Marburg-Fieber in Uganda

[Birgitt]

When cases of Marburg haemorrhagic fever were recently identified in a remote mining area in western Uganda, WHO and the Ugandan Ministry of Health immediately began an intense surveillance and response effort. They were supported by scientists and medical experts from the Uganda Virology Research Institute (UVRI), the National Institute of Communicable Diseases (NICD) in South Africa and the US-based Centers for Disease Control and Prevention (CDC).

A public information campaign was developed as well as training courses for local health workers. A team of experts meanwhile explored the mine cave where the outbreak appears to have started in search of the reservoir of the Marburg virus. One miner has died from the disease so far and two others have fallen sick but survived to assist in the investigation.

This photo story documents the combined efforts of WHO and its partners in the Global Outbreak Alert and Response Network to monitor, investigate and control the outbreak of Marburg fever in Uganda.

Managing Marburg fever in Uganda
WHO - 05.09.2007

Gruß
Birgitt

[Birgitt]

Uganda - Marburg-Virus
04.10.2007

Drei Bergleute sind zwischen Juli und September im (W) an diesem viralen hämorrhagischen Fieber erkrankt, einer von ihnen ist verstorben. Eine Reihe von Kontaktpersonen stehen noch unter Überwachung. Als mögliche Infektionsquellen gelten Fledermäuse oder Affen bzw. erkrankte Menschen. Entsprechende Kontakte sind im Infektionsgebiet zu meiden. / Quelle: crm

[Birgitt]

Personen, die eine Reise nach Uganda planen, sollten sich bewusst sein, dass der Besuch von Höhlen im Maramagambo-Wald mit einem Risiko verbunden sein kann., Quelle: promedmail

---

Case of Marburg Haemorrhagic Fever imported into the Netherlands from Uganda
WHO - 10.07.2008

WHO has been notified by the Government of the Netherlands of a case of Marburg haemorrhagic fever (MHF) in a Dutch tourist who visited Uganda. Marburg virus infection has been demonstrated by laboratory tests performed by the Bernhard Nocht Institute in Hamburg, Germany.

The 40-year-old woman travelled in Uganda from 5-28 June, 2008, and entered caves on two occasions. The first cave was visited on 16 June at Fort Portal. No bats were seen in this cave. She was reportedly exposed to fruit bats during a visit to the “python cave” in the Maramagambo Forest between Queen Elisabeth Park and Kabale on 19 June. This cave is thought to harbour bat species that have been found to carry filoviruses in other locations in sub-Saharan Africa. Filoviruses cause two types of viral haemorrhagic fever: Marburg and Ebola. A large bat population was seen in the cave and the woman is reported to have had direct contact with one bat.

The woman returned to the Netherlands on 28 June in good health. The first symptoms (fever, chills) occurred on 2 July and she was admitted to hospital on 5 July. Rapid clinical deterioration with liver failure and severe haemorrhaging occurred on 7 July. The patient remains in a critical clinical condition.

Contact tracing and temperature monitoring have been initiated for unprotected contacts with a history of possible exposure to the case after 2 July. Although further epidemiological investigation is needed to exclude other possible sites of exposure to MHF virus, as a precaution Dutch authorities have alerted the tour operator to avoid visits to the caves until further information is available.

No citizens of other countries were involved in this trip except for a local tour guide, but the cave in the Maramagambo Forrest is known to be a tourist attraction. No measures were taken with respect to the passengers on the flight from Uganda as the flight occurred four days before the onset of symptoms in the patient.

WHO has informed the Ministry of Health Uganda which will take appropriate steps nationally to investigate these events, and WHO has recommended that the MoH advise all residents and travellers to avoid entering caves with bat populations.

[Birgitt]

Eine niederländische Touristin hat erstmals das tödliche Marburg-Virus nach Europa eingeschleppt. Die aus Uganda kommende 40-Jährige liegt jetzt in der Universitätsklinik von Leiden. Das Marburg-Virus führt zu schweren inneren Blutungen, bis zu 90 Prozent der Infizierten sterben. Es gibt gegen das Marburg-Virus kein Medikament ...

