LATEST EBOLA SITREP

One new suspect case was reported in Bombo General Military Hospital in a 5
year old male from Ngalonkalu village, Zirobwe sub-county; she presented on
18TH May 2011, with two day history of high grade fever associated with head
ache, vomiting, general body pains, and bloody diarrhea. The patient has been
isolated and a sample retrieved for laboratory investigation.

•

There are four suspect cases currently admitted in Bombo General Military
hospital and they are all reported to be improving on treatment. Three of them
have tested negative for Ebola by PCR and ELISA Antigen testing.

Three of the contacts to the putative index patient developed a fever and two of
them are isolated while the third contact, a child with remote exposure was not
isolated since his fever had subsided following treatment with antimalarials. One
of the contacts (a health worker) that was earlier on reported to have travelled to

Kyengera was yesterday [18th May 2011] picked up from Kamuli in Kireka andhas since been isolated. The two contacts among health workers have tested
negative for Ebola by PCR and ELISA antigen testing.

The national rapid response team is on the way to Bugiri hospital to investigate
the suspect case reported there as well as support the hospital team to observe"
the recommended infection control standards...
A team from CDC team arrived on 17 May 2011 from Atlanta and traveled to
the Ngalonkalu Parish (Nakisamatta village) on 18 May 2011. The team set up
their equipment and captured 61 bats. They processed the bats onsite and will
return today [19 May 2011] to trap more. The specimens will be processed at
UVRI and results are expected in the next few weeks...

An isolation facility is being established at Bombo General Military Hospital with
support from MSF Spain. Temporary tents have been set up to accommodate
suspect cases as the main isolation facility is still under construction. Trainings for the isolation unit staff, ambulance and burial teams have
commenced at Bombo General Military Hospital with support from MSF Spain. Additional trainings are planned and these will target the health workers in
Luwero district, the five neighboring districts and health workers in the rest of the
country.

EBOLA Situation Report(Sitrep No 3) as at 08.00 Hrs; 18

May 2011

Summary of cases Luwero Other Districts
National
Total
18th May 2011

Hospital Kampala Bugiri

1. Epidemiology/Laboratory( Situation in the field):
Cases

•

The putative index patient was a 12 year old female from Nakisamata village,
Ngalonkalu Parish, Zirobwe sub-county, Luwero district who passed away on
6th May 2011 following a febrile hemorrhagic illness that lasted six days.
Laboratory investigations done through both real time PCR testing and
Antigen detection by ELISA confirmed Sudan Ebola virus (SEBOV).

•

Three of the contacts to the putative index patient developed and are being
observed.

•

One of these contacts had a positive blood slide for malaria and a negative
PCR test for Ebola. The blood samples for the other two contacts are being
analyzed at UVRI. Two contacts are reported to be improving on treatment
with antimalarials.

•

Two alert cases have been reported as indicated below:

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The first alert case was a soldier at Bombo military hospital on ARVs and
anti-TB treatment who developed bleeding while on admission and died on

14th May 2011. Laboratory investigations on this case revealed a
thrombocytopenia with a negative test result for Ebola by PCR.

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The second alert case has been reported by Mulago hospital today(17TH

May 2011). The patient is a 29 year old male from Muwafu zone, Makindye
Division, Kampala. He was admitted on 16 May 2011 with history of
vomiting blood and bloody diarrhea for one day without fever or headache.
He gave no history of travel or contact with a patient in the recent past.
The patient is improving on rehydration and ciprofloxacin. The blood
sample obtained tested negative for Ebola by PCR and ELISA Antigen
testing.

•

One suspect case was admitted in Bombo GMH in the evening of
17/May//2011; a 10 year old girl from Ngalonkalu village, Zirobwe sub-county
who presented with four days history of fever, vomiting with epistaxis and
abdominal pain. The child has been isolated and blood drawn for
investigations.

•

A new suspect case has been reported in an 8 year old male from Busoga
village, Buwunga sub-county, Bugiri district who presented early today with a
three days history of fever, measles like rash, bleeding gums and epistaxis.
The hospital has requested to be supported by the national rapid response
team since they don’t have anticeptics, gloves, or PPEs.

