Two doctors die as Uganda Ebola toll climbs to 21

KAMPALA (AFP) - The Ebola virus has killed two doctors in western Uganda, bringing the toll to 21 since the strain first appeared in September, an official said on Wednesday.

"The sad news is that our doctor who was admitted in Mulago died last night and a senior clinic officer who had been in critical condition died this morning," said Samuel Kazinga, district commissioner for Bundibugyo, the epicentre of the new outbreak.

Kampala's Mulago hospital is the largest in the country. Some health officials have said that a lack of appropriate equiment in Mulago and other hospitals has allowed the virus to spread.

The health ministry confirmed the latest fatalities caused by the virulent local strain of Ebola, which kills up to 90 percent of its victims, mostly by puncturing blood vessels and spurring non-stop hemorrhage.

Eight pathogen experts from the Atlanta-based Centers for Disease Control (CDC) arrived in the country on Tuesday to help battle the disease that has infected at least 64 people in Uganda.

Efforts to isolate suspected patients in the rural district neighbouring the Democratic Republic of Congo (DRC), have failed as many residents fear hospitals are unsafe, authorities have said.

The rare disease, named after a small DRC river, killed at least 170 people in northern Uganda in 2000, with experts blaming poor sanitation and hygiene.

It was first discovered in the DRC in 1976, but other outbreaks have been recorded in Ivory Coast and Gabon.

Ebola Strikes More Nurses

A 33-year-old man from Kyenjojo district, who had been admitted at
Virika Hospital in Fort Portal with suspected Ebola, died yesterday
afternoon [3 Dec 2007]. If confirmed, his demise would bring to 17
the number of people who have died since the outbreak of the epidemic
in August [2007]. The team that visited Bundibugyo Hospital yesterday
also learnt that 4 more medical workers were suspected to be
infected. They were among the 9 patients treated at one of the 2
isolation units in the hospital. All of them were health workers,
including the matron and a nursing assistant of the UPDF [Uganda
People’s Defence Force].

The unit, formerly an anti-natal ward, seen by a New Vision team, was
poorly equipped and understaffed. There was only one male nurse, who
was wearing gloves and a mask, but no protective over-all. The doors
were not locked and there was no sign that this was an isolation
ward. About 5 attendants walked in and out, some were wearing either
gloves or masks, while others were not protected at all. One
attendant, dressed in white, was touching a patient with her bare
hands, as if she was not aware of the danger. No doctors were seen at
the hospital. The superintendent was still admitted in a private wing
of the hospital. His condition was said to have improved.

Though foreign experts were reported to have come in to help with the
treatment, none were seen by The New Vision team at Bundibugyo
Hospital. Contrary to findings by The New Vision, the Ministry of
Health said only 6 new cases of Ebola had been reported over the last
week, including one health worker. “All the other 6 health care
workers who had been put under quarantine because of Ebola-related
complaints are still under observation,” said a statement by Dr. Sam
Zaramba, the Director General of Health Services.

According to Zaramba, experts from the World Health Organisation,
Medecins sans Frontieres and the Centres for Disease Control had
arrived in the country to help with laboratory diagnosis, case
research and management. A permanent laboratory will be set up this
week at the Uganda Virus Research Institute Entebbe to speed up the
diagnosis of Ebola and other viral haemorrhagic fevers, while
equipment for the laboratory is expected to arrive today [4 Dec
2007], the statement added. Currently, samples have to be taken to
South Africa or the Centres for Disease Control in Atlanta, USA.

Meanwhile, the UPDF has deployed a team of medical officers and
health educators to Bundibugyo. They will assist in the management of
Ebola patients and sensitising the public. UPDF 2nd Division
spokesperson, Lt. Tabaro Kiconco, said more personnel from the UPDF
Medical Department would be deployed in Bundibugyo today, while
emergency supplies would be delivered to Kabarole.

No new cases have been reported in Kabarole. So far, 2 patients with
Ebola symptoms have been admitted in Buhinga Hospital in Fort-Portal,
of which one died.

Following the Ebola outbreak, the 5 districts of the Rwenzori region
have postponed their joint education week celebrations, which were
slated to start today in Kasese. Other reports from Bundibugyo say
elders have resorted to consulting their oracles and sacrificing to
their ancestors to appease the gods.

[The number of fatalities in the outbreak has increased by one and
now stands at 17. Otherwise the overall situation remains confused
and the arrival of skilled medical support and diagnostic facilities
is still awaited. - Mod.CP]

http://www.promedmail.org/pls/promed/f?p=2400:1001:17448743357448622543::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,40330

The number of deaths has risen to 21 at this time.