Tödliches Marburg-Virus erstmals in Europa aufgetaucht
10.07.2008 - Focus

Gruß
Birgitt

[Götz Krieger]

Es war das erste Mal, dass eine Patientin mit dem tödlichen Marburgvirus nach Europa einreiste: Jetzt ist die Niederländerin im Universitätsklinikum von Leiden gestorben. Sie hatte sich bei einem Urlaub in Uganda infiziert....

Spiegel: 40-Jährige stirbt an gefährlichem Virus

[Birgitt]

Uganda - Marburg-Virus
11.07.2008

Eine 40-jährige holländische Touristin ist Anfang Juli nach ihrer Rückkehr aus Afrika an einem sog. "hämorrhagischen Fieber" erkrankt. Als Ursache wurde das "Marburg-Virus" nachgewiesen, das neben dem Ebola-Virus zu den gefährlichsten Erregern tödlicher Viruserkrankungen beim Menschen gehört [...] Dabei hat sie zwei Höhlen besucht, die erste in Fort Portal, die zweite im Maramagambo-Wald zwischen Queen Elizabeth Park und Kabale. In der letzteren, der sog. "Python-Höhle", fanden sich zahlreiche Fledermäuse, die nach den bisherigen Erfahrungen das Hauptreservoir für das Marburg-Virus darstellen [...] In der gleichen Region waren im vorigen Jahr bereits 5 einheimische Bergleute an Marburg hämorrhagischem Fieber erkrankt. Auch hier bestanden Kontakte zu Fledermäusen. Größere Ausbrüche durch das Marburg-Virus gab es zwischen 1998 und 2005 im Kongo (DRC) und in Angola. Nach dem derzeitigen Kenntnisstand muss in Afrika in einem Gürtel von jeweils 1000 km Breite nördlich und südlich des Äquators mit den beiden genannten Killerviren gerechnet werden. Ein Zusammenhang mit Fledermäusen ist offensichtlich. Die Python-Höhle in Uganda ist touristisch erschlossen. Vor dem Besuch derartiger Höhlen und dem Kontakt mit Fledermäusen muss in dieser Region eindringlich gewarnt werden. / Quelle: crm

Gruß
Birgitt

[Jürgen Kempe]

Die Frau ist inzwischen leider verstorben (wie annähernd alle damit infizierten Patienten).

Traurig Jürgen Kempe

[Birgitt]

MARBURG HEMORRHAGIC FEVER - UNITED STATES OF AMERICA ex UGANDA 2008
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******
[1]
Date: 22 Jan 2009
Source: CDC, Special Pathogens Branch, Outbreak Postings [edited]
<http://www.cdc.gov/ncidod/dvrd/spb/outbreaks/index.htm>


Marburg hemorrhagic fever, imported case ­ United States 2008
------------------------------------------------------------
On Wed 22 Jan 2009, CDC's Special Pathogens
Branch retrospectively diagnosed a case of
Marburg hemorrhagic fever in a U.S. traveler, who
returned from Uganda in January 2008. The patient
developed illness 4 days after returning to the
U.S., was hospitalized, discharged, and fully
recovered. Initial testing of samples collected
during the patient's acute illness in January
2008 did not initially show evidence of Marburg
virus infection. Testing of a convalescent sample
indicated a possible previous infection, and more
detailed testing of both samples at CDC confirmed
that the patient's illness was due to Marburg hemorrhagic fever.

The recovered patient had visited the "python
cave" in Maramagambo Forest, Queen Elizabeth
Park, western Uganda. This is a popular
destination among tourists to see the
bat-infested cave; a fatal case of Marburg
hemorrhagic fever occurred in a Dutch tourist in
July 2008 who had entered this cave. Both
patients likely acquired their infections as a
result of contact with cave-dwelling fruit bats,
which are capable of harboring Marburg virus.

