Ebola-Fieber in Uganda

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Ebola-Fieber in Uganda - Kibaale und Kampala

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Uganda's President Yoweri Museveni has called on people to avoid physical contact, after the deadly Ebola virus spread to the capital, Kampala. Fourteen people have died, including one in Kampala, since the outbreak began in western Uganda three weeks ago, he said in a special broadcast [...] Mr Museveni said seven doctors and 13 health workers at Mulago hospital - the main referral hospital in Kampala - were in quarantine after "at least one or two cases" were taken there. One victim - a health worker who had been transferred to the capital - later died [...] The BBC's Ignatius Bahizi in Kampala says that some people have not yet heard about the latest outbreak of Ebola and are shocked when they find out. At a bus station in the city centre, our correspondent saw officials warning passengers about the virus and telling them to avoid physical contact. The first victim of the latest outbreak was a pregnant woman in Kibaale district, about 170km (100 miles) west of Kampala. It then spread at a funeral, Mr Museveni said.
Uganda's Yoweri Museveni warns of Ebola threat
30.07.2012 - BBC

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Ebola-Fieber in Uganda - Kibaale und Kampala

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EBOLA HEMORRHAGIC FEVER - UGANDA (03): (KIBAALE) UPDATE
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Date: Mon 30 Jul 2012
Source: Uganda Medical Centre, Office of the President, Uganda Health Centre, Press statement [edited]
http://www.mediacentre.go.ug/details.ph ... &item=1777

Update on Ebola in Kibaaaale district
-------------------------------
The Ministry of Health declared an outbreak of Ebloa in Kibaale district on Sat 28 Jul 2012 after receiving confirmatory results from the Uganda Virus Research Institute that the strange disease that had killed 14 people in the district was [caused by] Ebola Hemorrhagic fever [virus], Sudan strain.

The announcement followed investigations after the Ministry received a report from Kibaale district health authorities on 11 Jul 2012 about the strange disease that was associated with death in Nyanswiga LCI in Nyamarunda Parish of Nyamarunda subcounty, Kibaale district. The report had indicated that the patients presented with the common symptoms of diarrhoea, vomiting and fever. It indicated that by 10 Jul 2012, despite many of the patients having received treatment from Emesco HCIII, Mugarama HCIII, Kagadi Hospital and St Ambrose, 10 of them had died.

It further indicated that initial samples of blood and stool taken from the sick did not yield any positive findings in the laboratories in Kagadi Hospital and Central Public Health Laboratories of the Ministry of Health, Kampala. The report also noted that people were delaying to present themselves to seek treatment, partly because they believed that the cause of the illness was due to "evil spirits". This caused civil strife among the community requiring Police intervention to quell the animosity.

In response to this report, a team from the Ministry of Health was dispatched to do a quick assessment of the outbreak and give direction for further measures to be taken. The team carried out an eye balling exercise and verbal autopsy on the affected family. Between the 24 and 25 Jul 2012, detailed laboratory investigations were conducted at the Uganda Virus Research Institute and confirmed that the "Strange Disease" was Ebola hemorrhagic fever, Sudan. Three samples taken from the dead confirmed Ebola [virus] to be present in their biological specimen.

The Ministry of Health wished to inform the public that the index case belonged to a family in Nyanswiga village in Nyamarunda Sub-county in Kibaale district. Nine other members of the family had also succumbed to death. Four other people including a clinical officer who had attended to the dead at Kagadi Hospital also died at Mulago Hospital after she had been referred there. Her three-month-old daughter also died after admission at Kagadi Hospital on 28 Jul 2012. This brings the total number of dead to 14 as of 28 Jul 2012.

The Ministry of Health and its partners mainly the World Health Organisation, U.S. Centers for Disease Prevention and Control (CDC), MSF [Medecins sans Frontieres] and other Health Development Partners convened an emergency meeting to discuss the management of the outbreak. The meeting agreed to embark on the following to contain the situation;
- Started active and sustained tracing and listing of all possible contacts that were exposed to the suspected and confirmed cases since 6 Jul 2012.
- Dispatched a team of experts from MoH, WHO and CDC to support the response plan
- Mobilise the necessary supplies and logistics for case management from the National Medical Stores
- CDC dispatched Personal Protective Equipment (PPEs) and body Bags to the district.
- World Health Organisation provided an initial supply of PPEs and body bags
- Requested Mulago National Referral Hospital to reactivate its isolation camp in readiness for any possible cases detected in the surrounding areas at the hospital.

Yesterday, the Ministry of Health high powered delegation visited the Kibaale district to assess the current situation and build confidence of the healthcare workers. The delegation was led by the National Disease Control Programme Dr. Denis Lwamafa and other Commissioner. Others on the team includd representatives from the World Health Organisation, the U.S. CDC and other Health Development Partners.

The Ministry of Health assures the public that it is working around the clock with its international partners to rapidly assess the extent of the outbreak and to bring it fully under control as quickly as possible.Currently, there have been no more deaths recorded since the outbreak of the epidemic. The death toll still remains at 14 with only three confirmed to have died of Ebola. There are seven suspect cases admitted at Kagadi District Hospital and are responding well to the treatment being given. Other people who got into contact with the dead have not reported any signs of the disease so far, but continue to be monitored closely.

The Ministry of Health has further set up a temporary Isolation centre at Kagadi Government Hospital to accommodate all people suspected to be infected with the disease. The facility is to be beefed up with a medical team from Mulago National Referral Hospital to manage the suspect cases. A team of experts from the centre for U.S CDC and the World Health Organization have collected seven more samples from close contacts for further investigations bringing the total number of specimens collected to 11. The samples are being investigated at the Uganda Virus Institute, Entebbe. The Ministry continues to undertake active and sustained tracing and listing of all possible contacts.

