Friday, October 20, 2017

WHO & Ugandan MOH Statements On Marburg Virus

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Overnight the World Health Organization emailed out a statement on yesterday's reported Marburg virus outbreak in Uganda (see Uganda's Virus Research Institute Confirms 2 Marburg Virus Deaths) and we have an initial statement from the Ugandan MOH as well.
While there are conflicting reports about how many cases are confirmed (WHO states: `One suspected and one probable case'), in the following statement we learn that hundreds may have been exposed at a traditional burial ceremony in Kween District.
First this, from WHO.
WHO supports containment of rare virus on Uganda-Kenya border

News release

20 October 2017 | GENEVA - WHO is working to contain an outbreak of Marburg virus disease (MVD) that has appeared in eastern Uganda on the border with Kenya.

At least one person is confirmed to have died of MVD and several hundred people may have been exposed to the virus at health facilities and at traditional burial ceremonies in Kween District, a mountainous area 300 kilometres northeast of Kampala.

The first case was detected by the Ministry of Health on 17 October, a 50-year-old woman who died at a health centre of fever, bleeding, vomiting and diarrhoea on 11 October. Laboratory testing at the Uganda Virus Research Institute (UVRI) confirmed the cause of death as MVD.

The woman’s brother had also died of similar symptoms three weeks earlier and was buried at a traditional funeral. He worked as a game hunter and lived near a cave inhabited by Rousettus bats, which are natural hosts of the Marburg virus.

One suspected and one probable case are being investigated and provided with medical care. An active search for people who may have been exposed to or infected by the virus is underway.

The Ministry of Health has sent a rapid response team to the area supported by staff from the World Health Organization, the Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFNET).

WHO is providing medical supplies, guidance on safe and dignified burials, and has released USD 500 000 from its Contingency Fund for Emergencies to finance immediate response activities.

“We are working with health authorities to rapidly implement response measures,” said Ibrahima-Soce Fall, WHO Regional Emergency Director for the Africa region. “Uganda has previously managed Ebola and Marburg outbreaks but international support is urgently required to scale up the response as the overall risk of national and regional spread of this epidemic-prone disease is high.”

Marburg virus disease is a rare disease with a high mortality rate for which there is no specific treatment.
        (Continue . . . )


And this detailed statement from Uganda's Ministry of Health.

Hon. Dr. Jane Ruth Aceng
Minister of Health
October 19, 2017


PRESS STATEMENT ON MARBURG HEMORRHAGIC FEVER

The Ministry of Health would like to inform the general public that there is a confirmed case of Marburg Virus Disease (MVD) in the country. This followed laboratory tests conducted by the Uganda Virus Research Institute (UVRI) which confirmed that one person had died of Marburg Virus Disease, a type of Viral Hemorrhagic Fevers (VHF) on 17th October 2017.

As at 19th October, 2017, only one case had been confirmed. The confirmed case was a 50-year-old female from Chemuron village, Moyok Parish, Moyok sub county, Kween District in Eastern Uganda. She presented with signs and symptoms suggestive of a Viral Hemorrhagic Fever (VHF) and unfortunately passed on during the night of October 11, 2017 at Kapchorwa Hospital, having been referred from Kaproron Health Center IV in Kween district.

Preliminary field investigations indicated that prior to her death; the deceased had nursed her 42-year-old brother, who had died on September 25, 2017 with similar signs and symptoms. She had also closely participated in the cultural preparation of the body for burial. The deceased’s brother was reported to be a hunter who carried out his activities where there are caves with heavy presence of bats. However, no samples were taken off his body prior to his death.

Marburg Virus Disease (MVD) is caused by the Marburg virus, a rare but severe type of Viral Hemorrhagic Fever which affects both humans and non-human primates like monkeys, baboons. The reservoir host of Marburg virus is the African fruit bat. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) are vulnerable to contracting the Marburg virus, which is known to have a very high mortality.

In Marburg outbreaks, the first person normally gets infected through contact with infected bats or animals (normally monkeys/baboons). Once the first person (Index case) gets infected with the Marburg Virus, human to human transmission of Marburg Virus Disease (MVD) then occurs through contact with the body fluids (blood, vomitus, Urine, feces, etc) of already infected persons. Close contacts to already infected persons (like close family members of already infected persons) and health workers are particularly at increased risk of getting infected with the Marburg virus.

A person suffering from Marburg presents with sudden onset of high-grade fever accompanied by any of the following symptoms:

1. Headache
2. Vomiting blood
3. Joint and muscle pains
4. Unexplained bleeding through the body openings including the eyes, nose, gums, ears, anus and the skin.

There is no specific treatment or vaccine available for Marburg for now, but patients are given supportive treatment which supports the natural recovery process of the body and this improves tremendously the patient’s survival chances. However, treatment outcomes are better for those who seek care early.

To mitigate the current threat of Marburg Virus Disease, the Ministry of Health is undertaking the following measures to control the spread of the disease:

  • Ministry of Health has deployed a Rapid Response Team comprising of highly experienced Epidemiologists, Risk Communication experts, Case Management,
  • Infection Control and Prevention experts, ecological environmental experts, Laboratory specialists, among others to Kween and Kapchorwa districts. The team will support District Rapid Response Teams to investigate and assess the magnitude of the threat and to institute appropriate control measures to avert the Marburg Virus Disease threat.
  • An isolation ward at the Kapchorwa District Hospital and Kaproron Health Center IV in Kween District have been established to handle cases.
  • Preparations are underway to train all health workers, particularly from Kapchorwa Hospital, and Kaproron Health Centre IV on VHF Infection Prevention and Control. Infection Prevention and Control measures have been heightened in all health facilities in Kapchorwa and Kween districts.
  • Personal Protective Equipment (PPE’s) and other supplies have been mobilized to support response in the affected facilities.
  • The National Medical Stores is delivering emergency supplies to the affected health facilities.
  • Increasing awareness in affected communities and among health-care providers on the clinical symptoms of patients with Marburg Virus Disease.
Marburg Virus Disease has the potential to spread over wide areas affecting many people especially health workers and family members nursing Marburg Viral Disease patients.
The Ministry of Health therefore appeals to the general public to remain alert and observe the following precautions to control the spread of the Marburg virus:
  • Report any suspected patient immediately to a nearby health facility.
  • Avoid direct contact with body fluids of a person presenting with bleeding tendencies or symptoms suggestive of Marburg virus disease.
  • Health workers are further reminded to wear gloves and appropriate personal protective equipment when taking care of ill patients or suspected cases.
  • Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
  • Avoid contact with persons who have died from the disease.
  •  Allow health workers perform dignified burials among victims who might have succumbed to the disease, so as to minimise its spread to others.
The Ministry of Health calls upon the general public to remain calm but be on alert amidst this epidemic. You can report all suspected cases via the Ministry of Health hotline on 0800100066.
For God and My Country
Hon. Dr. Jane Ruth Aceng
Minister of Health

Although most Marburg outbreaks over the past decade have been limited in size, after the horrific and unprecedented outbreak of Ebola in West Africa in 2014-15 - where 30,000+ people were infected and at least 11,000 people died - no one is taking this outbreak lightly.

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