Ebola death toll in Uganda rises to 29, 12 new cases recorded

KAMPALA, Dec 10, 2007 (Xinhua via COMTEX) -- Another seven people were killed by the deadly Ebola hemorrhagic fever in Uganda as twelve new cases were reported over the weekend amid an outbreak that has sounded alarm in ten out of 79 districts across the country.

A total of 29 people have so far been killed by Ebola out of 113 infections as of Monday morning, Sam Okware, chairperson of the National Task Force for Ebola, told Xinhua by telephone on Monday.

He said seven new cases were reported in the western district of Bundibugyo which has been hit hard by the epidemic since August.

According to Okware, 32 are still admitted in hospital while six have been discharged. He added that another five are to be discharged.

The deadly virulent disease hit parts of Bundibugyo in August before spreading to neighboring Kabarole and Kasese districts.

This is the second Ebola outbreak in Uganda, which is caused by a new strain of the virus seemingly milder than the other four strains.

The last outbreak in Uganda killed 224 people from October 2000 to March 2001, which started in northern Uganda and later spread to other parts of the country.

The Ugandan government last week declined to declare a state of emergency over the epidemic, arguing that it has put up a mechanism to contain the disease.

Alarmed by the outbreak, the neighboring Kenya, Rwanda and the Democratic Republic of Congo have since last week boosted surveillance along their border with Uganda to block migration of suspected Ebola victims.

http://allafrica.com/stories/200712100808.html

9 December 2007
Posted to the web 10 December 2007

Elizabeth Agiro
Kampala

Reports a month before the Commonwealth Heads of Government Meeting (CHOGM) stated that a mysterious disease was killing people in western Uganda. This highly infectious disease was believed to have arisen from a dead goat and spread on contact with infected people. After CHOGM, however, the disease suddenly acquired a name - Ebola.

Many speculated the Government had deliberately hushed the news in anticipation of the big event. This would have definitely ruled Uganda out of hosting the long-awaited summit.In its wake, Ebola has claimed so many lives, including that of Dr. Jonah Kule, the Medical Superintendent of Kikyo Health Centre in Bundibugyo. But even as the medical fraternity battles the deadly disease, patients aren’t making it any easier for them. One patient fled after she was placed in isolation for vomiting blood. Even long-standing aspects of our culture, say hugging and the handshake, are under threat.

While Ebola is taking its share of victims, four other epidemics have spread their tentacles in western and northern Uganda, killing many more and infecting thousands of others. Cholera, plague, meningitis and hepatitis, are also contagious. The plague alone has killed 10 of 121 infected people. Most affected are women who sleep on the floor unless their husbands invite them to bed for sex. Health state minister Emmanuel Otaala has blamed the outbreaks on climate change.

While the Government lacks the necessary funds to combat the diseases in their infant stages, there were definitely enough funds to go around for the CHOGM last month. A total of sh276b was used to repair roads and support private hotels through co-investment. The money also went into upgrading the security infrastructure. With the summit out of the way, donors have demanded accountability for the funds spent. They expressed interest in whether value for money for contracts was received and if the procurement law was followed. They hope that those suspected of misappropriating the funds will be brought to book within the given legal framework.

However, there was nothing untoward in the donors’ concern over the creation of new districts and sub-counties in the country. In a statement, the donors asked that the creation of these entities be based on robust and careful analysis and consideration. They warned that more districts would create more sub-counties, which sub-counties would in later years also demand for district status. Meanwhile, Makerere University cancelled the examinations of 550 students after whistle-blowers alerted authorities about two leaked exams. It is believed some lecturers leaked the scripts to mainly female students. Those who weren’t part of the clique felt obliged to unearth the scheme in anonymous letters to the law faculty dean, Dr. Sylvia Tamale.