Ebola Bundibugyo: Mid Wednesday

Since every day seems like a week, multiple posts seem appropriate. Joshua Kule, the senior clinical officer, and the head nurse of the hospital (?Peluce) also died this morning, so with Jonah that brings 3 of 6 health care workers admitted dying within 12 hours of each other. So it is not surprising that both Scotts found the hospitals rather empty of patients and short on staff. Many are afraid, but a few brave and hard working souls persist. Scott said it was very disturbing and poignant to be given the key to Dr. Sessanga’s office and told to use it . . .

And to find the top paper on his administrative stack was a request by Joshua Kule for his month of annual leave to begin today. I know that Dr. Jonah was also planning an annual leave beginning this week. . . . A Uganda Police Surgeon assisted Scott in seeing all the non-Ebola hospital inpatients, and then he worked with the administrator to designate a cemetery area.

It seems the district feels it would be a fitting honor to health care workers who die to offer burial on site, and to create some sort of memorial for them. We’re OK with that as long as they aren’t coerced out of fear of transporting the bodies home. Meanwhile our airstrip might need an air traffic controller. I met a mid-morning flight bringing in the director general of the Ministry of Health as well as an assortment of WHO officials and someone with MSF too I think, it gets confusing. We don’t shake hands here anymore, so that puts an odd crimp in introductions. I hear another flight landing now, and I know there’s a third one this afternoon, with CDC officials and I hope an MSF doctor. There are actually a significant number of doctors here now . . . But only three (as far as I can tell) are actually seeing patients (Scott, Dr. Yoti, and the Police Surgeon). The others are one step removed, tracing contacts and managing data and handling logistics and reports. By the end of the day we hope that will have changed as a new medical superintendent is promised, and the MSF team expands.

Our mission sent a prayer guide based on Psalm 91 that was very appropriate and encouraging, pleading with God to save people from this disease, asking Him to use it for good in some way that we can not yet see, confessing our bewilderment over the death of Jonah. In the church meeting here this morning people took turns standing up and giving testimonies, comments, etc., it is very African for everyone to get a chance to speak. I noticed that some chose John 9 as a text, the story where the Jesus rebuts the idea that sickness is a punishment for someone’s specific sin.

I’m glad to see people wrestling with the “why”, looking for meaning in a bleak and frightening situation. Even in the task force the idea of blame sort of swirls below the surface, if that patient died then maybe it was someone’s fault . . . But the truth is that Ebola is a powerful virulent organism, and there is not much one can do to stop a patient from dying once infected.

Concern is mounting all around us too. Two districts within Uganda announced that they would close off access to anyone from Bundibugyo, and the DRC announced closure of the Congo border (though I doubt their ability to enforce that). If the CDC lab can become operational today and the samples from scattered patients (Fort Portal, Mbarara) be confirmed negative that might help the general sense of this thing spiraling out of control.

More from the front lines when Scott gets back, he’s been gone all day again. Since so many are reading and praying, please pray for SLEEP. We are in a situation where the difference between life and death might be the overall resilience of our bodies to resist or pull through this infection; yet we’re also in a situation where the work is tremendous and the stress keeps us on edge, making it hard to get healthy rest.

So when one of us feels particularly tired, we have that sickening knot of wondering deep in the gut, is this because we laid awake for hours last night, or is this the beginning of a fever? Thankfully so far it is the former. Pray that for the MSF nurse Rosa too, who is the primary Ebola care-giver. And Dr. Yoti.

Thanks

http://paradoxuganda.blogspot.com/

Edwin Musoni
Kigali

Local and international health partners, among them epidemic experts, are scheduled to meet with officials from the Ministry of Health today to forge ways of preventing the deadly Ebola virus from spreading over to Rwanda from neighbouring countries.

Innes Mpambara, the Communications Director in the Ministry of Health, said officials will hold talks with the State Minister for HIV/Aids and Infectious Diseases, Dr Innocent Nyaruhirira.

“Dr Nyaruhirira is scheduled to meet with local and international partners to update them on the current situation of Ebola and to also request them to cooperate in stopping the virus from crossing over to Rwanda,” Mpambara said.

The deadly haemorrhagic fever has broken out and killed people in some parts of neighbouring Uganda and Democratic Republic of Congo (DRC).

Meanwhile, the Clinical Managing Director of TracPlus, a centre of disease and epidemic control, Prof. Michael Kramer said that screening of travellers had started at all border posts and that all people coming into the country are being diagnosed before entering the country.

Rwanda has installed isolation facilities at all medical centres close to the border posts and whoever will be suspected to be carrying the virus will be put in those isolation cubicles, Kramer said.

He added that the government is currently training medical doctors on handling Ebola cases and preventing it from spreading.