Another team of experts is undertaking disinfection control at the wards and the isolation facility at the Hospital. The hospital has set up burial committees to manage burials of people suspected to have died of Ebola. The committee has been oriented on burial procedures and infection prevention and control.This is one of the control measures to control the spread of the highly contiguous disease.

Mulago Hospital is in the process of reactivating its isolation camp to cater for any reported cases in Kampala and neighbouring districts.

The Ministry of Health once again urges the public to take the following measures to avert the spread of the disease.
- Report and immediately take any suspected patient to a nearby health unit
- Avoid direct contact with body fluids of a person suspected to be 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
Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation.

--
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[It has now been established according to the Uganda Ministry of Health that that the Sudan strain of Ebola haemorrhagic fever virus is responsible for the outbreak in Kibaaale. The index case belonged to a family in Nyanswiga village in Nyamarunda Sub-county in Kibaale district. Nine other members of the family had also succumbed to death. Four other people including a clinical officer who had attended to the dead at Kagadi Hospital also died at Mulago Hospital after she had been referred there. Her three-month-old daughter also died after admission at Kagadi Hospital on 28 Jul 2012. This brings the total number of dead to 14 as of 28 Jul 2012.

HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]



Voodoo lässt grüßen -
für den "normalen" Mediziner ist es enorm schwer, die Menschen dort "einzufangen".

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Ebola-Fieber in Uganda - Kibaale und Kampala

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EBOLA HEMORRHAGIC FEVER - UGANDA (04): (KIBAALE), WORLD HEALTH ORGANISATION
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[Anmerkung Birgitt:
WHO Statement vom 29.07.2012 - bereits gestern gepostet, bitte hochscrollen.
Interessant hier ist der nachfolgende Anhang.]


--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Other Information and comments extracted from current press reports and commentators:
- A total of 7 doctors and 13 health workers at Mulago hospital are in quarantine after "at least one or 2 cases" were taken there, with one later dying from the virus. (From The Standard, Mon 30 Jul 2012
http://www.thestandard.com.hk/breaking_ ... r=20120730).
- A number of schools in Buyaga County have been closed following the outbreak of the deadly Ebola virus in Kibaale district. There are 5 types of Ebola namely Ebola Zaire, Ebola Sudan, Ebola Cote d'Ivoire, Ebola Bundibugyo and Ebola Reston. The type confirmed in Kibaale is Ebola Sudan, which is less deadly than Ebola Zaire. When Ebola Sudan broke out in Gulu in 2000, about 4 out of every 10 patients were able to recover. On the contrary, Ebola Zaire inevitably kills most of the people who get it. (From New Vision, Mon 30 Jul 2012 http://www.newvision.co.ug/news/633564- ... break.html).
- The species of Ebolavirus responsible for the current Uganda outbreak has been identified as Sudan ebolavirus since early Saturday. The earliest mention that I can find currently is here:
http://www.sfgate.com/world/article/Dea ... 743722.php. They either overstate the average case fatality rate for that species, or are syntactically ambiguous. Sudan ebolavirus has a case fatality rate closer to 55% (see Field's Virology). This article has a more thorough discussion and more accurate case fatality rates:
http://online.wsj.com/article/SB1000087 ... 60564.html (This comment was sent by Zach Bjornson,Stanford University,Microbiology and Immunology .
- CDC spokesman Tom Skinner said Sunday that: "About 5 people from the Atlanta-based centers were expected to join a group of CDC staffers who are permanently based in Uganda. These outbreaks have a tendency to sort of stamp themselves out, if you will, if we can get in and sort of stop the chain of transmission," he said. Health Minister Dr. Christine Ondoa Ondoa described the Ebola-Sudan strain detected as "mild" compared to other types of Ebola, noting that victims' lives can be saved with intervention. (From Fox Ne Cleveland, 29 Jul 2012 http://fox8.com/2012/07/29/at-least-20- ... -outbreak/).
- A total of 7 doctors and 13 health workers at Mulago hospital are in quarantine after "at least one or 2 cases" were taken there, with one later dying from the virus. The latest outbreak started in Uganda's western Kibaale district, around 200 kilometres (125 miles) west of the Kampala, and around 50 kilometres from the border with Democratic Republic of Congo. (From The Monitor, 30 Jul 2012
http://www.monitor.co.ug/News/National/ ... index.html).

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]
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Ebola-Fieber in Uganda - Informationstelefon

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Das ugandische Gesundheitsministerium hat ein Informationstelefon geschaltet. Die Nummern lauten: +256 (0)774451762, +256 (0)706506294 und +256(0)757174555
Reise-/Sicherheitshinweis Uganda
31.07.2012 - Auswärtiges Amt

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Ebola-Fieber in Uganda - Kibaale und Kampala

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EBOLA HEMORRHAGIC FEVER - UGANDA (05): (KIBAALE)
************************************************
A ProMED-mail post
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******

[1] Date: Mon 30 Jul 2012
Source: New Vision [edited]
http://www.newvision.co.ug/news/633603- ... pital.html


New Ebola cases reported at Kagadi Hospital
-------------------------------------------
A total of 19 new Ebola cases [have been reported] at Kagadi Hospital in Kibaale district. Mubende district bordering Kibaale has set up an isolation centre center following reports that Ebola patients from Kibaale were flocking [to] the health unit for treatment. This caused panic as nurses turned away patients for fear that they could be [carrying] the deadly Ebola virus. Mubende Hospital chief Dr. Edward Nkurunziza told New Vision that the isolation center would handle Ebola cases if confirmed.

Meanwhile 7 doctors of Mulago Hospital who treated an Ebola patient from Kibaale district have been placed under quarantine. This was done to prevent the spread of the deadly disease that has claimed 14 lives. Another 13 health workers, who accompanied the patient who died a few days ago, have also been quarantined, President Yoweri Museveni revealed Monday [30 Jul 2012].

