Tuesday, 17 October 2017

UVRI in the Press - 2012

 

2012

Curbing rampant viruses with ‘one health’

The Observer, November 20, 2012

By Racheal Ninsiima

Barely a month after the World Health Organization (WHO), declared Uganda Ebola-free, scores of people in Luweero have been isolated following another outbreak. The outbreak was confirmed by the Uganda Virus Research Institute (UVRI) after two people belonging to the same family and a health worker died in Sombwe parish, Nyimbwa sub-county, Luweero district.

Currently, there are five suspects closely monitored by the ministry of Health surveillance team. This outbreak comes on the heels of a Marburg outbreak in Uganda that left over five people dead in south-western Uganda. However, with the country’s on-and-off attacks, no drug has been approved to treat the Ebola or Marburg viruses. People diagnosed with Ebola or Marburg simply receive supportive care and treatment for complications.

WHO’s revised international health regulations require that countries establish core capacities to address such emergencies at national, sub-national, health facility and community level, as well as at border crossings. In effect, health experts have approved a “one-health approach” which integrates human, animal and environmental health in curbing such outbreaks.

“Previously, different professionals responded to disease outbreaks differently and in isolation but a one-health approach will promote integration of these sectors to ensure holistic and exhaustive management of the diseases,” Dr David Mukanga, the executive director of the African Epidemiology Network (AFENET), says.
He adds that the approach is necessary since 60% of the infectious diseases affecting humans like Ebola, Marburg, anthrax and brucellosis originate from animals. A case in point where the approach has proven effective is in the prevention of tuberculosis and scabies in Bwindi.

However, implementation of the concept requires a new calibre of professionals with skills to monitor, detect, report, manage and prevent diseases which cut across the three sectors. Dr Thomas Easley, the country coordinator for the Emerging Pandemic Threats (EPT) programme says  such a solution must centre on  education. Government and its stakeholders must train professionals in the one-health approach.

 

“It is clear that no one discipline has enough knowledge to prevent the emergence or re-emergence of diseases,” he said. “Only by breaking down the barriers among agencies, individuals and specialties can we unleash the innovation and expertise needed to meet the integrity of eco systems.” In June this year, AFENET graduated six professionals trained in one-health approach.

 

Ebola

Ebola haemorrhagic fever may be caused by any of four of the five known Ebola viruses, namely:  the Zaire Ebola Virus, the Sudan Ebola Virus, the Taï Forest virus, more commonly called Côte d’Ivoire Ebola Virus and more recently the Bundibugyo Ebola Virus. The Zaire virus has the highest fatality rate (up to 90% in some epidemics.) There have been more outbreaks of Zaire Ebola virus than of any other species. Transmission has been attributed to reuse of unsterilized needles and close personal contact. On 24 November 2007, the Uganda ministry of Health confirmed an outbreak of Ebola Virus in the Bundibugyo district and this time it is being contained in Luweero district, Bombo and Mulago hospital.

 

Marburg

Marburg haemorrhagic  fever is a severe illness caused by the Marburg virus. It was first described in 1967 during outbreaks in Germany and the former Yugoslavia that were linked to monkeys imported from Uganda. The largest Marburg outbreak recorded to date began in late 1998 in north-eastern Democratic Republic of the Congo (DRC). The natural reservoir for the Marburg virus remains unknown, although it is presumed to be of animal origin. “Primary transmission of the virus from the natural reservoir appears to occur only in sub-Saharan Africa and is sometimes followed by secondary person-to-person transmission in both community and health facility settings,” Dr Ambrose Talisuna, former head of the Epidemiology and Surveillance Division at the ministry of Health, says.

  

Two more test positive for Ebola

 The Monitor, November 16, 2012  

By Dan Wandera
Blood Samples sent to the Uganda Virus Research Institute in Entebbe have confirmed two more Ebola positive patients, bringing the number of patients to four, including the two who died last week. 

Luweero District Health Officer, Dr Joseph Okware, says blood samples for a patient admitted at Bombo Army General Hospital on Monday have tested positive for the Ebola Sudan strain, while another patient who was in close contact with one of the deceased Ebola cases, and now admitted at Mulago National Referral Hospital, have tested positive for Ebola.

"We have 2 more results confirmed positive by UVRI bringing the number of confirmed cases to 4 for the Ebola Sudan Strain,” Dr Okware said.

“We are also sending more blood samples for 5 people whom we suspect came in contact with some of the victims.” Medical personnel at various health centres in Luweero told this newspaper that their units have not received protective gear. "We are increasingly getting worried because some of our units do not have protective gear. It would be very important that the lives of the health workers are also secure because our units have not closed", a nurse at Bamunanika Health Centre III told this reporter. However, Dr Okware says that focus, for now, is on the facilities at Bombo Military Hospital, Kasana Health Centre IV and Nyimbwa Health Centre, and other health units will be catered to later.

 

Uganda: Fresh Ebola Outbreak Burdens Health System

IRIN, November 15, 2012

Opinion

Kampala — Uganda's Ministry of Health says a fresh outbreak of Ebola haemorrhagic fever - the second in the country this year - is straining an already over-stretched health system. "An outbreak of this nature poses a serious financial and human resource challenge. Our resources have been strained since July. We need additional resources to handle the current outbreak. What we have at hand is not enough," Dennis Lwamafa, the acting director-general of health Services at the Ministry of Health, told IRIN.

"With the increasing epidemic outbreaks and their frequencies, we are further constrained... The costs to manage this outbreak cause a distortion... We had not planned for it." As of 12 November, three people - all members of the same family - were suspected to have died from Ebola in Luwero District, 50km northwest of Kampala. Five people who had close contact with the deceased are also suspected to have contracted the disease; two of these are in an isolation unit at Mulago National Referral Hospital in the capital, Kampala, two in health centres in Luwero and one at Bombo Military Hospital, 30km north of the capital. The Ministry of Health has begun tracing people who may have had contact with the deceased and those infected.

On 15 November, Uganda's Daily Monitor newspaper reported the death of a man who had presented with symptoms characteristic of Ebola at a health centre in the northwestern district of Koboko.