Marburg virus is a zoonotic virus that occurs in
tropical areas of Africa, and causes a severe,
often fatal, hemorrhagic fever in humans and
non-human primates. It can also be transmitted
through direct contact with a symptomatic patient
or materials contaminated with infectious body
fluids. The Ugandan Ministry of Health officially
closed the cave to visitors in August 2008, after the Dutch case.

The state and local health departments are
working with CDC's Special Pathogens Branch and
Traveler's Health and Animal Importation Branch
to further investigate the circumstances of this
patient's case. This include an assessment of any
persons who may have been at risk of exposure at
the time the patient was ill, and an
investigation of travelers potentially exposed
when visiting this or other caves in Africa.
There is no evidence of apparent transmission as a result of this case.

Travelers should be aware of the risk of
acquiring Marburg hemorrhagic fever and other
potentially fatal diseases such as rabies after
contact with bats. Health care providers should
be aware of the risk of viral hemorrhagic fever
among travelers returning from endemic countries,
and should report any suspected cases immediately
to their health department and to CDC's Special
Pathogens Branch Branch (Tel. 404-639-1115;
404-639-2888 after hours) for diagnostic testing and further guidance.

******
[2]
Date: Sat 31 Jan 2009
Source: CDC Travelers' Health [edited]
<http://wwwn.cdc.gov/travel/contentMarburgUganda.aspx>


Travelers' Notices (11): Marburg Case in US Traveler to Uganda
--------------------------------------------------------------
The Centers for Disease Control and Prevention
(CDC) has recently determined that a US citizen
who became ill in January 2008 contracted Marburg
hemorrhagic fever after a trip to Uganda. Marburg
hemorrhagic fever is caused by Marburg virus. The
traveler has since recovered. No other cases have
been identified in the United States at this
time. There is no evidence that this traveler infected other people.

Travelers should be aware of the serious health risks associated with
visiting caves in the Maramagambo Forest in Uganda and in other areas
of Africa. CDC advises people not to enter any caves or mines where
bats may live. These risks include infectious diseases spread by bats,
such as Marburg, rabies, and histoplasmosis.

Recommendations for U.S. travelers
----------------------------------
The main ways that travelers may get Marburg
virus are through direct contact with a patient
suffering from Marburg hemorrhagic fever or
through direct contact with infected bats,
monkeys, or other wild animals that may be
infected. The risk of Marburg virus infection for
travelers is very low. However, travelers should
take the following steps to protect themselves:

- Avoid contact with bats and other wild
animals. Travelers should not enter caves or mines where bats may live.

- Go to a doctor right away if you have a fever
AND you had contact with animals or sick people,
or visited bat-infested caves in Africa during the past 3 weeks.

If you are bitten or scratched by an animal or if
body fluid (such as saliva) from the animal gets
into your eyes, nose, mouth, or a wound, take these steps:

- Wash the area thoroughly with soap and water.
- Go to a doctor or hospital right away.
- Consider buying medical evacuation insurance
if you are visiting a country where there may not
be good access to medical care.

Travelers can contact the local U.S. Embassy or
Consulate for assistance in finding a doctor.
U.S. Embassies and Consulates abroad and in the
U.S. are available 24 hours a day, 7 days a week,
to provide emergency assistance to U.S. citizens.
To contact the U.S. Embassy or Consulate, dial 00
1 202-501-4444 if calling from overseas.

Recommendations for health care providers
-----------------------------------------
Health care providers treating returning
travelers should be aware of the risk of Marburg
and other viral hemorrhagic fevers in patients
who have visited endemic countries within 3 weeks
of symptom onset. Report all suspect cases to
your state health department and CDC Special
Pathogens Branch immediately (404-639-1115 and after-hours 404-639-2888).