In a statement on the outbreak of Ebola, Museveni cautioned Ugandans to avoid activities that could spread the disease. 2 more patients who are suspected to have contracted the deadly disease have been registered in Kibaale, according to the district health officer, Dr. Dan Kyamanywa. By Sunday [29 Jul 2012] evening, there were 5 new cases. "We have taken samples from the patients for testing," Kyamanywa said yesterday.

A total of 14 people have so far died of Ebola in the last 3 weeks. 13 died in Kibaale and [another] of them at Mulago Hospital, where she had been transferred.

[Byline: Ismael Kasooha and Luke Kagiri)

--
Communicated by:
ProMED-mail correspondent Kunihiko Iizuka

******
[2]
Date: Tue 31 Jul 2012
Source: Time Healthland, Associated Press report [edited]
http://healthland.time.com/2012/07/30/6 ... ble-ebola/


More Ugandans Admitted with Possible Ebola
------------------------------------------
A total of 6 more patients suspected to have Ebola have been admitted to the hospital days after investigators confirmed an outbreak of the highly infectious disease in a remote corner of western Uganda, a health official said on Monday [30 Jul 2012]. Stephen Byaruhanga, health secretary of the affected Kibaale district, said possible cases of Ebola, at 1st concentrated in a single village, are now being reported in more villages. "It's no longer just one village. There are many villages affected," Byaruhanga said. In a national address on Monday, Uganda's President advised against unnecessary contact among people, saying suspected cases of Ebola should be reported immediately to health officials.

Officials from Uganda's Ministry of Health and the World Health Organization announced on Saturday [28 Jul 2012] that the deadly Ebola virus killed 14 Ugandans this month, ending weeks of speculation about the cause of a strange illness that had some people fleeing their homes in the absence of reliable answers. If the 6 new cases are confirmed as Ebola fever, it would bring to 26 the number of Ugandans infected with Ebola [virus].

This is the 4th occurrence of Ebola in Uganda since 2000, when the disease killed 224 people and left hundreds more traumatized in norther Uganda. At least 42 people were killed in another outbreak in 2007, and there was a lone Ebola case in 2011. Investigators took nearly a month to confirm Ebola's presence in Uganda this year. In Kibaale, a district with 600 000 residents, some villagers started abandoning their homes to escape what they thought was an illness caused by bad luck. One family lost 9 members, and a clinical officer and her 4-month-old baby died from Ebola, Byaruhanga said.

D.K. Lwamafa, of Uganda's Ministry of Health, told reporters on Saturday that one Ebola patient from Kibaale had been referred to the national hospital in the capital but had then died in Kibaale.

The confirmation of Ebola's presence in the area has spread anxiety among sick villagers, who are refusing to go the hospital for fear they don't have Ebola and will contract it there. All suspected Ebola patients have been isolated at one hospital where patients admitted with other illnesses fled after Ebola was announced. Only the hospital's maternity ward still has patients, officials said, highlighting the deadly reputation of Ebola in a country where the authorities do not always respond quickly and effectively to emergencies and disasters. Barnabas Tinkasimire, a lawmaker from the area, said that some nurses refused to look after Ebola patients after one clinical officer died and another was taken ill.

"They are saying, 'We can't remain here if there is no sufficient allowance'," Tinkasimire said of medical officers handling Ebola cases. The lawmaker said the government's response so far has been poor and that it would have been worse without the technical support of organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC). "It took long for the government to respond, and up to now many people don't know how to guard against Ebola. We need sensitization," he said.

Ebola, which manifests itself as a hemorrhagic fever [But not in this outbreak - Mod.CP], is highly infectious and kills quickly. It was 1st reported in 1976 in Congo and is named for the river where it was recognized. A CDC factsheet on Ebola says the disease is "characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients."

Scientists don't know the natural reservoir of the virus, but they suspect the 1st victim in an Ebola outbreak gets infected through contact with an infected animal. The virus can be transmitted through direct contact with the blood or secretions of an infected person, or objects that have been contaminated with infected secretions. During communal funerals, for example, when the bereaved come into contact with an Ebola victim, the virus can be contracted, health officials said.

--
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<promed@promedmail.org>

******
[3]
Date: Tue 31 Jul 2012
Source: WHO Twitter [edited]



There are now 36 suspected cases of Ebola haemorrhagic fever in Kibaale district, Uganda, of which 4 are laboratory-confirmed and 14 dead.

--
Communicated by:
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<promed@promedmail.org>

[The number of confirmed fatalities remains 14, whereas the number of suspected cases and the extent of the outbreak are uncertain.

Ebola virus belongs to the family _Filoviridae_ which is comprised of 5 distinct species: Zaire, Sudan, Cote d'Ivoire, Bundibugyo and Reston. Zaire, Sudan and Bundibugyo species have been associated with large Ebola haemorrhagic fever (EHF) outbreaks in Africa with high case fatality ratio (25-90 percent) while Cote d'Ivoire and Reston have not. Reston species can infect humans but no serious illness or death in humans have been reported to date.

The natural reservoir of the Ebola virus is unknown despite extensive studies, but it seems to reside in the rain forests on the African continent and in the Western Pacific. Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir. They, like humans, are believed to be infected directly from the natural reservoir or through a chain of transmission from the natural reservoir. On the African continent, Ebola infections of human cases have been linked to direct contact with gorillas, chimpanzees, monkeys, forest antelope and porcupines found dead in the rain forest. So far, the Ebola virus has been detected in the wild in carcasses of chimpanzees (in Cote-d'Ivoire and the Republic of the Congo), gorillas (Gabon and the Republic of the Congo) and duikers (the Republic of the Congo).

