H5N1

Uganda: Strange disease kills two in Kagadi

Thanks to Viki Hansen-Landis for alerting me to this report in allAfrica.com, reprinted from the Daily Monitor in Kampala: Uganda: Strange Disease Kills Two in Kagadi. Excerpt and then a comment:

Kagadi — Two children have died of a strange disease which presented symptoms similar to those of the Ebola virus.  

The victims of the strange disease are 10-year-old Jovia Natukunda and David Niwagaba who was nine months old.  

They were children of Mr Valence Byaruhanga, a resident of Kikonda village in Kiryanga Sub-county, Kagadi District. They died on Thursday. 

They were passing out blood from the mouth and the nose which symptoms are similar to those caused by the Ebola virus. 

Their death has caused fear among residents in a district that was hit by an outbreak of Ebola in 2012.  

The Kagadi Ebola Task Force led by the District Surveillance Officer, Mr Selevano Thembo, went to the area to investigate the matter. 

Wearing protective clothes, the team carried out the burial as one of the precautionary procedures in cases of suspected contagious diseases.  

"When people see blood coming out of their sick relatives, they tend to take it as a serious disease and our team went to investigate," Mr Thembo said. 

He said that they got blood samples from the bodies which will be taken to the Uganda Virus Research Institute for analysis. 

"Our district is at risk because of the outbreak of the Ebola disease in DR Congo," Mr Thembo said.  

Diseases which present with signs and symptoms similar to those of Ebola include Rift Valley Fever-RVF, Crimean Congo Haemorrhagic Fever-CCHF and Marburg fever. 

In 2018, Crimean Congo Haemorrhagic Fever outbreak was confirmed in neighbouring Kakumiro District in Nkooko Sub-county. It claimed one person.  

In late April, the Ministry of Health gave Shs146 million to Kagadi District for Ebola preparedness activities.

This is not just another health-scare story. The link in the text will take you to a report in 2012 about a real Ebola outbreak in Kagadi, and the town had a similar case less than a month ago. It's also useful to be reminded that Ebola's early symptoms mimic those of several other common diseases in the region—a major reason why relatively few suspected Ebola cases are confirmed. 

Ebola-like virus found in Chinese bats

Thanks to Tony Trehy for sending the link to this report in the South China Morning Post: Ebola-like virus found in Chinese bats. Excerpt:

A new Ebola-related bat-borne virus with the potential to infect humans and animals has been found by a team of Chinese and Singaporean scientists in southwestern China. 

The Mengla virus – discovered in a fruit bat caught in Mengla county, Yunnan province – is closely related to the Ebola and Marburg viruses which are capable of causing severe and often fatal bleeding and organ failure in humans, according to the scientists. 

Their study, published in the January edition of the online journal Nature Microbiology, confirmed that the new virus could infect cells from monkeys, hamsters, dogs and humans. 

The team, led by Shi Zhengli from the Chinese Academy of Sciences’ Institute of Virology in Wuhan and Wang Linfa from the Duke-NUS Medical School in Singapore, discovered that the new virus had several important functional similarities with the Ebola and Marburg viruses. 

The similarities, which include using the same molecular receptor to gain entry into cells and cause infection, put the new virus into the filovirus family, which is known for causing severe haemorrhagic fever in humans.  

“Studying the genetic diversity and geographic distribution of bat-borne filoviruses is very important for risk assessment and outbreak prevention, as this type of infectious disease can affect the general public without warning and with devastating consequences,” Wang said. 

At present, the Mengla virus has only been identified in populations of Rousettus bats in China, and further tests will be conducted to assess the risk of the virus spreading to other species.

Sierra Leone fruit bats infected with Ebola-like Marburg virus

Via Reuters: Sierra Leone fruit bats infected with Ebola-like Marburg virus. Excerpt:

Scientists in Sierra Leone have found live bats infected with Marburg virus, a deadly hemorrhagic fever similar to Ebola and so far undetected in West Africa, a U.S. government statement said on Thursday. 

The African fruit bat is the reservoir host of the virus, which has caused at least 12 outbreaks of hemorrhagic fever on the continent. 

Angola suffered the worst epidemic in 2005, when 90 percent of the 252 people infected in the southern African country died. The continent’s most recent outbreak killed three people in Uganda last year. 

In a statement on Thursday, the U.S. Centers for Disease Control and Prevention (CDC) said five Egyptian rousette fruit bats caught in Sierra Leone tested positive for the Marburg virus.  

No human cases of the fever have so far been reported, although the presence of infected bats — who do not show obvious signs of the disease — increases the risk of contracting the virus.  

“We have known for a long time that rousette bats, which carry Marburg virus in other parts of Africa, also live in West Africa. So it’s not surprising,” said CDC ecologist Jonathan Towner in the statement.