Additional information
----------------------
CDC Information about Marburg
- Marburg Hemorrhagic Fever
<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... arburg.htm>
- Questions and Answers (Marburg hemorrhagic fever)
<http://www.cdc.gov/ncidod/dvrd/spb/mnpa ... urg/qa.htm>
- Bat bite management (questions and answers)
<http://www.cdc.gov/rabies/qanda/bats_camps.html#3>
- Studies of Reservoir Hosts for Marburg Virus,
Emerging Infectious Diseases, Vol.13 (12), December 2007
<http://www.cdc.gov/eid/content/13/12/1847.htm>

Information about Marburg case in the USA
-----------------------------------------
2008: Marburg hemorrhagic fever, imported case, United States
<http://www.cdc.gov/ncidod/dvrd/spb/outbreaks/index.htm>

Information about Marburg hemorrhagic fever imported to The Netherlands
-----------------------------------------------------------------------
Case of Marburg Haemorrhagic Fever imported into
the Netherlands from Uganda (WHO), 10 Jul 2008:
<http://www.who.int/csr/don/2008_07_10/en/index.html>

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[Birgitt]

Uganda - Marburg-Virus
03.08.2009

Bei Untersuchungen an Fledermäusen (Nilflughunden) in der Kitaka Höhle wurde das Marburg-Virus nachgewiesen. 2007 verstarb ein Mienenarbeiter in der Region der Höhle an Marburg-hämorrhagischen Fieber. Im letzten Jahr erkrankten zwei Touristen an Marburg-hämorrhagischen Fieber. Beide infizierten sich unabhängig voneinander bei einem Besuch der „Python Cave“ im Queen Elizabeth Nationalpark mit dem Virus. Die Erkrankung verlief in einem Fall tödlich. Vor dem Besuch von Höhlen und dem Kontakt mit Fledermäusen muss im äquatornahen Afrika eindringlich gewarnt werden. / Quelle: crm

Gruß
Birgitt

[Birgitt]

MARBURG VIRUS DISEASE - UGANDA: (KABALE) OUTBREAK CONFIRMED
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Date: Fri 19 Oct 2012
Source: New Vision [edited]
http://www.newvision.co.ug/news/636595- ... break.html


Health Ministry warns on Marburg outbreak
------------------------------------
The Ministry of Health has warned the general public of an outbreak of the deadly Marburg virus in Kitumba sub-county, Kabale district in western Uganda. A statement issued Friday [19 Oct 2012] afternoon said laboratory tests done at the Uganda Virus Research Institute (UVRI) confirmed 3 samples positive for the highly infectious viral hemorrhagic fever. Preliminary reports from the district indicate that 4 other people had allegedly died of a strange disease since [4 Oct 2012]. This strange disease has now been confirmed as Marburg hemorrhagic fever. Investigations indicate that all the cases occurred among members of the same family in Kiyonjo parish in Kitumba sub-county.

Marburg hemorrhaagic fever is a killer disease caused by a virus and is spread through direct contact with wounds, body fluids like blood, saliva, vomitus, stool and urine of an infected person. A person suffering from Marburg virus disease presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains and bleeding through the body openings, i.e. eyes, nose, gums, ears, anus and the skin.

Marburg is a highly contagious disease and kills in a short time but can easily be prevented [?}. The Ministry of Health is working with stakeholders and other development partners to contain the spread of this disease. The following measures have been put in place in order to limit the spread of this highly infectious disease;

- A team of experts has been dispatched to the district to support both clinical and public health investigations
- The National Taskforce has reactivated its rapid response committees to quickly act to any emergencies
- The surveillance team has commenced the active tracing and listing of all possible contacts that were exposed to the suspects and confirmed cases.
- The Kabale District Taskforce has been reactivated to effectively coordinate programs in the district

The Ministry of Health urges the general public to observe the following protective measures;

- Report any suspected patient to a nearby health unit
- Avoid direct contact with body fluids of a person suffering from Marburg by using protective materials like gloves and masks
- Avoid unnecessary public gatherings

The Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. For more information and reports of any cases, please contact the Ministry hotline on +256750996034. The country will be kept informed further on the outcome of this health emergency.

