New outbreak of Sudan Ebola strain claims health worker

The Ministry of Health has confirmed another outbreak of Sudan Ebola in Kampala, which has killed a 32-year-old male nurse working at Mulago National Referral Hospital.

The ministry’s Permanent Secretary, Dr Diana Atwine, yesterday said the discovery follows separate confirmations from three laboratories of the Central Public Health Laboratory in Kampala, the Uganda Virus Research Institute in Entebbe, and Makerere University.

Dr Atwine said the deceased initially developed fever-like symptoms and sought treatment in Saidina Abubakar Islamic Hospital in Matugga, Wakiso District, and Mbale Regional Referral Hospital in Mbale City and from a traditional healer.

“The patient presented with a five-day history of high fever, chest pain, and difficulty in breathing, which later progressed to unexplained bleeding from multiple body sites,” she said.

“The patient experienced multi-organ failure and succumbed to the illness at Mulago hospital on Wednesday,” Dr Atwine said, adding that postmortem samples confirmed the Sudan virus strain.

According to Dr Atwine, the Sudan strain is a highly infectious haemorrhagic fever that is transmitted through direct contact with infected bodily fluids or contaminated objects (medical equipment), for example from human to human through broken skin or mucous membrane; or through close contact with the blood secretions, organs, or bodily fluids of infected animals such as bats, chimpanzees, gorillas, monkeys, forest antelopes, or porcupines found sick or dead in the rainforest. Symptoms, according to Dr Atwine, include sudden onset fever, fatigue, chest pain, diarrhoea, vomiting, unexplained bleeding, yellowing of the eyes, restlessness, and headache.

“Bleeding manifestations usually appear in later stages after the above symptoms,” Dr Atwine said, adding that the latest outbreak marks the eighth Ebola outbreak in Uganda. Uganda last suffered an outbreak of the same Sudan strain in late 2022, which was declared over on January 11, 2023.

This last outbreak killed 55 of the 143 infected people. According to the World Health Organisation (WHO), since the last Ebola outbreak was published on November 24, 2022, one new confirmed case of the Sudan Ebola Virus (SUDV) was reported on November 27 in Kassanda District. On December 2, 2022, the Ministry of Health announced that all patients suffering from SUDV had been discharged from treatment units.

Further statistics from the WHO reveal that the EVD fatality rate ranges from 25 percent to 90 percent, depending on how the disease is handled. Data from the Ministry of Health indicates that 20 percent of the 43 people who contracted Ebola in 2022 died, a number higher than Covid-19 case-fatality rate which stood at around 3 percent.

Dr Stephen Ataro Ayella, a clinical epidemiologist, who has participated in three Ebola responses, told this newspaper in an earlier interview that EVD is more deadly than Covid-19 because of the nature of the virus and the serious complications it causes to the body.

“Ebola virus can enter from any opening of the body such as the ear and anus; it is also transmitted sexually. Whereas for Covid-19, it is more of respiratory; the entry into the body is [mainly] through the nose, eyes and mouth,” he said.

According to Dr Ataro, upon entering the body, the Ebola virus multiplies very fast and causes multiple complications such as diarrhoea, vomiting, and electrolyte imbalance (changes in the body system). Some health experts have also blamed the high mortality rate of EVD, specifically the Ebola Sudan strain, on the lack of approved drugs and vaccines for the disease.

This time, though, Dr Atwine said her ministry has activated the Incident Management Team and dispatched rapid response teams to both Mbale City and Saidina Abubakar Islamic Hospital in Matugga to list all the contacts and isolate them. According to her, a total of 45 contacts have been listed, including 30 health workers and patients from Mulago, 11 family members of the deceased and four health workers.

Further still, health workers have been urged to adhere to strict prevention and control measures, while private clinics must report any suspected cases to the district health authorities for further investigation . The Executive Director of UVRI, Prof Pontiano Kaleebu, said the best way Ugandans can manage Ebola is through quick response.

“Ebola is not something new in Uganda; however, the key strands are Ebola Sudan and Ebola Zaire; all we have to do is to move quickly, do contact tracing and isolate the cases,” he said.

The Secretary-General of the Ugan[1]da Medical Association (UMA), Dr Joel Mirembe, said Ebola puts healthcare workers at risk of death. “The government must equip all health facilities with adequate PPE to ensure that healthcare workers are protected while on duty and in the future. Additionally, there is an urgent need to recruit new doctors, nurses, and laboratory personnel to address staffing shortagess,” Dr Mirembe said.

BACKGROUND

The Ebola Sudan was named because the virus causing it was first discovered in the southern part of Sudan, present-day South Sudan, in 1976. According to WHO, Ebola Sudan is a single member of the Sudan ebolavirus species and one of the six known viruses within the genus Ebolavirus, and one of the four that causes EVD in humans and other primates.