WHO: Uganda ends Marburg virus disease outbreak

A WHO news release: Uganda ends Marburg virus disease outbreak. Excerpt:

Uganda has successfully controlled an outbreak of Marburg virus disease and prevented its spread only weeks after it was first detected, the World Health Organization said on Friday (December 8).

“Uganda has led an exemplary response. Health authorities and partners, with the support of WHO, were able to detect and control the spread of Marburg virus disease within a matter of weeks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.  

The Ugandan Ministry of Health notified WHO of the outbreak on October 17, after laboratory tests confirmed that the death of a 50-year-old woman was due to infection with the Marburg virus. A Public Health Emergency Operations Centre was immediately activated and a national taskforce led the response.  

Three people died over the course of the outbreak which affected two districts in eastern Uganda near the Kenyan border, Kween and Kapchorwa. Health workers followed up with a total 316 close contacts of the patients in Uganda and Kenya to ensure that they had not acquired the illness. 

The MVD outbreak was declared contained by the Ministry of Health after the contacts of the last confirmed patient completed 21 days of follow up (to account for the 21-day incubation period of the virus) and an additional 21 days of intensive surveillance was completed in affected districts.  

“As evidenced by the quick and robust response to the Marburg virus disease outbreak, we are committed to protecting people by ensuring that all measures are in place for early detection and immediate response to all viral haemorrhagic fever outbreaks,” said Ugandan Minister of Health Sarah Opendi. 

Within 24 hours of being informed by Ugandan health authorities in early October, WHO deployed a rapid response team to the remote mountainous area. The Organization also released US$623,000 from its Contingency Fund for Emergencies (CFE) to finance immediate support and scale up of the response in Uganda and Kenya.  

In subsequent weeks, WHO and partners supported laboratory testing and surveillance, the search for new cases and their contacts, establishing infection prevention measures in health facilities, managing and treating cases, and engaging with communities. 

Surveillance and contact tracing on the Kenyan side of the border by the Kenyan Ministry of Health and partners also prevented cross-border spread of the disease.

WHO: Marburg virus disease – Uganda and Kenya

WHO has published Marburg virus disease – Uganda and Kenya. This is the latest in a series of updates. Excerpt:

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg Virus Disease in Kween District, Eastern Uganda. The MoH officially declared the outbreak on 19 October 2017. As of 14 November, three cases have been reported including two confirmed cases, and one probable case. All three cases have died, resulting in a case fatality rate of 100%. The cases were epidemiologically linked and all belong to the same family. 

Chronologically, the first case (probable) was a 35-year-old herdsman who frequently hunted near the area of Kaptum, known for its bat-infested caves. He was admitted to hospital on 20 September with Marburg-like symptoms and died five days later. The first confirmed case was the sister and caretaker of the first case. The second confirmed case was the brother of the first two cases, who died on 26 October 2017 and had a safe and dignified burial on the same day.  

Prior to his death, the second confirmed case travelled to Kenya where he visited his relatives in West Pokot County, as well as a traditional healer in Trans Nzoia County. On 29 October 2017, the Ugandan MoH notified WHO and the Kenyan MoH of these high-risk contacts. The traditional healer tested negative for Marburg virus disease on repeated blood specimen analyses performed at the Kenyan Medical Research Institute (KEMRI) in Nairobi. She and her family were monitored for 21 days. The two relatives from West Pokot, as well as other contacts in the same county, also completed their 21 days of follow up. 

Active case search, death surveillance, safe and dignified burials and community mobilization are ongoing in Kween and Kapchorwa districts. In Uganda, of the 339 contacts listed, 283 have completed 21 days of follow-up and 56 are still being monitored. Contact follow-up is ongoing in Kween for the 56 contacts, while In Kapchorwa District, all the listed contacts have completed the 21 days follow-up period. All remaining contacts are expected to complete 21 days of follow up on 16 November 2017. Enhanced surveillance activities will continue until 7 December 2017.

ECDC: CDTR, week 45

ECDC has published Communicable disease threats report, 5-11 November 2017, week 45. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 5-11 November 2017 and includes updates on measles, rubella, chikungunya, West Nile virus, plague, monkeypox, legionnaires' disease, influenza and Marburg virus disease.

WHO: Marburg virus disease – Uganda and Kenya

WHO has published Marburg virus disease – Uganda and Kenya. Excerpt from a long report:

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017. 

As of 3 November, the three cases that have been previously reported (two confirmed and one probable case, the latter being the index case) have died, thus, resulting in an overall case-fatality rate of 100%. The cases were epidemiologically linked and come from one family.  

The second confirmed case travelled to Kenya, prior to his death. Contact tracing and active case search is ongoing in Kween in Kapchorwa district in Uganda, as well as in Kitale district and West Pokot in Kenya. On 4 November a high risk contact of the second confirmed case, a health care worker in Kween developed symptoms and was admitted to the treatment facility in Kween. Additionally, one close contact of the second confirmed case has been reported to have travelled to Kampala. The Kampala City Authority has sent a team to the village she is reported to be visiting to trace this contact and continue 21 days follow-up.