 

Sudan strain

The outbreak comes less than two months after the country was declared Ebola-free following an outbreak in July that killed 17 people in the western district of Kibaale. The virus in Luwero is the same strain - Ebola Sudan - as the Kibaale outbreak, according to the Uganda Virus Research Institute (UVRI). The Sudan strain was responsible for an outbreak that infected more than 400 and killed some 220 people in Uganda in 2000 and one person in Luwero in May 2011. The country is also battling an outbreak of Marburg - a viral haemorrhagic fever similar to Ebola - which has killed eight people in the southwest.

Ebola, which causes fever and bleeding from orifices, can cause death within days. There is no cure or vaccine for it, so efforts are concentrated on stopping its spread.

"We need more financial resources to put [in place] optimal response plans to contain this highly infectious disease," Lwamafa said. "We need doctors, nurses to manage isolation units, surveillance teams to list, monitor and track the contacts, laboratory technicians to take the specimens for testing, burial, mobilization teams and psychosocial support teams to handle trauma."

 

The UN World Health Organization (WHO) in Uganda has dispatched a team of experts to Luwero to help in surveillance, case management, health education, epidemiology, laboratory, infection control and psychosocial services, according to Miriam Nanyunja, WHO's adviser on disease prevention and control.

"The response is being mounted to effectively contain the outbreak," she told IRIN. 

Christine Ondoa, Uganda's minister of health, has appealed to the public to remain calm, take precautions to prevent contracting the virus and avoid public gatherings in the affected district.

[ This report does not necessarily reflect the views of the United Nations. ]

--

 

Uganda: Govt Hires Experts for Marburg Outbreak

The Independent, October 30, 2012 

By Julius Odeke

Ministry of Health and its partners have hired ten technical experts to handle and contain the spread of Marburg cases in the identified districts.

The ministry of health says the death toll of both the probable and confirmed cases stands at eight, with the latest being a case that died at the isolation facility at Rushoroza Health Centre III on October 27.

 The Minister Dr Christine Ondoa clarified that since the onset of the outbreak, her ministry has collected a total of 45 samples of which nine were confirmed positive; five in Kabale, two in Kampala and two from Ibanda.

She says that working closely with the US Center for Disease Control and Prevention (CDC), whereby the ministry has set up a field diagnostic laboratory at Kabale Regional Referral Hospital. "All samples from the affected neighbouring districts will hence be taken to this laboratory for quick diagnostics. This will shorten the time when we get results to three hours from the original 24 hours due to distance. Further serological testing will be undertaken at the Uganda Virus Research Institute (UVRI)," Ondoa said.

Dr Ondoa says due to the presence of cases in other districts, the ministry of health has established temporary isolation facilities to accommodate the suspected and confirmed cases. In Ibanda, a temporary isolation ward has been created at Ibanda Hospital, while plans are underway to set up a proper isolation facility by tomorrow.

She says at Mbarara Regional Referral Hospital, a separate temporary has been designated for the suspect Marburg cases. A triage has also been set up at the causality ward. 

We have assembled a team of experts to work in the newly established isolation facilities and they are expected in these districts today. We also plan to undertake infection control procedures in these facilities as safety measures for the workers and the admitted patients.

Dr Ondoa says there are seven suspect cases (student nurses) quarantined at Ibanda. These cases attended to the confirmed case that later died at Mbarara Regional Referral Hospital on October 24. Other health workers who attended to the patient are closely being monitored.

Dr Ondoa dispelled rumours that, "Dr. Sheila Ndyanabangi, the head of the Mental Health Unit Division, had contracted Marburg and had been isolated. Dr. Ndyanabangi has not been isolated but has been advised to exercise social distancing. She is one of the contacts who are being monitored. She has not developed any signs or symptoms of the disease and therefore cannot be isolated from the community. She is due to complete the 21 days of observation."

--

 

East Africa: Marburg Contained - Health Ministry  

East African Business Week, October 29, 2012 

By Eriosi Nantaba

Kampala — The Ministry of Health has urged the public to remain calm and avoid contact with victims of Marburg or report any suspected cases with the outbreak of the epidemic anywhere.

According to the Minister for health Hon. Christine Ondoa, The ministry has developed a response plan for the Marburg control, surveillance, and procurement of protective gear amounting to Ushs 2.3 billion(US$900,000). "The ministry of health surveillance team has listed up a total of 196 contacts for the close monitoring so individuals are called upon to be calm for all possible measures are undertaken to control the situation," said Ondoa during a press briefing in Kampala recently.

The ministry declared an outbreak of Marburg in Kabale District (Western Uganda) on October 19th 2012 after receiving laboratory results from the Uganda Virus Institute (UVRI) confirming that the two family members had died of the highly infectious viral hemorrhagic fever. According to the reports, patients presented with symptoms of diarrhea, vomiting, fever, headache, dizziness and generalized convulsions. "Marburg and Ebola have similar control mechanisms and since the outbreak of Marburg fever in the country, the ministry took the initiatives to alert all the medical workers to ensure that they disease is handled," explained Ondoa. "Six people have already been confirmed dead and other cases are also confirmed with one being suspected." Dr. Joaquim Saweka, Uganda WHO Country Representative alerted that Marburg is highly inflectional and kills in a short time but can be prevented. 

"Marburg is spread through direct contact with body fluids like blood, saliva, vomitus, stool and urine of an infected person," warned Seweka. "The public is told to continue accessing Mulago hospital and Kabale hospital without any fear despite the outbreak of Marburg in the country." 

Ondoa noted that the ministry continues to monitor 196 people who are suspected to have contacted with the dead. 

The last outbreak of Marburg in Uganda came in 2007 and killed two miners in the country's west. The Marburg outbreak in Uganda comes just after the World Health Organization had just declared an end of the Ebola outbreak.

 

An effective Aids vaccine is in sight at last, thanks to the efforts of African scientists
The East African: October 20,  2012 

By Pontiano Kaleebu & Omu Anzala

Researchers from around the world recently converged on Boston for a scientific conference dedicated to one of the most pressing challenges of our time 

Researchers from around the world recently converged on Boston for a scientific conference dedicated to one of the most pressing challenges of our time: The development of safe and effective vaccines for the prevention of HIV, the virus that causes Aids. They had much to discuss, given the extraordinary progress in this area of research, much of which has been widely reported in the press. 