Different hypotheses have been developed to explain the origin of Ebola outbreaks. Laboratory observation has shown that bats experimentally infected with Ebola do not die, and this has raised speculation that these mammals may play a role in maintaining the virus in the tropical forest.

Further information can be obtained from the he WHO Fact Sheet at: http://www.who.int/mediacentre/factshee ... index.html.
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]
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Ebola-Fieber in Uganda - Kibaale und Kampala

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EBOLA HEMORRHAGIC FEVER - UGANDA (06): (KIBAALE)
************************************************
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[1]

Date: Tue 31 Jul 2012
Source: SHOTS (NPR) [edited]
http://www.npr.org/blogs/health/2012/07 ... s=sh_sthdl


The number of Ebola cases in Uganda has increased during the past few days, a spokesman from the World Health Organization tells SHOTS. But the outbreak is still limited to a small region.

"Accumulatively to date, there are 36 suspected or confirmed cases," WHO's Gregory Hartl says. "All cases are in the Kibaale district," a rural region west of Uganda's capital, Kampala. Laboratory tests, conducted by the Uganda Virus Research Institute and the U.S. Centers for Disease Control and Prevention, have confirmed Ebola infection in 5 people. The specific strain of the virus is Ebola Sudan, which has caused 5 outbreaks in Africa since 1976, including one in Uganda that killed 224 people in 2000. Ebola Sudan typically kills about 50 percent of people infected.

A team, led by the CDC, WHO and Uganda's Ministry of Health, are now at the scene to determine the scope of the outbreak and then control it. This involves a strategy known as contact tracing. "You take every patient who is infected or suspected of infection and ask who they've been in contact with," Hartl explains. "Then you go find those people and do the same." All people in contact with the virus must be isolated and watched for 21 days, CDC spokesman Tom Skinner says. "Only once you've [i.e. all suspects] gone through 2 21-day periods can you be sure that the outbreak is over." This is a massive undertaking, but it's one of the only options for stopping a deadly virus that has no cure or vaccine.

The current Ebola outbreak 1st appeared at Ugandan clinics in early July 2012, but it was initially confused with cholera. Doctors didn't suspect Ebola until tests for cholera came back negative and a clinician got sick. "In Ebola outbreaks, health care workers often get infected because you touch somebody and can get the virus," Hartl says. Despite this ease of transmission, he says, Ebola rarely spreads outside a small geographic region.

One infected person traveled to a hospital in Kampala, triggering reports that the Ebola outbreak had spread to the capital city. But Hartl says there are no signs that people in Kampala have been infected.

[Byline: Michaeleen Doucleff]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[2]
Date: Wed 1 Aug 2012
Source: New Vision [edited]
http://www.newvision.co.ug/news/633642- ... uried.html


There is fear and panic going on in Kanungu district following the death of a health worker who was working in Kagadi whose body was transported for burial in the district. The victim is reported to have passed away on Mon 30 Jul 2012, and her body was transported over night to her parents' home in Nkunda village in Nyanga Sub County, Kanungu district, where she was buried hurriedly on Tue 31 Jul 2012 afternoon.

Kanungu district health officer Sister Florence Rwabahima told this reporter that she learnt about the deceased body being transported to Kanungu from Kibaale district after she heard about radio announcements announcing her burial in Kanungu district and tried to block the transportation of the body but failed as her relatives traveled at night. "I tried to block the transportation of the body, advising that she should be buried immediately in Kibale, but my efforts were fruitless," Rwabahima said. Rwabahima expressed concern that if the suspected victim died of Ebola, then it could be contracted by all her relatives who were involved in transporting her body and those who attended her burial in Nyanga. "The people who handled the transportation had no protective gear and must have had contact with the victim, and that is itself enough to pass on the disease," she said.

When contacted, the Resident District Commissioner, Kanungu Canon Ben Rullonga, said that he had ordered the burial of the suspected victim [to be carried out] immediately, but her relatives ignored him and took their time to bury her body according to custom, in the afternoon.

[Byline: Patson Baraire]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[The numbers of confirmed and suspected cases vary in different press reports. So far, the outbreak appears to have been contained, but incidents such as the transportation of one of the initial victims to her home village for burial risk expansion of the outbreak.

Kanungu District is a district in Western Uganda. Like most other Ugandan districts, it is named after its "chief town," Kanungu, where the district headquarters are located. It was estimated that the population of Kanungu District in 2010 was approximately 239 800. A map of the districts of Uganda can be found at: http://en.wikipedia.org/wiki/Districts_of_Uganda. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]
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Ebola-Fieber in Uganda - Kibaale und Kampala

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EBOLA HEMORRHAGIC FEVER - UGANDA (07): (KIBAALE)
************************************************
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[1]

Date: Wed 1 Aug 2012
Source: CDC Travel notice [edited]
http://wwwnc.cdc.gov/travel/notices/out ... a-2012.htm


The Ugandan Ministry of Health (MOH) has reported an outbreak of Ebola hemorrhagic fever in the Kibaale District of western Uganda. As of 31 Jul 2012, there have been 38 cases and 16 deaths. Five cases have been laboratory confirmed.

Ebola hemorrhagic fever (Ebola HF) is a rare and deadly disease. The disease is native to several African countries and is caused by the Ebola virus. It is spread by direct contact with blood and/or body fluids of a person infected with Ebola virus. It is also spread by contact with a contaminated object or infected animal. Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

There is no vaccine for Ebola and no specific treatment. Although travelers are at low risk for the disease, it is important to take steps to prevent Ebola HF.
- Practice good hygiene. Avoid contact with blood and body fluids of infected people. Do not handle items that may have come in contact with an infected person's blood or body fluids.
- Avoid contact with animals.
- Seek medical care if you develop fever, headache, aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.

