EBOLA OUTBREAK IN UGANDA

Ebola in Uganda – update

3 AUGUST 2012 - The Ministry of Health in Uganda has reported a cumulative number of 53 suspected cases of Ebola haemorrhagic fever including 16 deaths. Of these, five cases have been laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe (this includes three fatal cases and two cases currently being treated in the isolation facility).

Currently 32 cases are admitted to an isolation facility in Kagadi hospital, Kibaale district, and a total of 312 contacts were identified, of whom 253 are being closely followed-up. So far all samples from other districts have tested negative for Ebola, indicating that there has been no expansion of the outbreak beyond Kibaale District. However a clinical officer who attended to a case in Kibaale district was transferred to Mulago Hospital in Kampala for treatment but later died.

Among the contacts being monitored daily are the seven health workers who attended to the fatal case transferred to Mulago Hospital, none of them has so far developed symptoms of the disease.

Response

The Government of Uganda is continuing to work with a number of partners to control the outbreak.

At the central level the Prime Minister convened a Ministerial Task Force, chaired by the Minister of Health, to facilitate and coordinate the outbreak response.

In Kibaale district, the local health authorities are working through its task force with several partners to mobilize resources and supplies. These partners include WHO, US Centers for Disease Control and Prevention (US CDC), the Uganda Red Cross Society (URCS) and Médecins Sans Frontières (MSF). WHO has deployed logisticians and supplies, including personal protective equipment (PPE) to Uganda.

Required funds for local operations are being mobilized. Additional support is being received from the EMESCO Foundation (a local NGO), Members of Parliament from Kibaale district, the Infectious Diseases Institute (IDI) and the Uganda Red Cross Society (URCS).

Epidemiologists from WHO and US CDC have arrived in Kibaale district and are supporting the response by screening and triaging suspected cases of Ebola haemorrhagic fever. WHO is coordinating with Global Outbreak Alert and Response Network partners.

With the support of MSF, the construction of a new isolation facility in Kagadi, Kibaale district, is expected to be completed today and additional wards will open to address the increasing number of suspected cases. MSF, IDI and EMESCO are providing food to patients in the isolation facility and have committed to continue to do so for the next two weeks.

For active surveillance and contact tracing in the communities, arrangements with local authorities are being made to increase the number of mobile teams and ambulances.

With regard to social mobilization, the Uganda Red Cross Society has trained 62 teams of Red Cross volunteers and village health teams to conduct social mobilization and public awareness activities. Additionally, public announcements are being disseminated in 11 local languages on 20 radio stations. WHO is facilitating the deployment of a medical anthropologist to assist in these activities.

Neighbouring countries

A number of countries neighbouring Uganda have taken proactive steps to enhance their surveillance to detect and respond to cases of Ebola haemorrhagic fever.

In Kenya, two rumoured suspected cases have since been reported and investigated. Both cases have tested negative for Ebola.

The South Sudan Ministry of Health, in collaboration with WHO, has issued guidance to the general public and has activated a national task force to undertake enhanced surveillance as population movement and trade between South Sudan and Uganda are high.

WHO does not recommend that any travel or trade restrictions are applied to Uganda.

OUTBREAK NEWS 9JULY2012

Undiagnosed illness in Cambodia - update

9 JULY 2012 - As part of the continuing investigations into the undiagnosed illness, the Ministry of Health of the Kingdom of Cambodia is finalizing the review of all suspected hospitalised cases. This final review added an additional two cases between April to 5 July 2012, making the total number of children affected to be 59. Of these, 52 have died.

The age of the cases range from three months to 11 years old, with the majority being under three years old. The overall male: female ratio is 1.3:1.

Laboratory samples were not available for the majority of the cases as they died before appropriate samples could be taken.

Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients.

Additionally, a number of other pathogens, including dengue and streptococcus suis were identified in some of the samples. The samples were found to be negative for H5N1 and other influenza viruses, SARS and Nipah.

Further investigations into matching the clinical, laboratory and epidemiological information are ongoing, and are likely to be concluded in a few days.

WHO and partners, which include lnstitut Pasteur du Cambodge and US Centers for Disease Control and Prevention, are assisting the Ministry of Health with this event.

The Government is also reinforcing awareness of good hygiene practices to the public, which includes frequent washing of hands.

Some facts on hand foot and mouth disease:

Hand foot and mouth disease (HFMD) is a common infectious disease of infants and children. The symptoms commonly observed include fever, painful sores in the mouth, and a rash with blisters on hands, feet and also buttocks.

HFMD is most commonly caused by coxsackievirus A16, which usually results in a mild self-limiting disease with a few complications. HFMD is also caused by enteroviruses, including enterovirus 71 (EV71) which has been associated with serious complications in certain groups, and may cause deaths.

