2022–2023 Uganda Ebola outbreak
Spread of Ebola in Uganda
DiseaseEbola
Virus strainSudan ebolavirus
LocationWestern Region and Central Region, Uganda
Date20 September 2022–10 January 2023
Confirmed cases164
Deaths
77

The 2022–2023 Uganda Ebola outbreak was an outbreak of the Sudan ebolavirus, which causes Ebola, from 20 September 2022 until 10 January 2023 in the Western and Central Regions of Uganda. Over 160 people were infected, including 77 people who died.[1] It was Uganda's fifth outbreak with Sudan ebolavirus.[2] The Ugandan Ministry of Health declared the outbreak on 20 September 2022.[3] As of 25 October 2022, there were confirmed cases in the Mubende, Kyegegwa, Kassanda, Kagadi, Bunyanga, Kampala and Wakiso districts.[4][5][6][7][8] As of 24 October 2022, there were a total of 90 confirmed or probable cases and 44 deaths.[9] On 12 October, the first recorded death in the capital of Kampala occurred;[10] 12 days later on 24 October, there had been a total of 14 infections in the capital in the last two days.[11] On 11 January 2023 after 42 days without new cases the outbreak was declared over.[12]

Background

Uganda has previously had four outbreaks of Sudan ebolavirus; one outbreak in 2000 and 2011 and two outbreaks in 2012, as well as an outbreak of Bundibugyo virus disease in 2007 and an Ebola virus disease outbreak in 2019.[7]

Date Virus Human
cases		 Human
deaths		 CFR Description
Oct 2000–Jan 2001 SUDV 425 224 53% Occurred in the Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with Sudan virus infection were attending funerals of case-patients, having contact with case-patients in one's family, and providing medical care to case-patients without using adequate personal protective measures.[13] Victims included Matthew Lukwiya.
Dec 2007–Jan 2008 BDBV 149 37 25% Occurred in the Bundibugyo District in western Uganda. This was the first identification of the Bundibugyo virus (BDBV).[14][15]
2011–Aug 2012 SUDV 32 22 69% Occurred in the Kibaale District.[16]

Epidemiology

No human outbreaks of the Sudan ebolavirus have been reported in the last 10 years.[17] Given that this is significantly longer than any reported case of persistent infection in human survivors of ebolavirus infection,[18] this lends weight to the theory expressed by Kyobe Henry Bbosa, Ebola incident commander at Uganda's Ministry of Health, that this outbreak was caused by an unobserved spillover event from a wildlife reservoir.[19] However, this putative spillover remains unidentified. The first cases were detected in the Mubende District among people living around a gold mine. Whilst the mobility of gold traders has been suggested to play a role in onward transmission from the site where the outbreak was first detected,[20] no direct evidence of this has been forthcoming. As of 20 October, the eight most recent Ebola cases had no known contacts with known patients, suggesting incomplete contact tracing and unknown chains of transmission.[21]

As of 5 November, a total of 132 confirmed cases had been identified; 39% of confirmed cases died, a total of 61 patients with confirmed Ebola have recovered from illness and been discharged. Cases have been found in seven districts including Mubende, Kassanda District, Kyegegwa District, Bunyangabu District, Kagadi District, Wakiso District, and the capital of Kampala.[22] As of 8 November, 23 Ebola cases had been confirmed among pupils, hence education minister Janet Kataha Museveni announced schools across Uganda would close 25 November, two weeks before the scheduled end of term.[23]

Timeline

Mubende District in Uganda

On 11 September, the index case of the outbreak, a 24-year-old man in a village of the Mubende District developed symptoms of Ebola and died on 19 September.[7]

On 20 September, the Ugandan health authorities declared an outbreak of Sudan ebolavirus in the Mubende District.[7][24]

By 25 September, cases had been confirmed in Kyegegwa District and Kassanda District.[25] On the 29th September Kagadi District confirmed its first case.[5]

On 30 September, there were 38 confirmed cases and eight total deaths in confirmed cases.[26]

On 1 October, physician Mohammed Ali, one of six infected health workers who treated the index case, died as the first health worker.[21][27]

On 2 October, there were 41 confirmed cases and nine total deaths in confirmed cases. Furthermore, the Bunyanga District had its first confirmed case.[28]