Health care workers who may be exposed to people with the disease should follow these steps:
- Wear protective clothing, including masks, gloves, gowns, and goggles.
- Practice proper infection control and sterilization measures. For more information, see "Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting."
- Isolate Ebola HF patients from unprotected persons. Also avoid direct contact with infected deceased patients.

Clinician Information: Ebola is a notifiable condition in the United States. Diagnosing Ebola HF in a person who has been infected only a few days is difficult because early symptoms, such as red eyes and a skin rash, are nonspecific to the virus and are seen in patients with other diseases that occur much more frequently. However, if a person has the symptoms described above, and infection with Ebola virus is suspected, isolate the patient and notify local and state health departments and CDC.

Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA, polymerase chain reaction (PCR), and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms. Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies; the disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.

There is no standard treatment for Ebola HF. Patients receive supportive therapy that consists of balancing the patient's fluids and electrolytes, maintaining their oxygen status and blood pressure, and treating them for any complicating infections.

Additional Information:
Ebola Hemorrhagic Fever (CDC Viral Special Pathogens Branch) http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... /ebola.htm
Viral Hemorrhagic Fevers (CDC Yellow Book) http://wwwnc.cdc.gov/travel/yellowbook/ ... fevers.htm

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[2]
Date: Thu 2 Aug 2012
Source: CNN [edited]
http://edition.cnn.com/2012/08/01/healt ... index.html


Two more people have died in Uganda's Ebola outbreak, officials working at a hospital said Wednesday [1 Aug 2012]. This brings the death toll to 16 people. They died in an outbreak that began in the Kibaale district in western Uganda. One of the 2 latest deaths was of a 14-year-old boy whose 9 relatives also have died in the outbreak in the district's Nyanswiga village, where the 1st case is thought to have been. The 2 died in a hospital in Kagadi, a town close to the Congolese border. About 36 suspected cases have been reported, World Health Organization spokesman Tariq Jasarevic said Tuesday [31 Jul 2012].

The deaths have stoked heightened fear about the spread of the virus, a highly infectious, often fatal agent spread through direct contact with bodily fluids. Symptoms can include fever, vomiting, diarrhea, abdominal pain, headache, a measles-like rash, red eyes and, at times, bleeding from body openings.

Market day was canceled Wednesday [1 Aug 2012] after Uganda's president warned people not to gather in large groups. Drivers of taxi motorbikes called boda-boda have become reluctant to take on passengers, and there have been rumours that public transportation will be banned. Health officials urged the public to report any suspected cases, to avoid contact with anyone infected, and to wear gloves and masks while disinfecting bedding and clothing of infected people. Officials also advised avoiding public gatherings in the affected district.

Teams in Uganda are taking an aggressive approach, including trying to track down anyone who came into contact with patients infected with the virus, and health workers have been gearing up for better protection of health workers and an influx of cases. The workers include people from Uganda's Ministry of Health, the U.S. Centers for Disease Control and Prevention, and the WHO.

The outbreak initially went undetected because patients did not show typical symptoms, Ugandan Health Minister Dr. Christine Ondoa told CNN on Sunday [29 Jul 2012]. Patients had fevers and were vomiting but did not show other typical symptoms, such as haemorrhaging. Diagnosis in an individual who has only recently been infected can be difficult, since early symptoms, such as red eyes and skin rash, are seen more frequently in patients who have more common diseases, the CDC said.

Uganda's Ministry of Health declared the outbreak in Kibaale district Saturday [28 Jul 2012] after the Uganda Virus Research Institute identified the disease as Ebola hemorrhagic fever, Sudan strain. Some people delayed seeking treatment, in part, because they believed that "evil spirits" had sickened them, according to a report from district health authorities. "This caused civil strife among the community, requiring police intervention to quell the animosity," the Health Ministry said.

An emergency team of 100 volunteers underwent training this week to help spread the word in vulnerable communities about the disease and its transmission, the Uganda Red Cross Society said. Medecins Sans Frontieres helped set up a hospital isolation centre. The WHO did not recommend any travel or trade restrictions be applied to Uganda because of the outbreak. The U.S. Embassy in Kampala issued an emergency message for U.S. citizens that said the outbreak appeared to be centered in Nyamarunda Sub County, Kibaale district, although one suspected victim is reported to have traveled to Kampala for treatment at Mulago Hospital, where he died on 22 Jul 2012. It urged avoiding contact with dead animals, especially primates, and refraining from eating "bushmeat."

Ebola virus was 1st detected in 1976 in the central African nation of Zaire (now the Democratic Republic of the Congo). The virus is named after a river in that country, where the 1st outbreak of the disease was found. There are 5 species of Ebola viruses, all named after the areas where they were found: Zaire, Sudan, Cote d'Ivoire, Bundibugyo and Reston, according to the WHO.

[Byline: David McKenzie]

--
Communicated by:
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<promed@promedmail.org>

[The above are representative reports from current statements on the progress of the outbreak of Ebola haemorrhagic fever centred on Kibaale, Uganda.

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]
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Ebola-Fieber in Uganda - Kibaale und Kampala

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IRIN hat geschrieben:
UGANDA: Containment worries as Ebola numbers rise
02.08.2012 - IRIN

KAMPALA - Health officials in Uganda's western Kibaale District are struggling to deal with an outbreak of Ebola, as the number of suspected cases stretches local health systems.

The Ugandan government has so far reported 16 suspected Ebola deaths; four have been confirmed by testing carried out at the Uganda Virus Research Institute in Entebbe. The Ministry reports another 22 suspected cases, all in Kibaale District.

According to the Kibaale District Ebola Taskforce (KDET), reports of possible Ebola cases in the west continue to rise: health officials reported that they were following up on 176 people thought to have been in contact with infected patients on 31 July, up from 40 suspected contacts the day before. The disease is transmitted through direct contact with an infected person or their body fluids such as blood and sweat.

