Ebola detected in Uganda's capital city

[Catbird]

Hmmmm.

This is a tweet from a free-lance journalist who works in Uganda & Sudan.

"@ArneUganda

uganda's defence minister expected at press conference about #ebola."

The Ugandan Ministry of Health has held a press conference every afternoon this week. But, from what I can find, this seems to be the first time that the defense minister will be involved. Makes me wonder if they're going to use the military for containment or maybe transportation support. Or... ?

This new article from Uganda Daily Monitor repeats some of the same info about problems at the hospital:

“The facilities are not okay,” says Steven Byaruhanga, the chairperson of the district Ebola taskforce. “The incinerators we don’t have… electricity is on and off, the pump for water is not functioning, the sewer system is also broken down, there’s so many problems.”

But this is newly specific info and it doesn't sound good:

“There are so many cases reported but we could not move because there was no fuel,” Byaruhanga said.

Resources have been coming in piecemeal. According to Byaruhanga, World Vision this week donated 400 litres of fuel to fill in the gap, while Centres for Disease Control and the Red Cross have brought in thousands of protective suits. But as reports of suspected cases continue to increase into the district’s sub counties, a lack of the disposable wear has hindered containment efforts.

It's 7am in Kampala now, so perhaps there will be some new info coming out about the possible cases at the Mulago hospital.

[CanadaSue]

http://www.calgaryherald.com/health/...126/story.html


I'm not so sure.

[Pablo Escobar]

From the article, patient zero was a three month old infant. Since it was long thought that the reservoir for Ebola was monkey, hunted and eaten by other patient zeros, this time, that cannot be the case.

The fruit bat reservoir theory, looks much better. They already harbor the filo viruses asymptomatically

[Pablo Escobar]

I'm thinking direct transmission, saliva to saliva, by fruit bats, who land at night, and are attracted to open sleeping human mouths, as some species are nectar eaters, and as they lap up drool from thei sleeping victims who had remains of their last midnight snack around their mouth.

In the babies case, mothers milk.

A true kissing disease.

[NowVoyager]

Originally Posted by Pablo Escobar

From the article, patient zero was a three month old infant. Since it was long thought that the reservoir for Ebola was monkey, hunted and eaten by other patient zeros, this time, that cannot be the case.

The fruit bat reservoir theory, looks much better. They already harbor the filo viruses asymptomatically

Both bats and monkeys are mobile, though I would assume that bats would have a much wider range. With a baby being patient zero, your theory makes frighten sense.

Originally Posted by Pablo Escobar

I'm thinking direct transmission, saliva to saliva, by fruit bats, who land at night, and are attracted to open sleeping human mouths, as some species are nectar eaters, and as they lap up drool from thei sleeping victims who had remains of their last midnight snack around their mouth.

In the babies case, mothers milk.

A true kissing disease.

And that would help explain the locations of victims who had not had contact with one another.

[Catbird]

Some updates.

"Prisoner with suspected case of Ebola escapes from hospital in Uganda"

"One of five prisoners receiving treatment for a suspected case of Ebola virus in Uganda escaped overnight Friday from the hospital at the center of the outbreak, a health official said.

"Should his results come back and he is positive, that causes us a lot of worry. So right now, we have resolved that the remaining prisoners will be cuffed on the beds for fear that they might also escape," said Dr. Jackson Amune, commissioner at the Ministry of Health.

The inmates from Kibaale prison are among 30 people at Kagadi hospital with suspected cases of the virus. Two additional patients have confirmed cases, according to Doctors Without Borders.

The prisoners have been showing Ebola-like symptoms of vomiting, diarrhea and fever, Dr. Dan Kyamanywa said Thursday.

"We do expect the number of suspected cases to increase," Kyamanywa said. "

Ugandan media New Vision reports another death.

"ONE more person is suspected to have died of the deadly Ebola virus in Kagadi hospital, while other two patients have been admitted to the hospital’s isolation ward today.