A comment on the current Ebola virus outbreak in Uganda

There is much understandable but sometimes inaccurate commentary in
the reports on recent Ebola virus outbreaks on ProMED. One error
concerns the amount of gross hemorrhage in previous epidemics with
both the Zaire and Sudan species of the agent. Despite lay reports of
major bleeds from nose, other orifices and eyes, the amount of blood
lost externally in the syndrome has never been significant. Indeed,
this fact frequently produces difficulty in making a probable
clinical diagnosis in the early phase of febrile illness.

I do not think that the putative clinical differences cited in the
current Uganda outbreak should be used in any way to give support to
the notion of a new viral species. Moderator caution regarding that
question is rightly expressed. What could be significant is the
possible mortality rate described. When diagnostic capability is
established in the region, it will be important to seek samples from
those putatively recovered, once the work of confirming active cases
settles down.

http://www.promedmail.org/pls/promed/f?p=2400:1001:13282391902556388075::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,40397

Sunday, December 09, 2007

Ebola Bundibugyo: Sunday numbers, no sabbath

As usual we headed to Bundibugyo town this evening, but this time we stopped first in Kirindi. Jonah’s brother had called me earlier in the day, and I had gathered there was something he wanted to tell me though the connection was terrible. All I could ascertain was that everyone was OK . . .

So we drove up there at 4, bringing mosquito nets and insect repellant in response to massive numbers of insect bites I’d seen on the girls, and more air time for Melen’s phone in case one of the family became ill. We found Melen sitting outside for the first time, in a clean dress for the first time, and then it became clear that the message was about the Oluku, funeral rites, they had been inviting me to participate. Oh well. After four days of mourning there is a tradition of bathing, washing clothes, and bringing closure. I’m glad they were able to achieve this, and make some slight progress in life. Jonah’s mother and brother continue to remain symptom free.

The task force meeting occurred as usual outside, a circle of plastic chairs, in the shade of the RDC’s office building. Tonight he went on the offensive immediately. He wanted answers, and results, and now. We like him, he’s an effective and persuasive man. But tonight he was looking for people to blame, and this was the tone of the meeting in general. Everyone is under stress. Some of that may be related to unfavorable press in the Sunday papers questioning government response, some may be due to the growing possibility that this epidemic spread by travelers to a handful of other districts before Ebola was identified as the cause.

It is not a simple or hopeful picture. So here we go:

**Cumulative cases: 112

**Cumulative deaths: 28 (Case Fatality Rate 25%, which while horrific is certainly not as bad as the 90% sometimes seen)

**Contacts identified: 368

**Traced today: 189 (51% and building, they feel they are able each day to improve their outreach. This is the key to containing spread! I confirmed with Melen that their family had been checked on daily for the last three days).

**Social Mobilization: many churches were visited, but no one outshone our own Scott Will for sheer volume of services rendered!

**Isolation Ward, Bundibugyo: 19 current census. 5 new admissions today, 2 deaths, 3 discharges . . . And another 5 nearly recovered and ready for discharge. 3 however remain critical.

**Isolation Ward, Kikyo: 13 current census. 2 new admissions, 0 deaths, 3 discharges. Of these 13, 2 are considered critically ill.

**Staffing: complete staff of 16 nurses now in Bundibugyo but some still in training so only 7 functional, staff in Kikyo 8 of the desired 12. There was some controversy about doctor staffing. The RDC looked severely at Scott and asked why expatriate doctors weren’t working in the isolation ward. Hmmm. But MSF denies needing help. We’re not sure where that leaves us. If we could help build trust by being in the mix Scott would do it, but we don’t want to get in the way either. It is difficult to get people to understand that a 25% CFR in Ebola is actually good news; they tend to feel that the announcement of any death represents a medical failure of care.

**Labs: No results yet. 6 more samples collected.

**Controversies: besides staffing, the main discussion points were spraying and herbs. There is a public perception that spraying the house of an infected person with chlorine solution (bleach) will stop transmission. MSF routinely instructs their ambulance teams to spray the home after picking up a patient to transport in to the ward. However the district would like to see the homes of all 112 cumulative cases sprayed.

