Avian influenza viruses are changing pandemic threat

 31/10/2012
(AFP) - At the International Scientific Conference on the causes and management of severe influenza, which took place in Hanoi from 29/10- 31/10, scientists say concern about a flu pandemic can occur due to avian influenza virus changes.

According to the scientists, at present, the emergence of the H5N1 flu outbreak in poultry and the ability of the recombinant virus to other strains may occur will form strains have the ability to spread from person to people more quickly.

Deputy Minister of Health Nguyen Thi Xuyen said, appearing in the last eight years, the H5N1 flu is still a threat of a pandemic. From 2003 to now, Vietnam has recorded 123 cases of H5N1 flu (the third world), including 61 deaths. And in Vietnam, after a year of bird flu does not appear, in the year 2012 has recorded two cases of bird flu, including one case of death.  http://www.vnmedia.vn/VN/suc-khoe/tin-tuc/73_319750/vi_rut_cum_gia_cam_dang_bien_doi_de_doa_dai_dich.html

So far the H5N1 virus is highly pathogenic virus, the mortality rate ofnearly 50%, with time up to 70% - 80%. The virus often changesquickly, the disease likely to die from respiratory failure, multiple organfailure.

MURBURG UPDATE video

Ministry of health hires 10 foreign experts to handle Marburg outbreak

TUESDAY, 30 OCTOBER 2012 06:48 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 he 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.”  http://www.independent.co.ug/news/news/6708?task=view

436 being monitored for Marburg signs

Publish Date: Oct 30, 2012

The Ministry of Health and experts from the Centre for Disease Control and Prevention have set up a field diagnostic laboratory in Kabale district to quicken testing of suspected Marburg cases.

It will take three hours, instead of 24 hours, for patients to get their results at the new facility based at Kabale Regional Referral Hospital.

Health minister Dr. Christine Ondoa said the facility would also serve neighbouring districts while further serological results are to be undertaken at the Uganda Virus Research Institute in Entebbe.

The Kabale district health officer, Dr. Patrick Tusiime confirmed that the lab started tests on Sunday.

He said the equipment they got had reduced on the time required to transport specimen to Entebbe, which required 48 hours to get feedback.

He disclosed that three of the eight patients admitted at Rushoroza Health Centre III had tested negative.

He, however, said the hospital was facing logistical challenges in the use of ambulances and the transportation of burial teams.

At least eight people have been confirmed to have died from the Marburg infection over the last three weeks. Other 12 suspected cases have been isolated and are under surveillance in Kabale, Ibanda and Kampala districts.

http://www.newvision.co.ug/news/636887-436-being-monitored-for-marburg-signs.html

12 People Admitted Over Marburg as 436 are Put Under Surveillance

436 people have now been under surveillance over the marburg fever which broke out in the country at the beginning of the month.

The 436 people come from different parts of the country including Mbarara, Kampala, Ibanda, Fort Portal, Jinja, among others.

In addition, there are up to twelve people who were admitted to different hospital after having signs of the fever. Of the twelve, two are in Mulago hospital, eight at Bisolowoza and two at Mayanja Memorial Hospital in Mbarara.

The ministry of health has called out to the people to be careful as the fever spreads randomly across the country.

The marburg fever was first reported in Kabale after a group of people in one family, four in number, died from the disease. By then, it had not been identified as marburg and several people attended the burial without any protective measures.

However, after the burial, it was identified as such and several people were put under surveillance but were not isolated. Kabale district has already banned public gatherings as the fever takes root in the country.

The fever broke out after the country was declared Ebola free. A team of experts from Center for Disease Control (CDA) was expected to arrive in the country to find the cause of the fever and find a way to combat it.  http://www.ugandapicks.com/2012/10/12-people-admitted-over-marburg-as-436-are-put-under-surveillance-32447.html

Fungal Meningitis Outbreak Toll Now 28 Dead, 363 Sickened

Cases rise as investigation into compounding pharmacies implicated in the outbreak continues

TUESDAY, Oct. 30 (HealthDay News) -- As compounding pharmacies at the heart of the ongoing meningitis outbreak are inspected and closed, the death toll rose to 28 on Tuesday, with 363 illnesses reported across 19 states.

Three new fatalities -- two from Michigan and one from Tennessee -- have occurred since the last tally issued by the U.S. Centers for Disease Control and Prevention on Monday.

The latest numbers come days after Massachusetts officials closed a second compounding pharmacy after inspection revealed conditions that might threaten the sterility of its products.

According to The New York Times, Waltham, Mass.-based Infusion Resource voluntarily surrendered its license over the weekend after inspectors found "significant issues with the environment in which medications were being compounded," Dr. Madeleine Biondolillo, director of the Bureau of Health Care Safety and Quality at the Massachusetts Public Health Department, said at a press briefing.

While she did not release details of.. http://health.usnews.com/health-news/news/articles/2012/10/30/fungal-meningitis-outbreak-toll-now-28-dead-363-sickened

Gunfire Rocks Kamwezi sub county as Marburg Team Survives Lynching

The residents claimed that they had received reliable information that the deceased had tested negative for the Marburg virus and accused the medical workers of causing his death when they admitted him in the isolation ward.  http://ugandaradionetwork.com/a/story.php?s=46986

India-Coronavirus alert: Airport officials beef up surveillance

K R Rajeev, TNN | Oct 28, 2012, 04
KOZHIKODE: Taking a serious view of the reporting of two cases of a Sars-like novel coronavirus infection in the Middle East, the Union health ministry has issued an advisory to enhance surveillance on incoming passengers from Saudi Arabia and Qatar. 

Health officials at Karipur airport said they would keep track of passengers who have respiratory illnesses that are different from the local flu. "There won't be any special screening of passengers at the airport but we would keep track of those reporting symptoms of acute respiratory illness presenting with fever, cough and shortness of breath arriving from Saudi Arabia and Qatar," said Dr K V Hameed, medical officer, airport medical centre. 

The advisory issued by the Assistant Director General (International Health) of the Union Ministry of Health and Family Welfare has asked airports to report patients with symptoms of acute respiratory illness as per the case definition provided by the WHO. "The advisory has been made especially with respect to incoming Haj passengers from Saudi Arabia," the letter says. 

The advisory also provides the case definition, comprising clinical, epidemiological and laboratory information, for identifying cases that are listed under three categories — patient under investigation, probable case and confirmed case. 

The novel coronavirus, related to the Sars virus that claimed hundreds of lives in 2003, has claimed the life of a 60-year-old in Saudi Arabia and a Qatari man is currently under treatment in London after contracting the disease. 

Hameed said if a passenger falls under the 'patient under investigation' category, he/she would be subjected to X-ray and other examinations. "The details of patients would be passed on to Union health authorities... As of now, there is no reason to be scared as just two cases have been reported and human-to-human transmission has not been found."   http://timesofindia.indiatimes.com/city/kozhikode/Coronavirus-alert-Airport-officials-beef-up-surveillance/articleshow/16986945.cms

MARBURG UPDATE --- TARIFFA

29 People Under Surveillance for Marburg in Kampala

29 people have been put under surveillance in Kampala for the marburg fever which broke out in the country.

The number rose from 26 to 29 people. The marburg fever started with the death of four people from the same family in Kabale district.  The ministry of health put under surveillance every one who had attended the burial.

In Kabale district, the number has increased from 132 to 200 people while two deaths have so far been confirmed from the fever with Ebola like symptoms.

The fever was first detected in Kampala when a woman, Sharon Twinomujuni who had attended the burial of the four first deceased got the virus. It is said she was related to the deceased.

She was taken to Mulago hospital for treatment and is currently recovering.

A disease control team is expected to arrive in the country to monitor the marburg situation in Kabale and find what caused the fever. http://www.ugandapicks.com/2012/10/29-people-under-surveillance-for-marburg-in-kampala-39231.html

Marburg Erupts Inside Health Ministry

The Ministry of Health has been thrown into panic after it emerged some of its own are suspected to have contracted the deadly ebola-like Marburg virus, Red Pepper can authoritatively report. Sheila Ndyanabangi, the clinical officer in the ministry is reported to be one of the 29 contacts the ministry has quarantined and for that reason she has been asked to go on forced leave for fear of spreading the disease to other workers.

This comes after one of Ndyanabangi’s unidentified relatives visited her from Kabale recently. The relative developed signs of Marburg, and luckily, as a senior medic, she was able to tell that something unusual was happening to the former.

The patient was rushed to Mulago for treatment and when her ‘superiors learnt of the shocking incident’ she was forced to stay home until she can be passed as free of the virus. An insider in her home who preferred anonymity told our reporter.

Red Pepper confirmed this development yesterday when she failed to turn up for the psychiatric conference she was expected to chair and present a paper. Instead she forwarded her written apologies through a workmate who represented her. The message reads in part; “First of all I begin by extending my sincere apologies, I was unable to chair this conference because a sick relative having Marburg visited me. And in turn I have been ‘forced’ to stay home until I am declared Marburg-free.”

The Ministry publicist Lukiah Nakamatte confirmed the news when we contacted her last night. “Yes Dr. Sheila is among the 29 contacts that are being monitored, we have taken her blood samples and we are waiting for the results,” Lukiah exclusively revealed.

However, she denied claims by Ndyanabangi that she was forced to stay home as written. “She was not forced to stay home but rather put under close watch,” Lukiah stated. The news confirms our earlier story that the deadly Marburg has hit Kampala city.

The country has been living in fear following the outbreak of Marburg Fever two weeks ago in the south western district of Kabale and has since claimed six lives. http://www.redpepper.co.ug/?p=1124

New Marburg case reported in Ibanda

Sunday, October 28  2012 at  01:00

The deadly Marburg virus has claimed two more lives, raising the death toll to seven and scaling up the infected areas.

