On 20^th September Uganda officially declared an outbreak of the Sudan strain of Ebola Virus Disease in Mubende District. Although according to the World Health Organization the Sudan strain historically has lower levels of transmission, infections and deaths compared to the Zaire strain, the country has cited a number of cases in a short time period. Measures are currently being taken by the Ministry of Health, Uganda Virus Research Institute (UVRI) and partners to manage identified cases and curb the spread.

The MRC/UVRI/LSHTM Uganda Research Unit Director Prof. Pontiano Kaleebu, who is also the Director of UVRI shared insights into the on-going national strategy to contain the spread of the Ebola Virus Disease.

What is known about the latest outbreak of Ebola in Uganda?

This is Ebola Sudan and it is not the first time that we have dealt with it in Uganda. In the 2000’s we had an Ebola outbreak in northern Uganda, in Gulu, where we had about 425 cases and of these about 224 individuals passed away. So it had a mortality rate of more than 50%.

Our public health approach in terms of interventions has improved over time. Unlike previously, our laboratory is well set up and we can quickly get results. The Ministry and its partners have set up village teams comprised of local councils and health facilities, which are able to relay information quickly, share alerts, and we have more teams on the ground including surveillance teams and those to transport samples. In addition, the national task force, the public health emergency operating center, the laboratory and case management pillars have been set up and hold related meetings regularly. This way, our preparedness overtime has improved to ably handle the situation. There are also partners on the ground such as WHO, MSF and USA CDC.

How are risks to public health being managed?

The beginning of an Ebola outbreak is always difficult. Early infections are not easily differentiated from other infections, except later when people start showing symptoms like vomiting, diarrhea and un explained bleeding. By this time contacts, such as families and others are being infected. However, there’s no cause for alarm among the general public. There is only need for extra caution and attention to the Ministry of Health guidelines that have been issued. These apply to all Ugandans and will help to curb the spread.

For now, major measures are in Mubende and surrounding areas where people have been directed to immediately inform health workers when there’s a suspected case, not to participate in burials without health workers or people from the Ministry of health and to limit big gatherings, for now.

Major focus is on identification, isolation of cases and contact tracing led by the surveillance and case management teams.  UVRI working with USA CDC are mobilizing mobile labs to facilitate quick results and early intervention.

As a Unit, we are monitoring the situation to ensure support is offered where necessary. We are also taking steps to ensure the safety of all our teams both in Entebbe and in field stations across the country as they continue to conduct their duties.

What is the way forward?

One of the main concerns at this time is patient care. Supportive management is the key to avoiding death, treating symptoms, and conditions that result from loss of blood and body fluids. Proper and quick management of these patients is imperative for their survival. We are right now managing symptomatically, rehydrating if there is need, if they have fever or need transfusions, among other things.

At the back of all this however remains the key question, can we do a little more? There is currently no specific drug for the Sudan strain, but there are drugs that work against these RNA viruses that have been used before in more resourceful countries and are worth the interest. We do not have the Johnson and Johnson vaccine which contains both Ebola Zaire and Ebola Sudan strains, but we are working with the Ministry on a probable option that will be tested soon.

Ebola testing under the current outbreak is  being led by the Uganda Virus Research Institute. Key updates and resources from the Ministry of Health on preparedness and response can be accessed through the Ministry website: Ebola - Ministry of Health | Government of Uganda.