WHO: Marburg virus disease – Uganda and Kenya

Thanks to Helen Branswell for tweeting the link to this WHO report: Marburg virus disease – Uganda and Kenya. Excerpt:

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017. 

As of 3 November, the three cases that have been previously reported (two confirmed and one probable case, the latter being the index case) have died, thus, resulting in an overall case-fatality rate of 100%. The cases were epidemiologically linked and come from one family.  

The second confirmed case travelled to Kenya, prior to his death. Contact tracing and active case search is ongoing in Kween in Kapchorwa district in Uganda, as well as in Kitale district and West Pokot in Kenya. On 4 November a high risk contact of the second confirmed case, a health care worker in Kween developed symptoms and was admitted to the treatment facility in Kween. Additionally, one close contact of the second confirmed case has been reported to have travelled to Kampala. The Kampala City Authority has sent a team to the village she is reported to be visiting to trace this contact and continue 21 days follow-up.

WHO helps Kenya guard against Marburg virus disease

A news release: WHO helps Kenya guard against Marburg Virus Disease.

The World Health Organization is helping the Kenyan Ministry of Health guard against the spread of Marburg Virus Disease from neighbouring Uganda.  

Health authorities are strengthening preparedness measures in Trans Nzoia and West Pokot counties along the border with Uganda, where an outbreak was officially declared on 19 October.   

Although no MVD cases have been confirmed in Kenya, the Ministry of Health has set up a national task force to coordinate all rapid response activities, including WHO, the Kenya Red Cross Society, the the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF) and UNICEF. Several joint teams have been deployed to conduct risk assessments and initiate contact tracing and surveillance in Trans Nzoia and West Pokot.  

WHO is supporting enhanced surveillance and lab testing, an active search for potential cases and their contacts, community engagement, and isolation and treatment units.  

“We can save lives if sick people are identified early. Together with the Ministry of Health, we are actively looking for suspected cases and following up on their contacts,” said Dr. Rudi Eggers, WHO Representative in Kenya. “WHO staff in both Uganda and Kenya are coordinating cross border response activities including surveillance, contact tracing and active case search. This is key to breaking the chain of transmission and containing the outbreak.”  

A 73-year-old traditional healer in Trans Nzoia County tested negative for the virus on 01 November, after samples were transported to the Kenya Medical Research Institute (KEMRI) in Nairobi. She had come into contact with a Ugandan national with confirmed MVD who sought her out for treatment with herbal remedies.  

WHO is working with the Kenyan Ministry of Health to prepare local hospitals for possible cases, ensure the safe and timely transport of lab samples, provide information to local communities, and enhance preparedness measures and cross-border coordination.  

WHO has delivered 300 kits of personal protective equipment; with an additional 2,000 PPE kits on the way.

Uganda: Marburg update, October 26

Via the Uganda MOH: Update on the Marburg outbreak - 26th October 2017. Excerpt:

The number of cumulative cases has grown to 15 - two confirmed, four suspected, three probable cases and six ruled out.

In Kween district, our team managed to get a high risk contact who has been in hiding and was found to have developed Marburg-like symptoms.

This patient is a 38-year-old male, brother to the confirmed case and the probable case. Because of his close contact with the probable and confirmed cases, he was listed as a high risk contact. However, he refused review and follow-up by the contact tracing/surveillance team despite several attempts to do so. On the 24 Oct 2017, however, he accepted to speak to the contact tracing team which noted that he had developed Marburg-like symptoms. He was transported to the isolation unit with fever, body weakness, abdominal pain, loss of appetite, joint pains and history of vomiting blood while at home. Despite the tireless efforts from a dedicated case management team to revive this case, he unfortunately passed away earlier today (RIP).

A blood sample picked from this patient was sent to Uganda Virus Research Institute and tested positive for Marburg Virus Disease.

The other suspect case is a 25-year-old female from a village called government lodge, Kawowo parish, in Kapchorwa district who presented with Marburg – like symptoms. She has since been isolated and a sample was collected for confirmation. A pregnancy test was done and is positive. Her condition is however stable.

The new probable case is a 23-year-old male from Toywo village, Western Division, Kapchorwa Municipality. He shared a ward and his bed was next to the deceased confirmed case. A blood sample was collected and the case is still under isolation at Kapchorwa hospital in stable condition. His lab results are expected by tomorrow.

The total number of contacts under follow up currently stands at 130, 85 from Kween, and 45 from Kapchorwa district. None of the contacts has developed symptoms today.

As of this evening, 32 out of the 77 contacts from Kapchorwa district had either completed the recommended 21 days after exposure, or are no longer being followed because the case they were exposed to turned out to be negative.

Our multi-disciplinary and multi-stakeholder teams of experts will remain on ground in Kapchorwa and Kween districts until the outbreak is fully contained.

See also this October 27 report in the Kampala Monitor.