Wednesday, October 25, 2017

WHO Update: Marburg Virus Outbreak In Uganda


Six days ago, in Uganda's Virus Research Institute Confirms 2 Marburg Virus Deaths, we saw the the third outbreak of this hemorrhagic Ebola-like virus in Uganda in the last 5 years (previously in October of 2012 and again in 2014).  
Last Friday we reviewed both the WHO & Ugandan MOH Statements On Marburg Virus, when the case count stood at 1 confirmed, 1 suspected, and 1 probable case. 
Overnight the World Health Organization has released a lengthy statement, which raises the number of confirmed, suspected, or probable cases to 5, and details the steps being taken to contain this outbreaks.

Due to its length I've only included some excerpts (bolding mine).  Follow the link to read it in its entirety.

Marburg virus disease – Uganda

Disease outbreak news
25 October 2017

On 17 October 2017, the Ugandan Ministry of Health notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017.

As of 24 October, five cases have been reported – one confirmed case, one probable case with an epidemiological link to the confirmed case, and three suspected cases including two health workers.

Chronologically, the first case-patient (probable case) reported was a male in his 30s, who worked as a game hunter and lived near a cave with a heavy presence of bats. On 20 September, he was admitted to a local health centre with high fever, vomiting and diarrhoea, and did not respond to antimalarial treatment. As his condition deteriorated, he was transferred to the referral hospital in the neighbouring district, where he died the same day. No samples were collected. He was given a traditional burial, which was attended by an estimated 200 people.

The sister (confirmed case) of the first case-patient nursed him and participated in the burial rituals. She became ill and was admitted to the same health centre on 5 October 2017 with fever and bleeding manifestations. She was subsequently transferred to the same referral hospital, where she died. She was given a traditional burial. Posthumous samples were collected and sent to the Uganda Virus Research Institute (UVRI). On 17 October, Marburg virus infection was confirmed at UVRI by RT-PCR and it was immediately notified to the Ministry of Health.

The third case-patient (suspected case) is the brother of the first two cases. He assisted in the transport of his sister to the hospital, and subsequently became symptomatic. He refused to be admitted to hospital, and returned to the community. His whereabouts are currently not known though there is an ongoing effort to find him.

Two health workers who were in contact with the confirmed case have developed symptoms consistent with Marburg virus disease and are under investigation (suspected cases). Laboratory results to rule out Marburg virus disease are pending.

Contact tracing and follow-up activities have been initiated. As of 23 October, 155 contacts including 66 who had contact with the first case and 89 who had contact with the second case-patient have been listed in the two affected districts, including 44 health care workers. The number of family and community contacts is still being investigated.
WHO risk assessment
Marburg virus disease is an emerging and highly virulent epidemic-prone disease associated with high case fatality rates (case fatality rate: 23–90%). Marburg virus disease outbreaks are rare. The virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).

Candidate experimental treatments and vaccine are being reviewed for potential clinical trials.

Uganda has previous experience in managing recurring viral haemorrhagic fever outbreaks including Marburg virus disease. Cases have historically been reported among miners and travellers who visited caves inhabited by bat colonies in Uganda. Marburg virus disease outbreaks have been documented during:
  • 2007 – 4 cases, including 2 deaths in Ibanda District, Western Uganda;
  • 2008 – 2 unrelated cases in travellers returning to the Netherlands and USA, respectively after visiting caves in Western Uganda;
  • 2012 – 15 cases, including 4 deaths in Ibanda and Kabale districts, Western Uganda; and
  • 2014 – 1 case in healthcare professional from Mpigi District, Central Uganda.
As of 24 October, five cases have been identified – one confirmed case, one probable case, and three suspected cases, and the outbreak remains localised. Ugandan health authorities have responded rapidly to this event, and measures are being rapidly implemented to control the outbreak. The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies is a challenge for the response. In addition, hospitalised cases were handled in general wards without strict infection control precautions, and one probable case refused to be hospitalised for a period of time.

The affected districts are in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The Mount Elgon caves are a major tourist attraction, and are host to large colonies of cave-dwelling fruit bats, known to transmit the Marburg virus. The close proximity of the affected area to the Kenyan border, and cross-border movement between the affected district and Kenya and the potential transmission of the virus between colonies and to humans, increases the risk of cross-border spread.
These factors suggest a high risk at national and regional level, requiring an immediate, coordinated response with support from international partners. Tourism to Mount Elgon including the caves and surrounding areas should be noted and appropriate advice given and precautions taken. The risk associated with the event at the global level is low.
         (Continue . . . )

No comments: