October 11, 2022
Announcing the Outbreak:
- Health authorities in Uganda on the 20th of September 2022, declared the outbreak of Ebola disease caused by Ebola virus SDV, after a case confirmed in a village in Madudo County in Mubindi District, central Uganda.
- On October 5, Uganda had 63 confirmed and probable cases, of which 10 were from healthcare providers. 29 deaths were recorded, 4 of which were from healthcare providers.
- 62% of the total confirmed and suspected cases are female and 38% are male, and currently 13 confirmed cases are in hospital. The average age of cases is 26 years (from 1 to 60 years). On August 21, 2022, in the Democratic Republic of Congo, a death due to Zaire Ebola virus (ZEBOV) was reported in Beni Health District, North Kivu Province.
- The case was a 46-year-old woman who was admitted to hospital and treated from July 23 to August 15 (23 days) with cough, headache, joint pain and weakness. The patient died in hospital on August 15, 2022. The body was returned to his family and traditionally buried on August 16 before laboratory results came out.
- Samples tested 'Positive' for Ebola virus Zaire through two separate laboratories then outbreak was declared by the Ministry of Health.
- No additional confirmed or probable cases have been reported since August 16. Of the 182 contacts of the case, 172 were identified and followed up for 21 days, while the remaining 10 contacts could not be reached.
- Genetically, this case was related to 2018-2020 outbreak in North Kivu and Ituri and South Kivu. Investigations are still running to determine the source of this outbreak.
Ebola Virus Disease:
Ebola virus disease (EVD) is a fatal disease with occasional outbreaks that mostly occur on the African continent. Ebola virus disease most commonly affects people and non-human primates (such as monkeys, gorillas, and chimpanzees). It is caused by infection with a group of viruses within the genus Ebolavirus: Ebola Zaire, SVD, Tai Forest virus, Bundibugyo virus, Reston virus, Bombali virus. Of these, only four (Ebola, SVD, Tai forest, Bundibugyo viruses) have caused disease in people. Reston virus can cause disease in animals only.
History of the Disease in Africa:
- Ebola virus first appeared in 1976 near Ebola River in the Democratic Republic of Congo, and since then the virus has periodically spread and infected people in several African countries.
- The Democratic Republic of Congo experienced more than 10 outbreaks of Ebola virus disease (ZEBOV) during the past years, the most severe of which was between 2018-2020, where the number of infections reached 3,481 cases and death rate was 66%. The last of which was on April 22, 2022, and one confirmed case was a Congolese citizen.
- Ebola virus SVD was first reported in South Sudan in June 1976, and since then the virus has appeared periodically until now, seven outbreaks have been reported, four in Uganda and three in Sudan. Estimated case-fatality rates of Ebola SVD varied from 41% to 100% in previous outbreaks.
- Uganda reported four outbreaks in 2000, 2011 and 2012 (two outbreaks). Uganda also reported an outbreak of Bundibugyo virus disease in 2007 and an outbreak of Ebola virus disease (SVD) in 2019.
Disease Transmission:
- Contact with infected animals, such as: fruit bats, monkeys, chimpanzees, antelopes and porcupines
- Direct contact with blood or body fluids (urine, saliva, sweat, stool, vomit, breast milk, amniotic fluid, semen) of a person who is sick or has died of Ebola virus disease (EVD).
- Contact with objects contaminated with bodily fluids from a person who is sick or has died of Ebola virus disease. (such as clothing, bedding, syringes, and medical equipment)
- Semen of a man who has recovered from Ebola virus disease. The virus can remain in certain body fluids (including semen) of a patient who has recovered from Ebola virus disease, even if he no longer has severe symptoms.
- A person cannot spread Ebola to other people until signs and symptoms of Ebola appear thereon.
Symptoms and Diagnosis:
Incubation period ranges from 2 to 21 days. The main symptoms are fever, fatigue, muscle aches, headache, sore throat followed later by vomiting, diarrhea, rash, and symptoms of kidney and liver function disturbance. In severe cases, patient may experience internal and external bleeding (for example, bleeding from the gums or blood in the stool). People infected with Ebola virus SVD cannot spread the disease until they develop symptoms, and they remain infectious as long as their blood contains the virus. Onset of symptoms is very similar to common diseases such as Malaria and Typhoid Fever.
