Date: Mon, 16 Oct 2000 21:45:48 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Pro-Med Update -

Subject: PRO/AH/EDR> Ebola hemorrhagic fever - Uganda
------------------------------------------------------------------------

EBOLA HEMORRHAGIC FEVER - UGANDA
********************************
A ProMED-mail post
ProMED-mail, a program of ISID
<http://www.promedmail.org>

[see also:
Unidentified hemorrhagic fever - Uganda 20001014.1757
Unidentified hemorrhagic fever - Uganda (02) 20001015.1760]
[1]
Date: Mon, 16 Oct 2000 11:42:34 GMT
From: M. Cosgriff <mcosgriff@hotmail.com>
Source: PanAfrican News Agency, filed 15 Oct 2000 [edited]
Ugandan Ministry Identifies Ebola virus as the Cause of the Outbreak
------------------------------------------
KAMPALA: The dreaded Ebola virus that struck over 300 people in Kikwit, in
the Democratic Republic of Congo in 1995, has killed 31 people in northern
Uganda. A Ugandan Ministry of Health statement said laboratory tests had
revealed that the Ebola virus was the cause of the epidemic [of hemorrhagic
fever] which has been raging in the Gulu district since September. Three of
the dead were student nurses, who treated the first Ebola patients admitted
to a Lacor missionary hospital in Gulu town. A task force headed by Gulu
district administrator, Walter Ochora, has been set up to co-ordinate
efforts to control the epidemic.
Field officials in Gulu told the Kampala-based New Vision newspaper that at
least 7 more people came down with the disease on Saturday alone,
bringing the number of people affected in the past 2 weeks to 51. All the
affected came from Rwot-Obillo in Aswa county, northern Gulu, Kasubi and
Kabedo Opong in Gulu municipality. The New Vision said at least 5
patients have recovered from the disease, and are quarantined in hospitals
due to the fears associated with it. Reports in Kampala are rife that the
disease could have been brought into Uganda by returning Ugandan troops and
their Congolese wives who are camped in Aswa. But army spokesman, Major
Phenehas Katirima, said no soldier in Gulu had suffered from the disease.
******
[2]
Date: Mon, 16 Oct 2000 11:39:44 GMT
From: LuAnn McKinney, DVM <lmckinney@rvc.ac.uk>
Source: Reuters, Mon 16 Oct 2000, 11:41 AM [edited]
<http://uk.news.yahoo.com/001016/80/ambmu.html>
Suspected Ebola Hemorrhagic Fever Death toll Reaches 43
-------------------------------------------------------
REUTERS (Geneva): The World Health Organisation said the death toll in
Uganda from a disease identified as Ebola fever had risen to 43 according to
provisional data and it expected the number of cases to rise. But the UN
health agency said there was no need for travel restrictions to and from the
east African country to contain the disease, which spreads via direct
contact with blood or bodily fluids of infected people and kills 50 to 90
percent of victims.
Mike Ryan, WHO disease outbreak coordinator who is flying to Uganda on
Monday to head the agency's emergency response team, told Reuters that 43
people were reported dead in a total of 63 cases in the outbreak in northern
Uganda's Gulu district. "These are provisional figures and we are waiting
for the officially confirmed figures from the Ugandan government," he said.
The figure is up from 33 dead reported by local officials in Uganda,
including 10 in an Italian-sponsored Roman Catholic mission hospital. The
other deaths were in villages around Gulu. Ryan said WHO expected the number
of cases to climb but could not say whether the outbreak appeared to be as
bad as one that killed 245 people in the Congolese town of Kikwit in 1995.
"We're early in the outbreak. We expect more cases," Ryan said.
WHO says Ebola fever has claimed 793 lives in nearly 1100 documented cases
since the virus was first discovered in 1976 in the Democratic Republic of
the Congo where an epidemic killed more than 270 people. The exact origin of
the virus or how and why it flares up is unknown. Its symptoms include
sudden onset of fever, weakness, headache, muscle ache, abdominal pain and
sore throat, followed by vomiting, diarrhoea and internal and external
bleeding. Francis Omaswa, Uganda's director general of health services, said
in the capital Kampala there were 63 cases reported so far in the outbreak,
which Health Minister Crispus Kiyonga has said was confirmed by laboratory
tests to be Ebola fever. Since 1976, Ebola outbreaks have been reported in
Gabon, Sudan, Liberia and Ivory Coast with individual cases of infection
reported in Britain, where a laboratory worker was infected by a
contaminated needle in 1976. The latest outbreak is the first time Ebola has
struck in Uganda, although an outbreak of Marburg fever, which has similar
characteristics, killed 19 people there in 1976.
[Byline: Elif Kaban]
--
LuAnn McKinney, DVM
<lmckinney@rvc.ac.uk>
*******
[3]
Date: Mon, 16 Oct 2000 11:58:50 GMT
From: M. Cosgriff <mcosgriff@hotmail.com>
Source: Yahoo news, AFP Report, filed 16 Oct 2000 [edited]
New Cases Reported Over 100 Kilometres from Gulu
------------------------------------------------
PARIS: The outbreak of [suspected] Ebola [fever] in Uganda casts light on
one of the world's most terrifying diseases, for which disinfection and
common-sense isolation measures are the key weapons in the absence of any
cure. The head of a special task force told AFP in Kampala on Monday that
the death toll from the outbreak had risen to 37, with new cases reported in
densely populated areas more than 100 kilometers (60 miles) from the
epicentre in the north of the country.
