According to the World Health Organization (WHO), as of 22 November 2022, there have been 141 confirmed cases of Ebola virus disease (EVD), including 55 deaths (case fatality rate: 39%). No new cases have been reported in week 47.
Among these, at least 19 healthcare workers were infected, of whom seven died. There are also 22 probable cases who died before samples were obtained for confirmation.
79 cases have recovered.
Since the last report on 18 November 2022, no new cases nor deaths have been reported. The weekly number of confirmed cases reported has decreased for the third consecutive week after the peak observed in the week 43.
There are currently seven Ugandan districts affected by this outbreak: Jinja, Kampala, Kassanda, Kyegegwa, Masaka, Mubende and Wakiso. The districts of Bunyangabu and Kagadi have not reported any cases since 21 and 24 September 2022, respectively, and as two incubation periods of the virus have passed, the districts have been removed from the list. Although data are incomplete, the majority of new cases appear to be epidemiologically linked to known cases.
According to WHO, 4 654 contacts of cases have been identified across 15 districts, of which 3 636 contacts have completed 21 days of follow up.
Background
On 20 September 2022, the Ministry of Health in Uganda, together with the World Health Organization - Regional Office for Africa (WHO AFRO) confirmed an outbreak of EVD due to Sudan ebolavirus in Mubende District, Uganda, after one fatal case was confirmed.
The index case was a 24-year-old man, a resident of Ngabano village of the Madudu sub-county in Mubende District. The patient experienced high fever, diarrhea, abdominal pain, and began vomiting blood on 11 September 2022. Samples were collected on 17 September 2022 and EVD was laboratory-confirmed on 19 September. The patient died on the same day, five days after hospitalization.
On 15 October 2022, the President of Uganda imposed a 21-day lockdown on Mubende and Kassanda districts to contain the outbreak of EVD. Measures included an overnight curfew, closing places of worship and entertainment, and restricting movement in and out of the two districts.
On 28 October 2022, the Ministry of Health in Uganda implemented measures to restrict travel for contacts of confirmed Ebola cases during the follow-up period (21 days). On 5 November 2022, these measures were extended for further 21 days. Additionally, on 8 November 2022, the Ministry of Education and Sports directed schools across Uganda to finish the school term on 25 November 2022, two weeks earlier than planned.
The Ugandan government is carrying out community-based surveillance and active case finding. An on-site mobile laboratory has been established in Mubende and risk communication activities are ongoing in all affected districts. Africa CDC, WHO, GOARN and other partners have teams in Uganda to support the coordination of the response.
As of 16 November 2022, all travelers leaving or arriving at Entebbe International Airport in Uganda are required to complete a health declaration form.
As of 5 November 2022, there were five Ebola treatment units (ETUs) between Mubende, Kampala and Kabarole districts. A new ETU is being established in Kassanda in response to an increase in reported cases from the region.
Previously, EVD was reported in Uganda in 2019 due to Zaire ebolavirus, which was imported from the Democratic Republic of the Congo. EVD outbreaks caused by Sudan ebolavirus have previously occurred in Uganda (four outbreaks) and Sudan (three outbreaks). The last outbreak of EVD due to Sudan ebolavirus in Uganda was reported in 2012.
ECDC Assessment
Risk to EU/EEA citizens living in or travelling to affected areas in Uganda
Despite the increase in number of cases and the transmissions reported in the densely populated capital city of Kampala, the current probability that EU/EEA citizens living in or travelling to EVD-affected areas of Uganda will be exposed to the virus is very low, provided that they adhere to the recommended precautionary measures (see further information below). Transmission requires direct contact with blood, secretions, organs or other bodily fluids of dead or living infected people or animals; all unlikely exposures for the general EU/EEA tourists or expatriates in Uganda.
Considering that infection with Sudan ebolavirus leads to severe disease but that the probability of exposure of EU/EEA citizens is very low, the impact for the EU/EEA citizens living and travelling in affected areas in Uganda is considered low. Overall, the current risk for EU/EEA citizens living or travelling to affected areas in Uganda is considered low.
Risk of introduction and spread within the EU/EEA
The most likely route by which the Ebola virus could be introduced to the EU/EEA is through infected people from affected areas travelling to the EU/EEA or medical evacuation of cases to the EU/EEA. According to the International Air Travel Association, in 2019, there were about 126,000 travelers arriving in the EU/EEA from Uganda. Based on experience from the largest EVD outbreak in West Africa to date (2013-2016), where thousands of cases were reported, with transmission in large urban centers, and hundreds of EU/EEA humanitarian and military personnel deployed to the affected areas, importation of cases by travelers is considered unlikely.
The likelihood of secondary transmission of Ebola virus within the EU/EEA and the implementation of sustained chains of transmission within the EU/EEA is very low as cases are likely to be promptly identified and isolated and follow up control measures are likely to be implemented. During the large EVD outbreak in West Africa in 2013–2016, there was only one local transmission in the EU/EEA (in Spain) in a healthcare worker who had attended to an evacuated EVD patient. The impact for the EU/EEA citizens living in the EU/EEA is considered low and overall, the current risk for the citizens in the EU/EEA is considered very low.
Healthcare providers in the EU/EEA should be informed of and sensitized to:
· the possibility of EVD among travelers returning from affected areas;
· the clinical presentation of the disease and need to enquire about travel history and contacts in people returning from EVD-affected countries;
· the availability of protocols for the ascertainment of possible cases and procedures for referral to healthcare facilities;
· the imperative need for strict implementation of barrier management, use of personal protective measures and equipment and disinfection procedures in accordance with specific guidelines and WHO infection control recommendations when providing care to EVD cases.
Vaccines
The licensed vaccines available, protect against EVD due to Zaire ebolavirus. There are no licensed vaccines against EVD due to Sudan ebolavirus, and there are no available data on the level of cross-protections. The availability of a vaccine was proven to be very helpful in the control of the recent outbreaks in the Democratic Republic of the Congo. The unavailability of vaccines will be an additional challenge in the control of this outbreak.
ECDC actions
ECDC is monitoring this situation through its epidemic intelligence activities and will report relevant updates on a weekly basis.