What is less well known, perhaps, is how much that progress stems from the contributions of scientists in Africa, who continue to work with thousands of volunteers to find solutions to the Aids crisis. With steadfast support from governments and civil society organisations across Africa, scientists on the continent have played key roles in everything from the basic science that underlies vaccine design to the clinical evaluation of Aids vaccine candidates. 

Much of this work has been conducted in partnership with Western government agencies, such as the United States Agency for International Development and its counterparts in Europe, as well as an array of international and regional HIV care and research organisations — including the Centre for HIV/AIDS Vaccine Immunology (CHAVI) of the US National Institutes of Health (NIH), the Collaboration for AIDS Vaccine Discovery (CAVD) supported by the Bill & Melinda Gates Foundation, the International Aids Vaccine Initiative (IAVI) and the European and Developing Countries Clinical Trials Partnership. But African scientists have been front and centre, and their governments have backed their efforts. African researchers have helped establish proof of concept for other HIV prevention strategies as well, most notably for microbicides against HIV, medical male circumcision and the prophylactic use of antiretroviral drugs.

Research in this arena has also helped build the technical capacity essential to seeding medical and biotechnological innovation. We have witnessed nothing less than a silent revolution in African science over the past several years. If sustained, this revolution could have very positive implications for both the public health and, in time, the economies of the region. Take, for example, the evolution of the Kenya AIDS Vaccine Initiative. KAVI was launched a little more than a decade ago, the brainchild of a small band of prominent HIV researchers in Nairobi. Established as a partnership between UK’s Medical Research Council MRC-UK), IAVI and the Kenyan government, KAVI’s goal was to test HIV vaccines devised to prevent the subtypes of HIV prevalent in East Africa.

To accomplish that task, however, researchers at Kenyatta National Hospital had to first train their staff to conduct research with the rigour required to win regulatory approval for a future vaccine. With the support of IAVI, they ensured that their staff technicians, scientists and research physicians were trained in Good Clinical Practices, and that their labs obtained certification for compliance with Good Clinical Laboratory Practice (GCLP), a stringent, internationally recognised badge of laboratory quality. Throughout the past decade, KAVI researchers have spread those skills to colleagues across sub-Saharan Africa, even as they have tested a series of Aids vaccine candidates in clinical trials.

 

KAVI recently obtained a grant from the Canadian government to help develop biomedical research labs across the region, help them earn GCLP accreditation, and to build its own capacity to conduct cutting edge research in the subfield of mucosal immunology. Further, as a member of the Networks of Excellence programme run by the European and Developing Countries Clinical Trials Partnership (EDCTP), KAVI is today deeply engaged in building capacity for the conduct of clinical trials in East Africa. On the strength of its experience in clinical research, KAVI has also begun to branch out to assess treatments for other ailments, including tuberculosis. It is only fair to note that none of this would be possible without the active — and proud — support of the Kenyan government, which has consistently made resources and personnel available for these and many other HIV prevention projects.

 

Similarly, since Ugandan scientists completed the first Aids vaccine trial on the continent more than a decade ago, they have become major players in HIV prevention research. In fact, the Uganda Virus Research Institute in Entebbe was selected as a central laboratory by CAVD, which co-ordinates a global programme in Aids vaccine development. It is also a co-ordinating centre for EDCTP’s East African Networks of Excellence and, through its partnership with MRC-UK, was a key participant in the NIH-funded CHAVI. UVRI researchers contributed to the development and standardisation of experimental methods employed to assess immune responses to Aids vaccine candidates and conduct relevant basic research. Today, the technical capacity of UVRI and other research facilities in the country is increasingly being applied to support advanced research in vaccinology, virology and the immunology of HIV infection.

 

South African scientists have put their nation on the map in HIV prevention research as well, and not just for HIV vaccine development, in which they have played a leading role in both the design and clinical evaluation of candidates. A team led by scientists affiliated with the NIH-funded Centre for the Aids Programme of Research in South Africa provided the first evidence, in 2010, that a microbicide—in this case, a vaginal gel infused with an ARV—can prevent HIV transmission. Further, a South African biotechnology company, Elevation Biotech, has participated in the complex business of HIV vaccine design with funding from IAVI and BMGF. Now South Africa has launched a research programme in partnership with the government of India to design and develop vaccines against HIV, probably the first instance of South-South collaboration in HIV vaccine design. It is only right that researchers in sub-Saharan Africa focus as much as they do on the HIV crisis. After all, no other part of the world has been quite as severely affected by the pandemic. Though that pandemic remains far from contained, the good news is that the contributions of African scientists are making a tangible difference to the development of new HIV prevention technologies. Indeed, African participation in such research is now a proud tradition, one we expect will continue unabated until the day we have in hand a safe and effective Aids vaccine. 

Prof Pontiano Kaleebu is director of the Medical Research Council at the Uganda Virus Research Institute Unit on Aids and cofounder of the African Aids Vaccine Programme. Prof Omu Anzala is principal investigator, Kenya Aids Vaccine Initiative and current chair of the Department of Medical Microbiology at the University of Nairobi. 

 

Health Ministry warns on Marburg outbreak

The New Vision, October 19, 2012

By Vision Reporter

The Ministry of Health has warned the general public of an outbreak of a deadly Marburg virus in Kitumba sub-county, Kabale district in western Uganda. 
A statement issued Friday afternoon said laboratory tests done at the Uganda Virus Research Institute (UVRI) confirmed three samples positive of the highly infectious viral hemorrhagic fever.  
Preliminary reports from the district indicate that four other people had allegedly died of a strange disease since October 4th. This strange disease has now been confirmed as Marburg. Investigations indicate that all the cases occurred among members of the same family in Kiyonjo parish in Kitumba sub-county. Marburg is a killer disease caused by a virus and is spread through direct contact with wounds, body fluids like blood, saliva, vomitus, stool and urine of an infected person. 
A person suffering from Marburg presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains and bleeding through the body openings, i.e. eyes, nose, gums, ears, anus and the skin. 