Meanwhile, a shortage of trained health workers has affected containment efforts; just 56 percent of health worker positions in the country's public health sector are filled.

Burials in the affected communities have been taken over by KDET, whom the ministry has supplied with vehicles, though there have been delays in providing them with fuel. The ministry has also set up a telephone hotline for citizens to report suspected cases.

Though these efforts have been boosted by the Uganda Red Cross, Médecins Sans Frontières (MSF), the US Centres for Disease Control, the UN World Health Organization and others, KDET chairperson Steven Byaruhanga said suspected cases are quickly outpacing relief efforts.

"At sub-county health centres, we are getting reports that they are shying away from handling patients because they don't have protective gear," he said.

According to Byaruhanga, the district is asking for the equivalent of US$334,000 to upgrade Kagadi Hospital - the centre of the outbreak - to increase awareness messages and to support traumatized health workers.

"Some of them are demoralized, others are stigmatized because their colleague has passed away," he said. "They need at least some motivation."

Dilapidated

Byaruhanga said the facility was already dilapidated when the outbreak began, citing an irregular water supply and electricity, a broken sewer system and no medical incinerator.

Local media reports this week said patients at the hospital had protested about the lack of food and water, and wanted to leave.

The Ministry of Health is requesting emergency supplies from the Prime Minister's Office - responsible for disaster preparedness - as well as support from developing partners such as MSF, who are helping to build isolation centres.

On top of that, the ministry has access to a 2.5 billion Uganda shilling ($1 million) reserve fund for emergencies, according to its permanent secretary, Asuman Lukwago. "We can frontload that money and use it early," Lukwago said.

The outbreak was reported by the government on 28 July, but the first case is thought to have appeared weeks earlier.

The death of a clinical officer from Kagadi in Kibaale District who was taken to Mulago Hospital in the capital, Kampala, sparked fears of an outbreak in the city, but health officials say seven health workers being held in isolation at the hospital have not shown any symptoms, 11 days after their potential exposure. By 1 August, no further cases had been reported in the capital.

Delayed response

The nearly month-long delay in identifying the current outbreak was in part due to the spiritual beliefs of the community. According to Byaruhanga, the virus wiped out nine members of one family, who believed they were "cursed". He added that the delay also erased any real hope of tracing the source of infection.

"It blindfolded other research that would have taken place," he said.

The UN World Health Organization has identified the strain in Kibaale as Ebola-Sudan, the same strain responsible [ http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... atable.htm ] for some 425 infections and 224 deaths in Uganda in 2000-2001 and one death in 2011; another strain, Ebola-Bundibugyo - named after a western Ugandan district - killed some 42 people in the country in 2007-2008.

Byaruhanga also said health officials did not recognize the Sudan strain, which can achieve a 70 percent fatality rate, as it presented differently from the previous Bundibugyo strain, with a 30-40 percent fatality rate; patients presented with fever and vomiting rather than the more typical haemorrhaging usually associated with Ebola.

"We thought it was a strange disease because the symptoms first of all were not like the previous Ebola - that's why people were not cautious about it," he said.

Uganda's President Yoweri Museveni has cautioned the public against physical contact. "Avoid shaking of hands; do not take on burying somebody who has died from symptoms which look like Ebola - instead call the health workers to be the ones to do it and avoid promiscuity because these sicknesses can also go through sex," he said in a statement.

In Kibaale District, Byaruhanga said more than 250 schools had been closed, markets abandoned, and public gatherings banned.
Quelle: IRIN

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Ebola-Fieber in Uganda - Dutzende in Quarantäne

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16 Menschen sind bisher am Ebola-Fieber in Uganda gestorben, Dutzende werden in Quarantäne behandelt. In der besonders betroffenen Region im Westen des Landes sind die Kliniken nur schlecht vorbereitet. Auch in Ugandas Nachbarländern wächst die Angst vor dem Virus.
Uganda kämpft gegen die Ausbreitung des Ebola-Virus
02.08.2012 - tagesschau

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Ebola-Fieber in Uganda - Ntungamo - Kibutamo Vollage

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EBOLA HEMORRHAGIC FEVER - UGANDA (08): (NTUNGAMO) SUSPECTED CASES
******************************************************************
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Date: Thu 2 Aug 2012
Source: The Monitor [edited]
http://www.monitor.co.ug/News/National/ ... index.html


Strange disease kills 5 people in Ntungamo, 7 hospitalised
-------------------------------------------------------
A total of 5 people in Kibutamo Village in Kitwe Town Council, Ntungamo District have died of a strange disease in the past 2 weeks and 7 others are admitted at a health centre. A 22-year-old, who was working as a security guard in Kamwenge, died on 17 Jul 2012; and a A 45-year-old close neighbour died 3 days later. A 93-year-old, another resident of the village, died 3 days later. A 42-year-old died last Saturday [28 Jul 2012] while a 21-year-old, died on Sunday.

Mr Eliphaz Tayebwa, the area village vice-chairperson, told visiting Ntungamo district health officials on Tuesday that the deceased were vomiting, had headache, fever, and were complaining of too much heat [fever]. The Ntungamo District Health Officer, Dr Benon Bamuturaki, said they cannot rule out Ebola and have sent samples from the patients to the Virus Research Centre at Entebbe to ascertain the [cause of the] disease.

"We can't say this is not Ebola before we carry out necessary tests. However, the symptoms of Ebola we know are different from these ones," Dr Bamuturaki said. 7 others were admitted to Kitwe Health Centre with similar symptoms. A special ward for the people suffering from the strange ailment has been created the health centre. Dr Bamuturaki asked residents to avoid contact with the affected people. Meanwhile, Kanungu District leaders have asked residents to report any suspected Ebola cases to the concerned authority immediately.