Contact Tracing

•

A total of 25 contacts are being followed up in Luwero; 12 in Bombo General
Military Hospital; 3 in Kisakye clinic, Zirobwe Town; 9 in Nakisamata village,
Zirobwe sub-county; and 1 in Negulumye village, Wakiso district.

•

All these contacts were followed up yesterday (17th May 2011) with just three
of them manifesting with fever and are reported to be improving on
antimalarials.

•

None of the febrile contacts has tested positive for Ebola.

Specimen collection

•

Seven blood samples have been obtained.

•

Only one 14% (1/7) sample has tested positive for Sudan Ebola virus
(SEBOV) through both real time PCR testing and Antigen detection by ELISA.

•

All these samples have been tested at Uganda Virus Institute, Entebbe and
aliquots have been shipped to CDC Atlanta, USA.

Continued investigation

•

Further investigations into potential source of the current outbreak were
conducted by a joint MoH, WHO, CDC team in Nakisamatta village:

o

Household bats were identified in the house of the putative index case.

o

Bats were also identified in the neighboring Ngalonkalu Primary school and
neighboring houses that are under construction.

o

The team visited the area where the family of the putative index case went
for gardening and collect firewood and observed that the area was close to
thickets that harbor monkeys.

o

An ecological team from CDC is in the country and has been engaged to
trap bats in the area. The locals have been alerted to keep away from the
infested structures.

Continued surveillance

•

All the listed contacts are being monitored on a daily basis to ensure that they
are isolated as soon as they manifest with symptoms.

•

All the districts on the contact pathway have been put on high alert

•

Surveillance tools based on Ebola experience have been adapted and will be
distributed to all affected districts starting today. These are: Case definitions,

Case reporting forms and contact tracing sheets and follow up forms..

Panic as Ebola spreads into another district

Friday, May 20th, 2011
By PATRICK JARAMOGI
Panic is the word that can best be used to describe the state at which the residents of Luwero are living in following the reported outbreak of Ebola last week. The strange twist to the epidemic that left a 12 year-old girl dead is its source of origin. Health experts including senior World Health Organisation (WHO) doctors are puzzled with the origin of the deadly disease, which has been identified as Sudan straight (Sudan Ebola). This type of Ebola has a killing rate of up to 60 percent (fatality).
The ministry of Health has, following the outbreak of the disease moved in fast to curb infections and control deaths, though they are still dogged by logistical problems. Luwero District Health Officer Dr Joseph Okware described the situation as “tense” but “calm”. He told a team of officials from the Health ministry, Centre for Disease Control, The African Field Epidemiology Network (AFNET) and WHO that the outbreak had indeed caused panic and anxiety among the locals. “Ebola is not an easy enemy to fight. We need cooperation and dialogue and networking to address it,” said Okware at the Luwero district headquarters on Tuesday.

He confirmed that Kate Nakiguli, the 12 year-old girl indeed died of Ebola. Nakiguli, formerly a primary five pupil at Ngalo nkalu primary school in Zirobwe, Luwero district succumbed to death on the May 6 at the Bombo military hospital where she was admitted. Okware said the 23 people who had had contacts with Nakiguli have been isolated and are being monitored closely.

“Eleven people are from the clinic in Zirobwe where she was admitted first, nine from the girls village in Ngalo nkalu, two from Bombo military barracks, and one person from where the burial took place in Wakiso,” said Okware. He said two other suspected cases, one of a one and half year old baby and that of a mortuary attendant attached to military hospital in Bombo had been reported, though the laboratory results indicated that they had malaria.
The acting director general Health services, Dr. Denis Lwamafa said government was taking the immediate measures to handle the situation. “As government moves in to take control measurers, it is very important that we take precaution and appropriate risk handling of Ebola,” he said. He said surveillance is going to be expanded to exceed Luwero. He urged the district leaders to ensure that burial arrangements are handled well by a team of experts to curb on infections. “We need to be strict while handling Ebola victims. Only body bags must be used. Avoid social gatherings and shaking of hands,” he said.