Marburg is a highly contagious disease and kills in a short time but can easily be prevented. The Ministry of Health is working with stakeholders and other development partners to contain the spread of this disease. 
The following measures have been put in place in order to limit the spread of this highly infectious disease; 
•     A team of experts has been dispatched to the district to support both clinical and public health investigations   
•    The National Taskforce has reactivated its rapid response committees to quickly act to any emergencies
•   The surveillance team has commenced the active tracing and listing of all possible contacts that were exposed to the suspects and confirmed cases.
•   The Kabale District Taskforce has been reactivated to effectively coordinate programs in the district
The Ministry of Health urges the general public to observe the following protective measures;
•     Report any suspected patient to a nearby health unit 
•    Avoid direct contact with body fluids of a person suffering from Marburg by using protective materials like gloves and masks 
•   Avoid unnecessary public gatherings  
The Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation.
 For more information and reports of any cases, please contact the Ministry hotline on +256750996034.  The country will be kept informed further on the outcome of this health emergency

 

 

 

Deadly Marburg Virus Breaks Out In Kabale

The Red Pepper, October 19, 2012 

Three people have tested positive to the Marburg virus in Kabale district. The Kabale district director of health services Dr. Patrick Tusiime confirmed that tests carried out by Uganda Virus Research Insititute (UVRI) Entebbe on Thursday had turned out positive.

The Marburg virus was last reported in Uganda in 2008. According to the World Health Organization, Marburg is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever.

According to the global health body, the illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Case fatality rates have varied greatly, from 25 percent in the initial laboratory-associated outbreak in 1967, to more than 80 percent in the Democratic Republic of Congo from 1998-2000, to even higher in the outbreak that began in Angola in late 2004.

Marburg virus was first noticed and described during small epidemics in the German cities of Marburg and Frankfurt and the Yugoslavian capital Belgrade in the 1960s. Workers were accidentally exposed to tissues of infected grivets (Chlorocebus aethiops) at the city’s former main industrial plant, the Behringwerke, then part of Hoechst, and today of CSL Behring. During these outbreaks, 31 people became infected and seven of them died.

  

Uganda Is Ebola Free

East African Business Week, October 14, 2012

By Eriosi Nantaba

Kampala, Uganda — The Ugandan Ministry of Health officially declared the country free from Ebola outbreak that broke out in the country in July.

According to the press statement by the Ministry, the announcement follows completion of 42 days of the post Ebola surveillance countdown period. "As you may recall, the Ministry of Health declared an outbreak of Ebola in Kibaale district on July 28th after receiving confirmatory results from the Uganda Virus Research Institute (UVRI) that the strange disease that had killed 14 people in the district was Ebola Hemorrhagic fever, Sudan strain," Health Minister Christine Ondoa

She revealed that the Post Ebola Surveillance countdown period is a prerequisite of the World Health Organization (WHO) which requires any affected country to monitor the Ebola situation for a period of 42 days after the last discharged patient case before finally declaring that the outbreak is over. The last patient in Kibaale was allowed to go home on 24th August.

 

The outbreak, which was reported to have occurred in Luwero district (47 miles north of Kampala city), had remained a mystery until a 12-year-old girl from Luwero district died at a Military Hospital on May 12. 

However the outbreak of Ebola has left Ugandan Muslims barred from taking part in this year's pilgrimage following delays in clearing the group over Ebola fears. This is the second time in 12 years Ugandan pilgrims are barred from travelling to Saudi Arabia over Ebola, the first being in 2001 when the deadly disease struck Gulu District.  A total of 900 pilgrims had registered for pilgrimage this year.

  

Uganda Declared Ebola-free

The Red Pepper, October 6, 2012 

By Jane Kamanzi

Uganda has been declared Ebola-free according to a press statement signed by Health Minister Dr. Christine Ondoa. While addressing journalists this morning on the launch of Ministry of Health and the Uganda Peoples’ Defence Forces (UPDF) Ugandan Golden jubilee activities, Ondoa said the deadly disease was no more. “As you may recall, the Ministry of Health declared an outbreak of Ebola in Kibaale district on July 28th after receiving confirmatory results from the Uganda Virus Research Institute (UVRI) that the strange disease that had killed 14 people in the district was Ebola Hemorrhagic fever, Sudan strain. The index cases were reported from Nyanswiga LCI in Nyamarunda Parish of Nyamarunda sub-county. On October 4th, the Ministry will declare an end to the outbreak after completing 42 days of the post Ebola surveillance phase,” she announced.

She revealed that the Post Ebola Surveillance countdown period is a prerequisite of the World Health Organization (WHO) which requires any affected country to monitor the Ebola situation for a period of 42 days after the last discharged patient case before finally declaring that the outbreak is over.  The last patient in Kibaale was allowed to go home on 24th August. In addition to the good news, Dr. Andoa announced that the Ministry of Health and the Uganda Peoples’ Defence Forces (UPDF) are partnering to undertake a series of activities as a climax to the Independence Day celebrations.
 

Fight against Ebola in Uganda

Uganda is celebrating 50 years of independence on October 9th and various institutions as well as individual Ugandans have planned different commemorative activities. The Central Bank announced earlier this week that it would issue a shs. 1000 commemorative coin “This initiative came as a result of realizing that the two partners play a critical role in protecting the lives of people through different ways. It is for this reason that the two groups have joined hands to take health services closer to the people,” said Ondoa. In collaboration with the UPDF, the Ministry of Health will hold a national event at Hoima Regional Referral Hospital tomorrow (29th September) to flag off the activities. This will signify the beginning of a series of social mobilization and service provision activities in the five districts.

 

At the national level, the Ministry of Health and the UPDF will conduct a cleaning exercise of all the 14 regional hospitals throughout the country. This will be done in a bid to improve on the sanitation of these facilities as Uganda marks 50 years of independence. The hospitals are Moroto, Mbarara, Mbale, Soroti, Hoima, Mubende, Gulu, Arua Lira, Fort Portal, Masaka, Kabale, Jinja and Kawolo.

 

Uganda declares end of Ebola outbreak

CNN, October 6, 2012

 By the CNN Wire Staff 

Researchers work at U.S. Center for Disease Control and Prevention, after Ebola outbreak in Uganda.

