H5N1

WHO: Ghana reports first-ever suspected cases of Marburg virus disease

Via WHO AFRO:Ghana reports first-ever suspected cases of Marburg virus disease. The news release and then a comment:

Accra – Ghana has announced the preliminary finding of two cases of Marburg virus disease and if confirmed these would the first such infections recorded in the country. Marburg is a highly infectious viral haemorrhagic fever in the same family as the more well-known Ebola virus disease.   

Preliminary analysis of samples taken from two patients by the country’s Noguchi Memorial Institute for Medical Research indicated the cases were positive for Marburg. However, per the standard procedure, the samples have been sent to the Institut Pasteur in Senegal, a World Health Organization (WHO) Collaborating Centre for confirmation. The two patients from the southern Ashanti region – both deceased and unrelated – showed symptoms including diarrhoea, fever, nausea and vomiting. They had been taken to a district hospital in Ashanti region.   

Preparations for a possible outbreak response are being set up swiftly as further investigations are underway.  

“The health authorities are on the ground investigating the situation and preparing for a possible outbreak response. We are working closely with the country to ramp up detection, track contacts, be ready to control the spread of the virus,” said Dr Francis Kasolo, World Health Organization (WHO) Representative in Ghana.  

WHO is deploying experts to support Ghana’s health authorities by bolstering disease surveillance, testing, tracing contacts, preparing to treat patients and working with communities to alert and educate them about the risks and dangers of the disease and to collaborate with the emergency response teams.  

If confirmed, the cases in Ghana would mark the second time Marburg has been detected in West Africa. Guinea confirmed a single case in an outbreak that was declared over on 16 September 2021, five weeks after the initial case was detected.  

Previous outbreaks and sporadic cases of Marburg in Africa have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.  

Marburg is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Many patients develop severe haemorrhagic signs within seven days. Case fatality rates have varied from 24% to 88% in past outbreaks depending on virus strain and case management.  

Although there are no vaccines or antiviral treatments approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival. A range of potential treatments, including blood products, immune therapies and drug therapies, are being evaluated.

When I hear of an outbreak like this, I go straight to the affected country's media and ministry of health. Too often, I find the media have nothing on the story (or the websites aren't accessible) and neither does the ministry. It was a big problem early in the West African Ebola outbreak, though the media and most of the health ministries finally began to provide prompt, reliable information.

I hope this Marburg outbreak will be brief, but also that it will push the Ghanaian government to pay more attention to health communication in general—and to its online communication in particular.

West Africa COVID-19 deaths surge amid Ebola and other outbreaks

A news release from WHO AFRO: West Africa COVID-19 deaths surge amid Ebola and other outbreaks. Excerpt:

Brazzaville, 20 August 2021 – West Africa has recorded its highest number of COVID-19 deaths since the pandemic began as several countries grapple with outbreaks of cholera, Ebola Virus Disease and Marburg Virus Disease that threaten to further strain the already stretched emergency response capacity in the region. 

COVID-19 fatalities in West Africa over the past four weeks increased by 193% from 348 in the previous four weeks to 1018 in the week ending on 15 August. Although the case fatality ratio, or the proportion of people diagnosed with the disease who have died, stands at 1.4%—below the continental average of 2.5%—it is higher than the previous two waves in the sub-region, a sign that health systems are feeling the strain of a heavy caseload. While new cases in West Africa have dropped this week, they were surging for eight consecutive weeks. 

Overall Africa recorded over 244 000 new cases in the week ending on 15 August, an 11% drop from the week before and a second straight week of declining cases. However, nine out of 23 countries experiencing a resurgence are in West Africa. Cote d’Ivoire, Guinea and Nigeria are experiencing a surge in cases and all three countries are tackling other outbreaks. 

West Africa health systems are even more fragile than those in other sub-regions. A World Health Organization (WHO) assessment of the functionality of health systems in West Africa found that they were 21% lower than in Southern Africa, 

“We are particularly concerned about West Africa and we can expect the pressure of COVID-19 to hit health services harder and faster,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “In addition to the strain of COVID-19, comes Ebola and other outbreaks. Fighting multiple outbreaks is a complex challenge.” 

COVID-19 vaccines deliveries 

West Africa has to date received around 29 million vaccine doses—almost the same amount as East and Southern Africa. However, the rollout has been slow, with 38% of the doses administered compared with 76% in East and Southern Africa and 95% in North Africa. West Africa has delivered 2.4 doses per 100 people. In East and Southern Africa, the figure stands at 4.8 doses per 100 people. 

Vaccine shipments to Africa have picked up with the COVAX Facility delivering almost 10 million doses to Africa so far in August, that is nine times what was delivered in the same period in July. The African Union has so far delivered 1.5 million doses to nine countries. Since June, the number of doses administered per 100 people in sub-Saharan Africa has almost tripled from 1.2 per 100 people to 3.4 per 100 people. 

“While COVID-19 vaccine shipments seem to be taking off, Africa is encountering headwinds. Moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa. As some richer countries hoard vaccines, they make a mockery of vaccine equity,” said Dr Moeti.

Canadian-made Ebola vaccine could have saved more lives if research was funded earlier, microbiologist says

Via CBC Radio: Canadian-made Ebola vaccine could have saved more lives if research was funded earlier, microbiologist says. Excerpt:

In 2005, microbiologist Steven Jones was part of a medical team in Angola, which was in the midst of an outbreak of Marburg, Ebola's sister virus. 

The team had samples of an experimental vaccine, developed by Jones and researchers in Winnipeg to treat Ebola and Marburg, with them. But clinical tests weren't yet complete, so they couldn't use it on infected patients, even though preliminary research had shown it to be effective as early as 2003, Jones says. 

That restriction sparked a tense confrontation with a military doctor. 

"He begged us to use it and we had to tell him no. And it was an extremely difficult conversation, because nothing else had been working," Jones, associate provost of health at the University of Saskatchewan Health Sciences, told The Current's guest host Matt Galloway.  

The vaccine, also known as VSV-ZEBOV, is currently being used to combat an Ebola outbreak in Congo, which has killed at least 1,900 people in the last year. But Jones believes it could have been used to save more lives if governments and pharmaceutical companies committed to greater funding and support years earlier. 

The 2005 Marburg outbreak in Angola killed 329 people, with a nearly 90 per cent case fatality rate of those infected. Jones believes that if he were able to use the vials of the vaccine they had on hand, they might have saved "at least half" of the lives lost. 

A long regulatory process 

But he recognizes the need for meticulous testing and research to ensure a new vaccine is proven safe to use on humans. 

That process, however, takes a lot of money and the political will to keep that money flowing, he says, adding it has been coined the "valley of death: where bright ideas go to die." 

Jones and his team requested $6 million from Canada's CBRNE Research and Technology Initiative (CIRT) to develop vaccines for Marburg and Ebola, but only received $2 million in 2006, specifically for the Ebola vaccine. It wouldn't last through the series of required clinical trials. 

"We were not funded to do the clinical trials, because those start to get more expensive," he said. "At the time, I thought the decision was wrong. I still think the decision was wrong, but I understand why it was made."

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.