Uganda declares end of marburg virus disease outbreak
The Marburg Virus Disease (MVD) outbreak was declared by the Ministry of Health on 19 October, 2017 following laboratory tests conducted at the Uganda Virus Research Institute (UVRI) which confirmed that one person had succumbed to MVD on 13 October 2017. The first patient, who will remain a probable case, was 35-year-old herdsman from Kween district that made frequent hunting missions to Kaptum sub-county, where there are caves with large populations of Egyptian fruit bats, and died on September 25th, 2017. [A probable case is any person who died from ‘suspected’ MVD and had an epidemiological link to a confirmed case but did not have laboratory confirmation of the disease] The first confirmed case was a 50-year-old woman from Chemuron village, Moyok Parish, Moyok sub county, Kween District in Eastern Uganda, who presented with signs and symptoms of a viral haemorrhagic fever and died on October 13, 2017 at Kapchorwa Hospital, having been referred from Kaproron Health Center IV in Kween district. She had nursed her 35-year-old brother, mentioned above, who died with similar signs and symptoms and had closely participated in the cultural preparation of the body for burial. The second confirmed case, a 38-year-old man, was the brother of the two previous cases. Due to his close contact with the probable and confirmed cases, he was listed as a high-risk contact. He initially objected to a review and followup by the contact tracing/surveillance team despite several attempts. On October 24, 2017, however, he accepted to speak to the contact tracing team which noted that he had developed MVD-like symptoms. He was transported to the isolation unit at Koproron Health Center IV with fever, body weakness, abdominal pain, loss of appetite, joint pains and history of vomiting blood while 3 at home.
Despite the tireless efforts of the case management team, he died on 26 October 2017. Since 19th October 2017 to date, a total of 311 people have been followed up from Kween (230) and Kapchorwa (81) districts. These are people who had come into contact with the confirmed cases either during their sickness or after death. Of these, 18 developed symptoms similar to those of MVD. However, their results tested negative for the disease at UVRI. The rest did not develop symptoms indicating that none contracted the virus. By 16th November, all the contacts had completed their 21 days of monitoring to account for the 21-day incubation period of the virus. An additional 21 days of intensive surveillance was carried out in the affected districts to comply with the WHO requirement for management and control of viral Haemorrhagic fevers and registered no other confirmed MVD patients. Today, marks 42 days since the death of the last confirmed case which occurred on 26th October 2017, indicating that the MVD outbreak which occurred in Kween and Kapchorwa districts has been contained. MOH is therefore pleased to officially declare the country free from the Marburg Viral Disease. The declaration comes after completion of 42 days of the post-MVD surveillance countdown period for the contacts of the last confirmed case, as per the World Health Organization (WHO) requirement for declaring an end to an outbreak of any Viral Haemorrhagic Fever (VHF). Efforts undertaken to combat the MVD outbreak From 19 October 2017, when the MVD 2017 outbreak was declared, the Public Health Emergency Operations Centre (PHEOC) was immediately activated for response to this outbreak, and the National Task Force (NTF) on epidemics took up the coordination of all interventions to combat the outbreak. Additionally, the district taskforces of Kween and Kapchorwa were alerted to trace all people 4 who could have got into contact with the confirmed or probable cases.
Two isolation centers were setup at Koproron Health Center IV and Kapchorwa Hospital for treatment of any suspected MVD patients. A mobile laboratory was deployed at Kapchorwa Hospital during the MVD outbreak to perform real-time testing of samples for MVD and strengthen surveillance and response to the Marburg virus disease outbreak. Appeal to the public to embrace Safety Precautions The Ministry of Health urges the public to reduce the risk of wildlife-to-human transmission by avoiding contact with wild bats, including visits to caves inhabited by bats. The Ministry also urges the public to reduce the risk of humanto-human transmission in the community by avoiding direct or close contact with suspected patients should any suspected cases occur. Marburg virus disease is a highly infectious viral haemorrhagic fever that is spread through direct contact with body fluids such as blood, saliva, vomitus, stool and urine of an infected person. A person suffering from Marburg presents with sudden onset of high-grade fever with any of the following symptoms: headache, vomiting blood, joint and muscle pains and bleeding through body openings like the eyes, nose, gums, ears, anus and the skin. We urge the health workers to be mindful of infection prevention procedures including wearing gloves and other appropriate personal protective equipment when taking care of ill patients. The public is also urged to embrace regular hand washing after visiting patients in health facilities, before eating and after using the toilet, to avoid infection. Recognition of support to the fight against the MVD outbreak 5 The total cost of the outbreak response was approximately Uganda Shillings 3.5Billion, both in cash, services and material commodities from Government and partners.
The Ministry of Health acknowledges the contribution of the different development partners for their support during the outbreak. Special recognition goes to the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), Médicins Sans Frontières (MSF), United Nations Children’s Fund (UNICEF), United States Agency for International Development (USAID), European Union, Uganda Red Cross Society (URCS), World Vision Uganda, Infectious Diseases Institute (IDI), African Field Epidemiology Network (AFENET), WALIMU, FHI360, JMEDICC, and the media. The Ministry of Health further acknowledges the efforts and contribution of the Kween and Kapchorwa district authorities staff and VHTs to the control of this outbreak. We also wish to thank the communities for their cooperation. Lastly, we wish to once again reassure the general public that the Government of Uganda with support from partners has built the capacity of health workers in dealing with outbreaks, as evidenced in the quick and robust response to the just-ended Marburg virus disease outbreak. However, we appeal to the public to always report to the nearest health facility for proper medical attention, whenever they get any illness, for without this MOH cannot effectively deal with the outbreaks in time. I thank you,
FOR GOD AND MY COUNTRY
Hon. Sarah Opendi Minister of State for Health – General Duties HOLDING PORTFOLIO OF MINSTER OF HEALTH