Disease Outbreak News (DON) – Ebola disease caused by Sudan ebolavirus – Uganda (8 December 2022)

Since the last Disease Outbreak News published on 24 November, one new confirmed case of Ebola disease caused by the Sudan ebolavirus (SUDV) was reported on 27 November in Kassanda district. According to information shared by the Ministry of Health, the new case was a stillborn baby delivered at 28 weeks of gestation. The mother was infected with SUDV while pregnant and had since recovered and was in good condition at the time of delivery.

Since the outbreak declaration on 20 September, to 5 December 2022, a total of 142 confirmed cases have been reported by the Uganda Ministry of Health. Among them, 55 deaths occurred leading to a CFR of 39%. In addition, 22 probable cases (all are deaths) have been also reported. The number of cases among healthcare workers (HCWs) remains unchanged since the last DON report, with 19 confirmed cases, and seven deaths.

On 2 December, Uganda health authorities announced that all patients have been discharged from Ebola treatment units (ETUs) and that no more cases are currently hospitalized. As of 5 December, there are no active cases.

As of 5 December 2022, out of 2564 contacts listed, 2167 (84.5%), have completed the 21-day follow-up period. There are currently 36 contacts actively being followed up in four districts, with a follow-up rate of 100%.

Public health response

For further information on the public health response in Uganda by the Ministry of Health, WHO and partners, see the latest situation reports jointly published by the Ministry of Health and the WHO Regional Office for Africa: https://www.afro.who.int/countries/publications?country=879.

Following a Global Outbreak Alert and Response Network (GOARN) Request for Assistance, as of 7 December, there have been 66 offers of support received from 23 partner institutions. Five experts are currently deployed through GOARN in the functions of case management, infection prevention and control and Go.Data implementation. Additional offers of support have been received for the functions of water, sanitation and hygiene (WaSH), epidemiology and surveillance, partner coordination and laboratory capacities. In addition to the GOARN Request for Assistance, partners continue to support the Ministry of Health led response across multiple areas.

WHO held expert consultations to identify candidate therapeutics and vaccines for inclusion in trials throughout October and November 2022 and developed clinical trial protocols for both vaccine and therapeutic candidates against Sudan ebolavirus. The experts recommended that three candidate vaccines should be included in the planned ring vaccination trial: VSV-SUDV from Merck/IAVI, ChAd3-SUDV from the Sabin Institute, and biEBOV from Oxford University/Jenner Institute. On 8 December, 1200 doses of one of these candidate vaccines arrived in the country and will be evaluated in a clinical trial.

WHO is working closely with partners on the ‘accelerated campaign’ in Kampala, carrying out Risk Communication and Community Engagement (RCCE) activities. A festive season RCCE plan was developed to orient RCCE activities in Uganda and prevention in neighboring countries during this period.

WHO continues to support the Uganda MoH and collaborate with partners to implement Infection Prevention and Control (IPC) measures in health facilities to prevent onward transmission including development of a national IPC strategy for SUDV response, implementation of screening, isolation and notification of suspect cases and health worker trainings. The IPC ring approach has been implemented and remains in place to support facilities and communities in the event of a confirmed case is reported.

Preparedness and operational readiness in neighboring countries

WHO has revised the prioritization of the surrounding countries after conducting a risk assessment. In addition to the six surrounding countries (Burundi, Democratic Republic of the Congo, Kenya, South Sudan, Rwanda and Tanzania) that were assessed to be at-risk, five additional countries, with important population movements to and from Uganda, have been included, namely Central African Republic, Djibouti, Ethiopia, Somalia, and Sudan.

The Ministries of Health, WHO, in-country and international partners, are supporting SUDV preparedness and operational readiness activities in these countries.

