Public health officials in Uganda are scrambling to catch up with a burgeoning Ebola outbreak caused by a lesser-known species of Ebolavirus called Sudan virus (SUDV), for which there is no vaccine or treatment.
Information so far suggests efforts to respond to the outbreak may be three weeks behind the initial spread of SUDV, which has an incubation period of up to 21 days and a mortality rate of between 41 percent and 100 percent. So far, 36 cases (18 confirmed, 18 probable) have been identified with 23 deaths. Health authorities have listed a total of 223 contacts.
But that number is probably an undercount. Several chains of transmission have not been followed, and some healthcare facilities that saw Ebola patients did not follow optimal infection control measures, The World Health Organization warned. In addition, due to the delayed detection of the outbreak, some patients were buried in traditional ceremonies with large gatherings, which may have allowed further transmission of the virus.
Another complicating factor is that the outbreak has been identified among people living near an active gold mine, which relies on a highly mobile population. “Declaring the outbreak may cause some miners who are already hatching the disease to flee,” the WHO warned, potentially allowing the disease to spread to new areas.
In an update on the outbreak on Monday, the WHO assessed the risk of spread through Uganda as high, given the numerous factors of concern.
The concern is even greater because there is no approved vaccine or treatment for SUDV, as there is for the more common type of Ebola virus, Zaire. Currently there is two vaccines and two treatments for the Ebola disease caused by the Zaire species, which has caused almost all documented Ebola outbreaks and all of the largest outbreaks. In addition to Zaire and SUDV, there are four other rare Ebolavirus species: Bundibugyo, Taï Forest, Reston, and Bombali.
Of The WHO lists 41 outbreaks on its websiteSUDV was responsible for just seven cases, the last of which was in 2012. This outbreak, also in Uganda, involved seven cases and had a death rate of 57 percent.
The current outbreak became known through the death of a 24-year-old man on September 19 in central Uganda. The man developed a number of worrying symptoms on September 11, including a high-grade fever, tonic convulsions, bloody vomiting and diarrhea, loss of appetite, pain when swallowing, chest pain, dry cough and bleeding in the eyes. He unsuccessfully sought help at two different private clinics and was finally referred to a regional referral hospital (RRH) on September 15. Health workers there suspected he had a viral hemorrhagic fever, isolated him and took blood samples for testing. On September 19, the Uganda Virus Research Institute (UVRI) in Kampala confirmed he had SUDV infection – the same day he died. Uganda’s health authorities declared an outbreak the next day.
Now, a week later, the case count stands at 36, with 23 dead and the remaining 13 confirmed cases still hospitalized. The median age of cases is 26 years, with ages ranging from 1 year to 60 years.
For the time being, the WHO assessed the regional and global risks of this outbreak as low overall. However, the agency noted that the extent of the outbreak is not yet known and cross-border spread cannot be ruled out.
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