Epidemiologists experts bury Mr Nathan Biryamubaho on Saturday. He died
of Marburg virus. The relatives were not allowed to participate in the
burial ceremony because they did not have protective gear. Photo by
Robert Muhereza.
FIRST READ:
Marburg out break in Uganda : 132 now being monitored:
Naïve Ugandans think the diseases has come about because Ugandans are dirty
http://watchmanafrica.blogspot.com/2012/10/marburg-out-break-in-uganda-132-now.html
Why is Uganda prone to infectious
diseases?
By Agatha Ayebazibwe
Posted Thursday, October 25 2012 at 00:00
In Summary
With one epidemic after another being reported,
there is obvious fear in the country. Though the viruses of the recent outbreak
of Marburg have
no treatment yet, medics says victims can recover once they have been detected
and attended to in time.
Barely a month after Uganda
was declared Ebola free, another virulent hemorrhagic viral infection – Marburg, a disease caused
by a sister virus to Ebola is back on the scene.
Such infectious diseases are emerging and occurring more frequently in Uganda today.
Globally, the World Health Organisation (WHO) says the number of these
diseases has quadrupled in the last half century and is one of the biggest
threats to public health.
In its annual world health report in 2007, WHO reported that infectious
diseases are not only spreading faster, they also appear to be emerging more
quickly than ever before.
“Since the 1970s, newly emerging diseases have
been identified at the unprecedented rate of one or more per year. There are
now nearly 40 diseases that were unknown a generation, says WHO.
It further shows these emerging viral diseases including Ebola, Marburg haemorrhagic
fever and Nipah virus are a threat to global public health security and require
containment at their source due to their acute nature and resulting illness and
mortality.
But why is Uganda
more prone to these diseases now? Public health experts say human activity is
largely to blame. With more people encroaching on wildlife habitat, with
animals are hosts to these viruses, chances of transmission to humans is high.
Health ministry officials say these outbreaks will not stop as long as human
beings continue to encroach on wildlife habitats.
The commissioner national disease control Dr Dennis Lwamafa explained that
most of these diseases revolve around humans, environment and zoonotic factors.
“And this will continue so long as man continues feeding on wildlife animals
or encroach on their habitats for human activities. We are even likely to see
more new emerging diseases.”
Forest encroachers at risk
Ebola and Marburg haemorrhagic fevers outbreaks are
said to occur in places near forests and forest reserves that have been
encroached on by human activity such as cutting trees, leaving the place open
for wildlife to freely interface with man.
Dr Lwamafa explains that where optimal condition exists for direct interface
of man and wildlife, there will be transmission of diseases which are not
typically human diseases, moving from the wild animal kingdom to human beings
through the environment.
“The extent to which man continually invades the environment, the deeper he
moves into the forest areas, the more likely he is going to encounter
organisms, viruses, and other biological agents that are were normally
preserves of animal kingdom. These will have a direct impact on the human life
inform of contagious disease such as Ebola and Marburg.”
Reports from the Ministry of Health from ecological studies done in the
areas where these outbreaks have occurred indicate direct interface between
wildlife and human animals especially monkeys and bats.
“Where we have had Ebola, the monkeys were coming
into people’s homes and sharing food, while the bats were even staying in some
houses after their habitats were destroyed and bushes cleared for farming in
the cases of Luweero, Kibaale, Bundibugyo among other areas.” Dr Lwamafa says.
According to Dr Joaquim Saweka, WHO’s country representative, diseases
classified under zoonotic originate from animals to human beings through
secretions, fluids or shared food.
“Increased exposure of human beings to saliva, secretions, urine and other
fluids of virus hosts which are bats and monkeys is more likely to cause
disease that are harbored by wild animals,” Dr Saweka said.
Acts of terrorism?
Dr Myers Lugemwa, a specialist in international health holds a totally
different view arguing that before conclusions are drawn, the government should
investigate why these outbreaks occur ahead of international events and near
national parks.
He says it is possible that the disease outbreaks
could be acts of bio-terrorism aimed at terrorising and crippling the rather
booming tourism sector in the country.
“Uganda
is not the only country with monkeys and fruit bats in forests. Uganda is not
the only place where people eat monkey meat. We just need to think outside the
box and it doesn’t cost us a lot to investigate this issue,” Dr Lugemwa said.
He argues that these highly infectious disease outbreaks have not occurred
in all areas around forests or other countries that have more monkeys, bats and
forests being encroached on.
“It is not a coincidence that the recent Ebola
epidemic broke out just a few months before Uganda’s golden jubilee
celebrations.