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[The 1st outbreak of this disease occurred in Marburg, Germany, and Belgrade, former Yugoslavia, in 1967 leading to the initial recognition of this disease. The outbreak was associated laboratory work using African green monkeys (_Cercopithecus aethiops_) imported from Uganda. Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic Republic of the Congo, Kenya, South Africa (in a person with a recent travel history to Zimbabwe) and Uganda. The most recent outbreak in Uganda occurred in 2007, and this new outbreak follows closely on an outbreak of hemorrhagic fever caused by Ebola virus, another filovirus, in Kibale district, recently declared over by the Ugandan Ministry of Health and WHO.

Neither disease has a vaccine or specific treatment. Ecological studies are in progress to identify the natural reservoir of both Marburg and Ebola. There is evidence that bats are involved, but much work remains to be done to definitively describe the the natural transmission cycle. Monkeys are susceptible to infection but are not considered plausible reservoir hosts as virtually all infected animals die too rapidly to sustain survival of the virus. Infection of humans occurs sporadically. Information on the characteristics and treatment of Marburg fever can be obtained at: http://www.who.int/mediacentre/factshee ... index.html.

Kabale District is bordered by Rukungiri District to the north, Ntungamo District to the northeast, the Republic of Rwanda to the east and south, Kisoro District to the west and Kanungu District to the northwest. The town of Kabale, where the district headquarters are located, lies approximately 420 kilometres (260 mi), by road, southwest of Kampala, the capital city of Uganda. A map of the districts of Uganda can be accessed at: http://en.wikipedia.org/wiki/Kabale_District. - Mod.CP]

Karte: OpenStreetMap

Gruß
Birgitt

[Birgitt]

MARBURG VIRUS DISEASE - UGANDA (02): (KABALE), FIFTH FATALITY
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******

[1]

Date: Sat 20 Oct 2012
Source: All Africa from New Vision [edited]
http://allafrica.com/stories/201210200510.html


Uganda: Marburg Virus Claims Another Victim
-------------------------------------------
Another person has died of Marburg virus disease in South West Uganda, bringing the toll from the outbreak to 5, government officials said on Saturday [20 Oct 2012]. The death occurred in Bukora Kitumba sub-county in Kabale district. "It's sad the 5th person has died because the emergency team delayed to reach Kabale on Friday [19 Oct 2012]", according to Patrick Besigye Keihwa, the Kabale District Chairman.

Meanwhile, the emergency team dispatched to deal with the outbreak has arrived in Kabale. The team will be conducting burials and managing an emergency zone to treat people. Efforts are also underway to track all people who had had contact with the victims, the government said. The authorities urged the public to avoid direct bodily contact with a person suffering from Marburg virus disease and unnecessary public gatherings.

Marburg virus disease, also known as Marburg haemorrhagic fever is transmitted through bodily fluids such as saliva and blood, or by handling infected wild animals such as monkeys. The disease [is caused by a virus belonging] to the same family of viruses as Ebola virus [the family _Filoviridae_], starts with severe headache and leads to haemorrhaging and, in previous outbreaks in Africa, to death in 80 percent or more of cases, usually within 8 to 9 days.

The last outbreak of Marburg virus disease in Uganda occurred in 2007 and killed 2 miners in the west of the country. The latest outbreak comes after at least 16 people died from Ebola virus disease in August [2012]. In 2000, 425 people contracted Ebola virus disease in Uganda and more than half of them died.

A major outbreak of Marburg virus disease occurred among gold miners in the Democratic Republic of Congo between 1998 and 2000, causing 128 deaths out of 154 cases. An outbreak in Angola in 2004-05 killed 150 people out of 163 cases, according to the World Health Organisation (WHO).

