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Monday, 30 July 2012

The evil that humans do: Ebola Kills 14 in Kibale District of Uganda: Locals believed the illnesses were the result of an attack of evil spirits, send the sick for prayers

TUSKEGEE Part II in Africa: HIV Vaccine trials on Ugandan guinea pigs: 250 Ugandan women for vaginal ring anti-HIV study



Ebola Kills 14 in Kibale District


Emerging Viruses: Aids & Ebola - Nature, Accident or Intentional?

Ebola Outbreak in Uganda Kills 14


By Nicholas Bariyo And Betsy Mckay

KAMPALA, Uganda—The world's first major outbreak of Ebola hemorrhagic fever since 2009 has killed at least 14 of 20 people infected in a remote area of midwestern Uganda.

International health officials are rushing to respond to the outbreak, which erupted at the beginning of July but was identified as the deadly Ebola virus only on Friday, meaning it potentially spread substantially before being caught.

A team of responders from the Ugandan government, the World Health Organization, and the U.S. Centers for Disease Control and Prevention, or CDC, was dispatched Friday to the affected region—the Kibaale district, a forested area about 125 miles west of the Ugandan capital, Kampala, and near the Democratic Republic of the Congo border.

The outbreak started and spread first within one family, said Rukia Nakamate, a spokeswoman for the Ugandan Ministry of Health. Initially, locals believed the illnesses were the result of an attack of evil spirits rather than one of the deadliest viruses known to man, and took the patients to a Christian religious shrine for prayers, where the first two victims died, she said.

"Some of the victims came into contact with many people, including churchgoers," she said.

Once Ebola was suspected, a patient sample was sent to a special laboratory recently established and maintained by the Uganda Virus Research Institute and the CDC to identify and study Ebola and other deadly viral hemorrhagic fevers in central Africa.

The lab received that sample on Thursday, followed by three other samples, and confirmed results Friday, said Stephan Monroe, chief of the CDC's Division of High-Consequence Pathogens and Pathology in Atlanta.

The dead thus far include nine members of the one family; Clare Muhumuza, a clinical officer who treated one of the initial patients, and Ms. Muhumuza's 4-month-old daughter, Uganda's Ministry of Health.

Ms. Muhumuza's sister, who tended to her when she fell ill, also contracted the disease and is in "fairly stable" condition, through still experiencing fever, diarrhea and vomiting, according to a Ministry of Health statement. A female member of the initial family is in stable condition but also still experiencing symptoms, the ministry said.

Panic has gripped the region where the outbreak was confirmed, prompting scores of locals to flee their homes, the Ministry of Health said.

While the Kibaale district is far from Kampala, Ms. Muhumuza was treated at a hospital in the capital, home to at least four million residents. The possibility that the disease may have reached the capital has sparked some concerns, Ugandan and international officials said. Medical officials didn't handle Ms. Muhumuza's body with protective gear after her death because her ailment hadn't been confirmed, Ms. Nakamate said.

Because the outbreak is in a "fairly remote area, the chance for widespread transmission is not great," Dr. Monroe said. Still, that it might reach Kampala is "always a concern," he added.

Ebola occurs throughout central Africa. There is no vaccine or cure, and its ultimate source isn't known, though the hypothesis is that its reservoir—where it is maintained naturally—is in bats, said Dr. Monroe.

The disease was first reported in 1976 and named for the river in Congo where it was first recognized. Ebola is rare but extremely deadly; the most lethal strain has killed as many as 89% of those it infected, though death rates vary widely among outbreaks.

The current outbreak was identified as caused by a strain believed to be somewhat less virulent, known as Ebola Sudan. Still, in the largest recorded Ebola outbreak, which occurred in Uganda in 2000 and 2001, that strain killed 224, or 53%, of 425 people infected.

The previous most recent outbreak of Ebola occurred in Congo in late 2008 and early 2009, infecting 32 people, with 15 deaths. Ebola caused the death of a 12-year-old girl last year in Uganda, but the disease didn't spread.

The cause of the current outbreak isn't yet known, though Ebola is normally contracted through contact with the blood or other bodily fluids of infected monkeys—who may have become infected by bats, researchers hypothesize.

Once the virus infects a human, it spreads to others through contact with the blood, urine, or other bodily fluids of the infected person, putting family members, hospital staff, and others who tend to the ill at risk.Infected people remain contagious even after they are dead—a challenge because traditional funeral rites in Uganda call for touching a loved one's body. The lab in Uganda that confirmed the virus is the only one in the region to be able to test for Ebola; previously samples had to be shipped elsewhere, taking valuable time. The nearest labs able to test for Ebola aside from the new one in Uganda are in South Africa and Gabon, and getting samples to them would take a minimum of two days and involve special expertise in packing and shipping, Dr. Monroe said.

