Thursday November 22 2012

Why are viral haemorragic fevers rampant these days?

By Ambrose Talisuna

There is a report of another Ebola outbreak, this time in Luweero District. Recently there was a report of a Marburg outbreak too.

The Ebola and Marburg viruses are related viruses that cause hemorrhagic fevers, an illnesses marked by severe bleeding (haemorrhage), multiple organ failure and, in many cases, death.

Both the Ebola and Marburg viruses are native to Africa, where sporadic outbreaks have occurred for decades. The Ebola virus and Marburg virus live in animal hosts, and humans can contract the viruses from infected animals. After the initial transmission to humans, the viruses can spread from person to person through contact with body fluids or contaminated needles.

Marburg haemorrhagic fever is a severe illness caused by the Marburg virus. It was first described in 1967 during outbreaks in Germany and the former Yugoslavia that were linked to monkeys imported from Uganda. Since then, only a few sporadic cases in East and southern Africa and one laboratory infection have been identified.
The largest Marburg outbreak recorded to date began in late 1998 in northeastern Democratic Republic of Congo (DRC).

Ebola haemorrhagic fever may be caused by any of four of the five known Ebola viruses, namely: the Zaire Ebola Virus, the Sudan Ebola Virus, the Taï Forest virus, more commonly called Côte d’Ivoire Ebola Virus and more recently the Bundibugyo-Ebola Virus.

There have been more outbreaks of Zaire-Ebola virus than of any other species. The first outbreak occurred on August 26 1976 in Yambuku in DRC. Transmission has been attributed to re-use of unsterilised needles and close personal contact.

The Sudan-ebola virus, like the Zaire-virus, emerged in 1976. The first outbreak was among cotton factory workers in Nzara, Sudan, with the first case reported as a worker exposed to a potential natural reservoir. The animal carrier is still unknown. The most recent outbreak of the Sudan-ebola occurred in May, 2004, with 20 confirmed cases in Yambio County, Sudan, and five deaths.

The Côte d’Ivoire Ebola virus, also referred to as Taï Forest Ebola virus was first discovered among chimpanzees from the Taï Forest in Côte d’Ivoire, in 1994. The source of the virus was believed to be the meat of infected Western Red Colobus monkeys, which are preyed on by chimpanzees.

More recently, in 2007 the Bundibugyo Ebola Virus was discovered in Uganda. Again this year, there was an outbreak of the Bundibugyo-Ebola Virus in a northeastern province of DRC with 15 confirmed cases and 10 fatalities. Before the year ends, we have reports of another Ebola coming on the heels of a Marburg outbreak.

The biggest risk for transmission once the outbreaks have spread from their animal reservoir to humans is person to person contact either in hospitals without good infection control procedures or not observing safe burial procedures.

The first question therefore is: Does Uganda have adequate strategies for infection prevention and control at the community and health facility level?
My biggest questions to ministries of health and scientists in DRC, Sudan and Uganda are: How come we frequently have this common interaction between animal reservoirs and humans?
Is it cultural, is it hunting patterns, even then what has changed in recent years? Are there specific populations that are frequenting the jungles in Uganda, Sudan and DRC either in line of duty, in search of a livelihood or food and hence come into close contacts with animal reservoirs?

If yes, have they been sensitised about infection prevention? Have they been equipped with infection control facilities for the community and facility level? Is there more frequent mixing of the populations in DRC, Uganda and Sudan than in the past? Who are these populations groups that could be starting these outbreaks? I do not have the answers but surely we need to seriously start asking tough questions?

World Health Organisation’s revised international health regulations require that states should establish core capacities to address such emergencies at national, sub-national, health facility and community level, as well as at border crossings.

Is Uganda compliant to the requirements of the revised international health regulations? Surely the era has passed for us to be implementing re-active approaches instead of pro-active approaches.

We cannot continue addressing one crisis after another, go into slumber when it is over and only wake up to manage another crisis. Something needs to be done and done urgently.
By Dr Talisuna is a former Head of the Epidemiology and Surveillance Division at the Ministry of Health where he led the investigation and outbreak response to several outbreaks including Ebola and Marburg.