Ebola: Experts yet to find cause, index case

While health teams managing the Ebola Virus Disease (EVD) that broke out in five districts of Central Uganda are making strides at the treatment centres with admissions reportedly scaled down, the mystery of the index case and cause still eludes the health experts and epidemiology teams a month later.
On September 19, the Ministry of Health broke the unfortunate news about the EVD and declared it an epidemic on September 20, causing panic among residents of Mubende, Kyegegwa, Kassanda, Kakumiro, and Bunyangabo.
 
The Ebola virus, which has now raised international concern and attracted different local and international organisations to join hands with the government of Uganda, has claimed 25 lives.
The lockdown and night curfew slapped on Mubende and Kassanda districts on October 15, partly explains the big task and challenge of controlling its spread. 

In Mubende; the epicentre of the EVD epidemic, the chairperson of the district Ebola taskforce, and Resident District Commissioner (RDC), Ms Rosemary Byabasaija, says the disease could soon be contained considering the fewer numbers admitted at the isolation centre.
“We have 10 people admitted to the Mubende Hospital isolation centre but the cumulative confirmed cases were 58 by October 18,” she says.
Ms Byabasaija adds: “We are now under lockdown and night curfew that targets scaling down the spread of the epidemic. We lost many of our people.  EVD could have spread earlier than the dates when the sample tests were taken and tested and came out positive.”

While the Health ministry in its latest figures puts the deaths at 25 and the cumulative confirmed cases at 64, the question about the conflicting figures from the ministry and those released recently by the World Health Organisation are among the challenges that possibly explain the magnitude of the EVD.
Mr Emmanuel Ainebyoona, the spokesperson of the Ministry of Health, on October 17, put the cumulative confirmed cases at 60 and cumulative recoveries at 24. The total number of cumulative contacts was 1,521. But international media on October 19 quoted the WHO Chief Tedros Adhanom Ghebreyesus stating the death toll was at 44, the confirmed cumulative case at 64 while the recoveries stood at 25.

“We remain concerned that there may be more chains of transmission and more contacts than we know about in the affected communities,” Mr Ghebreyesus said.
Eight of all the cases haven’t had contacts.
Health Minister Jane Ruth Aceng on Monday, October 17 while addressing residents of Mubende District said all the measures put in place, including the lockdown imposed on Kassanda and Mubende, target containing the spread of Ebola.
“The President announced a 21-day lockdown and night curfew simply because he wants the EVD to go away. He wants the people in the affected areas to be safe and return to their respective development programmes. Cooperate with the security forces enforcing the epidemic measure,” she appealed.
In Kyegegwa District, the surveillance officer, Mr Reuben Nyesinga, said by Thursday they had only three people in the isolation ward at Mubende Regional Referral Hospital awaiting their results.

Since September 20, Kyegegwa has registered three Ebola confirmed cases and one death.
Mr Nyesinga said they have also registered 47 Ebola alert cases where 34 were evacuated to Mubende hospital by yesterday.
He added that of the three Ebola confirmed cases, the surveillance team listed 61 contacts, and their 2-day incubation period has elapsed.  By yesterday, they had no contact they were following.
In Kyegegwa, the Ebola outbreak was confirmed in Kabarugi village and Bugogo Town Council.

Bunyangabu District
In Bunyagabu, one Ebola case was confirmed in the Rwimi Town Council. The  Bunyangabu District Health Officer, Dr Richard Obeti, said the patient was a fourth-year medical student of Kampala International University and a resident of the area who had come from Mubende hospital.
The patient was admitted to Fort Portal Regional Referral Hospital together with six others from Mubende and has since recovered.
Dr Obeti said the district surveillance team listed 48 contacts and all their 21-day incubation period elapses today.

Kagadi District
Kagadi District registered one Ebola case of a 23-year-old private clinic health worker identified as Ronald Agaba. Agaba succumbed to Ebola on September 27, at St Ambrose Charity Health Centre IV in Kagadi Town.
The deceased was a resident of Rugashali Town Council in Buyaga west, Kagadi District.

Health workers contracting Ebola
Since the outbreak of Ebola in Uganda, the country has lost five health workers to the disease, according to the ministry of health.
The first health worker was Kenneth Ssendagi, 32, an enrolled nurse at St Florence Medical Clinic in Madudu Sub-county, who is a probable case, according to the Ministry of Health because he died before testing.

He died at Cure Medical Clinic in Mubende Town before the confirmation of the Ebola outbreak.
The second was Ronald Agaba, a 23-year-old attached to a private clinic in Madudu Sub-county in Mubende District.
He reportedly treated suspected Ebola patients. He fled to his uncle’s home in Kakindo Sub-county in Kakumiro District after hearing that Ebola contacts suspects were being tracked by the Ministry of Health.
He then proceeded to Rugashali Town Council in Kagadi District.
After developing signs and symptoms of Ebola, he was admitted at St Ambrose Charity Health Centre IV in Kagadi Town where he passed on  September 27.
The third was Dr Ali Mohammed, a Tanzanian national and medical student at Kampala International University. He died on October 1 at Fort Portal Regional Referral Hospital.

Margaret Nabisubi, 58, was the fourth health worker to die of Ebola. She died at Fort Portal Regional Referral Hospital. She was an anaesthetic officer from Mityana District but was attached to Mubende Regional Referral Hospital.
The fifth person was Dr John Grace Walugembe who succumbed to the disease on October 16.
Five other health workers from Mubende hospital, who had contrated the disease, recovered and were discharged on October 11.
Dr Alex Adaku, the director of Fort Portal Regional Referral Hospital, said the facility has more than 30 health workers managing Ebola patients.
He revealed that they also received two more staff from WHO to support the team.  

Stats
General
• Confirmed cases – 64 
• Deaths – 25 
• Discharged  – 24 
• Admitted – 11 
• Children tested positive – 4 
• Health workers dead  – 5

Kyegegwa district
• Number of confirmed Ebola cases  – 3
• Number of recoveries – 2
• Number of deceased  – 1

Bunyangabu district
• Number of confirmed Ebola case – 1
• Number of recoveries – 1
• Number of deceased – 1
 
Kagadi district
• Number of confirmed cases – 1
• Number of deceased – 1