Rwanda issued a red-light alert after the first outbreak in the Democratic Republic of Congo (DRC) in April this year; since then, hundreds have died of the deadly haemorrhagic fever in both DRC and Uganda.

The disease has hit two districts, Bundibugyo and Mbarara, in the neighbouring country Uganda in the last month.

http://allafrica.com/stories/200712050059.html

Background info:

Just a quick synopsis of the current state of Ebola research.

GENETIC ANALYSIS OF THE OUTBREAKS

Investigations into the outbreaks of Ebola in humans during the late 1990’s pointed to a link with great apes.

The origins of many of these epidemics could be traced to direct human contact with dead chimpanzees or gorillas, either through hunting bush meat or from handling carcasses found in the forest.

The index [first] cases were mainly hunters and transmission occurred by direct person-to-person contact.

We have identified at least 10 separate chains of transmission, each originating from one index case occurring between October 2001 and May 2003.

By analyzing the genetic material of the virus to see whether these outbreaks had resulted from multiple introductions of a single viral strain or separate introductions of several strains of Ebola it was discovered that:

(1) There were at least eight different strains of Ebola involved, showing that for this relatively short period under study the mode of transmission of the disease was more complex than previously imagined.

(2) Because Ebola is a genetically stable virus - unlike say influenza, which mutates rapidly - the fact that many strains are involved suggested that there have been multiple independent introductions of the virus from the reservoir species into apes and humans.

Different strains of Ebola virus may be widespread throughout the forests of central Africa, with simultaneous infection of great apes occurring from unknown natural hosts under particular but unknown environmental conditions.

Ebola outbreaks probably do not occur as a single outbreak spreading throughout the Congo basin as others have proposed but are due to multiple episodic infection of great apes.

THE UKNOWN RESERVOIR

The great unknown, of course, is the name of this reservoir species.

We aren’t near to identifying the animal but we have some ideas, in particular fruit bats.

We don’t have much evidence at all, just observations and ideas.

Both apes and fruit bats eat the same kind of food so it is not unreasonable to assume that they may come into close contact with one another at certain times of the year.

Ebola outbreaks in wild animals seem to occur at the beginning of the dry season. But no one has yet shown that it is possible to find Ebola virus in wild bats.

In South Africa a scientist succeeded in infecting fruit bats experimentally and he observed rapid development of the virus.

So although it is technically possible to infect fruits bats with Ebola, there is still no evidence that this is the mystery reservoir species.

Until this animal is found, the sole measure that we can take in predicting and preventing an Ebola outbreak in humans is to watch what is happening to gorillas and chimpanzees in the wild.

57 posted on 04/26/2004 8:05:52 PM PDT by Mother Abigail
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Gene-swapping Ebola is a slippery target

Scientists have genetically sequenced Ebola viruses from gorillas and chimpanzees for the first time and found the virus to be more varied than previously thought.

Unexpectedly, they have also discovered that different strains of the virus can swap genes - a find that could make producing a vaccine much more difficult.

The Ebola virus causes fever and haemorrhage and kills up to 90% of people who catch it. It has spread cross Africa since 1976, infecting humans and apes sporadically and also hiding in bats.

An outbreak currently underway in the Democratic Republic of the Congo is so far thought to have infected 76 people. Ebola has also killed thousands of apes and has caused the lowland gorilla to be classed as endangered.

The genetic code for human versions of the viruses taken from humans has been sequenced before.

But, as sick animals are so difficult to find in the wild, and dead ones decompose quickly, until now no one has sequenced the virus from an ape.

Distributed virus

Eric Leroy and colleagues at the International Centre for Medical Research in Franceville, Gabon, managed to retrieve all or part of the Ebola virus from the remains of six gorillas and one chimpanzee. The viral genes were found to be similar to each other and to viruses from human victims in the same region.

But when all the sequences were analysed and compared, they clustered in two groups that, according to a model of how fast such viruses evolve, diverged from each other in 1976.

Furthermore, when all available samples - from both humans and apes - were analysed together, those collected after 1996 were found to be more similar to each other than to those collected (from humans alone) before 1996.

Leroy believes this shows that the virus is already distributed across central Africa and something else must be responsible for the current wave of outbreaks.
Leroy says the genetic differences “add to evidence for the pre-existing distribution of the virus.”

Rare recombination

The results may not resolve the rivalry between competing theories about how Ebola spreads. Peter Walsh of the Max Planck Institute for Anthropology in Leipzig, Germany, does not believe the virus is already distributed, and says different forms of it may simply be spreading together. “We have too few samples to know,” he says.

But both experts agree that the real surprise is that recent samples from humans show some genes from one cluster and some from another.