Summary of the country’s preparedness and operational readiness activities (no new updates for Djibouti, Somalia and Sudan):

*Burundi *continues to strengthen its surveillance at points of entry and is prepositioning infection prevention and control materials at the district level. The MoH has also received international experts in the areas of case management and IPC. Efforts to scale up the functionalities of points of entry and Ebola treatment centers continue as well as public communication and sensitizations.

*Central African Republic *is conducting screening and all alerts are being investigated. The national Emergency Operation Center has been activated, and the national Strategic Preparedness and Response Plan is being finalized.

*Democratic Republic of the Congo *continue to conduct screenings at 42 points of entry including airports, seaports, and ground crossings. Samples have been collected from suspect cases and resulted negative for SVD. The MoH is conducting surveillance, case management and IPC trainings of all staff deployed to at-risk health zones.

*Ethiopia *has been on alert mode since September 2022. The MoH is in the process of conducting the SUDV readiness assessment to identify challenges and gaps to increase its readiness capacities. At international airport, screening activities continue.

*Kenya *is planning on participating in a simulation exercise. In addition, a training course was held on case management at national and subnational levels. The MoH has also completed the SUDV readiness assessment and reports gained capacities in response and will continue scaling up its efforts to address challenges and gaps.

*Rwanda *continues to conduct screenings and investigating all alerts. There are no reports of SUDV cases in the country. The MoH is coordinating readiness activities at national and subnational levels. A trainer-of-trainers workshop will be conducted in the coming week on digitalized community-based surveillance for community health workers. As well, trainings on case management and safe and dignified burial will be in mid-December in high-risk districts.

*South Sudan *reports having conducted screening in Juba and Nimule. All 28 alerts have been investigated and all are negative for SVD. Rapid response teams and health care workers in laboratory procedures are being trained in Juba and Yambio next week.

*United Republic of Tanzania *has increased its readiness activities in the past two weeks by strengthening its call centers, and increasing screenings at points of entry. All alerts have been investigated and are negative for SVD.

On 6 December, WHO Regional Office for Africa in partnership with Africa Centres for Disease Control and Prevention, West African Health Organization, United States Centers for Disease Control and Prevention, UK Health Security Agency, Robert Koch Institute and the Bill and Melinda Gates Foundation, implemented a two-day public health emergency operation centre (PHEOC) simulation exercise with 36 countries in the WHO African Region, to improve readiness to respond to public health emergencies.

WHO risk assessment

On 4 November 2022, WHO revised the rapid risk assessment for this event from high to very high at the national level, and from low to high at the regional level, while the risk remained low at the global level. As of 8 December 2022, WHO’s assessment of risk remains unchanged.

The risk will be continuously assessed based on available and shared information.

WHO advice

Successful SUDV disease outbreak control relies on applying a package of interventions, including case management, community engagement, surveillance and contact tracing, strengthening laboratory capacity, safe and dignified burials.

Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. Implementation of IPC measures in health care (e.g., hand hygiene, training of health workers, adequate personal protective equipment (PPE) supplies, waste management, environmental cleaning, and disinfection etc.) with ongoing monitoring and supervision for implementation is required to reduce risks of health care facilities amplifying the outbreak.

Ensuring the provision of safe and dignified burials, supporting IPC in community settings (including adequate WASH facilities, hand hygiene capacity and safe waste management) and community engagement and social mobilization are essential to prevent and mitigate ongoing transmission.

Upon case identification, early diagnosis and early initiation of supportive treatment has been shown to significantly improve survival. There are currently no proven therapeutics for SUDV but candidate therapeutics are available and due to be used in randomized controlled trials. Care of SUDV patients should occur in safely designed isolation and treatment/care centers with trained health workers.

Establishing active surveillance at points of entry is an essential component of the outbreak response to mitigate the risk of international spread due to the high cross-border mobility between Uganda and neighbouring countries.

There are no licensed vaccines for SUDV, but there are candidate vaccines which are going be used in trials.

WHO advises against any restrictions on travel and/or trade to Uganda based on available information for the current outbreak.

Source: World Health Organization