Ebola [virus], discovered only 24 years ago, is [one member of a] family of
viruses [the _Filoviridae_] that cause haemorrhagic fever. The virus,
transported in infected blood, semen and possibly urine and respiratory
droplets, takes 3 weeks to incubate. Death occurs in 50 to 90 percent of
cases, usually just a few days after the first symptoms appear. In the lack
of any pharmaceutical weapons against Ebola [virus], the vital task is to
identify people with symptoms of the fever and to isolate them in special
wards, World Health Organisation (WHO) specialist Mike Ryan told AFP. The
measures were common-sense, he said in an interview from WHO headquarters in
Geneva. "Once you have the equipment and you have the people, you can train
them very quickly," Ryan said. "Establishing an isolation facility is not
rocket science. It's about establishing very systematic procedures about
gowning up, using goggles, using masks and properly disposing of body
fluids, proper disinfection of all items that are used," he said. Ryan, the
agency's coordinator for disease surveillance and response, was due to fly
to Kampala later Monday along with a WHO colleague who specialises in
disease containment. Their task is to advise the Ugandan government on
patient isolation and helping to train health care workers in barrier
nursing, a field that requires rigorous disinfection procedures and the use
of gowns, gloves and masks to prevent any contact with the patient's body
fluids. He gave high marks to the Ugandan authorities for responding "quite
aggressively" to the emergency and seeking outside help at an early stage.
Ryan spoke out strongly against any idea of restricting flights with Uganda
or other clamps on movement. Such steps are rarely effective and could
backfire by damaging the local economy, thereby indirectly hurting the
population's health, he said. "This disease is controllable, it is
containable. But slapping on measures of restricting movement is not going
to be effective, particularly when it comes to international travel," he said.
No treatment exists for Ebola fever, nor any vaccine, although in August, US
scientists at the National Institutes of Health Vaccine Research Center
announced an important breakthrough in understanding [of the pathogenesis of
the infection]. They had identified a protein manufactured by the virus that
destroys the lining of blood vessels in pigs. If this holds true for humans,
that could open the way for drugs that block production of the protein,
hopefully giving the body's immune system enough time to defeat the virus
itself. Ryan said that basic health care, such as rehydration and proper
nutrition, often caused the death toll to drop in previous outbreaks of
Ebola. An unexplained phenomenon is that people who catch Ebola in the
second or third wave of an outbreak have a better chance of survival.
[This report was also received from ProMED-mail moderator Marjorie Pollack
- Mod.ES]
******
[4]
Date: Mon, 16 Oct 2000 13:01:23 +0100
From: Prof. Slenczka <slenczka@mailer.uni-marburg.de>
Filovirus serology in the West Nile Province of Uganda
------------------------------------------------------
MARBURG: I wonder whether Ebola virus will be confirmed as the etiologic
agent of this outbreak and whether or not the outbreak was imported from the
republic of Congo? We have recently studied a group of 1000 human sera, from
the West Nile Province of Uganda for antibody against filoviruses. The sera
were collected between 1990 and 1992 mainly in Obongi and in Rhino Camp by
Prof. Dr. D"ring, University of Bonn. In our study 1,5% of these sera were
found to be positive for Ebola virus antibody in an Elisa test using a
recombinant NP antigen, whereas none of these sera was positive for antibody
against Marburg virus. A group of 200 sera taken from medical students of
our university was used as the negative control and did not show any
filovirus specific antibodies. As people in this region seem to have
migrated a lot during the civil war and afterwards, and as the place is not
too far distant from Maridi (200 km) or from the Democratic Republic of
Congo, we can not have certainty, whether our serological findings point to
the occurrence of Ebola virus right in the Arua or Moyo district of Uganda.
However the possibility exists that these antibody findings point to the
occurrence of Ebola virus in the West Nile Province of Uganda. If there is
any need for our cooperation in the diagnosis of this outbreak, we are
willing to offer any scientific assistance which might be needed.
--
Dr. Werner Slenczka
Institute of Virology
Philipps-University Marburg
35037 Marburg/L
Germany
<slenczka@mailer.uni-marburg.de>
[All reports now indicate that Ebola virus may be the etiological agent in
this outbreak, although the nature of the evidence remains to be disclosed.
Dr Slenczka's offer of assistance in tracing the origins of this outbreak
should be taken up by those involved in the investigation of the
epidemiology of the outbreak. - Mod.CP]
[Subsequent reports received after these items were processed indicate that
the WHO has now confirmed that this outbreak is indeed Ebola hemorrhagic
fever based upon laboratory confirmation from a reference laboratory in
South Africa. Another contributor has indicated that PCR confirmation has
been obtained. More details will be posted later. - Mod.ES]
..............................cp/es
*##########################################################*
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.