The National Task Force head, Dr. Anthony Mbonye said the surveillance will be expanded to include surrounding districts of Wakiso, Nakasongola, Nakaseke, Mukono and Kampala. “We can’t only take care of Luwero because we are not certain of the source and the spread that is why we are expanding surveillance to the other five districts neighboring Luwero. Funds are being channeled for surveillance and monitoring,” said Mbonye. He said government was closely working with WHO, AFENET and the MS Spain to ensure that Ebola is contained.
The AFENET senior epidemiologist Dr Monica Musonero Musanza said they would commit funds for training the health workers and communication for the surveillance team on ground. “We have funds to support government with training and communication because these are vital in curbing spread. We are also sending a team of experts on the ground to trace for the exact source of this Ebola,” said Musanza. But government and other development partners seek to control the spread of the killer Ebola in Luwero and its suburbs, reported emerged that another Ebola case had been reported in Bugiri, a town in eastern Uganda.
The Ebola virus is highly contagious and causes a range of symptoms including fever, vomiting, diarrhoea, generalised pain or malaise and in many cases internal and external bleeding. The 30 people who are believed to have had contact with the deceased have not yet developed symptoms according to the ministry of Health officials. “They are currently being monitored and isolated from the public,” said Mbonye. Mbonye said that preliminary investigations have showed that this Ebola virus is similar to the one that broke out in Sudan, thus named Sudan Ebola.

The other subtype is the Congo Ebola which also attacked the western district of Bundibugyo in 2007 claiming 37 lives including a senior doctor Jonah Kule. In 2000 Ebola outbreak in Gulu left at least 170 people dead. These earlier ones had a fatality rate of over 80 percent. Mbonye said that there also ongoing investigations to find out whether the index case got into contact with moneys or bats, the known reservoirs of the Ebola virus.

Following the outbreak, government has reactivated the National Ebola Task Force (NETF) to coordinate the fight against the disease at the national level. District task forces are also in the process of being formed according to Mbonye, who is the chairperson of the NETF. Immigration officials at all the country’s border posts have been put on alert and the neighbouring countries have been notified about the outbreak.

According to Joachim Saweka, World Health Organisation (WHO) representative here, tight border controls are not yet necessary although the immigration officers should be on alert. With some people reluctant to disclose their exact areas of origin for fear of being inconvenienced and perhaps quarantined, it remains a challenge how the immigration staff will handle the situation. According Saweka, a team of experts from WHO are also on the way to Uganda to beef up the team which is already camped in the affected district. A ministry of Health statement issued on Thursday urged the public to stay calm as all possible measures are being undertaken to control the situation. The ministry urged the public to avoid direct contact with body fluids of a person suffering from Ebola by using protective materials like gloves and masks. The public is also urged to bury people who have died of Ebola immediately and avoid feasting and funerals.
Government has also stocked the necessary drug supplies and logistics for case management. Isolation facilities have also been set up in the affected district. “Any claim of somebody bleeding should not just be disregarded but should be rushed to the nearest health centre and then from there we are already working with the health system to try to instruct how to deal with these cases,” said Saweka.

Ebola Hits Uganda again

Posted by Andy on 5/20/11 •
It all began with the death of a young girl from Zirobwe, a sub county in Bamunanika district of Uganda. The doctors later found out that the young girl died from Ebola, a deadly diseases which had never been so close to the capital of Uganda.
The Ebola case in Zirobwe came as a shock to many. Zirobwe is less than 30 miles from the capital city of Uganda- Kampala. The mother of the victim reported that the dead girl used to frequent the forest. Research has in the past linked Ebola virus to monkeys.
An isolation center was set up in Bombo which is just 20 miles from Kampala, the capital. More than 30 people who were believed to have come into contact with the deceased where have been isolated in the area

Two days ago, a young girl lost her life after the doctors in Gombe suspected that she had Ebola. It was later discovered that the girl had died from poisonous substance she had consumed. Actually, she was admitted with 5 others who had taken the substance with her. The doctors neglected all of them which led to the death of one. The fear of Ebola has now engulfed the country

Ebola Haemorrhagic Fever Epidemic DREF operation

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20 May 2011

CHF 133,744 has been allocated from the Federation’s Disaster Relief Emergency Fund (DREF) to support the national society in delivering immediate assistance to some 1,731,900 beneficiaries (targeted population for information dissemination campaign). Unearmarked funds to repay DREF are encouraged.
Summary: An Ebola haemorrhagic fever epidemic has been reported in Luwero District of Uganda. One death so far has been reported with two suspected cases in the isolation unit at Bombo military hospital since the outbreak was confirmed on 13 May by the Ugandan Ministry of Health (MoH). The World Health Organization (WHO), MoH, MSF and the Uganda Red Cross Society (URCS) are active in the affected area. The four agencies have conducted preliminary assessments and highlighted the main gaps that need to be addressed for the epidemic to be brought under control.
This operation is expected to be implemented over three months, and will therefore be completed by August 2011; a Final Report will be made available by November 2011 (three months after the end of the Operation).http://reliefweb.int/node/402927