Early 2010, US nuclear experts, visited the Ministry of Agriculture and
Uganda Virus Research Institute (UVRI) laboratories in Entebbe to assess the next-generation
security threats, among them bio-terrorism.
Dr Lugemwa recommends more research to investigate the correlation between
international events and disease outbreaks.
aayebazibwe@ug.nationmedia.com
Medical
team disperched to contain Marburg dressing up in Rushoroza health
centre isolation ward in Kabale district. Photo by Goodluck Musinguzi
newvision
Marburg Virus claims another victim; death toll at 6
Publish Date: Oct 25,
2012
By Vision
Reporters
One of the two people, who were admitted on Monday with signs of the deadly marburg fever, has died.
Edward Turyamureba, a 38-year-old resident of Kicumbi Cell, Kamuganguzi sub-county,
succumbed to severe bleeding and vomiting on Tuesday evening.
He is the sixth person suspected to have died from the disease since it was
reported earlier this month. He was laid to rest at a brief funeral yesterday.
Two people were admitted to an isolation centre at Rushoroza Health Centre III
in Kabale district on Monday.
However, the Ministry of Health spokesperson, Rukia Nakamatte, yesterday said
samples from the patients tested at the Uganda Virus Research Institute
laboratory in Entebbe
were negative.
Since the marburg
virus was first reported in the country, only one person has been confirmed to
have contracted it since the five suspected victims were buried before tests
were carried out.
Meanwhile, Obed Ntegyereize, the first confirmed victim, is steadily
recovering, after tests conducted on him on Tuesday turned out negative, health
officials disclosed.
Ntegyereize is related to the five people who died from a mysterious disease
linked to the marburg
fever two weeks ago.
Dr. Patrick Tusiime, the Kabale district director of health services, said a
surveillance team was monitoring the bereaved family to ascertain whether they
are not infected.
Panic engulfed residents yesterday after one of the patients at Kabale Hospital,
initially suspected to have marburg,
passed away. However, Tusiime said the deceased succumbed to a stroke.
At Mulago Hospital,
Sharon Twinomujuni, who tested positive for Marburg, is steadily improving. The
hospital’s spokesperson, Enock Kusasira, said doctors had recommended a strict
diet to aid her recovery.
He also said the hospital had not registered any new case of Marburg although the 26 people who came into
contact with her were under surveillance. An additional 132 people are being
monitored in Kabale district.
In Rukungiri district, health officials have put at least 21 families on
surveillance in Nyamitoma village, Bikurungu parish, on suspicion that they
came into contact with the first victim during prayers in a church. Authorities
have since closed the church to prevent the spread of the virus.
Marburg: Kampala
safe, no travel restrictions
Publish Date: Oct 25,
2012
By Taddeo Bwambale
Despite having one person admitted at Mulago Hospital
with Marburg Haemorrhagic fever, health minister, Dr Christine Ondoa has
assured Ugandans that the city is safe from the deadly virus.
The World Health Organisation has also said it will not recommend travel
restrictions within or outside the country at the moment, since the epidemic is
under control.
A team of health experts from the US Centres for Disease Control (CDC) arrives
in the country next week to carry out a study on wild animals in districts
where suspected cases of the Marburg
virus has been reported.
Addressing journalists at the media centre Thursday, Ondoa said the CDC team
would help to confirm the cause of the outbreak which was confirmed this month.
She warned that communities living near forest areas in western Uganda were susceptible to infection from the Marburg virus since they
often come into contact with wild animals.
The last Marburg outbreak in Uganda was reported in October 2007
in Kamwenge district, and studies linked the virus to bats and wild game in
Imaramagambo forest.
Marburg fever
is caused by a virus that easily spreads through direct contact with wounds,
body fluids like blood, saliva, vomitus, stool and urine of an infected person.
A person suffering from Marburg
presents symptoms such as high fever, vomiting blood, joint and muscle pains
and bleeding through the body openings like eyes, nose, gums, ears, anus and
the skin.
Ondoa confirmed that four of the six suspected cases had from suspected Marburg fever, while 196 people are under surveillance for
possible contact with the infected in Kabale, Rukungiri, Ibanda and Kampala.
One of the two confirmed Marburg victims is
admitted at Mulago
Hospital and in stable
condition while another person is recovering at Rushoroza Health Centre III in
Kabale district.
Dr Joachim Saweka, the WHO country representative said Uganda had one of the best
surveillance teams in the region, but decried Government’s slow commitment to
funding such interventions.