On 5 October, there were 43 confirmed cases and 29 reported deaths.[29]

On 10 October, there were 63 confirmed or suspected cases and 29 reported deaths.[20]

On 12 October, the first confirmed case and death in the capital of Kampala occurred, although he was believed to have fled from an already infected district.[10][30]

On 20 October, there were 60 confirmed cases and 44 reported deaths.[21] On the 22 October Wakiso District had confirmed its first case.[31]

On 24 October, there were 90 confirmed cases and 28 confirmed deaths, with 14 confirmed cases reported in Kampala in the previous 48 hours.[32]

On 26 October, the Ugandan Ministry of Health confirmed that there were 6 cases in school-aged children who attended classes at 3 different schools in the Rubaga Division of Kampala. One of the children died from the disease and 170 contacts were identified from these cases.[33][34]

On 2 November Masaka District confirmed its first case and death after a 23-year-old woman came to Masaka from Kampala to be looked after by her parents and was admitted to a hospital on the 31 October and later died after being transferred back to Kampala.[35]

On 13 November Jinja District confirmed its first case and death after a 45-year-old man died and was linked to a probable case connected to the Rubaga Division of Kampala.[36]

Districts Cases Deaths Last update
Mubende District 64 + 19 probable 29 + 19 probable 11 January 2023[4][37]
Kyegegwa District 4 1 11 January 2023[4][37]
Kassanda District 49 + 2 probable 20 + 2 probable 11 January 2023[4][37]
Kagadi District 1 1 11 January 2023[4][37]
Bunyangabu District 1 11 January 2023[4][37]
Kampala District 17 2 11 January 2023[4][37]
Wakiso District 4 11 January 2023[4][37]
Masaka District 1 1 11 January 2023[4][37]
Jinja District 1 + 1 probable 1 + 1 probable 11 January 2023[4][37]
Total (142 confirmed + 22 probable) 164 Total (55 confirmed + 22 probable) 77 Total 11 January 2023[4][37]

Response

According to Jane Aceng, Uganda's health minister, local people initially believed the new Ebola outbreak was caused by witchcraft.[20] Aside from this misinformation, there are also no effective vaccines against the Sudan ebolavirus,[7] and merely early supportive care is the best management option of an infected person, but experts are hopeful that much has been learned about infections with Ebola viruses, including diagnosis, contact tracing and how to improve survival.[38] The World Health Organization (WHO) has been supporting the Ugandan Ministry of Health with surveillance, communication and coordination efforts.[7] Similarly, Médecins Sans Frontières has been supporting the Ministry of Health with deploying initial emergency response.[39]

The International Federation of Red Cross and Red Crescent Societies (IFRC) has appealed for emergency aid to Uganda.[2] The European Union has responded to the request with €200,000 in initial emergency funding.[40]

On 6 October, the United States announced that they would begin screening air passengers from Uganda for cases of Ebola.[41]

According to Ana Maria Henao-Restrepo and her team in WHO's Health Emergencies Program, an adenovirus based vaccine developed by the Sabin Vaccine Institute in a partnership with the Vaccine Research Center at the US National Institute of Allergy and Infectious Diseases will be offered to contacts of known cases as part of a clinical trial.[42]

On 15 October, the first lockdown came into effect. The lockdown, affecting the Mubende and Kassandra districts, prevents anyone, except cargo trucks, from leaving or entering the districts for three weeks. Furthermore, bars, nightclubs, places of worship and entertainment venues are closed and a curfew is in place.[43]

On 17 October, president Museveni put Kampala under high response alert after two cases from Mubende reached the capital. One of the patients died. Museveni also warned that there had been contacts and risks of infections in the city.[44]

The United States has sent the antiviral drug remdesivir and the experimental combination of antibodies MBP134 to Uganda to help protect healthcare workers from the outbreak with CDC-responsible Joel Montgomery saying that if healthcare workers are at risk, then it will negatively impact the response to the outbreak.[45] Supply shortages, for example inadequate PPE, and limited food for those in quarantine have meant that patients and contacts have escaped isolation; interns have only been paid every three months, meaning they were unable to cope with the rising cost of living, all of which are important issues in the response to stem the epidemic.[46]

Transmission and virology

Ebola is mainly spread through contact with bodily fluids. The average case fatality rate of Ebola (all 4 viruses) is 50%.[47] In this outbreak of Sudan Ebolavirus, the case fatality rate has been 39%.[22]