[Byline: Goodluck Musinguzi]

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****
[2]
Date: Fri 19 Oct 2012
Source: eTN Global Travel Industry News [edited]
http://www.eturbonews.com/31810/refugee ... urg-uganda


Refugees from Congo suspected to have brought Marburg to Uganda
----------------------------------------------------------
According to emerging reports from Southwestern Uganda, there is increasing suspicion of an outbreak of the deadly Marburg virus disease, and affected individuals have been tested and put into a full quarantine. A team of health officials is on the ground, assisted reportedly by security personnel, combing areas where refugees have sought shelter to identify anyone displaying symptoms in line with the early signs of the disease.

Only 2 weeks ago, Uganda was declared free Ebola virus disease, after an outbreak, also suspected to have been brought into Uganda from the Eastern Congo, which [was responsible for the deaths of] patients and health workers. Marburg virus disease falls into the same category of virus diseases as Ebola virus disease, and while less virulent, is still known to be a disease with a high percentage of fatalities.

Diseases in Congo's rain forests are common but normally contained within a small radius of one or 2 communities. But with the lack of health care structures in that part of the [Democratic Republic of Congo], where at the moment intense fighting is going on, it makes refugees often the main carriers to bring such disease across the border into Uganda, where a much better-equipped health care infrastructure is then compelled to deal with the unwanted 'imports.'

The local media in Kampala is now starting to pick up on the news, which almost inevitably started to emerge on Twitter as individuals on the ground sent messages out, which were then picked up and retweeted.

The outbreak comes on the day prior to Uganda's National Bird Watching contest, with the opening ceremony taking place this afternoon at the Uganda Museum in Kampala from where the participating teams were to leave for their chosen locations upcountry and in the national parks.

A full statement is expected later today [19 Oct 2012] from the Ministry of Health, but the Uganda Virus Research Institute in Entebbe has reportedly confirmed that [the causative agent] is Marburg virus, prompting widespread containment measures now unfolding around the affected areas between Kabale and Kisoro.

[Byline: Dr. Wolfgang H. Thome]

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[Kabale District is bordered by Rukungiri District to the north, Ntungamo District to the northeast, the Republic of Rwanda to the east and south, Kisoro District to the west and Kanungu District to the northwest. The town of Kabale, where the district headquarters are located, lies approximately 420 kilometres (260 mi), by road, southwest of Kampala, the capital city of Uganda.

A map of the districts of Uganda can be accessed at: http://en.wikipedia.org/wiki/Kabale_District. Kabale District has a common border with Rwanda, but is not directly adjacent to the Democratic Republic of Congo, which lies further to the west. So refugees would have to transit another Ugandan district which has not yet reported Marburg virus disease.

Transmission of the virus from person-to-person requires close contact with a patient. Transmission does not occur during the incubation period 3 to 9 days). Infection results from contact with blood or other body fluids (faeces, vomitus, urine, saliva, and respiratory secretions) with high virus concentration, especially when these fluids contain blood. Transmission via infected semen can occur; virus has been detected in semen up to 7 weeks after clinical recovery.

Patients become increasingly infectious as their illness progresses, and are most infectious during the phase of severe illness. Close contact with a severely ill patient, during care at home or in hospital, and certain burial practices are common routes of infection. Transmission via contaminated injection equipment or through needle-stick injuries is associated with more severe disease, rapid deterioration, and possibly higher fatality. (For additional information, see: http://www.who.int/mediacentre/factshee ... index.html.)

In an outbreak of Marburg virus disease in the Democratic Republic of Congo in 1999/2000 the majority of cases occurred in young male workers at a gold mine in Durba, in the north-eastern part of the country. In the most recent previous outbreak in Uganda in 2007, 3 confirmed cases were reported in mine workers from Kamwenge, western Uganda. The 2nd and 3d miners developed illness after caring for their colleague; one of the caregivers also died.

