 27, 2019 in Mabalako. They were detected by the teams of the National Border Health Program (PNHF) installed at Kasindi health checkpoint. 

 Recognizing the symptoms of Ebola, PNHF teams did not let the family pass and transferred the 12 symptomatic people to the transitional isolation center at Kasindi Hospital pending transfer to the Ebola Treatment Center in Beni to take the samples. Of the 12 suspected cases, there were seven children aged 7 months to 12 years.   

On the evening of June 10, 2019, six members of this family left the Kasindi isolation center and crossed the border on foot through secondary tracks to avoid health checks. Congolese health authorities immediately notified the Ugandan authorities and provided them with the names and phone numbers of suspected cases. 

Ugandan health workers found the child and his family at Kagando Hospital in Uganda. The child and five other members of his family were then transferred and isolated to the Bwera Ebola Treatment Unit where the samples were taken. Eight Ugandan contacts have been listed and will be followed for 21 days.    

The remaining six family members in Kasindi were transferred to the Beni Ebola Treatment Center on Tuesday, June 11, 2019, and their samples are being analyzed. A cross-border meeting between the Congolese and Ugandan health authorities is scheduled for Wednesday, June 12, 2019 in Kasese, Uganda, to discuss the possibility of repatriation of the family to the Democratic Republic of Congo to continue their treatment in Beni.    

The DRC Ministry of Health thanks the Ugandan health authorities for this effective cross-border collaboration. As a reminder, from the beginning of the tenth Ebola outbreak in the DRC, the Ministry of Health is working in full transparency with the health authorities of neighboring countries to prevent the spread of the epidemic in the region. This collaboration takes the form of regular technical meetings, a permanent exchange of information on the evolution of the epidemic, as well as the sharing of the identities of contacts of confirmed Ebola patients wishing to cross, or having crossed, the border.    

A sanitary control system at the entry points of the DRC is organized by the PNHF in collaboration with the World Organization for Migration (IOM). It is this system that allows for the rapid detection of contacts of confirmed Ebola cases who are traveling and trying to cross borders to escape health control. On average, 20 to 25 thousand passengers cross the border daily at the Kasindi port of entry. Since the beginning of the epidemic, more than 65 million travelers have been checked at the various entry points and checkpoints set up. 

WHO AFRO: Confirmation of case of Ebola virus disease in Uganda

WHO AFRO has just published Confirmation of case of Ebola virus disease in Uganda. The complete report:

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.  

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored. 

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. 

In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place. 

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.    

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, feces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:  

• Fever 

• Fatigue 

• Muscle pain 

• Headache 

• Sore throat 

People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well. 

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.  

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.  

The Ministry of Health has taken the following actions to contain spread of the disease in the country: 

• The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing. 

• The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur. 

• Social mobilization activities are being intensified and education materials are being disseminated. 

There are no confirmed cases in any other parts of the country. 

The Ministry is working with international partners coordinated by the World Health Organization. 

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.