HFMD mainly occurs amongst children under 10 years old. The usual period from infection to onset of symptoms is 3-7 days.

The disease usually begins with fever, poor appetite, malaise, and frequently with a sore throat. One or two days after fever onset, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums and inside of the cheeks. A non-itchy skin rash develops over 1-2 days with flat or raised red spots, some with blisters. The rash is usually located on the palms of the hands and soles of the feet, and may also appear on the buttocks and/or genitalia. A person with HFMD may not have symptoms, or may have only the rash or only mouth ulcers. In a small number of cases, children may experience a brief febrile illness, present with mixed neurological and respiratory symptoms and succumb rapidly from the disease.

HFMD virus is contagious and infection is spread from person to person by direct contact with nose or throat discharges, saliva, fluid from blisters, or the stool of infected persons. Infected persons are most contagious during the first week of the illness but the period of communicability can last for several weeks. HFMD is not transmitted from pets or other animals. HFMD should not be confused with the different disease in animals called foot-and-mouth disease.

Presently, there is no specific treatment available for HFMD. Patients should drink plenty of water or other liquids and may require treatment of the symptoms.

Health care providers are advised to treat patients according to their symptoms and to refrain from using steroids.

OUTBREAK NEWS 6JULY2012

Avian influenza – situation in Indonesia – update

6 JULY 2012 - The Ministry of Health of Indonesia has notified WHO of a new case of a human infection with avian influenza A(H5N1) virus.

The case is an 8 year-old female from the province of West Java. She developed fever on 18 June 2012 and then travelled on vacation the following day to Singapore, where she saw a private physician who diagnosed pharyngitis on 20 June. The case returned to Jakarta on 24 June and was still feeling unwell with coughing, decreased appetite and vomiting. Her family took her for treatment to the local hospital. Her condition deteriorated and she was transferred to intensive care, but died on 3 July. Infection with avian influenza A(H5N1) virus was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health.

Epidemiological investigation has been conducted in the case’s neighborhood and nearby market, which revealed that the case had contact with poultry when she went to a market with her father to buy live chickens. She was present when the chicken was culled in the designated part of the market.

The Ministry of Health in Singapore has been informed about the case under the International Health Regulations.

To date, the total number of human influenza A(H5N1) cases in Indonesia is now 190 with 158 fatalities.

OUTBREAK NEWS 7JUNE2012

Avian influenza – situation in Egypt – update

7 JUNE 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

The case is a four year-old female from Kfr -Elsheikh governorate. She developed symptoms on 25 April 2012, was admitted to a hospital on 26 April 2012 and received oseltamivir treatment upon admission. She was discharged from the hospital on 7 May 2012.

Investigations into the source of infection indicated that the case had exposure to backyard poultry.

The case was confirmed by the Central Public Health Laboratories and the Naval Medical Research Unit 3 (NAMRU-3), a WHO reference laboratory.

To date, a total of 168 cases have been confirmed in Egypt, of which 60 have been fatal.

TRAVEL VACCINE REQUIREMENT

Travel vaccine are required by people traveling to other countries for

• Business
• Studies
• Leisure
• Adventure
• Official work

Depending upon current medical and epidemiological situations at the destination.

HAJJ TRAVEL

This year the Hajj,  the pilgrimage to Mecca and the largest annual gathering in the world, will take place from October 24th  to 29th.  It is estimated that over 3 million Muslims are planning to participate in the upcoming Hajj.

Travelers are advised to plan ahead and see a travel health specialist at least 6 weeks prior to departure.  Because of the large number of people gathering there is an increased risk for certain infectious diseases such as influenza, tuberculosis, meningococcal disease and gastrointestinal infections.  Furthermore, Saudi Arabia requires proof of certain vaccines when entering the country.

Last year we saw a record number of Hajj travellers receive their required Hajj vaccinations at our clinic .  This year, we are happy to offer pilgrims a Hajj special.

Please call  09873691351 to find out more about our special Hajj rates or to make an appointment for your vaccinations. At ITVC,  your travel health experts are up-to-date on the latest requirements and we carry the meningococcal vaccine required for entry into Saudia Arabia.

 As in years past, pilgrims will most likely need:

• Proof of Meningococcal Vaccine:  vaccine needs to be given no less than 10 days and no more than three years before arrival in Saudi Arabia.  All adults and children over two years of age must be vaccinated with the meningococcal quadrivalent vaccine (serogroups A,C, Y and W135).  Routine childhood meningococcal vaccine generally used in INDIA is NOT sufficient for entry.
• Flu Vaccine is highly recommended
• Routine childhood vaccinations should be up-to-date
• Also recommended are vaccinations against Hepatitis A and B, Measles, Mumps, Rubella and Typhoid Fever (available at ITVC with a travel consult).
• Depending on your point of departure, you may also need to show proof of Yellow Fever and Polio vaccinations.

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