The situation

The Ugandan Ministry of Health (MoH) and the World Health Organization (WHO) have confirmed an
outbreak of Ebola haemorrhagic fever in the Luwero District located in the central region of Uganda
neighbouring Wasiko, Kayunga, Nakaseke, Nakasongola and Kampala Districts just along the highway to
Northern Uganda and Sounthern Sudan. One death (index case) has been reported and 23 suspected
contacts so far from the military hospital: of these, two suspected cases have so far been reported and have
been admitted to Bombo military hospital in Luwero District, the clinic that attended to the deceased victim
and the village members.
The initial assessment has not yet identified the source of the outbreak, but the national task force has
singled out six districts neighbouring Luwero for active case search, surveillance and social mobilization for
the Ebola outbreak. The Ugandan MoH and WHO have sent blood samples of the other cases admitted to
referral laboratories in Entebbe, and more tests are being conducted to provide detailed information on the
suspects.
Ebola Sudan, the type confirmed at this time in Uganda, is a highly contagious killer disease in the category
of viral haemorrhagic fevers, with no known cure and with high fatality rate of up to 90% of people exposed
to infection. Its symptoms include high fever, headaches, muscular pain, diarrhoea, reduced urine and
extensive bleeding through body openings such as nose, eyes, ears, gums and sexual organs. It is spread
through direct physical contact with body fluids of an infected person or consumption of animals carrying the
virus.
Uganda was last affected by Ebola in 2007 and 2008 in Bundibugyo where over 180 people were infected
resulting in 36 deaths including health workers. In 2000 and 2001, over 800 people were infected in Gulu
and Masindi Districts and more than 150 deaths were reported including health workers.

Coordination and partnerships

The MoH, URCS and other partners have conducted a preliminary needs and capacity assessment in
Luwero. The assessment has identified gaps as outlined below:

•

A national taskforce has been set up in Kampala coordinated by the MoH and similar task forces
have been formed in Luwero and surrounding districts. Experts from the WHO are already in
Uganda working closely with the Ugandan MoH to contain the epidemic and more are on the
way. WHO is providing technical support to the MoH and is coordinating the international
response.

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An isolation unit has been established in Bombo military hospital equipped with protective tools
(50 Personal Protective Equipment (PPE) Kits) provided by the Centre for Disease Control
(CDC) to be used by those handling suspected Ebola cases.

•

Save the Children has rehabilited the isolation units in Bombo military hospital.
Two meetings so far have been organized and attended by partners to forge a way forward and the following
action points have been agreed on:

•

Community mobilization and sensitization of the populations on the symptoms and preventive
measures of Ebola in the six districts of Luwero (the epicentre), Kampala, Nakasongola, Wakiso,
Mukono/Kayunga and Nakaseke.

•

Information, education and communication materials that are context-specific and produced in
local languages.

•

Active community surveillance case search and referral of contacts in the community.

•

Being a permanent member of the social mobilization sub-committee of the national and district
level epidemic task forces, URCS has been requested to lead in these related activities in the
Ebola operation.

•

CDC in collaboration with Central Public Health Laboratory (CPHL) will continue to received
samples from the affected districts in Northern Uganda and will continue supporting the
Government of Uganda in screening samples in response to outbreaks

•

WHO country office with the MoH are part of the response team supporting the case
management - including drugs and sundry medical supplies for the treatment of Ebola cases,
PPE kits for the health workers and people involved in the response case management,
monitoring the trend of the disease, capacity building with experts in the field.

•

The MoH deployed technical officers to support case management, surveillance and referral

activities in the affected districts...

Red Cross and Red Crescent action

Actions to date of the Uganda Red Cross Society Ebola Action Team:

•

Mobilized 50 volunteers in Luwero Branch (the epicentre) and 10 volunteers each from the other
affected branches to be trained in social mobilization and active case research in the
community.