 

STORY HIGHLIGHTS

  • 17 people died in Uganda's Ebola outbreak
  • The last patient was released on August 24
  • The initial announcement of the outbreak caused panic and sent patients fleeing
  • At least 10 more died in a separate outbreak in the Democratic Republic of Congo

 

(CNN) -- Ugandan health officials are declaring the country free of an Ebola outbreak blamed for 17 deaths since late July.The last patient with a confirmed infection was released on August 24, the World Health Organization said in a statement. "WHO does not recommend that any travel or trade restrictions be applied to Uganda with respect to this event," it said. The outbreak's initial confirmation at a hospital in the western town of Kagadi sent patients fleeing and the facility scrambling to contact those who may have had the disease. In a separate incident, a convict brought to the hospital on suspicion of an infection escaped. Less than a third of the outbreak's "24 probable and confirmed cases" survived, according to the WHO. More than 350 people were isolated for testing on suspicion of having the disease. 

Ebola is caused by a highly infectious virus that spreads through direct contact with bodily fluids. Symptoms include fever, vomiting, diarrhea, abdominal pain, headache, a measles-like rash, red eyes and, at times, bleeding from body openings. Initial symptoms of Ebola can be mistaken for other illnesses such as the flu.The Ebola virus was first detected in 1976 in the central African nation of Zaire (now the Democratic Republic of the Congo), Uganda's neighbor to the west. The virus is named after a river in that country, where the first outbreak of the disease was found.

 

At least 10 people died in a separate Ebola outbreak in late August in the Democratic Republic of Congo.

 

 

 

WHO declares Uganda Ebola free

The New Vision, September 4, 2012

The World Health Organisation (WHO) has confirmed that there are no new cases of Ebola haemorrhagic fever reported in Kibaale district, Uganda, since 3 August 2012, indicating that the outbreak is coming to an end.
 A total of 24 probable and confirmed cases including 17 deaths have been reported since the beginning of the outbreak. Of these, 11 cases were laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe. 
The last confirmed case was discharged on 24 August 2012 following recovery.
All contacts of probable and confirmed cases have been followed up daily and have completed the recommended 21 days of monitoring for any possible signs or symptoms of Ebola.
The partners who are involved in the response to the Ebola outbreak are transferring capacity to national and district authorities to sustain the essential functions, including enhanced surveillance and response, psychosocial support and infection prevention and control in health care facilities.

The Ebola isolation facilities in Kibaale District Hospital and at Mulago National Referral Hospital in Kampala remain on stand-by for receiving any suspected cases.
The ecological studies team in Kibaale district has collected samples from bats, primates and livestock to study the possible natural history of Ebola virus and putative initial human infection from wildlife.
Neighbouring countries
At the time of this update, an Ebola outbreak is on-going in the Province Orientale of the Democratic Republic of Congo. These two Ebola outbreaks are not epidemiologically linked and have been caused by two different Ebola subtypes; (Uganda: Ebola subtype Sudan, Democratic Republic of Congo Ebola subtype Bundibugyo).
With respect to this event, WHO does not recommend that any travel or trade restrictions are applied to Uganda.

General information on Ebola subtypes:

There are five identified subtypes of Ebola virus. The subtypes have been named after the location they have been first detected in Ebola outbreaks. Three subtypes of the five have been associated with large Ebola haemorrhagic fever (EHF) outbreaks in Africa: Ebola-Zaire, Ebola-Sudan and Ebola-Bundibugyo. 

EHF is a febrile haemorrhagic illness which causes death in 25-90% of all cases. The Ebola Reston species, found in the Philippines, can infect humans, but no illness or death in humans has been reported to.

  

Suspected Ebola patients discharged
 The New Vision, August 7, 2012
By Ismael Kasooha

 

Experts test for the Ebola virus in the newly-upgraded state of the art laboratory at the Uganda Virus Research Institute (UVRI) in Entebbe. 

A total of nine suspected Ebola patients have been discharged from the Ebola isolation centre in Kagadi hospital, Kibaale district. Those discharged include five-year-old Businge Mugabi, Geofrey Kaija, 7, Costa Mugabi, 9 and their father John Mugabi, 35. The children were admitted following the death of their mother identified as Aida Tuhaise who died with signs and symptoms of Ebola in Butumba village, Muhorro town, Kibaale district. The others discharged were prisoners from Kibaale prison who were sent back to the cells. Dr. Joseph Amonye the national coordinator of the Ebola task force said blood samples taken from these people were negative and there was no reason of confining them at the isolation centre. "We have tested their samples and found that although these children were contacts, they are not having the Ebola virus," said Amonye. The patients were given a package that includes household items such as mattresses, utensils and food for the start of their new life.

 

EA in panic as Ebola strikes again in Uganda
 The East African, August 4, 2012 

 JOINT REPORT Special Correspondents

Uganda is studying the puzzling behaviour of the Ebola Sudan virus in the latest outbreak that had killed 16 people mid last week. 

“So far what we see is that it is atypical. Its behaviour is very suspicious,” Dr Anthony Mbonye the Commissioner for Health Services at the Ministry of Health told The East African, explaining that unlike the typical Sudan strain, victims in the latest suffer fevers without the bleeding normally associated with the virus. “Thank God we took a sample early because we would be thinking they are suffering from fever yet it is Ebola,” said Mbonye.

The Uganda Ministry of Health declared an outbreak of Ebola in Kibaale district, about 160km west of Kampala. Confirmatory test results were done at the Centres for Disease Control, Uganda Virus Research Institute (UVRI) laboratory in Entebbe. Authorities were following 176 people that came into contact with the deceased while another 38 suspected cases were under observation.

 

Although it is confirmed as the Sudan Ebola strain, a viral haemorrhagic fever, it is presenting with less bleeding or haemorrhage, as should be the case with Ebola. Ebola has no cure and vaccine while this particular strain, Ebola Sudan, kills at least 50 per cent of the people who get infected so more deaths are expected. “We are not seeing much of the bleeding this time,” said Dr Jackson Amone, the Assistant Commissioner Integrated Services at the Ministry of Health who was travelling to Kagadi Hospital in Kibaale, western Uganda, where the first cases were reported. Ebola typically presents with fever, fatigue, vomiting, diarrhoea, joint pains and bleeding. “Most of the patients bleed when they are about to die with the cases we are handling. Sometimes you can confuse it for malaria because there is a high fever, vomiting, diarrhoea,” said Dr Amone. 