Misinformation

Some politicians and other public figures opposed to the 36-year rule of President Yoweri Museveni declared that the Ebola outbreak was fake or exaggerated, and that Ugandans were being used as vaccine "lab rats" to enrich the ruling party. Individuals such as former presidential candidate Joseph Kabuleta further claimed that the Ebola vaccines undergoing clinical trial may have deadly side effects, similar to his earlier claims about COVID-19 vaccines.[48] Other popularized theories have included that Ebola is caused by witchcraft and that burials of Ebola victims are closed so that their organs can be harvested and sold.[49]

A contributing factor in misinformation campaigns has been what researchers observed to be uneven application of public health measures during the COVID-19 pandemic, used by the ruling party to stifle dissent and shut down public discourse.[50] An independent fact-checking organization in Uganda has found that a lack of community education regarding disease spread is more widespread than "targeted misinformation", which Ugandan Health Minister Margaret Muhanga had cited, saying opposition politicized the Ebola outbreak.[48]

Citizens also expressed fears of heavy-handed lockdowns at a time when the economy was still struggling with the fallout from nationwide COVID-19 lockdowns and ongoing global inflationary pressures.[51] Museveni locked down Mubende and Kassanda districts on 15 October, one month after the first case was reported, but promised no national lockdowns akin to those deployed for COVID-19, even when the virus had spread to Kampala and killed upwards of 77 people in the capital. In the districts undergoing lockdown, markets, bars, and churches were to be closed for the duration of the lockdown, together with travel bans and dawn-to-dusk curfews.[52][49] Some citizens claimed that the districts placed under lockdown were being deliberately punished for their support of opposition politician Bobi Wine and that police had beaten locals to enforce overnight curfews.[49]

