The recent outbreak of Ebola haemorrhagic fever in the Gulu district of Uganda is continuing to claim lives. As the BMJ went to press, the death toll was 60, with 165 cases having been reported.
The National Institute of Virology in South Africa confirmed that the Ebola virus was the cause of the outbreak on 16 October, when 81 cases were reported, including 35 deaths.
This is the first known outbreak of the Ebola virus disease in Uganda. The Gulu district is particularly vulnerable because it is densely populated and has nearly half a million internally displaced people living in squalid conditions.
Ebola haemorrhagic fever is one of the most virulent viral diseases, causing death in 50-90% of all clinically ill people. It is transmitted through direct contact with blood, secretions, organs, and semen of infected people, putting healthcare workers particularly at risk.
The incubation period is two to 21 days, and the disease starts with fever, muscle pain, headache, and sore throat. There is no known treatment or immunisation, so isolation of suspected cases with strict barrier nursing is the only option available. Patients who die from the disease must be promptly buried or cremated.
Despite extensive ecological research in the countries where previous outbreaks have occurred—such as Zaire, Gabon, and the Ivory Coast—the natural reservoir for the virus remains unknown.
The World Health Organization (WHO) is coordinating the national response to the outbreak. Médecins Sans Frontiàres and the US Centers for Disease Control and Prevention have sent experienced medical staff, epidemiologists, laboratory specialists, and logisticians to help assess and contain the situation. They have also provided several tonnes of protective equipment.
The WHO team in Gulu has reported that the isolations are well organised, with cases being managed “effectively.”
Mr Greg Hartl, a spokesman for the WHO, said: “We are still in the middle of the first wave. There may be another three to four depending on transmission times. This means that this outbreak could last for another three months.”
The WHO has appealed for more funds to help contain and control the outbreak.
Figure.
SAYYID AZIM/AP PHOTO
Relatives of Ebola patients wait outside the ward at Gulu hospital