It would be relevant to establish the proximity of mine-working to the current outbreak. - Mod.CP

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

[Birgitt]

Marburg haemorrhagic fever in Uganda
21.10.2012 - WHO

The Ministry of Health in Uganda has declared an outbreak of Marburg hemorrhagic fever in Kitumba sub-county, Kabale district in South-western Uganda.

Blood samples from 3 cases have tested positive for Marburg at the Uganda Virus Research Institute (UVRI). Investigation into the outbreak is ongoing.The Ministry of Health (MOH) is working closely with partners to control the outbreak.

The MOH and WHO have deployed a team to the district to support the outbreak investigation and response, including case contact tracing. The national and district taskforces have been reactivated.

WHO will provide support to the national authorities as needed in the areas of coordination, infection prevention and control (IPC), surveillance, epidemiology, public information and social mobilization, anthropological analysis and logistics for outbreak response.

With respect to this outbreak, WHO does not recommend that any travel or trade restrictions are applied to Uganda.

Gruß
Birgitt

[Birgitt]

Marburg haemorrhagic fever in Uganda - update
22.10.2012 - WHO

As of 21 October 2012, nine (9) probable and confirmed cases, including 5 deaths have been reported with Marburg haemorrhagic fever in Kitumba sub-county, Kabale district in South-western Uganda. Of these, 3 have been laboratory confirmed by the Uganda Virus Research Institute (UVRI).

An investigation into the outbreak is ongoing. Preliminary investigations indicate that all these cases belong to the same cluster – family and relatives of the index case.

WHO is supporting the Ministry of Health and partners in controlling the outbreak.

Gruß
Birgitt

[Butterblume]

Marburg Virus Reaches Uganda's Capital Kampala

KAMPALA, Oct 22 (Reuters) - An outbreak of the deadly Marburg virus in Uganda has spread to the capital Kampala after an infected woman travelled to the city and the death toll from the disease, a cousin of Ebola, climbed to five, a health official said on Monday. "We have one case confirmed in Mulago Hospital while the number of the dead is now five," Rukia Nakamatte, spokesperson for the ministry of health told Reuters on Monday.

"Thirty -four contacts (people are) being monitored and an isolation facility is being set up."

A health official told Reuters on Monday that the woman at Mulago, the country's largest referral hospital, had travelled to Kampala about five days ago and is a member of a family in Kabale which lost three people.

Quelle: Reuters/Huffingtonpost

Grüße
Marina

[Birgitt]

MARBURG VIRUS DISEASE - UGANDA (05): (KABALE) REQUEST FOR INFORMATION
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Date: Thu 25 Oct 2012
Source: Office of the President, Uganda Media Centre [edited]
http://www.mediacentre.go.ug/details.ph ... &item=1875


Press statement and update on the Marburg virus disease outbreak
----------------------------------------------------------------
The Ministry of Health declared an outbreak of Marburg [virus disease] in Kabale district on 19 Oct 2012 after receiving laboratory results from the Uganda Virus Research Institute (UVRI) confirming that 2 family members had died of the highly infectious viral hemorrhagic fever; 3 other members of the same family had earlier died of a strange disease in a period of one month.

The deaths of these people prompted the District Health Office to undertake further investigations of this strange disease that had ravaged Kitumba parish in Kitumba sub-county, Kabale district. According to the reports, the patients presented with symptoms of diarrhoea, vomiting, fever, headache, dizziness, and generalized convulsions. Initial samples of blood and cerebral spiral fluid taken from the sick people ruled out malaria and meningitis. The family then invited a cult leader, a retired Reverend from Rukungiri district, to visit their household and pray for the sick. The index case is believed to have been a member of a family in Rwabirondo village, Kitumba parish in Kitumba sub-county, which occurred on 20 Sep 2012. After the death of the index case, 2 other people, a sister and mother reportedly got sick and died. This outbreak comes barely 2 weeks after the Ministry declared an end to another viral haemorrhagic fever (Ebola virus disease) on 4 Oct 2012. The last Marburg outbreak [occurred] in October 2007 in Kamwenge district.