“The patient had been admitted in the isolation ward, with signs of having contracted Ebola. But, he unfortunately died in the evening, on arrival in the isolation ward,” Dr. Dan Kyamanywa, who is Kibaale’s district health officer, revealed.

This brings the death toll to 17, and the suspected patients admitted to 31, according to Dr. Kyamanywa."

[Oric]

Originally Posted by Pablo Escobar

I'm thinking direct transmission, saliva to saliva, by fruit bats, who land at night, and are attracted to open sleeping human mouths, as some species are nectar eaters, and as they lap up drool from thei sleeping victims who had remains of their last midnight snack around their mouth.

In the babies case, mothers milk.

A true kissing disease.

This scenario makes it very difficult to have frequent attacks of Ebola (luckily)

[Pablo Escobar]

It does explain why outbreaks are few and far between. While Marburg has been positively found in fruit bats, this particular strain of Ebola has not.

It could be a simple as only a specific species of fruit bat, that only feeds on a specific jungle fruit, that has to be eaten right before sleep, and sleep outside or with windows open. Maybe only juvenile bats, and therfore breeding cycles play a role, as a larger adult bat would fly in and attrack attention, or be afraid of an animal as large as a human.

It would be interesting to see the dates of the various patient zeros to see if a there is a pattern that would lead to a candidate fruit or fruit bat.

Researchers have looked for half eaten fruit (by bats), and then finished off by a human scavenger, with the hope that the virus doesn't die between fruit being dropped, and human picking up, a scenario that is much harder to justify.

[Catbird]

The timeline and transmission history of cases may be a little iffy. A 3 month old infant, considered to be the index case, was the first to die but her mother was also ill at the same time as the baby.

NCB News:

"..."The first case appears to have been a 3-month-old girl whose mother was also sick. When the girl passed away, her family tried to find out what she had died from but couldn’t find the answer — though there were rumors of witchcraft and magic," according to Olimpia de la Rosa, emergency coordinator for Doctors without Borders...

Fifteen of the 65 people who attended the baby’s funeral became sick..."

Some of the people who attended the funeral became ill but there's also another possible path of transmission.


New Vision:

"...the affected families initially thought it was either witchcraft or evil spirits.

As a result they took the first patients to Owobusubozi Bisaka’s shrine for prayers. Bisaka is the leader of a religious sect called Faith of Unity. Two patients died in that shrine."

According to a Ugandan MoH spokesperson, the deaths at the shrine were the first.

WSJ:

"The outbreak started and spread first within one family, said Rukia Nakamate, a spokeswoman for the Ugandan Ministry of Health. Initially, locals believed the illnesses were the result of an attack of evil spirits rather than one of the deadliest viruses known to man, and took the patients to a Christian religious shrine for prayers, where the first two victims died, she said.

"Some of the victims came into contact with many people, including churchgoers," she said."

So, it's possible that the mother of the 3 month old infant was actually infected first and passed it on to her baby. Then people were exposed at the shrine, which is probably the one located in Kagadi, in the Kibaale district. (See "Healing Place of God of All Armies"). And then more people were exposed at the funeral of the baby.

I think the delay in identifying the disease has muddied the waters to the point that it's impossible to accurately trace a possible source for the original infection.

ETA: Just read this - an article from the Ugandan media, dated July 27th.

"The Ministry of Health is investigating a strange and contagious disease that has broken out in Nyamarunda sub-county in Kibaale district.

The Director General of Health Services Dr. D.K.W Lwamafa says surveillance reports from the investigations undertaken by the Ministry of Health, the district and international partners indicate that 21 people have been affected with 13 deaths since June 21.

The cases have been reported largely from one family in Nyansigwa village in Nyamarunda parish. "

So, although the 1st case was officially reported on July 6, the outbreak actually started in June.

[Kassy]

Originally Posted by Pablo Escobar

From the article, patient zero was a three month old infant. Since it was long thought that the reservoir for Ebola was monkey, hunted and eaten by other patient zeros, this time, that cannot be the case.

The fruit bat reservoir theory, looks much better. They already harbor the filo viruses asymptomatically

This assumes the report is totally accurate which it might not be.