•

Actively participates in the national and district task force planning meetings for the Ebola
response (as a member of the communications and social mobilization team) in Luwero and
Kampala.

•

Provided some 30 PPE kits to MoH to assist in the Ebola response and established a URCS

Ebola task force which is meeting every day....

Although the only indexed case so far is that of the 12-year-old girl confirmed in Luwero district, the WHO
threshold requires that only one laboratory confirmed case represents an epidemic and WHO recommends a
mass emergency response campaign for all residents within the affected districts. Uganda has over 95

districts with Kampala having the highest population of over 1.2m people.

Due to the high level of illiteracy in the affected rural and peri-urban populations in Luwero there is generally
a low level of community awareness on the risk factors of Ebola fever transmission, its identification,
prevention and control strategies. This has led to panic in the affected communities. The general conditions
that exacerbate the Ebola fever situation are:

•

Due to low level of education, majority of the people in the affected communities lack knowledge
and understanding of the disease and what they need to do to avoid contracting it.

•

The high incidence of poverty forces the residents to spend time in the bush hunting wild
animals for alternative diet as well as income and grazing. This means that the majority of
residents in the affected communities are exposed to fruits and animal diet that could expose
them to the deadly virus.

•

There is a general lack of resources for response. The NTF developed a plan of action that
requires USD 2.2m to facilitate the planned activities, where over 50 percent of the funds are
required for case management and the protective gears.

•

Active surveillance and community follow-up cases needs support. This calls for intensive
health promotion campaign to sensitize the affected and/or at risk communities and creates
public awareness about Ebola fever disease, the risk factors for its transmission, its prevention

and control among the people in central Uganda...

Suspected Ebola case in Bugiri

By Dan Wandera

Friday, May 20 2011 at 00:00

A new suspected case of Ebola has been reported in Bugiri District, hardly a week after a 12-year-old girl died of the disease, the ministry of health said in a statement yesterday.
The patient, who is admitted to Bugiri Hospital had fever, measles-like rashes and a bleeding gum—all symptoms of Ebola.
Meanwhile, 25 people in Luweero, who had direct contact with the deceased girl remain under close monitoring.

The ministry said one person who got in contact with the girl was treated for malaria and is improving.
In a statement yesterday, the ministry said, two other people who got in contact with the girl “have their samples being analysed for Ebola”.

Dr Denis Rwamafa, the commissioner for national disease control, said districts that are at high risk of the disease are, Luweero, Wakiso, Kampala, Mukono, Nakaseke and Nakasongola.

“We are enhancing surveillance and have expanded the monitoring to all the six-risk districts until the 42 days expire as the mandatory period to declare an area Ebola free,” said Dr Rwamafa.

A team of health experts on Tuesday visited Luweero to reinforce the emergency health teams set up to respond to the Ebola outbreak in the district and possible outbreaks across the country.

Ebola is a highly-contagious disease that spreads fast when one gets in contact with body fluids of an infected person.
All district task forces have been asked to reactivate their responses to any possible outbreak of the virus.

Ebola Raids Gombe

5/19/11

Ebola has been recently heard in Bombo and Zirobwe in Luweero district.
It has now raided Gombe Sub county and 5 children from the same family have been admitted at Gombe Hospital with Ebola signs and symptoms. Unfortunately one has died before receiving treatment.

Ebola on Saturday killed a 12 year old girl at bombo military hospital
Efforts have been made by the Ministry of Health to fight the disease and funds have been assigned at Bombo military hospital.
Ebola signs and symptoms include fever, bleeding through all body openings, vomiting, diarrhea, abdominal pain, headache, rash, red eyes and it comes into contact with infected bloody fluids like saliva, blood, stool, vomit, urine and sweat.

Ebola epidemic reaches Busoga

20110519 4:12:12 PM EST

A new suspected case of Ebola has been reported in Busoga village in Bugiri district, eastern Uganda.

The patient who is currently admitted at Bugiri hospital is reported to have fever, measles-like rashes and a bleeding gum.
The director general of general health services Dr. Dennis Lwamafa in a statement released this evening however said there haven't been any new cases confirmed so far.

He says the ministry of health continues to monitor and observe the 25 people who got in contact with 12 year old girl, who died of the virus in Luwero district.

