National measures effective in curtailing Ebola outbreak in Uganda

Aug 16 2012
VERTIC Blog >> National Implementation Measures

Edward Perello, London

On 28 July 2012 the Ugandan government and the World Health Organization (WHO) stated that the Ebola virus was the culprit behind a spate of deaths in Kibaale district, Western Uganda. To date, 16 people have died with a further 185 remaining under observation for signs of infection. Nonetheless, with the last confirmation of a new case being on 4 August, the Ugandan Health Ministry has said that the outbreak is under control, though not necessarily over. It is now prudent to examine the manner in which the Ugandan government and its regional partners have dealt with this deadly disease.
There is no cure or vaccine for Ebola. It kills 50 and 90 per cent of patients and can do so within four days to a week. It is easily transmitted through contact with body fluids and the maximum 21-day incubation period gives the virus ample time to spread throughout a population. Infection typically manifests itself as a haemorrhagic fever characterised by high fever, vomiting, diarrhoea, extensive internal and external bleeding and multiple systems failure. In Uganda, the disease is highly feared as it killed 224 people in 2000 and 37 in 2007. Its characteristics along with the lack of an effective treatment all contribute to its label as a WHO Risk Group 4 pathogen, highlighting the need for states to implement the most stringent measures to protect public health.
In June, an infant was found dead in Nyansigwa village, Kibaale district, shortly after it was momentarily left alone. The infant’s left palm had the sign of an animal bite and about 300 meters from the family’s house lies a forest, from which an Ebola-infected animal could have emerged to attack the infant. A 15-year-old girl who later touched the baby's wound became sick two days later, and died on 21 June. Nine members of the family followed suit.
According to the national Ebola task force, the 15-year-old girl was the first patient. Locals, however, insisted that she got the disease from the baby. While Ebola is not fully understood, current medical theory indicates that its natural reservoir is in forest primate and bat populations. The rapid progression to illness in both the girl and family, which is incongruous with the 21-day incubation period, indicates that there was likely an earlier infection event and that the baby’s death was unrelated. Additionally, there were some unusual symptoms among the infected, namely a lack of bleeding until well after death, which is not normally observed. These confusing findings, along with no ability to rapidly deploy advanced diagnostic equipment to the rural village, meant that it took 37 days before the Health Ministry was confident in the aetiology of the disease and the implementation of specific containment measures.
While some have criticized this delay, the joint actions of Ugandan and international public health authorities are to be applauded. Active epidemic controls were enacted in accordance with the 2005 International Health Regulations (IHR), a legally binding international instrument on public health, which requires all WHO member states to notify the WHO of events that may lead to a public health emergency of international concern. The Ugandan government took successful measures such as the closure of schools throughout the country, the stoppage of prison visits, quarantine and surveillance of all those in contact with suspected patients, and public awareness efforts to discourage large meetings, handshakes and sexual contact. It also worked closely together with organizations such as the Uganda Red Cross Society and Médecins Sans Frontières.
These actions have not only helped to prevent further spread of the disease, but have also assured smooth international traffic. Indeed, the WHO has not recommended any travel or trade restrictions to be applied to Uganda.
Unfortunately, as of 12 August there are now five suspected cases of Ebola in the town of Isiro in the district of Haut Uele, Orientale (Eastern) Province in the Democratic Republic of Congo (DRC), along with one death in Dungu, also in Haut Uele. The potential outbreaks could be related given the proximity between the Orientale Province and Kibaale District, along with the intense traffic between the two countries. However, confirmation and identification of the virus responsible for the DRC cases are awaited.

Last changed: Aug 16 2012 at 3:28 PM