We talked a long time about the fact that the virus can’t live more than a few hours outside of a host, so going back to spray the homes of people sick weeks or months ago seems pointless, except for the psychological benefit, which may not be justifiable if it drains precious human resources from stemming the current spread. On herbs, some of our district leadership truly believes that the local culture may have herbs that cure this disease. It seems that patients don’t want to enter isolation because then they’ll be cut off from their local remedies. The CDC voice of reason pointed out that we don’t know if any of these treatments might actually be harmful, and that if they are administered by cuts or enemas they could promote transmission of the disease. The RDC voice of reason stated categorically that we will only use science to determine treatments. But it was clear that most of the people present at the meeting who were actually from this district had their doubts, and were holding onto the hope that some herbal combination would provide a cure.

Please pray for our team in Kampala tonight. Three members will leave in the morning, two for normally scheduled ends of their terms, and one for an earlier-than-scheduled month-long trip. The rest of the team remains in the competent and caring hands of Dan and Gini Herron. Tonight there was some panic because of a typical minor illness in one of the kids, the kind that happens on almost every trip to Kampala, different food and water leading to fever and a bit of diarrhea. This is not Ebola. But we realize now that as a team we’ll be living with that added stress, the impending doom feel that every head ache or loose stool could be the beginning of the end. That’s pretty difficult for all of us.

http://paradoxuganda.blogspot.com/2007_12_01_archive.html

This is one day old in a very dynamic situation

Rwanda: Ebola Screening Intensifies

The New Times (Kigali)

10 December 2007
Posted to the web 10 December 2007

Ambrose Gahene
Gatuna

All travellers entering Rwanda from Uganda have been advised to avoid direct contact with blood and other body fluids to minimise threats of contracting the deadly Ebola virus.

A standby ambulance is stationed at Gatuna border post, the main entry point from Uganda to Rwanda, to attend to emergency cases.

A special tent with medical equipment has already been erected at Byumba Hospital, for any eventualities.

Medical gloves have also been distributed to all staff working at Gatuna border to protect them from getting direct contact with individuals.

“There are no reported Ebola cases so far in Rwanda,” Bonaventure Butare, the nursing chief at the border, said.

“We are mainly advising people to take preventive measures against the spread of Ebola,” he explained.

Butare said all incoming passengers are asked whether they have had any direct contact with Ebola patients or attended burial ceremonies of Ebola victims.

Recent Ebola outbreak in western Uganda districts of Bundibugyo, Kasese, Kabarole and Mbarara have prompted the Ministry of Health to introduce precautionary measures at all border posts with Uganda and DRC to prevent the disease from spilling over into Rwanda.

A team of medical personnel and nurses from Byumba Hospital and CHK were dispatched last week to screen incoming passengers hailing from Ebola affected districts in Uganda and neighbouring regions of DRC.

http://allafrica.com/stories/200712100866.html

http://ca.today.reuters.com/news/newsArticle.aspx?type=topNews&storyID=2007-12-10T161413Z_01_L10361107_RTRIDST_0_NEWS-UGANDA-EBOLA-COL.XML

Uganda confirms 113 suspected Ebola cases
Mon Dec 10, 2007 11:14 AM EST

By Tim Cocks

KAMPALA (Reuters) - Uganda has 113 suspected cases of a new strain of Ebola fever that has killed 29 people, officials said on Monday, vowing to take the necessary steps to stop the virus spreading.

Ugandans fear the outbreak could mushroom into a major epidemic affecting the capital Kampala.

“We have an Ebola lab in Entebbe (near Uganda’s international airport) where we are testing samples we took from suspected cases,” Health Ministry spokesman Paul Kabwa said.

Some banks and supermarkets in the city issued their staff with protective rubber gloves for handling money they feared could be contaminated with the virus, which often causes victims to bleed to death through ears, eyes and other orifices.

All cases so far have been in western Uganda’s Bundibugyo district, bordering Democratic Republic of the Congo, except a doctor from the region who went to the capital after treating patients and died soon afterwards in a Kampala hospital.