References

  1. ↑ "Ebola in Uganda as of November 2022 | Ebola Cases - Ebola Deaths". ebola-cases.com. Retrieved 4 November 2022.
  2. 1 2 "Uganda, Africa: Ebola Virus Disease Emergency Appeal No. MDRUG047 - Uganda". reliefweb.int. 1 October 2022. Archived from the original on 6 October 2022. Retrieved 1 October 2022.
  3. ↑ "Ebola Cases, Fatalities Rise in Uganda". VOA. 27 September 2022. Archived from the original on 27 September 2022. Retrieved 27 September 2022.
  4. 1 2 3 4 5 6 7 8 9 10 11 ECHO (25 October 2022). "ECHO Daily Map of 23 October 2022". ECHO. Retrieved 26 October 2022.
  5. 1 2 "WHO African Region on Twitter". Twitter. Archived from the original on 17 October 2022. Retrieved 1 October 2022.
  6. ↑ "September 2022 Uganda, Mubende District Ebola (Ebola Virus Disease)". www.cdc.gov. 26 September 2022. Archived from the original on 17 October 2022. Retrieved 1 October 2022.
  7. 1 2 3 4 5 6 "Ebola Disease caused by Sudan virus – Uganda". www.who.int. Archived from the original on 27 September 2022. Retrieved 1 October 2022.
  8. ↑ "New Cases- Ebola Bunyangabu district". Archived from the original on 17 October 2022. Retrieved 2 October 2022.
  9. ↑ "WHO supports Uganda Ebola response, faces challenges fighting Haiti cholera outbreak". UN News. 12 October 2022. Archived from the original on 13 October 2022. Retrieved 13 October 2022.
  10. 1 2 "Uganda Ebola outbreak: First death recorded in capital Kampala". BBC News. 11 October 2022. Archived from the original on 16 October 2022. Retrieved 16 October 2022.
  11. ↑ "Uganda says 9 more Ebola cases confirmed in Kampala, urges vigilance". Reuters. 24 October 2022. Retrieved 25 October 2022.
  12. ↑ "Ebola outbreak in Uganda declared over". B. N. O. News. 10 January 2023.
  13. ↑ Okware, S. I.; Omaswa, F. G.; Zaramba, S.; Opio, A.; Lutwama, J. J.; Kamugisha, J.; Rwaguma, E. B.; Kagwa, P.; Lamunu, M. (2002). "An outbreak of Ebola in Uganda". Tropical Medicine & International Health. 7 (12): 1068–1075. doi:10.1046/j.1365-3156.2002.00944.x. PMID 12460399.
  14. ↑ Towner, J. S.; Sealy, T. K.; Khristova, M. L.; Albariño, C. S. G.; Conlan, S.; Reeder, S. A.; Quan, P. L.; Lipkin, W. I.; Downing, R.; Tappero, J. W.; Okware, S.; Lutwama, J.; Bakamutumaho, B.; Kayiwa, J.; Comer, J. A.; Rollin, P. E.; Ksiazek, T. G.; Nichol, S. T. (2008). Basler, Christopher F. (ed.). "Newly Discovered Ebola Virus Associated with Hemorrhagic Fever Outbreak in Uganda". PLOS Pathogens. 4 (11): e1000212. doi:10.1371/journal.ppat.1000212. PMC 2581435. PMID 19023410.
  15. ↑ "End of Ebola outbreak in Uganda" (Press release). World Health Organization. 20 February 2008. Archived from the original on 1 March 2008. Retrieved 29 November 2009.
  16. ↑ World Health Organization (4 October 2012). "End of Ebola outbreak in Uganda". Geneva, Switzerland: World Health Organization. Archived from the original on 26 March 2014. Retrieved 25 March 2014.
  17. ↑ "History of Ebola Virus Disease (EVD) Outbreaks | History | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 15 September 2022. Retrieved 5 December 2022.
  18. ↑ Deen, Gibrilla F.; Broutet, Nathalie; Xu, Wenbo; Knust, Barbara; Sesay, Foday R.; McDonald, Suzanna L.R.; Ervin, Elizabeth; Marrinan, Jaclyn E.; Gaillard, Philippe; Habib, Ndema; Liu, Hongtu; Liu, William; Thorson, Anna E.; Yamba, Francis; Massaquoi, Thomas A. (12 October 2017). "Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors — Final Report". New England Journal of Medicine. 377 (15): 1428–1437. doi:10.1056/NEJMoa1511410. ISSN 0028-4793. PMC 5798881. PMID 26465681.
  19. ↑ Adepoju, Paul. "Ebola Outbreak in Uganda Surges, but the Country Has a Plan". Scientific American. Retrieved 5 December 2022.
  20. 1 2 3 Devi Sridhar (10 October 2022). "Uganda is battling Ebola again – and the world doesn't have a vaccine". The Guardian. Archived from the original on 10 October 2022. Retrieved 10 October 2022.
  21. 1 2 3 "WHO: 'Concerned' about Ebola spread as latest eight cases not contacts of others infected". Reuters. 20 October 2022. Retrieved 24 October 2022.
  22. 1 2 Health Alert Network , CDC (7 November 2022). "Update on Ebola Virus Disease (Sudan ebolavirus) Outbreak in Central Uganda". emergency.cdc.gov. Retrieved 7 November 2022.
  23. ↑ "Uganda to close schools early after eight children die of Ebola". 8 November 2022. Retrieved 12 November 2022.
  24. ↑ "Ebola kills doctor in Uganda, first health worker killed in latest outbreak". Reuters. 1 October 2022. Archived from the original on 17 October 2022. Retrieved 1 October 2022.