According to health workers, in the absence of body fluids the latest strain is easier to manage because Ebola virus is transmissible through contact with body fluids-saliva, vomit, sweat, blood or other fluids in the body of an infected person. Like in all Ebola outbreaks in Uganda, patients may have transmitted it to medical personnel. All medical personnel who were initially in contact with the people who died have been asked to stay at home until after 21 days. As more investigations are ongoing, samples have been sent to the Centres for Disease Control and Prevention (CDC), Viral Haemorrhagic Fevers (VHF) laboratory in USA. Results are expected after one week. 

“CDC is sending samples to Atlanta to do additional sequencing. But the indication now is that it is not a new strain. It is the Sudan strain based on PCR testing, which is specific,” said Erik Friedly, the associate head of communication at CDC-Uganda. 

Top of Form 

 

 

Renovated lab to ease diagnoses

The Observer, June 26, 2012

By Racheal Ninsiima

Of recent, Uganda has been a focal point for emerging and re-emerging infectious diseases, especially vector borne diseases (zoonoses).

Since 2000, we have witnessed diseases like Ebola, typhoid, anthrax, Hepatitis E and yellow fever, among others. An Ebola outbreak in Gulu in October 2000 claimed more than 170 lives including that of Dr Matthew Lukwiyaa 

The disease broke out again in Bundibugyo in November 2007, claiming 37 lives and leaving 148 people infected. According to Dr Gladys Kalema Zikusoka, a practicing veterinary doctor, zoonoses are associated with people living in close proximity with their animals.

“The burden of zoonoses is usually greatly underestimated and this has had serious consequences in terms of funding for both research and control initiatives,” Dr Kalema says.

 

Once infected, people, especially the rural poor, are less likely to have access to proper treatment. As with other neglected diseases, it is hard to calculate the national burden for zoonoses. 

Dr Issa Makumbi, head of Epidemiology and Surveillance at the ministry of Health, says sustainable control of zoonoses is reliant on surveillance but this is rarely implemented in the developing world because of lack of sufficiently cheap diagnostics. “Many zoonotic diseases are notoriously difficult to diagnose as they are often confused with other diseases; for example, where malaria is present, fevers owing to brucellosis may be misdiagnosed,” he explains. It response, the US Centres for Disease Control and Prevention (CDC) and the Uganda Virus Research Institute (UVRI) renovated the viral haemorrhagic fever lab (VHF) in Entebbe.

The lab provides for rapid detection, surveillance and diagnosis of viral diseases associated with haemorrhagic fevers like Ebola and Marburg. The lab includes specialized diagnostic equipment for virus detection, rapid tests for characterization of viruses, a high containment area with secure and limited access and improved ventilation and air access systems. 

“This state of the art containment lab will enable us to make appropriate recommendations to the Health ministry in order to effectively implement public health programmes to reduce spread of zoonotic diseases,” Dr Edward Mbidde, the UVRI director, said. 

There will be a 24-hour diagnosis of samples which hitherto had been sent to Geneva, China and South Africa

 

Virus research institute gets Shs240m lab

Saturday Monitor, June 23, 2012  

By Martin Ssebuyira


In Summary
The laboratory is expected to enable scientists to quickly identify outbreaks of diseases and limit their rapid spread because it can detect viral diseases within 24 hours. The Uganda Virus Research Institute (UVRI) has opened a Shs240 million laboratory. The laboratory was funded by the US based Centers for Disease Control (CDC). The laboratory includes state-of-the-art equipment for rapid diagnosis of viral diseases associated with hemorrhagic fevers. 

“Testing for hemorrhagic fever viruses like ebola and marburg are just several of the diseases that the laboratory is capable of diagnosing. All testing and research are conducted in a secure and isolated environment where staff are properly trained in safety and protective measures,” Mr Tadesse Wuhib, CDC Uganda country director, said last week during the opening of the laboratory in Entebbe.

He said the laboratory will enable scientists to quickly identify outbreaks and limit their rapid spread because it can detect viral diseases within 24 hours.

 Mr Trevor Shoemaker, an epidemiologist at CDC, said the organisation has a long history of working with the Ministry of Health to address public health emergencies and routinely provides surveillance, investigation, laboratory diagnostics, and response support for contingencies involving dangerous pathogens and diseases of pandemic potential.  “CDC has supported numerous outbreak investigations in Uganda, including ebola, marburg, botulism, anthrax, and typhoid. They have of late joined the ongoing investigation into nodding syndrome,” Mr Shoemaker said.  He said the laboratory would enable them come out with general statements on specific viruses and send the samples to Atlanta, US, where the CDC headquarters is based, to further specific viral diagnoses when need arises. Dr Edward Katangole Mbidde, the UVRI director, said additional virus detection capabilities will be added in the next several months to make Uganda a centre for virus diagnosis in East and Central Africa. 

Virus Research in Uganda
CDC has supported various outbreak investigations in Uganda like ebola that struck in Gulu in 2000, marburg in Kamwenge in 2007, ebola in Bundibugyo in 2007, Schistosomiasis in Jinja in 2007 and Hepatitis E in Kitgum in 2008. Others were botulism in Kasese in 2008, typhoid in Kasese in 2008, anthrax in Bushenyi in 2008, yellow fever in northern Uganda in 2010, Ebola in Luweeo in 2011, anthrax in 2010 and nodding disease syndrome in northern Uganda. 

UVRI was established in 1936 by the International division of the Rockefeller Foundation as a yellow fever research institute. In 1950 the Institute became the East African Virus Research Institute under the East African High Commission. In 1977 the East African Community collapsed and the Institute was subsequently named the Uganda Virus Research Institute.

 

Uganda: How Close Are We to Finding an HIV Vaccine?

The New Vision, May 21, 2012 

The hunt for an HIV vaccine in Uganda is younger than the hunt for rebel commander Joseph Kony of the disparaging LRA. Both have cost a lot of lives and money. 

The hunts involve the international community, hope to put an end to the scourge soon, and are so far failing to hit the ultimate target, but insist, very hopefully, that the end is drawing nearer with each passing day. 