Marburg is a highly infectious viral haemorrhagic fever, which kills in a short time but can be prevented [avoided?]. Marburg virus infection is spread through direct contact with body fluids like blood, saliva, vomit, stool, and urine of an infected person. A person suffering from Marburg virus disease presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains, and bleeding through the body openings, that is, eyes (red eyes), nose, gums, ears, anus, and the skin. Virus can be spread also through use of unsterilised injection syringes, contaminated linen, beddings, and clothes; by the use of skin piercing instruments that have been used by an infected person. And also by direct physical handling of persons who have died of Marburg virus disease.

Current situation
-----------------
- Of the 6 people who have died so far, only 3 [have been] confirmed positive for Marburg virus infection.
- Currently, there is only one confirmed case admitted in our isolation facility at Mulago National Referral Hospital. The patient admitted [there] is from Kitumba sub-county and is a relative of the index case.
- One convalescent case is detained at Rushoroza Health Center III, while 5 suspect cases linked to the initial cases have ben admitted there awaiting the results of diagnostic tests. Special teams of doctors and nurses have been assigned to attend to the patients in both isolation facilities.
- The Ministry of Health surveillance team has listed a total of 196 contacts for close monitoring. These contacts are mainly in Kabale, Rukungiri, and Ibanda districts while 29 are from Kampala. Those being monitored reportedly got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 10 days without showing any signs and symptoms.
- A team of experts from the Ministry of Health, the US Centers for Disease Control and Prevention and the World Health Organisation have so far collected a total of 18 samples from suspected cases for further investigations. The samples are being analyzed at the Uganda Virus Research Institute, Entebbe.
- The Ministry is conducting an orientation of local healthcare workers in Kabale Regional Referral Hospital and in the other peripheral health facilities on infection prevention and control, barrier nursing, surveillance, and clinical case management. This is being done to build health workers' capacity to handle such cases.
- In Rushoroza Health Centre, a burial committee has been set up to manage burials of people suspected to have died of Marburg virus disease. The committee has been oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly contiguous disease. The committee has so far supervised 2 burials.
- A team from the US Centers for Disease Control and Prevention (CDC) is expected in the country to undertake anthropological [sic; epidemiological?] studies.

The Ministry of Health once again urges the public to take the following measures to avert the spread of the disease.
- Report immediately any suspected patient to a nearby health unit
- Avoid direct contact with body fluids of a person suspected to be suffering from Marburg virus disease by using protective materials like gloves and masks
- Persons who have died of Marburg virus disease must be handled with strong protective wear and buried immediately
- Avoid eating dead animals [sic; presumably animals that died of disease]
- Avoid unnecessary public gatherings especially in the affected district
- Burial of suspicious community deaths should be done under close supervision of well trained burial teams
- Report all suspicious deaths to a nearby health facility.

Once again the Ministry of Health calls upon the public to stay calm, as all possible measures are being undertaken to control the situation.

Hon Dr Christine Ondoa
Ugandan Minister of Health

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

[The situation remains confused and hopefully will be clarified soon as the investigation of the outbreak gets underway. Further information is awaited.

As of 25 Oct 212 the index case and 2 of her family members have died as a result of confirmed Marburg virus disease. Previously 3 other members of the same family had died over a period of one month of an undiagnosed severe disease. A patient now in Mulago National Referral Hospital is another confirmed case, and is also a relative of the index case. So far all the confirmed cases are linked to the index case.

A convalescent case and 5 suspected cases are being treated at the Mulago National Referral Hospital. A total of 196 cases who had contact with either the index case, or any of the confirmed cases, are now under surveillance.

The District of Kabale is located approximately 420 km [261 mi] southwest of Kampala, the capital city of Uganda. A map of the districts of Uganda can be accessed at http://en.wikipedia.org/wiki/Districts_of_Uganda.
The HealthMap/ProMED-mail map can be accessed at http://healthmap.org/r/3NfD.
- Mod.CP]