An isolation ward has been set up at Kagadi hospital in Kibaale, and relatives aren't allowed to attend to patients suspected of infection with Ebola, said Denis Lwamafa, director of health services for the Ugandan Ministry of Health.

The government is awaiting at least 2,000 sets of protective clothing and body bags from the World Health Organization to contain the spread of the disease, he said.

The CDC is preparing to send additional experts, including a team of epidemiologists and a laboratory expert, pending a formal request from Uganda's Ministry of Health, Dr. Monroe said. They will help identify cases, trace possible contacts, help strengthen infection-control practices in hospitals, and educate people about how to bury their loved ones without infecting themselves.


Anxiety as Ebola returns


Sunday, 29 July 2012 20:41

Family of 12 wiped out; death toll at 14 in Kibaale district
Medical authorities in the western district of Kibaale were today investigating more suspected cases of Ebola, as haemorrhagic fever returned, causing anxiety around the country. Unofficial sources at Kagadi hospital, the main health facility in Kibaale, said more suspected cases were being investigated, but officials would not comment by press time.

By Saturday six people had been admitted with the disease. Ebola manifests as a haemorrhagic fever, is highly infectious and kills quickly.  Signs and symptoms of the disease include fever, vomiting, diarrhoea, abdominal pain, headache, measles-like rash, red eyes, and – sometimes – with bleeding from body openings. People in the district, in Bunyoro sub-region, have been troubled by the mysterious illness, until last Saturday when health authorities confirmed it was Ebola haemorrhagic fever.

By press time, 14 people were known to have died from the fever, including an entire family of 12, in Nyanswiga village, Nyamarunda sub-county. In a statement, Dr Denis Lwamafa, Commissioner National Disease Control in the ministry of Health, said the fever had been confirmed after tests at the Uganda Virus Research Institute in Entebbe.

Lwamafa said the first case was reported on July 6.  The dead include a clinical officer and her four-month-old baby, who passed away at Mulago hospital. Yesterday the permanent secretary in the ministry of Health, Dr Asuman Lukwago, sought to assure the country that authorities were doing everything to keep the situation under control.

Speaking on the Kampala-based Radio One, Lukwago said with mass movement of people, as has happened with Congolese refugees who have fled to Uganda because of fighting in their country, diseases can break out. He, however, said authorities were monitoring the situation in western Uganda, while people who recently visited Kibaale would be assisted once they reported to medical authorities.

Twelve of the dead belonged to the family of Yostus Isoke of Nyanswiga village, Nyamarunda sub-county. They include Isoke himself; his five children – Byaruhanga Isoke, Fred Isoke, Roggers Byaruhanga, Doreen Nantongo and an unidentified son.  Also among the dead is Lovinsa Kabwimukya, 42, a sub county councilor for people with disabilities in Nyamarunda sub-county council.

The family at first complained of being bewitched and at one stage resorted to visiting witch-doctors. One of the victims is reported to have died in a shrine. Because of the deaths, many people have abandoned the bereaved families for fear of losing lives. Dr Joseph Wamala, a senior epidemiologist in the ministry of health, identified the type of Ebola reported in Kibaale district as Sudan Ebola, which is less deadily than Ebola Zaire.

Other types of Ebola are Ebola Zaire, Ebola Cote d’Ivore, Ebola Bundibugyo and Ebola Reston  Ebola can be spread through direct physical contact with body fluids like saliva, blood, stool, vomit, urine and sweat from an infected person and soiled linen used by a patient. One can get it from contact with the body of a person who has died of the disease.

This is the third time a major Ebola outbreak is reported in Uganda in 12 years. In 2000, Ebola killed 224 people, including a prominent physician fighting it, Dr Matthew Lukwiya. In 2007, Ebola struck again, in Bundibugyo district; this time it claimed at least 38 people; they included Dr Jonah Kule and two other medical workers.

Precautionary measures

Dr Lwamafa urged the public to take precautionary measures to avert the spread of the disease. “We have set up a national emergency taskforce to contain the disease from spreading far and wide” Dr Lwamafa said.

He warns against unnecessary contact with suspected people especially during communal funerals and parties. As part of the precautionary measures, he said the ministry of Health has started active and sustained tracing and listing of people that may have been exposed to suspected and confirmed cases since July 6, 2012.

Precautionary measures to contain Ebola
•  Report and immediately take any suspected patient to a nearby health unit
•  Avoid direct contact with body fluids of a person suffering from Ebola by using protective materials like gloves and masks
•  Disinfect the bedding and clothing of an infected person
•  Persons who have died of Ebola must be handled with strong protective wear and buried immediately, avoid feasting and funerals
•  Avoid eating dead animals especially monkeys
•  Avoid public gathering especially in the affected district
•  Burial of suspicious community deaths should be done under close supervision of district health workers
•  Report all suspicious deaths to the health workers