  25. ↑ "Ebola Disease caused by Sudan virus - Uganda". 26 September 2022. Retrieved 25 October 2022.
  26. ↑ "Ministry of Health- Uganda on Twitter". Twitter. 30 September 2022. Archived from the original on 17 October 2022. Retrieved 2 October 2022.
  27. ↑ "Africa Live: Uganda rules out lockdown to contain Ebola". BBC News. 1 October 2022. Retrieved 29 September 2022.
  28. ↑ "Ebola outbreak 2022". Archived from the original on 2 October 2022. Retrieved 2 October 2022.
  29. ↑ "Uganda: Four things to know about the Ebola outbreak". Doctors Without Borders - USA. Archived from the original on 7 October 2022. Retrieved 7 October 2022.
  30. ↑ Yahoo (13 October 2022). "Uganda leader cracks down on traditional healers to stem Ebola". Yahoo. Retrieved 25 October 2022.
  31. ↑ WHO (23 October 2022). "Ebola Virus Disease in Uganda SitRep - 32". WHO Sitrep 38. Retrieved 2 November 2022.
  32. ↑ Voanews (24 October 2022). "Uganda Confirms Ebola in Kampala; Officials Urge Public Not to Hide Possible Cases". Voanews. Retrieved 25 October 2022.
  33. ↑ "Update on the Ebola Virus Disease Outbreak and Containment Measures 26 October". Ugandan Ministry of Health. Retrieved 29 October 2022.
  34. ↑ "Uganda: School children test positive for Ebola". Africa News. 28 October 2022. Retrieved 30 October 2022.
  35. ↑ "Masaka records first Ebola death". 2 November 2022. Retrieved 3 November 2022.
  36. ↑ "Dr. Jane Ruth Aceng Ocero" on Twitter". Twitter. Archived from the original on 13 November 2022. Retrieved 13 November 2022.
  37. 1 2 3 4 5 6 7 8 9 10 WHO (11 January 2023). "Ebola Virus Disease in Uganda SitRep - 93". WHO Sitrep. Retrieved 25 May 2023.
  38. ↑ Adepoju, Paul (8 October 2022). "Experts hopeful about Ebola control in Uganda". The Lancet. 400 (10359): 1184. doi:10.1016/S0140-6736(22)01924-9. ISSN 0140-6736. PMID 36215997. S2CID 252739403. Archived from the original on 17 October 2022. Retrieved 10 October 2022.
  39. ↑ "Ebola in Uganda: Four things you need to know". Médecins Sans Frontières (MSF) International. Archived from the original on 5 October 2022. Retrieved 5 October 2022.
  40. ↑ "Ebola outbreak: EU provides immediate support to Uganda". civil-protection-humanitarian-aid.ec.europa.eu. Archived from the original on 9 October 2022. Retrieved 5 October 2022.
  41. ↑ Mandavilli, Apoorva; Stolberg, Sheryl Gay (6 October 2022). "U.S. to Begin Screening Air Passengers From Uganda for Ebola". The New York Times. ISSN 0362-4331. Archived from the original on 6 October 2022. Retrieved 6 October 2022.
  42. ↑ Helen Branswell (29 September 2022). "Ebola experimental vaccine trial may begin soon in Uganda". STAT News. Retrieved 10 October 2022.
  43. ↑ "Ebola in Uganda: Three-week lockdown announced for two districts". BBC News. 16 October 2022. Archived from the original on 16 October 2022. Retrieved 16 October 2022.
  44. ↑ "Ugandan president puts capital city on Ebola response alert". Xinhua. 17 October 2022. Archived from the original on 17 October 2022. Retrieved 17 October 2022.
  45. ↑ "U.S. sends experimental antibody, antiviral drug to Uganda for Ebola outbreak". Reuters. Retrieved 21 October 2022.
  46. ↑ Newey, Sarah; Reporters, Telegraph (8 November 2022). "Ebola outbreak projected to surge as response repeats mistakes of Wuhan". The Telegraph. ISSN 0307-1235. Retrieved 12 November 2022.
  47. ↑ "Ebola virus disease". www.who.int. Retrieved 21 September 2022.
  48. 1 2 Mwai, Peter; Schraer, Rachel (29 November 2022). "Ebola in Uganda: The people spreading misinformation online". BBC News. Archived from the original on 29 November 2022. Retrieved 29 November 2022.
  49. 1 2 3 Latif Dahir, Abdi (8 December 2022). "'Ebola Could Have Wiped Us All': Slow Lockdown Haunts Uganda". New York Times. Archived from the original on 9 December 2022. Retrieved 9 December 2022.
  50. ↑ Grasse, Don; Pavlik, Mel; Matfess, Hilary; Curtice, Travis (31 July 2020). "Autocratic governments are using coronavirus as a pretext to clamp down on opponents". Washington Post. Archived from the original on 31 July 2020. Retrieved 29 November 2022.
  51. ↑ "Ebola in Uganda: lessons from COVID show that heavy-handed lockdowns may be a bad idea". The Conversation. 2 November 2022. Archived from the original on 29 November 2022. Retrieved 29 November 2022.
  52. ↑ "Uganda's Museveni vows no national lockdown as Ebola cases rise". France 24. Agence France-Presse. 4 November 2022. Archived from the original on 29 November 2022. Retrieved 29 November 2022.
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