Infants at three month do not have a well develop immune system so the infant might get it from a parent and succumb to the disease first thus becoming patient zero.

[mordan]

I think they have it covered. If this virus was the one I think we would know it by now.
From past experience it stands little chance when the strike team arrives.
Maybe a bit of an edge with a reduction of mortality and presentation. Seems though it needs to go through another iteration or two to sneak through.

[mordan]

Kenya

Murang’a district hospital is on high alert after a man was admitted exhibiting symptoms similar to those of ebola. The man later died sparking panic among local residents. Murang’a north medical officer of health ephantus maree has called for calm in the area urging residents to allow medical practitioners to establish what the man was suffering from.

here

[mordan]

Tanzania

Ebola patient allegedly diagnosed in Kagera


here

[Catbird]

Coverage of this outbreak in the Uganda media has dropped to almost zero. I suspect the word has gone out to downplay things as there are reports that the ecotourist income is taking a big hit.

There was one interesting article I found at UG Pulse, published 1am, Aug 4th.

"The World Health Organization has sent a team of ten experts to Uganda to help fight the Ebola epidemic.

The WHO Country Representative Dr. Joaquim Saweka says these experts are from USA and Geneva and their major task is to train Ugandan medical personnel on how to handle and treat the epidemic.

He says that by today some of them will be off to Kibaale district to assess the situation on ground.

Saweka has also re-affirmed the organization’s commitment to help the country in times of health disaster and advised government not to restrict movement since World Health Organization is working closely with the ministry of health to control the spread of Ebola."

The following are some excerpts from the WHO update from Aug. 2nd. This is the latest official info that I can find.

"Ebola Outbreak in Uganda (As of 02 August 2012)"

"As of 2 August 2012, 53 suspected and confirmed cases, including 16 deaths have been reported in Kibaale district, Uganda. A total of 312 people who came into contact with cases are being followed up. To date, there are no confirmed Ebola cases outside Kibaale district.

...Kibaale hospital has established an isolation ward for suspected, probable and confirmed cases. Currently, there are 32 cases admitted on the isolation ward. However, due to the increasing number of patients, a second isolation ward and a convalescent ward for admitted cases that have tested negative to Ebola have been opened at Kagadi hospital. The new isolation center constructed by MSF will begin operations on 4 August 2012. Additional staff from other districts with experience of managing previous Ebola outbreaks have been deployed to support and manage the isolation centre."

A spokesman for Doctors w/o Borders (MSF) has said that the treatment center being constructed will provide capacity to treat 50-60 patients.

Some further detail on the possible case in Tanzania. A couple of Tanzanian blogs and forums have posted a report from Radio 1 saying (Google translated):

"The disease is believed to enter the village mentioned in the name of Longo Karagwe district.

...first patient admitted in the hospital room of Karagwe in Kagera ... the hospital's chief doctor reports!
Information shortly [breaking news] from ITV / Radio One is a child of six years in Karagwe is seen to have all symptoms of Ebola disease. Anavuja blood, ears and nostrils. Also fever. Her mother baby, nurse and child were placed in special care."

[Catbird]

Possible further info on the Tanzanian report. This tweet is from a doctor who is also in the Tanzanian Parliament.

"Faustine Ndugulile ‏@DocFaustine

Checked with MOH. The suspected #Ebola case in Karagwe could have been a false alarm. The child is doing well, samples taken 4 verification "

[Malcolm]

Originally Posted by Pablo Escobar

From the article, patient zero was a three month old infant. Since it was long thought that the reservoir for Ebola was monkey, hunted and eaten by other patient zeros, this time, that cannot be the case.

The fruit bat reservoir theory, looks much better. They already harbor the filo viruses asymptomatically

Those suckers must fly about 80 Klm. every night just for a feed of bananas .
Are we screwed if they carry it. In Australia they carry everything in the book including.......... rabies

[NowVoyager]

Originally Posted by Malcolm

Those suckers must fly about 80 Klm. every night just for a feed of bananas .
Are we screwed if they carry it. In Australia they carry everything in the book including.......... rabies

Bats can carry rabies here in the US, too. They're a mammal, a flying one and cool in their own way, but a mammal nevertheless and that's all rabies needs as a host.