The health ministry urgently needs sh2.3b to stem the epidemic, of which sh1.7b
will be used to for surveillance, research and procurement of protective gear
while sh650m is to be spent in the affected districts.
Marburg haemorrhagic fever
http://www.who.int/mediacentre/factsheets/fs_marburg/en/index.html
Fact sheet
Revised: December 2011
Marburg
haemorrhagic fever is a severe and highly fatal disease caused by a virus from
the same family as the one that causes Ebola haemorrhagic fever. Viewed by
electron microscopy, the viruses show particles shaped like elongated
filaments, sometimes coiled into strange shapes, that give the Filoviridae
family its name. These viruses are among the most virulent pathogens known to
infect humans.
Though caused by different viruses, the two diseases are clinically similar.
Both diseases are rare, but have a capacity to cause dramatic outbreaks with
high fatality. Historically, outbreaks have tended to reach the attention of
health authorities only after transmission has been amplified by inadequate
infection control in health-care settings.
Neither disease has a vaccine or specific treatment. Ecological studies are
in progress to identify the natural reservoir of both Marburg and Ebola. There is evidence that
bats are involved, but much work remains to be done to definitively describe
the the natural transmission cycle. Monkeys are susceptible to infection but
are not considered plausible reservoir hosts as virtually all infected animals
die too rapidly to sustain survival of the virus. Infection of humans occurs
sporadically.
Natural history and clinical features
Causative agent. Marburgvirus of the Filoviridae
family.
Geographical occurrence. A large, 2-centre outbreak in Marburg, Germany,
and Belgrade, former Yugoslavia, in 1967 led to the
initial recognition of the disease. The outbreak was associated laboratory work
using African green monkeys (Cercopithecus aethiops) imported from Uganda.
Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic
Republic of the Congo, Kenya,
South Africa (in a person
with a recent travel history to Zimbabwe)
and Uganda.
Transmission. Transmission of the virus from
person-to-person requires close contact with a patient. Transmission does not
occur during the incubation period. Infection results from contact with blood
or other body fluids (faeces, vomitus, urine, saliva, and respiratory
secretions) with high virus concentration, especially when these fluids contain
blood. Transmission via infected semen can occur; virus has been detected in
semen up to seven weeks after clinical recovery.
Patients become increasingly infectious as their illness progresses, and are
most infectious during the phase of severe illness. Close contact with a
severely ill patient, during care at home or in hospital, and certain burial
practices are common routes of infection. Transmission via contaminated
injection equipment or through needle-stick injuries is associated with more
severe disease, rapid deterioration, and possibly higher fatality.
Incubation period. 3 to 9 days.
Susceptibility. All age groups are susceptible to
infection, but most cases have occurred in adults. Prior to the outbreak in Angola,
paediatric cases were considered extremely rare. In the largest outbreak
previously recorded, which occurred in the Democratic Republic of the Congo
from late 1998 to 2000, only 12 (8%) of the cases were under the age of 5
years. This may be due to factors around social behaviour.
Clinical features. Illness caused by Marburg virus begins abruptly, with severe headache
and severe malaise. Muscle aches and pains are a common feature.
A high fever usually appears on the first day of illness, followed by
progressive and rapid debilitation. A severe watery diarrhoea, abdominal pain
and cramping, nausea, and vomiting begin about the third day. Diarrhoea can
persist for a week. The appearance of patients at this phase has been described
as showing “ghost-like” drawn features, deep-set eyes, expressionless faces,
and extreme lethargy. In the 1967 European outbreak, a non-itchy rash was a
feature noted in most patients between days 2 and 7 after symptom onset.
Many patients develop severe haemorrhagic manifestations between days 5 and
7, and fatal cases usually have some form of bleeding, often from multiple
sites. Findings of fresh blood in vomitus and faeces are often accompanied by
bleeding from the nose, gums, and vagina. Spontaneous bleeding at venipuncture
sites can be particularly troublesome. During the severe phase of illness,
patients have sustained high fevers. Involvement of the central nervous system
can result in confusion, irritability, and aggression. Orchitis has been
reported occasionally in the late phase of disease (day 15).
In fatal cases, death occurs most often between 8 and 9 days after symptom
onset, usually preceded by shock.
Natural reservoir of the virus. Unknown.
History of some recorded outbreaks
1967: Germany and
Yugoslavia.