But while Kony has killed thousands, HIV has claimed over 25 million people since 1981, according to the World Health Organisation. And efforts to eradicate it have included a lot more of research and trials consuming millions of dollars. And, according to Dr. Hannah Kibuuka, the director at Makerere University Walter Reed Project (MUWRP) in Nakasero, big diseases are usually eradicated by vaccines. "Look at smallpox!" she says, "HIV prevention and treatment strategies are very important, but a successful vaccine would give us a magic bullet."

 

World awareness day 

Yesterday was the World HIV Vaccine Awareness Day. This annual observance is meant to recognise and thank the thousands of volunteers, community members, health professionals, and scientists, who are working together to find a safe and effective HIV vaccine. It is also a day to educate our communities about the importance of preventive HIV vaccine research. In Uganda vaccine research efforts started as early as 1992, and according to Dr Juliet Mpendo, the medical director of the Uganda Virus Research Institute (UVRI), the very first HIV vaccine trial was conducted at the Joint Clinical Research Centre (JCRC).  "Since then, a number of trials have been conducted at various sites in collaboration with international organisations. We have conducted four HIV Vaccine trials so far," she says.

 Kibuuka adds that at MUWRP, two trials were conducted in 2004 and 2006.

 

The HIV vaccine

A vaccine is a biological preparation that contains an agent that resembles a disease-causing micro-organism. This agent stimulates the body's immune system to recognise it as foreign and attack it not only to destroy it, but also to keep remembering it in case it returns later.

 

Dr. Mukwaya, Uganda’s most renowned malaria researcher 

The New Vision, April 26, 2012

To mark 50 years of Uganda’s independence, New Vision will until October 9, 2012 be publishing highlights of events and profiling personalities that have shaped the history of this country. Today, Gladys Kalibbala brings you the story of Dr. Louis Mukwaya, the Ugandan face spearheading the anti-mosquito war

Dr. Louis Mukwaya, 73, the assistant director at Uganda Virus Research Institute, Entebbe, and head of the entomology department devotedly goes about his work. The researcher, who prefers to keep a low profile, is checking on the eggs of mosquitoes. He later tells me he has been doing this for a decade and that he was the first black Ugandan researcher at this center.

Mukwaya is happy his hard work has finally been recognized with international researchers naming a new subgenus stegomyia (mosquito) after him. “It’s difficult to explain my excitement when I received the e-mail from a friend!” he exclaimed.

The report released on November 30, 2009, by international researchers; John F. Reinert, Ralph E. Harbach and Ian J Kitching from Centre for Medical, Agricultural and Veterinary Entomology, United States Department of Agriculture, Agricultural Research Science, indicated that a new subgenus stegomyia, Mukwaya, includes different species of mosquitoes found all over Africa south of the Sahara. 

It further stated that Mukwaya (the mosquitoes) is named in honour of Dr. Louis Mukwaya, in recognition of his many contributions to medical entomology. Subgenus Mukwaya was noted to transmit yellow fever, but it does not bite human beings. A month before on October 30, 2009, Mukwaya had been elected as a fellow of the Uganda Academy of Sciences.

 

Venturing into entomology 
Mukwaya traces his research instinct from his early days, when, at his parent’s home in Kangave-Kirema village, Makulubita, Luweero district, he suffered from a strange eye disease. He says the eye infection could not heal with ‘the tube’(ointment) his parents got from the hospital. “For two weeks the eyes remained swollen and very painful until an aunt picked some herbs from the bush and rubbed them on,” he recalls. 

Mukwaya adds that in two days the eyes were better and he was able to continue with school. This experience, he believes, ignited in him the passion to discover what it was in plants that made people’s lives better. He decided to study pharmacy. “Although I was in P.5, I resolved not to remain behind the counters and dispense medicine, but go deep into research,” he recalls.

In 1965, while still at Makerere University, he succeeded in the multiplication of over 100 grasshoppers at his laboratory. His lecturer, Prof. Rowell Hugh, who he calls his mentor, had given him this project.

“Like all other people I did not know how grasshoppers produced because we only saw them come around in May and in November,” Mukwaya says. He picked a few from the lights outside and put them into cages in the laboratory at the Zoology Department. He fed them and monitored them, and kept changing types of grass since he did not know what type they exactly needed.

The doctor later celebrated his success when he got over 100 of them without waiting for the month of May or November to come. After his PhD in 1972, Mukwaya who had joined Uganda Virus Research Institute as a trainee, where he met and interacted with only two other black men from Zambia and Kenya, was given a hard task. 

Dr. Williams Miles, the then director of the institute, wanted Mukwaya to find out why the mosquitoes transmitting yellow fever, which seemed to be all over the country, were only infecting people in the western region (Bundibugyo). 

According to Mukwaya, this heavy task could also have been a turning point for him as it took him deeper into his research. Since he required a good laboratory where he could work from, he started sending applications abroad to for a place to work on his research. 

His luck came when the director, Vincent G. Dethier, gave him a vacancy at Princeton University in the US in 1973. WHO in Geneva funded his stay there for one year.  He was the first black man to do research at this laboratory. 

Mukwaya says he walked a distance of 3km to this laboratory every day for a year since he could not afford transport. “Even during winter I walked and would be in the laboratory by 9:30am, leaving at 1:00am, ” he recalls. Mukwaya says he benefited a lot as he worked alongside Dethier, who also researched on the feeding of insects. Although on completion of his research the director wanted him to stay in the US, he had plans to come back and accomplish his dreams. 

“When I came back in 1974, there was a lot of insecurity in the country during Idi Amin’s regime, which did not allow me to start my work immediately,” Mukwaya says. In 1975, he was elected a fellow of the Royal Entomological Society of London and in 1976; he was elected a member of an Expert Advisory Body for Vector Biology and Control, working with the World Health Organisation (WHO) in Geneva.

In 1979, WHO invited him to Florida for a three-year study about the diseases of insects with a view of starting a programme in Uganda. “The study was about controlling insects without using chemicals. Due to financial constraints the programme has never taken off,” he says.

 

Educational background
Mukwaya was born on August 2, 1939 to late Yowana David Basajjassubi Makumbi and Marian Nansubuga. His mother died in labour in 1941 when he was about two years old. 

