2022 Ebola Outbreak: ASK’s Involvement In Uganda
Conflagrations of infectious diseases lashing out through cities and clinics are not uncommon in Sub-Saharan Africa. Yet still, with a lack of information on legitimate available resources and preventative actions, fear and despair blaze through the people's hearts in these areas.
Throughout the fall and winter of 2022, ASK witnessed a surge in unease, worries, and questions from both the clinics and the communities in Uganda regarding the current Ebola outbreak in their areas: doctors expressed their concerns of the lack of protocols and government-issued PPEs, while communities were reluctant to visit clinics in fear of nosocomial infection. Moreover, during this time, many cases were sent to ASK with questions regarding specific treatment for patients presenting symptoms of Ebola, such as muscle pain, headaches, diarrhea, and internal bleeding, further conveying the doctor’s unrest. It soon became evident that despite being in the hot zone of Ebola, little information was known about the rehabilitative actions from the Ugandan Ministry of Health or other organizations.
In order to help quell some of these concerns, I attended a series of WHO-led webinars that aimed to spread awareness about Ebola disease in African countries, through their health emergencies program.
The new WHO-accepted filovirus disease classification (ICD-11) shows there are several subclassifications of the virus. EBOD is classified as D60.0
The subcategories are as follows:
D60.00 Bundibugyo virus disease (BVD) caused by Bundibugyo virus (BDBV);
D60.01 Ebola virus disease (EVD) caused by Ebola virus (EBOV);
D60.02 Sudan virus disease (SVD) caused by Sudan virus (SUDV);
D60.03 Atypical Ebola disease;
D60.0Y Other specified Ebola diseases caused by, for instance, Taï Forest virus (TAFV);
D60.0Z Ebola disease, virus unspecified
The first webinar examined the historical background, epidemiology, classification, and burden of SUDV. Furthermore, it addressed a variety of questions including who needed to be tested, what sample to be tested, when the sample should be collected, and the available treatment options and vaccines.
The origin of this strain of the Ebola virus first started in June of 1976 in Sudan. In merely 6 months there were already 284 cases and 151 deaths, leading to a case fatality ratio (CFR) of 53%. The next outbreak in July 1979 presented with 34 cases, 29 deaths, and a CFR of 65% followed by a third outbreak in August 2000 with 426 cases, 223 deaths, and a CFR of 52%. Finally, the fourth outbreak was in April 2004 with 17 cases and 7 deaths, resulting in a CFR of 41%. Among these major outbreaks of Ebola, several smaller outbreaks of Ebola have arisen, the most recent of which in fall of 2022
The reservoir of the virus is in fruit bats. Infected fruit bats enter in direct or indirect contact with other animals beginning this chain of infection. Primary infection in humans typically follows the handling of infected dead or sick forest animals or, though much less common, direct contact with infected bats. Secondary human-to-human transmission may be transferred through direct contact with the blood, secretions, organs, or other body fluids of an infected individual. Additionally, transmission risks significantly increase when providing direct patient care or handling dead bodies (most commonly at funerals).
Patients can present with non-specific symptoms of viral illness such as fevers, chills, or headaches making early clinical diagnosis difficult. Consequently, patient history is essential and would be most beneficial if it were to include exposure to places with ongoing outbreaks or contact with a suspected human or animal with EVOD. Diagnosis involves testing via reverse transcriptase polymerase chain reaction (RT-PCR) assay and IgG and IgM antibodies with enzyme-linked immunosorbent assay (ELISA) antigen detection tests or virus isolation by cell culture. Specimens need to be handled appropriately using maximum biological containment conditions and staff should be trained appropriately, including proper donning and doffing of personal protective equipment (PPE).
Below are the types of testing for the Ebola Virus:
Different technologies and brands of assays can be used; however, it is paramount that the laboratory staff work safely and that reliable results are produced in a timely manner, which requires proper training and proper allocation of resources.
WHO played a crucial role in opening laboratories for recruiting and training staff for the diagnosis and treatment of patients with EBD. Thirteen field labs were deployed, starting from Beni in August 2018, Goma, Mangina, Butembo, Tchomia, and Bunia in September 2018, Katwa and Komanda in January 2019, Tchowe and Bukavu in August 2019, Mombasa in September 2019, and finally Makato and Kasindi in October 2019. This allowed for the collection of over 230,000 samples creating a functional biobank for the world.
Having collected this new information, I got in touch with John Kigere, a nurse in charge of setting up the protocols and isolations in Kampala. I shared government-developed videos addressing how they are confronting the ebola outbreak in Katanguru, Mbara, Biwindi, and Rushaga, the actions from the WHO and Uganda Ministry of Health, as well as the location of official testing sites in hopes to provide a catalog of information and resources amidst the terrifying reality of disease.
When searching through article after article or while having a pen voraciously jot down key information from webinars, it has occurred to me before that sudden outbreaks of disease, at least for now, are inevitable in Uganda and areas of Sub-Saharan Africa. Yet despite this, uncertainty and fear, heart-clenching emotions obscuring the thoughts of many, should not be percolating through individuals of the communities. As the wave of rampant Ebola questions begins to subside, I hope that the light of knowledge was able to help restore confidence within doctors and guide communities through the seemingly endless darkness of disease.
References
Ahuka-Mundeke, Steve and Daniel Mukadi-Bamuleka. “Deployment, Management, and Performance of Field Laboratories in a Context of Chronic Insecurity in Eastern Democratic Republic of Congo Ebola Outbreaks.” Public Health Laboratories-EVD, World Health Organization, 2 Nov 2022.
Formenty, Pierre. “Brief introduction to Sudan virus disease (SVD) Caused by Sudan Virus (SUDV) from the Sudan Ebolavirus Species.” Health Emergency Program, World Health Organization, 12 October 2022.