Lwamafa adds that, all district and hospital task forces should re-activate and liaise with the National task force to initiate a coordinated response to contain the outbreak.

He reveals that government and other development partners have committed funds, equipment and human resources to respond to the outbreak.

Bombo hospital health worker gets Ebola

One of the health workers who handled a girl who is alleged to have died of Ebola on May 6 has been suspected to have contracted the same disease.
The nurse whose name was not yet identifiedat the time of compiling the story is said to be having all the symptoms of Ebola such as bleeding in every opening of the body and vomiting.
The Bombo hospital has set aside special shelters and wards for the people suspected to be having the diseases.

Last week, the Ministry of Health reported that it is monitoring 33 people who participated in handling the girl

Study: Pigs susceptible to deadly Ebola strain

Robert Roos News Editor

May 13, 2011 (CIDRAP News) – Canadian researchers have shown that an Ebola virus species that can kill humans can also infect pigs and spread among them, raising the specter of Ebola virus as a potential foodborne pathogen.

The researchers infected two groups of pigs with a high dose of the Zaire Ebola virus ("ZEBOV"), a strain that is up to 90% fatal in humans, according to a report published in the Journal of Infectious Diseases. The pigs became ill to varying degrees, with severe signs in some cases, and they transmitted the virus to other pigs that were previously unexposed.

A US expert who wrote a commentary on the findings said the probability of Ebola virus becoming a foodborne pathogen is small but can't be dismissed for now.

Ebola kills girl in Uganda, more cases expected

KAMPALA: The rare and deadly Ebola virus has killed a 12-year-old Ugandan girl, and health officials said on Saturday they expected more cases.
The girl from Luwero district, 75 km north of the capital Kampala, died on May 6, said Anthony Mbonye, the government’s commissioner for community health, in the first outbreak of the virus in Uganda in four years.
“Laboratory investigations have confirmed Ebola to be the primary cause of the illness and death. So there is one case reported but we expect other cases,” he said.
“Just one case is considered an epidemic because it can spread quickly and it is highly fatal.”
The last time Uganda was hit by Ebola – a disease in which those infected often bleed to death – it killed 37 people.
Mbonye said this was the closest a case had ever been reported to Kampala.
Ugandan health officials are following up 33 people who were in contact with the girl, he said.

Deadly Ebola breaks out in Uganda, kills one, 30 monitored

Deadly Ebola breaks out in Uganda, kills one, 30 monitored!

KAMPALA, May 14 (Xinhua) -- The deadly Ebola hemorrhagic fever has broken out in Uganda, killing one person and leaving over 30 others being monitored by health officials, ministry of health announced here on Saturday.
The epicenter of the outbreak is in the central Ugandan district of Luwero located about 50 km north of the capital Kampala.
According to Anthony Mbonye, head of the community health department at the ministry of health, a 12 year old girl in Zirombwe Sub-county developed symptoms of Ebola and when she was admitted at a military hospital in the district, laboratory test confirmed that it was Ebola.
The Ebola virus is highly contagious and causes a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise and in many cases internal and external bleeding.
The girl died on May 6 and about 30 people who she got contact with are being asked to not get into contact with the public as health officials monitor them for about 21 days.
The 30 people have not yet developed the symptoms but if they do, they will be isolated from the public.
Mbonye said that preliminary investigations have showed that this Ebola virus is similar to the one that broke out in Sudan, thus named Sudan Ebola.
The epicenter of the outbreak is also located along the high way to southern Sudan.
This viral subtype has a human case fatality rate of 60 percent meaning that it will kill 60 percent of the infected people.

WHO H5N1 Indonesia Update

Avian influenza – situation in Indonesia - update 4

13 May 2011 - The Ministry of Health of Indonesia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case is an 8-year old female from West Jakarta district, DKI Jakarta Province. She developed symptoms on 1 April, was admitted to a health care facility on 4 April and referred to a hospital on 8 April. She died on 11 April.

Epidemiological investigation identified a possible risk factor as exposure to wild bird faeces found around the house. In addition, during the week before the child developed symptoms, her mother purchased chickens from a local market.

Laboratory tests have confirmed infection with avian influenza A(H5N1) virus.

Of the 177 cases confirmed to date in Indonesia, 146 have been fatal.