“I’m very worried,” said Valentine Oketcho, 25, who hands out fliers for restaurants in a Kampala shopping mall. “It’s terrible, it’s killing people in less than a week. This is worse than AIDS. At least you can survive AIDS for some years.”

Others said the government should declare a state of emergency, although it has said it is on top of the epidemic.

The outbreak, which started in August, has sparked panic among officials, health workers and the public. A fifth health worker was among the latest dead, officials said.

Kampala was rife with rumors of two Ebola deaths in the city over the weekend, including a man who collapsed in the street, although Kabwa said neither fitted the definition of a suspected Ebola case.

The affected region borders Democratic Republic of the Congo, where the Ebola river gave the virus its name after some of the first cases were recorded in its valley in 1976.

“If it can do all this in Bundibugyo, it could spread further, even Kampala,” said Amira Hussein, who runs a gift shop. “So now in addition to malaria, AIDS, plague and all the rest, we have Ebola. Are we unlucky?”

The last Ebola outbreak in Uganda was in 2000, when 425 people caught it and more than half died.

Uganda: Sironko in Ebola Scare

The Monitor (Kampala)

10 December 2007
Posted to the web 10 December 2007

David Mafabi
Mbale

Sironko District authorities have been thrown into panic after one of their workers suspected have contracted Ebola hemorrhagic fever case died at the Mbale Regional Hospital.

Olive Mukite, the Sironko District Information Officer who was admitted at Mbale regional hospital with high fever, diarrhea and vomiting on Thursday morning died later in the day.

Mukite died barely a week after the Sironko District council, technical staff and heads of departments visited Kisoro and Kabale districts for a study tour from November 26-29.

According to the Vice Chairman LC5, Mr Patrick Kibere, who led the team of 66 people, the team visited Kabale District, where they spent a night before traveling to Kisoro and then later Mbarara districts.

“We are really scared because if this girl has died of Ebola, then the entire council and heads of departments besides other technical personnel and their families are in danger,” Mr Kibere said.

“We don’t know what to do. We fear for our lives and our families and friends because we have mixed freely with them ever since we came back.”

The district speaker, Mr Perez Mango, was lost for words.

When contacted by Daily Monitor, Mr Mango said, “Ministry of Health should just come to our rescue if it is true.”

The Deputy Cao, Mr Peter Wotunya, who led the technical team, said the entire technical and political teams at the district were paralysed. No work was done because everyone is scared and awaiting a report from the Ministry Of Health.

The LC5 chairman, Mr Kibale Wambi, who did not make the trip to the western districts, said he was ready to die with his team.

“I didn’t go to Kabale and Kisoro but if it is true this girl has died of Ebola, then my entire council and technical team is likely to perish. So as a leader, I have no choice but to go to my people and die with them,” Mr Kibale said.

When Daily Monitor visited Sironko District headquarters, many people were shunning members of the team that made the trip.

Health officials at the district had not yet made a comment by press time.

Monday, December 10, 2007
Ebola Bundibugyo, Monday night

Just when I thought the tears had run dry, someone sent us a beautiful picture of Scott and Jonah together taken a few months ago. I still can’t believe he won’t come back from Kampala any day and sort things out. I do think sometimes about him meeting my Dad in Heaven. They had a good relationship of respect, and I like to think of them recognizing each other there.

OK here is today’s report. Scott was gone from morning to night. The day began with a clinical conference, with Scott, Dr. Jackson Amoni from Ministry of Health, our heros Dr. Yoti from WHO ( also a Ugandan and formerly with MOH) and chief nurse Rosa from MSF. The four of them were tasked to sort out protocols and procedures for caring for the sick in isolation. Our main contribution is to agree with Dr. Yoti and confidently endorse him to everyone else. Scott then went to Kikyo to try and install the Gray’s “village phone”, which includes an antennae we hoped would overcome the mountainous terrain and distance from the tower and allow that health center immediate phone access at all times.