[AndreaCA]

http://allafrica.com/stories/201208080238.html

A total of 29 people in Kibaale district, who were initially suspected of having contracted the deadly Ebola virus, have been cleared to return home, the health ministry has said.

Of the 36 cases that are in isolation, only three have been confirmed to have the Ebola virus, the health ministry spokesperson, Rukia Nakamatte, told New Vision online

She said health experts are still monitoring the condition of those that will be discharged before allowing them to return home. However, nine were discharged on Monday, New Vision has learnt.

"We are finalising plans to allow 29 of the cases to return home because they tested negative for the Ebola virus," she said.

Nakamatte explained that while no new cases have been recorded, the ministry surveillance team is still on high alert.

Nakamatte also disclosed that health experts were monitoring 398 cases believed to have come into contact with people who died of Ebola. Of these, 84 have passed the 21- day period during which signs of infection would have shown, although they are still being monitored.

---------- Post added at 11:08 AM ---------- Previous post was at 11:07 AM ----------

http://allafrica.com/stories/201208080878.html

THE headlines lack subtlety: "Uganda races to stop spread of Ebola virus", "Ebola prisoner escapes...", "Outbreak of Ebola in Uganda kills 13".

CNN, BBC, and Al Jazeera, all transmit stark images of medical personnel wearing white protective outfits hunting down victims of the virus in-between their coverage of the London Olympics.

But the numbers and the media attention just doesn't add up. The intense media focus is for a disease which has resulted in 859 deaths across Africa between 1976 and 2003. And ironically, no comparable alarm is raised when we are confronted by other shocking public health realities.

According to the World Health Organisation (WHO), one-third of the world's population has tuberculosis, and 25 million people are living with HIV/AIDS in sub-Saharan Africa. The UN predicts that there will be 50 million deaths from HIV/AIDS in Africa by 2025.

Cancer, today, kills more people globally than HIV/AIDS, tuberculosis and malaria combined, which according to WHO (2010) figures, is over eight million people per year.

Still, over one million people die per year from malaria in Africa alone one million per year! These are not just depressing statistics but should generate outrage in a world, which has the resources to do something about it.

[NowVoyager]

JMO but the mental images that 'Ebola' evokes is so horrific that it staggers the mind.

And whether right or wrong, AIDS was taken up as a cause by many who had considerable media power........ TB, malaria? Sorry, but those deadly diseases lack the level of 'celebrity status' to get publicity that gets them funding.

The sad reality is the funding to study / find a cure and or funding treatment seems too often be tied into who is affected and who jumps on their bandwagon.

Suffering it seems is viewed differently when those affected are not connected

[AndreaCA]

I agree, Now. Ebola scares the snot out of me.

I just hadn't seen any action on this thread in several days so I went searching to see what was up. These are the latest headlines I could find concerning this outbreak.

Gosh, ain't it great that there's nothing to worry about?!? *sarcasm off*

I thought that the second article I posted was particularly snotty. I agree that we need to keep things in perspective, but . . .

[Malcolm]

What realy scares the snot out of me is that Avatar "Andreaca"

[Catbird]

I've still been following this, although I haven't posted more about it because the info that I'm seeing is more confusing than informative.

The numbers and timeline as presented by different media sources just don't add up. For a good summation of reports, check this blog.

[CanadaSue]

What Catbird said - numbers don't add up & I'm having 'issues' with progression of the disease.

[Kassy]

I forgot to post yesterdays ProMed update quite some info there.
Site is down now (some database error).

Catfish thanks for that link, been a while since i saw anything by Treyfish!

[Catbird]

Originally Posted by Kassy

I forgot to post yesterdays ProMed update quite some info there.
Site is down now (some database error).

Catfish thanks for that link, been a while since i saw anything by Treyfish!

No problem Kissy!

(couldn't resist )