29 November 2012

Uganda: We Need Proactive Approach to Ebola, Marburg

Photo: New Vision/File
After 42 days of no new cases, the health ministry has declared Ibanda and Kabele free of Marburg (file photo).

Luweero district recently announced the containment of an Ebola outbreak there. Not long before this, there had been a Marburg outbreak in Kabale district which had in turn been preceded by an Ebola outbreak in Kibale district. All these coming within weeks of each other.

Ebola and Marburg are related viruses that cause haemorrhagic fevers, an illnesses marked by severe bleeding (haemorrhage), multiple organ failure and, in many cases, death. Both the Ebola and Marburg viruses are native to Africa, where sporadic outbreaks have occurred for decades.

These viruses live in animal hosts, and humans contract them from infected animals. After the initial transmission to humans, the viruses spread from person to person through contact with body fluids or contaminated sharp objects.

No drug has been approved to treat Ebola or Marburg. People diagnosed with Ebola or Marburg just receive supportive care and treatment for complications. Sero-surveys of Marburg in the general population have shown a prevalence of less than 2%, suggesting that this is a rare but highly lethal disease.

Primary transmission of the virus from the natural reservoir appears to occur only in sub-Saharan Africa and is sometimes followed by secondary person-to-person transmission in both community and health facility settings.

Ebola haemorrhagic fever may be caused by any of four of the five known Ebola viruses, namely: the Zaire, the Sudan, the Taï Forest, more commonly called Côte d'Ivoire Ebola, and more recently the Bundibugyo Ebola viruses. The Zaire virus has the highest fatality rate (up to 90% in some epidemics).

I have not delved into the fifth known Ebola virus, called the Reston Ebola virus, which was discovered in a laboratory because, since the initial outbreak in Reston, Virginia, it has only been found in primates in Pennsylvania, Texas and Siena, Italy.

It is striking that the commonest Ebola viruses that have spread to humans from their animal reservoir are the Zaire, Sudan and Bundibugyo viruses. The first question to ask, thereforem, is: does Uganda have adequate strategies for infection prevention and control at the community and health facility levels?

But my own biggest questions to the ministries of health and scientists in DRC, Sudan and Uganda are: how come we frequently have this common interaction between animal reservoirs and humans? Is it cultural? Is it the hunting patterns? Even then, what has changed in recent years?

Are there specific populations that are frequenting the jungles in Uganda, Sudan and DRC, either in line of duty, in search of a livelihood or food and hence come into close contacts with animal reservoirs? If yes, has there been any sensitization about infection prevention?

Are there any infection control facilities for the communities? Is there more mixing of the populations in DRC, Uganda and Sudan than in the past? Which are these populations groups that could be starting these outbreaks?

I do not as yet have the answers to these questions, but surely we need to seriously start asking ourselves even tougher questions! WHO's revised international health regulations require that states establish core capacities to address such emergencies at national, sub-national, health facility and community levels, as well as at border crossings.

Is Uganda compliant with the requirements of the revised international health regulations? The era has passed in which we merely implement reactive instead of proactive approaches.

We cannot continue addressing one crisis after another and go into a slumber when it has blown over only to wake up to manage another crisis. Something needs to be done, and done urgently!

The author is the former Head of the Epidemiology and Surveillance Division at the Uganda ministry of health where he led the investigation and outbreak response to several outbreaks, including Ebola and Marburg.

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