Such recombination is rare in RNA viruses and has never been seen before in filoviruses such as Ebola.

This recombination also means that a much wider range of genetic variants may emerge, making it harder to create an effective vaccine, says Walsh.

http://www.newscientist.com/article/dn12750-geneswapping-ebola-is-a-slippery-target.html

67 posted on 10/09/2007 5:26:06 AM PDT by Mother Abigail
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What concerns me most is that we might begin to see an infection pattern with Ebola that is now well documented in Marburg outbreaks.

1. We know that human infection with Ebola comes about through the intermediary of infected great ape carcasses.

2. The viral transmission to primates occurs in the dry season, a period when food resources become increasingly scarce. The great apes then come into competition with bat species for fruit supplies when foraging and can be infected notably by blood or by placental fluid that escapes when bats give birth. (See my post #57 from 2004)

3. The mode of contamination by Marburg virus appears to be different, however. It does not appear to need any intermediary to be pathogenic for humans, as foreseen from the data on Marburg epidemic outbreaks.

In one outbreak, which raged in the north-east of DRC in 2000, most people infected worked in a goldmine, which turned out to be the refuge for a large colony of Egyptian rousettes. During the second epidemic, in Angola, the first victims were children who had gathered fruit from trees where a large population of this species of fruit bat roosted.

4. R. aegyptiacus - Carries both antibodies and viral RNA fragments - strongly suggesting that this bat species is a non-symptom developing carrier of the Marburg virus - (i.e.) the natural reservoir.

If Ebola were to recombine in a way that gave it any of the infection abilities of its cousin Marburg - well.....

Not as far-fetched as once it seemed.

75 posted on 10/09/2007 7:58:39 AM PDT by Mother Abigail
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http://www.freerepublic.com/focus/f-chat/865868/posts?q=1&;page=51

http://www.iht.com/articles/ap/2007/12/05/africa/AF-GEN-Uganda-New-Ebola.php#end_main

LONDON: The new type of Ebola in Uganda might be less deadly than others — but that’s not necessarily good news.

The World Health Organization said last week that an ongoing Ebola outbreak in Uganda was caused by a new subtype, the fifth to be detected since the virus was first identified in 1976 in Sudan and Congo. While information about the outbreak was still limited, it appeared to be killing fewer of its victims than other strains typically do.

Dr. Tom Ksiazek, chief of the special pathogens branch at the United States’ Centers for Disease Control and Prevention, said Tuesday it was premature to conclude whether the new Ebola strain was milder.

If it were, its victims could be less contagious, Ksiazek said.

A less lethal version of Ebola, though, might spread unnoticed and be confused with other diseases, making it “a more difficult challenge,” Asiya Odugleh-Kolev, a WHO communications expert who has worked on numerous Ebola outbreaks, said Wednesday.

Ending previous Ebola outbreaks in Africa has largely depended on Odugleh-Kolev’s specialty: teaching people to spot the disease early and to reduce behaviors that could spread it. She said people might not take a less dangerous form of Ebola seriously, or fail to take the proper precautions because they think they have measles or some other disease.

The new type of Ebola has so far killed at least 22 people in Uganda, including four health workers, said Dr. Sam Zaramba, director general of Uganda’s health service. He also said there were 93 suspected cases. Typically, Ebola kills between 50 to 90 percent of the people it infects.

Two teams of international experts, including infection control doctors, have been sent by the CDC and the World Health Organization to help local officials contain the virus.

Ugandan officials report that some health workers have fled the outbreak’s epicenter in fear and that there is a manpower shortage.

Ebola causes fever, intense weakness, muscle pain and other symptoms. In severe cases, the virus damages the kidneys and liver, and patients may bleed internally and externally. Ebola is usually spread by close contact with an infected patient, or by contact with the secretions of an infected patient.

In Uganda, WHO said the classic Ebola symptoms were not always present, and that in the current outbreak, there were more reports of vomiting than usual. That slowed diagnosis, according to Ugandan health authorities who said that the outbreak might have begun in August.

The Ebola viruses from Uganda examined so far appear to be up to 25 percent different genetically from previously known Ebola strains. Ksiazek was unsure whether this difference might be significant for patients and doctors.

“What we know from previous Ebola outbreaks is still going to apply,” he said. “We now have to figure out if the mortality might be any different.”

Doctors also worry that the presence of other diseases in Uganda could complicate the effort to contain Ebola. Because the symptoms for diseases like malaria and typhoid are sometimes similar to those for Ebola, doctors and nurses will need to be careful not to mix Ebola patients with other patients, which could spread the virus in health care centers.

The last outbreak of Ebola in Uganda occurred in October 2000 when 173 people died and a total of 426 people were infected in the north of the country.

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