An anti-Ebola advocacy van drives along Kyadondo road amid the Ebola outbreak and alert in Kampala, Uganda October 27, 2022.
In the last two decades, Uganda has endured eight Ebola outbreaks, with nearly half of the 766 infected people losing their lives, according to our analysis of available reports.
The Ebola Virus Disease (EVD) deaths and containment efforts for the contagious disease have caused deep family pain amid severe economic strain on the country.
The suffering has continued as different types of ebolaviruses emerge and torment people amid a lack of or inconclusive reports on the exact source of the outbreaks, hampering the prevention of future outbreaks.
“For Ebola Sudan, Ebola Zaire, Ebola Bundibugyo (species/types of ebolaviruses), nobody has ever really said, ‘This is where it has come from’,” notes Dr Julius Lutwama, a virologist at the Uganda
Virus Research Institute (UVRI).
“This is because, in almost all the cases, we find secondary infection when the original, very first person, who was infected is not there anymore. So, we cannot tell exactly where the infection comes from.
“So, that is why we do not know the reservoirs. Because if we knew the reservoir, where it (ebolavirus) is coming from, then we would be going for those reservations,” he adds.
Dr Lutwama heads the Department of Arbovirology, Emerging and Re-Emerging Infectious Diseases at UVRI.
The country is presently battling its eighth Ebola outbreak, confirmed by the Ministry of Health in January, with two fatalities reported so far. This adds to a total of 368 deaths from intermittent outbreaks spanning 2000 to 2022.
“We don’t know for now,” says Col Dr Henry Kyobe, the Ebola Incident Commander at the Ministry of Health, when the Monitor asked him about the source of the current outbreak reported in Kampala.
“But what we know is that the individual (the index case), in the period we think he was exposed, he never moved out of Kampala. So we think the exposure that he got was either in Kampala or Wakiso,” he adds.
Data from the Ministry of Health on Ebola indicates that as of March 9, for this current outbreak, there have been 12 confirmed cases, eight discharged patients, two under care, two dead patients and two probable cases.
Uganda has had EVD outbreaks in 2000, 2007, 2011, two in 2012, 2019, 2022 and 2024, largely caused by three different strains of ebolaviruses. The biggest and most deadly was the 2000 outbreak
that registered 425 cases and 224 deaths.
In between, the country has also had outbreaks of Marburg, Crimean Congo Hemorrhagic fever, Yellow Fever, Rift Valley Fever, Avian Influenza and measles among others, according to information from the World Health Organisation (WHO).
On the 2022 outbreak in Mubende, which saw a total of 164 cases with 77 deaths reported in nine districts, Dr Kyobe suspected that the disease could have entered the population from the wild.
Dr Kyobe postulates that some people could have eaten wild animals like bats.
“We think these viruses live innocently in the wild but for some reasons, including human-wild interaction, there is a breach of that human-wild interaction and the virus ends up in the human population,” he says.
According to the epidemiologist, even in the human population, it is because of our vulnerability to the same -interactions among humans, that we end up with transmission.
“This can sometimes lead to sustained transmission, leading to huge transmission lines and creating a huge outbreak. But those viruses live in the wild, in some specific animals where they are reservoirs and in other animals where they cause disease,” Dr Kyobe adds.
However, the country has also faced outbreaks caused by cross-border movement, especially from DR Congo to Uganda because of the unrest in the area. One of the outbreaks was the 2019 Ebola outbreak in Kasese District where infected people from DR Congo crossed to Uganda,a country with very frequent outbreaks of the viral disease.
Congo war debate
Commenting on the 2022 EVD outbreak in Mubende, Dr Ekwaro Obuku, a researcher and health policy expert, said the government had not done enough work to determine what has caused this outbreak and the past outbreaks.
“The [gold] mines and the forests could be mapped and in so doing, they can understand the risk areas. It is possible the virus could have been imported. If you look at the situation in Gulu, remember, there was an ongoing war in Congo and at the end of that war, a virus popped up in 2000,” he argues.
“We had an ongoing campaign against Allied Democratic Forces (ADF) and the virus popped up in 2007. Then there was an ongoing campaign in DR Congo recently and the virus popped up.So it is possible that the virus was brought from other countries,” he suggests. But Dr Kyobe says there was no evidence that the virus was imported into the country.
Photo taken on October 27, 2022, Ebola Sudan doctors inside an isolation center together with suspected patients in Mubende, Uganda. PHOTO/ FILE
Are bugs escaping from labs?
Laboratories such as those at UVRI handle samples containing the pathogens. Dr Lutwama says their laboratories have very tight biosecurity measures that ensure no escape or misuse of the infectious agents handled in their facilities.
“At UVRI, we have a biosafety and biosecurity committee which oversees the laboratories. Of course, each lab has its own Standard operating procedures which it has to follow very keenly to make sure that they are there to make sure that the pathogens which come to the lab with the samples --they may be blood samples or maybe plasma or saliva or swabs are kept as securely as possible,” he explains.
The virologist says the precautions and standards are followed even by those who bring in the samples from the field or other health facilities that refer the samples to them.
“When the samples come to the gate, they are supposed to come when they are in a carrier. This carrier must be tightly closed. But also having the destination lab indicated,” Dr Lutwama says.
“And of course, there should have been an earlier hint to the lab that we are going to receive a specimen, and they know, or they have an idea what type of specimen, so they know how to handle what is coming in,” he adds
Improving surveillance system
However, Dr Lutwama, while presenting on March 11, before researchers and scientists in Kampala during an international conference, indicated that the country has significantly improved its disease surveillance system.
The three-day research dissemination conference was organised by the Medical Research Council and Uganda Virus Research Institute (UVRI) and ran under the theme: “Building on our Past Discoveries, Paving the Way for a Healthier Future.”
“Surveillance has been very good that at least we get to know before many people have been infected. That is why we have had single-case outbreaks,” Dr Lutwama notes.
“You can imagine a single case outbreak of Ebola, a single case outbreak of Marburg, when only one individual has been infected, so that shows that the surveillance is working very well,” he adds.
The virologist also says they are now emphasising one health approach where communities are encouraged to report the death of animals and pets for investigations and also report abnormal health occurrences or diseases to the health workers. He says many of the emerging infectious agents are from animals.
“With this era of (smart) phones, I think participatory surveillance should be the key to what we need to do such that you just see something happening, you take a picture and send it somewhere. A surveillance application would be very useful.
“They may be having monkeypox, and yet they were saying they have measles. Then, I take a picture, and I send that. And probably, I’ve stopped monkeypox from that Community just by that.
“It doesn’t have to be somebody who knows what it is. It has to be anything strange, and you report, and somebody comes and investigates and says, no, that is, okay, that is, something normal, or it is not normal. That would be the best way to stop outbreaks in the country,” he proposes.
Dr Kyobe also indicates they are working hard to determine the source of the outbreak in Kampala, which has attracted mixed reactions from the public, with some politicians claiming that there is no Ebola in Kampala. The Ministry of Health dismissed the claims.
“Teams are working backwards using different techniques to find the source. And this may come in possibly in several weeks. But as of now, what we know is the index case,the 33-year-old male spoken about earlier,” Dr Kyobe says.
Misinformation
On the issue of misinformation around outbreaks, Dr Lutwama says it could point to a poor community engagement strategy that should be improved.
“There should be continued sustained awareness for the so many different diseases in the country. We need to do this in the community at the grassroots levels such that everybody in the community is responsible for their community,” he adds.