So far, 2 people who died of Ebola in Kibaale District where the disease broke out recently, have been buried in Kanungu District. A man, who had gone to visit his sick sister in Kibaale also got infected and died. He was buried in Kabimbiri, Kanungu on 28 Jul 2012. A woman passed away in Kibale and her body was transported and buried in Nkunda Village in Nyanga Sub-county on Tuesday.

The LC5 chairperson, Ms Josephine Kasya, asked people should be careful in handling the dead, especially those who pass away from their homes. More than 30 Ebola cases have been registered in western region and Kampala since the hemorrhagic fever broke out in Kibaale District last week.

[Byline: Peter Rumanzi and Arans Mark]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Ntungamo District is a district in Western Uganda. Like most Ugandan districts, it named after its 'chief town,' Ntungamo, the location of the district headquarters. Ntungamo District is bordered to the north, from west to east by Mitooma District, Sheema District and Mbarara District. Isingiro District lies to the east, the Republic of Rwanda to the south, Kabale District to the southwest and Rukungiri District to the northwest.

The proximity of Mtungamo District to the location of the confirmed outbreak of Ebola haemorrhagic fever in Uganda is the principal reason for considering a diagnosis of Ebola haemorrhagic fever in these patients. The results of analysis of patient samples at the Entebbe Virus Research Centre s awaited.

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]

Karte: Google Maps / Kitwe = Punkt A
Karte: Google Maps / Kitwe = Punkt A
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Ebola-Fieber in Uganda - Kibaale

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EBOLA HEMORRHAGIC FEVER - UGANDA (09): (KIBAALE)
************************************************
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[1] Date: Thu 2 Aug 2012
Source: Montreal Gazette, Associated Press report [edited]
http://www.montrealgazette.com/business ... z22QSuCJR6


The aid group Medecins sans Frontieres says the 1st victim of the latest Ebola outbreak in Uganda was a 3-month-old girl and that of the 65 people who attended her funeral, 15 later contracted the deadly disease. At least 11 of those who attended the baby's funeral have since died, the group said in a statement on Wednesday [1 Aug 2012].

Funerals in Uganda are typically elaborate affairs that draw huge crowds. In a national address this week, Uganda's president urged people to avoid unnecessary contact with each other and discouraged handshakes. Medecins sans Frontieres says that while that is good advice, people without symptoms are not contagious, and avoiding contact with others' bodily fluids is the best way to limit an Ebola outbreak. Ebola is highly infectious and kills quickly.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******

[2] Date: Thu 2 Aug 2012
Source: CNN [edited]
http://edition.cnn.com/2012/08/02/healt ... ?hpt=hp_t3


The hospital at the center of an Ebola outbreak in Uganda is now dealing with 30 suspected cases, including 5 from Kibaale prison, Dr. Dan Kyamanywa said Thursday [2 Aug 2012]. Three patients at Kagadi hospital have been confirmed as having the virus, said Kyamanywa, a district health officer. Doctors are now testing the suspected cases urgently so they can separate confirmed cases from those who do not have the disease, aid agency Medecins sans Frontieres stated. Suspected cases are still trickling into the hospital, Kyamanywa said.

At least 16 people have died in the current outbreak.

[Byline: David McKenzie]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6. - Mod.CP]
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Ebola-Fieber in Uganda

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Ebola in Uganda – update
03.08.2012 - WHO

The Ministry of Health in Uganda has reported a cumulative number of 53 suspected cases of Ebola haemorrhagic fever including 16 deaths. Of these, five cases have been laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe (this includes three fatal cases and two cases currently being treated in the isolation facility).

Currently 32 cases are admitted to an isolation facility in Kagadi hospital, Kibaale district, and a total of 312 contacts were identified, of whom 253 are being closely followed-up. So far all samples from other districts have tested negative for Ebola, indicating that there has been no expansion of the outbreak beyond Kibaale District. However a clinical officer who attended to a case in Kibaale district was transferred to Mulago Hospital in Kampala for treatment but later died.

Among the contacts being monitored daily are the seven health workers who attended to the fatal case transferred to Mulago Hospital, none of them has so far developed symptoms of the disease.

Response

The Government of Uganda is continuing to work with a number of partners to control the outbreak.

At the central level the Prime Minister convened a Ministerial Task Force, chaired by the Minister of Health, to facilitate and coordinate the outbreak response.

In Kibaale district, the local health authorities are working through its task force with several partners to mobilize resources and supplies. These partners include WHO, US Centers for Disease Control and Prevention (US CDC), the Uganda Red Cross Society (URCS) and Médecins Sans Frontières (MSF). WHO has deployed logisticians and supplies, including personal protective equipment (PPE) to Uganda.

Required funds for local operations are being mobilized. Additional support is being received from the EMESCO Foundation (a local NGO), Members of Parliament from Kibaale district, the Infectious Diseases Institute (IDI) and the Uganda Red Cross Society (URCS).

Epidemiologists from WHO and US CDC have arrived in Kibaale district and are supporting the response by screening and triaging suspected cases of Ebola haemorrhagic fever. WHO is coordinating with Global Outbreak Alert and Response Network partners.

With the support of MSF, the construction of a new isolation facility in Kagadi, Kibaale district, is expected to be completed today and additional wards will open to address the increasing number of suspected cases. MSF, IDI and EMESCO are providing food to patients in the isolation facility and have committed to continue to do so for the next two weeks.

For active surveillance and contact tracing in the communities, arrangements with local authorities are being made to increase the number of mobile teams and ambulances.

With regard to social mobilization, the Uganda Red Cross Society has trained 62 teams of Red Cross volunteers and village health teams to conduct social mobilization and public awareness activities. Additionally, public announcements are being disseminated in 11 local languages on 20 radio stations. WHO is facilitating the deployment of a medical anthropologist to assist in these activities.