Sadly it did not work, but we are still grateful that the Grays let us try. Somewhere in there he managed to get the lawnmower back to complete the airstrip mowing for the daily flights, and to pick up mosquito nets for pregnant and HIV positive women, and to see some maternity patients too I think. The day ended with the two of us zipping back up to Bundibugyo on the motorcycle for the evening task force meeting, while Scott Will, who had been working at Nyahuka Health Center today, stayed back to cook us dinner. Very nice.

The meeting tonight was a bit calmer and more amicable, thanks for prayers for cooperation. Here are the facts:

Cumulative cases: 115
Cumulative deaths: 29 (CFR 25.2%)
Contacts: 368. 298 were seen today! Amazing really if you think about the challenges.

Bundibugyo Isolation Ward: 17 inpatients, 4 discharges today (!!), 2 admissions, 0 deaths, with 2 of 17 remaining in critical condition.

Kikyo Isolation Ward: 12 inpatients, 1 discharge, 1 admission, 1 death (sadly a 17 year old boy), and 1 of 12 remaining in critical condition.
LABS AT LAST!!: 17 patients had samples run today in Entebbe, some were specimens that had been collected days ago. 10 of 12 samples from Bundibugyo were positive for Ebola, either by antigen detection or production of antibody response. ZERO of 5 samples from other districts were positive. In other words all confirmed cases to date stem directly from Bundibugyo.

There is still a large back-log of tests so we are not quite ready to breathe a sigh of relief, but at least the initial news is good, the spread may not be as fast and violent as feared.

Jonah’s labs: his initial test done on Saturday (day 4 of illness, day 2 of admission) was positive for antigen (presence of the virus) but negative for IgM antibody (he was not yet mounting a detectable immune repsonse). The sample two days later was positive on both counts. It is no surprise that he truly died of Ebola, but provides some closure to have it confirmed.
Tribalism: Sadly almost all the cases stem from the Bakonjo tribe (including Jonah). The Bakonjo are a minority in the district; most of them live in Kasese and Congo. The majority tribe here, the Babwisi, have been relatively spared. Since transmission is person to person, this makes sense, that the disease would stay within one primary ethnic group. However even in ADF days there was suspicion and accusation between the tribes. Now the Bakonjo are accusing the Babwisi of poisoning them, and we heard that today some refused to buy rice in market that was grown by the Babwisi women. Yet another way that fear and misunderstanding can be used to foment ethnic unrest.

More unrest: on the Fort Portal side of the mountains, that district had decided to locate their isolation unit as close to the Bundibugyo district border as possible, in Kichwamba. But local people rioted last night, breaking windows in the ward, and forcing transfer of two suspect cases back to Fort Portal Town’s main hospital. These tensions are essentially the same that sparked Rwanda, the fear that one’s own family and tribe are at risk and therefore the justification to lash out violently against those perceived to be enemies. We are praying for peace. Thankfully no violence here where the real cases are, but the mistrust and bickering is a smaller symptom of the same issue.

More discrimination: a local government official who has been conspicuously absent all week showed up today, complaining that in Kampala he was ostracized as “the walking dead” because he was from Bundibugyo. We all acknowledge that the country is in a quandary, most people are very upset about the possibility of catching Ebola, and anyone from Bundibugyo is suspected to be a carrier. The district’s ONLY bank closed today, in spite of pleas by the security officer that there was no danger in banking. Inability to access money will definitely put a damper on the response.
Tomorrow’s tasks: The minister of health himself and three other top ministry officials will fly in for an official visit tomorrow. Before that Scott and Dr. Yoti will ceremoniously discharge Dr. Sessanga from his home isolation, declaring him cured. Then the Scotts (both) will be participating in training staff at NHC to help allay fears and provide adequate protection so patient care for non-Ebola cases can proceed.

We can’t thank you enough for your care. We’ve been particularly encouraged by several people contributing to the emergency response fund. We will be spending some immediate money on more gloves, and trust that the school fees for Jonah’s children will be provided by the time they need them in late January. It is good to sense how clearly we are only one small part of the larger community of Christ in this time.

http://paradoxuganda.blogspot.com/

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