Last month, Uganda reported a case of Ebola that evoked fears of another deadly outbreak across the region.
Since the declaration of the Ebola outbreak in Uganda on September 20, the Ugandan Ministry of Health has confirmed 43 cases of Ebola and reported 29 deaths (nine confirmed deaths from the disease and 20 probable).
Health authorities say the outbreak is caused by a rare variant of the virus known as the Sudan strain, which raises several medical and operational challenges for the teams on the ground.
Doctors Without Borders says the spread of the disease requires the rapid development of effective detection and treatment solutions in a country that has been relatively free of epidemics for the past decade.
These are four things you need to know about the Ebola outbreak in Uganda, according to Doctors Without Borders:
Are vaccines available to tackle the epidemic?
There is no vaccine for the Sudan strain of the virus, which is responsible for the outbreak in Uganda. Discussions are under way at the World Health Organization to determine which candidate vaccine could be deployed in a new clinical trial, with a view to potentially getting it licensed for use.
All health organisations involved in the response will have to do without the vaccine until trials have been conducted and an effective vaccine has been found. As with the clinical trials conducted for the Johnson & Johnson vaccine on the Zaire strain in the Democratic Republic of Congo in 2019, we are ready to assist in this research.
Is there a medical treatment available for the Sudan strain of Ebola?
Clinical trials conducted in the DRC from 2018 to 2019 identified treatments based on the use of monoclonal antibodies, which are specific to a virus strain: Mab114 and regn-eb3. These allow a significant improvement in a patient’s chances of survival.
However, the antibodies are not effective against the Sudan strain of the disease. In the absence of this tool, treatment involves managing the symptoms of the disease and providing intensive care (including compensating for fluid loss, supplying oxygen, monitoring blood and cardiac parameters and so on) to improve patients' chances of survival.
What kind of Ebola treatment facilities are available in Uganda?
During an Ebola outbreak, it is important that the medical response take place close to the affected communities.
"We know that the earlier patients receive medical attention, the greater their chance of survival,” says Dr Guyguy Manangama, MSF's deputy head of emergency programmes. “As the initial symptoms of Ebola are not distinctive, being similar to those of malaria or other febrile viruses such as typhoid, the main issue is rapid access to information, diagnosis and care. In Ebola outbreaks, too many people arrive at health centres with advanced disease or even die at home, infecting others in the process. This is what we need to avoid."
MSF teams plan to support the response in Uganda by setting up small centres in affected sub-districts such as Madudu (the epicentre of the outbreak) and we have set up a 36-bed isolation unit with intensive care capacity for suspected and confirmed patients in Mubende.
In past outbreaks, patients were often taken straight to large case-management centres outside their communities, which in many instances led to rumours circulating within the community, causing hostility towards health workers and the rejection of the response.
What is known about the spread of the epidemic?
In the current outbreak, cases have been confirmed in five districts of Uganda, so patients and contacts will need to be identified and followed up across a relatively large area.
Although the outbreak was declared on September 20, the affected region recorded several suspected deaths potentially linked to the disease as early as August.. As is often the case at the beginning of an Ebola outbreak, case-finding and contact-tracing lag behind the spread of the epidemic. It is vital to reconstruct the early stages of the epidemic as accurately as possible in order to screen people for the disease and provide medical care in the right locations.
It is also essential that people in affected areas have knowledge and understanding of the disease and are co-operative and involved in the response. Community-based surveillance activities and contact-tracing are needed to rapidly identify potentially infected people. Once identified, they and their families need to access appropriate health care or isolate themselves for 21 days. To facilitate this, social and economic barriers (such as the cost of transport to health centres, or costs linked to not being able to go out to work) need to be removed.
IT tools can also facilitate real-time monitoring of the epidemic. During the 2018 to 2020 Ebola outbreak in the DRC, Epicentre (MSF's epidemiological wing) developed new tools to facilitate the co-ordination of epidemiological activities, including tools for systematic monitoring and collection of patient data, automated reports, and a web-based platform to visualise data on case management and the evolution of the epidemic.