Marburg haemorrhagic fever was initially
detected following simultaneous outbreaks in Marburg
and Frankfurt, Germany
and Belgrade, former Yugoslavia. The initial cases
occurred in laboratory workers handling African green monkeys imported from Uganda. The
outbreaks involved 25 primary infections, with 7 deaths, and 6 secondary cases,
with no deaths. The primary infections were in laboratory staff exposed to Marburg virus while
working with monkeys or their tissues. The secondary cases involved two
doctors, a nurse, a post-mortem attendant, and the wife of a veterinarian. All
secondary cases had direct contact, usually involving blood, with a primary
case. Both doctors became infected through accidental skin pricks when drawing
blood from patients.
1975: South Africa,
possibly via Zimbabwe.
In mid-February 1975, an Australian, aged 20 years, was admitted to a hospital
in Johannesburg, South Africa. During early
February, he and a companion had travelled extensively through Zimbabwe, often
camping outdoors. He died of Marburg
haemorrhagic fever four days after hospital admission. His travelling companion
became infected, as did a nurse who attended both patients. Both secondary
cases recovered.
1980: Kenya.
In January 1980, a 56-year-old Frenchman, who had visited Kitum
Cave in Kenya’s
Mount Elgon National Park, became infected. Despite
specialized care in Nairobi
and aggressive resuscitation attempts, he died on 15 January. The doctor who
attempted resuscitation developed symptoms 9 days later. He recovered.
1987: Kenya.
In August 1987, a 15-year old Dane, was admitted to a hospital in Kenya, suffering from Marburg haemorrhagic fever. His illness
proved fatal. Nine days prior to symptom onset, he had visited Kitum Cave
in Mount Elgon National Park. No further cases were
detected.
1998–2000: Democratic
Republic of the Congo. The outbreak
in DRC marked the first large outbreak of this disease under natural
conditions. The outbreak, which occurred from late 1998 to 2000, involved 154
cases, of which 128 were fatal, representing a case fatality of 83%. The
majority of cases occurred in young male workers at a gold mine in Durba, in
the north-eastern part of the country, which proved to be the epicentre of the
outbreak. Cases were subsequently detected in the neighbouring village of Watsa. Family members involved in the
close care of patients accounted for some cases, but secondary transmission
appeared to be rare. Subsequent virological investigation indicated that virus
of several different strains was introduced to human populations, from some yet
unknown environmental source, on more than seven separate occasions.
2004–2005: Angola.
In what was to become the largest outbreak of MHF in history, this outbreak is
believed to have begun in Uige
Province in October 2004.
By the time the last laboratory-confirmed case was identified in July 2005, the
Ministry of Health had reported a total of 374 cases, including 329 deaths (CFR
88%) countrywide. Of these, 368 cases, including 323 deaths, were reported in Uige Province.
All cases detected in other provinces have been linked directly to the outbreak
in Uige.
2007: Uganda.
From June to August 2007, three confirmed cases were reported in
mineworkers from Kamwenge, western Uganda. The second and third miners
developed illness after caring for their colleague; one of the caregivers died.
2008. In July 2008, a Dutch tourist developed Marburg four days after returning to the Netherlands from a three-week holiday in Uganda.
To date, the source of the exposure has not been confirmed, although it is
known that the woman visited caves in western Uganda where bats were present.
Ebola outbreak in Democratic Republic of Congo – update (24 October 2012)
http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/3717-ebola-outbreak-in-democratic-republic-of-congo-update-24-october-2012.html
26 October 2012 -- As of 24 October 2012, 52 cases (35
laboratory confirmed, 17 probable) with Ebola haemorrhagic fever (EHF) have
been reported in the Democratic Republic of Congo (DRC). Of these, 25 have been
fatal (12 confirmed, 13 probable).
The cases are reported from Isiro and Viadana health zones in Haut-Uélé
district in Province Orientale.
The Ministry of Health (MoH) continues to work with local health authorities
and international partners in active surveillance, tracing of contacts of
probable and confirmed cases, infection prevention and control in health care
settings, management of patients in health care facilities, logistics, social
mobilization, provision of psychosocial support and conducting anthropological
analysis to support the control of the outbreak.
Surveillance activities are being strengthened in Isiro and neighbouring areas,
including Bedhe and Nakwapongo. In Isiro, health care workers are being trained
on basic infection prevention and control in health care settings. Through the
Global Outbreak Alert and Response Network (GOARN), a field laboratory has been
set up by the Public Health Agency of Canada (PHAC).
Social mobilization activities are being carried out in schools and churches in
Isiro, Rungu and Ngosaku to provide information on protection against the Ebola
virus and to discuss concerns of the local population.