Neighbouring countries

A number of countries neighbouring Uganda have taken proactive steps to enhance their surveillance to detect and respond to cases of Ebola haemorrhagic fever.

In Kenya, two rumoured suspected cases have since been reported and investigated. Both cases have tested negative for Ebola.

The South Sudan Ministry of Health, in collaboration with WHO, has issued guidance to the general public and has activated a national task force to undertake enhanced surveillance as population movement and trade between South Sudan and Uganda are high.

WHO does not recommend that any travel or trade restrictions are applied to Uganda.

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Ebola-Fieber in Uganda

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Uganda - Ebola hämorrhagisches Fieber (EHF)
03.08.2012

Seit Anfang Juli gibt es einen Ausbruch des hämorrhagischen Fiebers im Distrikt Kibaale im Westen des Landes, offizielle Stellen haben nun bestätigt, dass 16 Menschen verstorben und insgesamt mindestens 36 erkrankt seien. Die Infektion verläuft in bis zu 90% der Fälle letal. Die ugandischen Gesundheitsbehörden zusammen mit Experten der WHO und des CDC versuchen eine Ausbreitung zu verhindern. Die Übertragung erfolgt durch engen Kontakt (Blut, Körperflüssigkeiten) von Mensch zu Mensch. Die Infektion ist hochansteckend, eine spezifische Therapie existiert nicht. Zuletzt waren bei Epidemien in den Jahren 2000 und 2007 über 200 Menschen verstorben. Im vergangenen Jahr starb ein 12-jähriges Mädchen. / Quelle: crm

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Ebola-Fieber in Uganda - Kibaale

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EBOLA HEMORRHAGIC FEVER - UGANDA (10): (KIBAALE) 17TH FATALITY
***************************************************************
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ProMED-mail is a program of the
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Date: Fri 3 Aug 2012
Source: New Vision via AllAfrica.com [edited]
http://allafrica.com/stories/201208040122.html


Uganda: Ebola - Death Toll Rises to 17
--------------------------------------
One more person is suspected to have died of the deadly Ebola virus in Kagadi hospital, while another 2 patients have been admitted to the hospital's isolation ward today. "The patient had been admitted in the isolation ward, with signs of having contracted Ebola. But, he unfortunately died in the evening, on arrival in the isolation ward," Dr. Dan Kyamanywa, who is Kibaale's district health officer, revealed.

This brings the death toll to 17, and the suspected patients admitted to 31, according to Dr. Kyamanywa. Only 2 patients out of those admitted were on Wednesday confirmed to have contracted Ebola; 3 others were earlier this week also confirmed to have contracted Ebola, after laboratory tests were conducted. A total of 7 more specimens were taken on Wednesday [1 Aug 2012] from the patients admitted at the isolation facility bringing the total number of samples collected since the [beginning] of the outbreak to 37, according to Dr. Lwamafa. Results are to be released soon.

The samples are currently being investigated at the Uganda Virus Research Institute, Entebbe. The health ministry's surveillance team in Kibaale district is actively and closely following up 232 people suspected to have been in contact with the dead and sick. They continue to monitored even though they have not showed any symptoms of the disease yet.

More so, in Kibaale district, one of the prisoners, who had been admitted to the isolation ward, escaped and is yet to be found. An inter-ministerial committee on Ebola has been formed to coordinate the management of the epidemic.

(By Conan Businge)

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[The number of confirmed cases has risen to 17 and the number of suspected cases admitted to hospital is now 31. A total of 232 potential contacts are under surveillance. One of several prisoners admitted to the isolation ward of Kagadi prisoner has escaped. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]
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Ebola-Fieber in Uganda - Kibaale

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EBOLA HEMORRHAGIC FEVER - UGANDA (11): (KIBAALE) UPDATE
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Date: Sun 5 Aug 2012
Source: NTA Newstime Africa [edited]
http://www.newstimeafrica.com/archives/2752


8 new Ebola cases confirmed
---------------------------
Health officials in Uganda's Kagandi Hospital have so far confirmed 8 new cases of Ebola. Statistics released by Health officials on Friday [3 Aug 20212] indicate that the number of people currently "actively being followed up" has increased from 232 to 253 in the recent 24 hours. Speaking on the matter, the chairman of the Ebola National Task Force, Mr. Anthony Mbonye said, "Of the 46 samples collected since the outbreak began, by 2 Aug 2012, 8 of them were confirmed positive and all are from Kibaale."

Uganda's Health Minister, Dr. Christine Ondoa revealed that out of the 312 civilians who were earlier confirmed to have been in contact with the sick and the dead, 253 of them were being closely monitored in connection with the transmission of the deadly virus.

Meanwhile, the country's World Health Organisation [representative], Dr. Joakin Saweka said that the situation is being closely monitored and there's no need for alarm in issuing any travel advisories against visiting Uganda. He assured the public that the situation was under control with enough structures put in place by the Ugandan government. The assurance came after continued international media attention which seemed to portray Uganda as a country in dire need of assistance, terming the situation as "deadly".

Uganda's Tourism Minister Ephraim Kamutu backed the remarks, questioning, "If it were deadly you would not be here. There are 312 contacts being followed in a population of over 34 million people, is that enough to say that the country is deadly?"

Generally, a national task force in Uganda has been formed in conjunction with an inter-ministerial committee established to strengthen and coordinate resources, management and response to the Ebola hemorrhagic fever outbreak. A national task force and an inter-ministerial committee have been established to better coordinate resources, response and management of the Ebola hemorrhagic fever outbreak.

(By Roggers Momata)

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[It would be useful to know if the confirmation of these [new] cases has been achieved by laboratory diagnosis. There is some ambiguity in the presentation of the data. - Mod.CP]
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