PCR is one of the most common diagnostic methods due to its ability to detect low levels of Ebola virus. An antibody test also reveals a person's exposure to Ebola virus.
Treatment:
- The drug, Inmazeb™, is a combination of three monoclonal antibodies, approved in October 2020.
- The drug, Ebanga™, is a monoclonal antibody and was approved in December 2020.
Neither Inmazeb™ nor Ebanga™ has been evaluated for efficacy against species other than Ebola virus ZEBOV.
Vaccinations:
- Ervebo Vaccine, approved in 2022 and given to those over 18 years of age. It is effective against ZEBOV but based on available evidence. This vaccine does not provide comprehensive protection against Ebola virus disease (SVD).
- Zebadeno vaccine, approved in 2020 by European Medicines Agency (EMA) and is given in two doses, 8 months apart to those over a year. The first dose provides protection against Ebola Zaire virus, and the second dose is designed to provide protection against other types of the virus.
Public Health Response in Uganda and Congo:
- Activating national and local emergency management committees to coordinate the response, deploying multidisciplinary teams to effectively search for and provide care for cases, identifying, accessing and following up on contacts, and educating communities on outbreak prevention and control interventions.
- All notifications are verified in outbreak areas and travelers are screened at points of entry for Ebola virus disease.
- Targeting contacts by conducting vaccination campaigns in the affected areas against Ebola virus. Frontline healthcare workers make up most vaccinated people.
Protection:
- Reducing the risk of transmission, whether from wildlife to humans or from human to human, through direct or close contact with people with Ebola symptoms, especially body fluids, and reducing the risk of potential transmission from persistence of the virus in some body fluids of survivors. The World Health Organization recommends providing medical care, psychological support and biological testing (up to two consecutive negative tests) through 'Ebola Survivor Care Program'.
- Provision of continuous training to the health workforce on appropriate personal protection when caring for patients, infection control, early detection, isolation and treatment of Ebola virus disease cases, as well as safe and dignified burial.
- Raising awareness on risk factors of Ebola infection and preventive measures that individuals can take as an effective way to reduce human-to-human transmission.
Healthcare Providers:
- Health care providers should be alert and assess any patients suspected of having Ebola virus disease, especially among people who have recently traveled to Ebola affected areas.
- The doctor should suspect the possibility of the patient contracting Ebola if the patient has clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding (some diseases show symptoms similar to Ebola such as: Malaria and Typhoid) and should be isolated in an airborne infection isolation room.
- Provide continuous training for the health workforce on appropriate personal protection when caring for patients, infection control and early detection, isolation and treatment of Ebola virus disease cases.
Samples and laboratories:
- Recommended infection control practices must be adhered to for prevention of infection and transmission among laboratory workers.
- Laboratories should conduct extensive risk assessments to identify risks associated with handling Ebola samples to create a safe environment.
- Laboratories that handle blood and body fluids should have a pathogen control plan in place to reduce and eliminate the risk of staff exposure to pathogens.
- Appropriate PPE must be identified, made available, and staff trained to properly put on and take off PPE.
- Personnel in the laboratory must be specially trained, passed efficiency tests, and attended trainings for handling and dealing with these samples.
- The laboratory should have dedicated space, equipment for handling and testing samples from patients, and plans to minimize sample tampering. Wastes management plan should also be developed for laboratory reagents and Class A waste, including PPE and samples.
- If continuous training of the health workforce is not available on appropriate personal protection when caring for patients, infection control, early detection, isolation and treatment of Ebola virus disease cases, and the facility does not have appropriate capabilities to mitigate risks, the sample must be transferred to another facility qualified to handle such sample.
Risk Assessment:
Improved capacities in detection and laboratory confirmation and increased epidemiological surveillance may explain the increased frequency of detection of Ebola virus disease outbreaks. However, WHO is concerned that persistent challenges with regard to political instability and insecurity as well as health system challenges in infection control and epidemiological surveillance, along with emergence of COVID-19 and other ongoing outbreaks, may limit the country's ability to manage the crisis, speed of response and increase risks of spreading the disease locally and abroad.
Based on the current risk assessment and previous evidence of an Ebola outbreak, WHO advises no restrictions be imposed on travel and trade to the Democratic Republic of Congo.
Sources:
- WHO
- US Center for Disease Control and Prevention (CDC)