He says after their mother’s death, their father worked hard to raise him and two of his siblings. He died in 1967, when Mukwaya had just completed his course at Makerere University. He studied at Kangavve Preparatory School, then Kijjaguzo Primary School in Luweero, where he completed P.6 in 1952 and was ranked the second-best pupil in Buganda.

Mukwaya went to Rubaga Junior School in 1953, while living with relatives at Lungujja. Due to his being naughty all the time, students at Rubaga connived and elected him head prefect, which annoyed him. At the end of their P.3 he was among the three boys that performed well and were offered places at St Mary’s College, Kisubi. He was good in physics, chemistry and biology, which later enabled him to join Makerere University in 1960 and completed in 1965. He hails the late Senkubuge whom he met at UVRI when he had just joined, but later worked with him even after the hard times of the breakup of the East African Community.

“He was a P.4 drop-out but taught me a lot about mosquitoes,” he says. Mukwaya explains that with time, with the use of grants, he has been able to train students in his field where four of them have attained PhDs and there are over 10 technicians.

He is married to Annet Mukwaya, a housewife and together they had eight children (two have since passed on). The other six are Dr. Josephine Birungi who works with UVRI; Anthony Makumbi of Plan International; Christine Mukwaya, a senior water officer at the water ministry; Annet Namukwaya who works with the Malaria Project and Solomy Mukwaya of the Walter Reed Project, Kayunga.

 

  

HIV drug resistance worries Uganda medics
The Observer, April 24, 2012
 
By Racheal Ninsiima

As the Ugandan Anti-retroviral Therapy (ART) programme matures, new challenges have begun to emerge. Available research indicates that the longer one stays on ART, the more likely for them to develop HIV drug resistance (HIVDR). The emergence of resistance in persons on antiretroviral therapy and transmission of drug-resistant HIV strains to newly infected persons are now major public health concerns.

According to Dr Cissy Kityo, the Deputy Executive Director Joint Clinical Research Centre (JCRC), HIVDR is a situation whereby a client on ART does not respond to the prescribed drugs and therefore, experiences health deterioration despite the fact that he/she takes the drugs efficiently and effectively. 

“This means the clients have to be moved from first-line therapy to second line ART, the latter being a more expensive course of treatment,” Kityo explains.

 

A recent survey by the Health ministry of infected young people in Kampala showed that 8.6% had evidence of the drug-resistant virus, with resistance to all three classes of ARVs currently available in the country. 

How drug resistance occurs 
According to Prof Tobias Rinke de Wit, the Research and Development Director of PharmAccess – a Dutch foundation that provides HIV treatment services for the private sector in Sub-Saharan Africa – drug resistance is caused by changes (mutations) in the virus’s genetic structure. 

“These mutations can lead to changes in certain proteins, most commonly enzymes, that help HIV reproduce (replicate),” he explains. 

Prof Rinke adds that mutations are very common in HIV because HIV replicates at an extremely rapid rate and does not contain the proteins needed to ‘correct the mistakes’ it makes during copying. Mutations occur randomly on a daily basis, but many are harmless. In a research conducted by AIDSMEDS, most mutations actually put HIV at a disadvantage because they reduce the virus’s “fitness” and slow its ability to infect CD4 cells in the body.

“However, a number of mutations can actually give HIV a survival advantage when HIV medications are used, because these mutations can block drugs from working against the HIV enzymes they are designed to target,” reports the research. 

Accordingly, continued viral replication in the presence of drug pressure allows for the progressive accumulation of mutations that can lead to increased resistance. Some ARVs require only a single-point mutation to have high-level drug resistance, whereas others require multiple-point mutations. The number of mutations required to confer resistance contributes to the genetic barrier to resistance.

 

Causes of resistance 
Prof Rinke says poor treatment adherence to ARVs is the leading cause of drug resistance. 

“In order for HIV drugs to work correctly, they must be taken exactly as prescribed. Skipping doses or not taking your medication correctly can cause the amount of an HIV drug to decrease in the bloodstream. If the drug level becomes too low, HIV can reproduce more freely and accumulate additional mutations,” he explains. 

Poor absorption 
Dr Kityo says not only must HIV drugs be taken on schedule; they need to be absorbed effectively into the bloodstream. A drug or combination of drugs that is not absorbed properly can result in levels in the bloodstream that are too low and, ultimately, allow HIV reproduction and the accumulation of drug-resistance mutations. 

Effects of drug resistance
According to Prof Pontiano Kaleebu, the Director, Uganda Virus Research Institute (UVRI), drug resistance means that clients on ART that have developed resistance can transmit an HIVDR virus.

 

“Mothers may pass on this virus to their unborn babies, meaning that by the time a child is born, they resist drugs, which exposes them to high infant mortality,” Kaleebu says.

 

What has been done?
A number of initiatives have been taken to address challenges presented by HIVDR in ART programmes. One of the critical activities is to monitor emergence of HIVDR among patients that have started ART.  Prof Kaleebu says the Uganda Virus Research Institute has established a national HIV drug resistance surveillance programme charged with the duty of monitoring the spread of HIV.

“We have established an HIV technical working group under this programme and its main duty is to monitor and report early warning indicators like drug stock outs, patients’ adherence to the drug and drug resistance in individuals among other roles,” Prof Kaleebu says.

More, the JCRC with other partners have for the last four years carried out research on the emergence of HIVDR in clients on ART over time. Prof Peter Mugyenyi, the Executive Director JCRC, says the research was done in both adults (18 years and above) and children below 12 years with the aim of minimizing HIVDR prevalence in selected geographical settings (Kampala, Fort Portal and Mbale) and other African countries such as Kenya, Nigeria, Zimbabwe, and variations within individuals.

 

Challenges 
According to Dr Alex Ario, the national coordinator of the ART programme in the ministry of Health, of the 1.2 million people positively living with HIV, 577,000 need ARVs and only 331,000 are on treatment.  This is because drug resistant tests are expensive (about Shs 1.3 million). 

“While determining the viral load can help you determine if your drugs are not working effectively, it cannot explain why this is happening and hence the need for drug resistance testing,” Dr Ario says. 

With budgets for HIV/AIDS treatment already shrinking as a result of the global economic crisis, and second-line ARVs costing at least five times more than first-line drugs, this could stall efforts to expand treatment access.

 

Loading...
Select UVRI Video to watch