Thursday, November 16, 2017

WHO Update: Marburg Virus In Uganda & Kenya

Credit CDC


The Marburg outbreak we began following almost a month ago (see Uganda's Virus Research Institute Confirms 2 Marburg Virus Deaths) appears to have been contained with only 3 confirmed (fatal) cases, although enhanced surveillance activities will continue until December 7th. 
According to the WHO, all three cases were epidemiologically linked and belonged to one family. Several hundred potential contacts have been followed up on, and monitored, but none have developed the disease. 
While small, this is the third outbreak reported by Uganda (15 cases in 2012's outbreak see Here & 1 one in 2014's Here) over the past 5 years, with all three starting in the month of October.

Like with Ebola viruses, bats are believed to be the primary reservoir host for Marburg, although it isn't known what other hosts might carry the virus.  Human infection is often attributed to the consumption of bush meat.

Excerpts from yesterday's update follow:

Marburg virus disease – Uganda and Kenya

Disease outbreak news

15 November 2017

On 17 October 2017, the Ugandan Ministry of Health (MoH) notified WHO of a confirmed outbreak of Marburg Virus Disease in Kween District, Eastern Uganda. The MoH officially declared the outbreak on 19 October 2017. As of 14 November, three cases have been reported including two confirmed cases, and one probable case. All three cases have died, resulting in a case fatality rate of 100%. The cases were epidemiologically linked and all belong to the same family.

Chronologically, the first case (probable) was a 35-years-old herdsman who frequently hunted near the area of Kaptum, known for its bat-infested caves. He was admitted to hospital on 20 September with Marburg-like symptoms and died five days later. The first confirmed case was the sister and caretaker of the first case. The second confirmed case was the brother of the first two cases, who died on 26 October 2017 and had a safe and dignified burial on the same day.

Prior to his death, the second confirmed case travelled to Kenya where he visited his relatives in West Pokot County, as well as a traditional healer in Trans Nzoia County. On 29 October 2017, the Ugandan MoH notified WHO and the Kenyan MoH of these high-risk contacts. The traditional healer tested negative for Marburg virus disease on repeated blood specimen analyses performed at the Kenyan Medical Research Institute (KEMRI) in Nairobi. She and her family were monitored for 21 days. The two relatives from West Pokot, as well as other contacts in the same county, also completed their 21 days of follow up.

Active case search, death surveillance, safe and dignified burials and community mobilization are ongoing in Kween and Kapchorwa districts. In Uganda, of the 339 contacts listed, 283 have completed 21 days of follow-up and 56 are still being monitored. Contact follow-up is ongoing in Kween for the 56 contacts, while In Kapchorwa District, all the listed contacts have completed the 21 days follow-up period. All remaining contacts are expected to complete 21 days of follow up on 16 November 2017. Enhanced surveillance activities will continue until 7 December 2017.

Public health response
  • The Ugandan MoH continues to proactively respond to the outbreak with support from WHO and partners. 
  • Contact tracing and active case search in health facilities and at the community level are ongoing. On 14 November 2017, 56 contacts were still under follow up. Reported deaths are also investigated for Marburg before burial and suspicious deaths are buried according to safe and dignified burial protocols. 
  • Two Marburg treatment centers have been set up in Kapchorwa hospital and Kaproron with logistical support from Médecins Sans Frontières (MSF) France, UNICEF and WHO. 
  • Social mobilization and risk communication are ongoing. Over 12 000 community members have received information on Marburg virus disease with the support from Red Cross volunteers, UNICEF and WHO communication experts.
  • Psychosocial support specialists have been deployed to Kween and counselling sessions are being conducted for family members of the deceased Marburg cases, health workers, and other community members.
  • Guided tours of the Marburg treatment units in Kapchorwa and Kaproron were organized in order to dispel fear of the treatment centers and rumours of wrong practices by healthcare workers that cause deaths among admitted patients.
  • On 7 November 2017, a cross-border meeting between Uganda and Kenya health authorities was organized to strengthen cross-border surveillance in Kapchorwa, and cross-border surveillance activities are ongoing.
  • The Kenyan Marburg virus disease outbreak contingency plan and the public health Emergency Operations Center have been activated and preparedness measures have started. 
  • Two thousand Personal Protective Equipment (PPE) kits have been dispatched by WHO and shipped to Trans Nzoia County, Kenya.
  • A temporary treatment center (Kaisangat Health center) has been identified and the Kenya Red Cross Society is recruiting and re-orienting nurses to manage the Marburg Virus Disease treatment centre.
  • UNICEF is assisting with communication activities and community engagement.
WHO risk assessment

Marburg virus disease is an emerging and highly virulent epidemic-prone disease associated with high case fatality rates (CFR: 23 to 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 therapeutics are being reviewed for potential clinical trials.
         (Continue . . .)

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