Lydia Rusanyuka, 50, the mother to the former Kabale Regional Referral Hospital mortuary attendant, Mr Jason Tumukunde, succumbed to the disease in less than six hours after she tested positive. Another person was confirmed dead in Ibanda District, medical officials said.

The Kabale District Health Officer, Dr Patrick Tusiime, told this newspaper yesterday that Rusanyuka, a resident of Bukora Village Kitumba Sub-county, died in the isolation centre at Rushoroza Health Centre III shortly after midnight.

“A total of cumulative Marburg virus cases both probable and confirmed in Kabale District is now 14, the cumulative specimens collected so far are 14, the total number of admissions at the isolation centre is seven and the total number of people that got into close contact with the Marburg virus victims is now 198. The situation is becoming complicated,” Dr Tusiime said.

Marburg experts currently in Kabale have released a report indicating that a new Marburg case has been confirmed in Ibanda.

New Marburg case in Ibanda
“The Ibanda case is of a 32-year-old woman, resident of Sigiria Village, Kihani Parish in Kinkye Sub-county. She was admitted at Mbarara Regional Referral Hospital on October 19 and died five days later after having miscarriage. The specimens were collected from her body and they tested Marburg positive and a supervised burial was conducted. Seven people that got in close contact with the deceased have been listed and are being followed up,” the report issued by Dr Tusiime and the Marburg epidemic experts, reads in part.

One of the Marburg victims, Mr Obed Tutegyerize, was discharged after specimens collected from him tested negative, six days after he was admitted at the isolation centre.
“Tutegyerize lost his two brothers, a sister and a mother to Marburg virus.

The specimens from him tested Marburg positive after he had escaped to Rukungiri for spiritual healing. The Marburg virus experts now camped in Kabale traced him and was put in the isolation centre. Specimens were again taken from him and on October 26 and tested negative and was discharged,” Dr Tusiime said.  http://www.monitor.co.ug/News/National/New+Marburg+case+reported+in+Ibanda/-/688334/1604776/-/jni7ajz/-/index.html

Marburg Feared In Kampala

Deadly ‘unprecedented’ Marburg virus is likely to hit Kampala city center. The shocking news was unveiled by the Minister of Health, Christine Ondoa at Uganda Media Center.

Though she seemed not want to raise alarm, the statistics she gave were very clear that the fatal contagion is swimming in the ‘air’ of our dusty streets.
Ondoa said that so far six people have been succumbed to the disease with four testing positive. The health experts are monitoring 196 contacts (patients) in Rukungiri, Kabale, Ibanda and Kampala districts, plus one put under isolation in a  facility in Kabale and another in Mulago.

She said that 29 people including relatives of the affected and health workers are under surveillance here in Kampala while their blood samples taken to Entebbe Research Center for laboratory tests.
When Red Pepper asked her how safe the city center, the polite Minister responded that she wouldn’t want to arouse fears because the Ugandans not recovered from the ‘Ebola tragedy’.

Foreign Experts Fly In
A team of health experts from Center for Disease Control (CDC) based in Atlanta USA will jet in to back up the local expertise on bringing the tragedy to an end.  http://www.redpepper.co.ug/?p=1094

Uganda: Marburg - Kabale Bans All Public Gatherings

BY EDWARD SSEKIKA, 24 OCTOBER 2012

In a bid to avert further spread of the deadly Marburg haemorrhagic fever in Kabale, authorities in the western Ugandan district have banned all public gatherings, including church crusades.

The ban takes immediate effect. Kabale district chairman, Patrick Besigye, told The Observer yesterday that since the virus has no treatment, the most effective way of fighting it is to control its spread.

Marburg haemorrhagic fever was confirmed in Rwabihondo village, Kitumba parish, in Kabale last week and has claimed five lives from one family in a space of one month.

"We have also suspended graduations at Kabale University and Independence day celebrations for the district," Besigye said.

Kabale University's graduation ceremony was scheduled for October 27, while the district's Independence day celebrations were due October 31. Besigye further revealed that pupils from families suspected to have Marburg virus have also been stopped from attending school.

"The schools and markets will keep operating until we assess the situation," he said, urging the public to respect the ban.

Dr Patrick Tusiime, the Kabale district health officer, urged the public to take precautionary measures as one of the best ways of guarding against the Marburg virus. Besigye said four Marburg patients, including a relative of the family where five people died, have been admitted at Rushoroza health centre III, which has been designated as an isolation unit.

"The families of the dead are being monitored from their respective homes," he said.

Health experts are also monitoring some 40 people suspected to have had contact with the five killed by the deadly virus. Kabale has put in place several committees to respond to the disease. They include the Marburg district task force, with smaller, manageable specialized committees: the case management committee, surveillance committee and logistics committee, among others.

"We meet every morning and plan for the day and also meet in the evening to evaluate," Besigye said.

Meanwhile, Dr Jane Aceng, the Director General of Health Services, in a statement issued on Monday, said health experts in Mulago hospital are still monitoring a woman who tested positive for the Marburg virus. The woman is related to the five people who succumbed to the disease in Kabale and is in a stable condition in the isolation room at Mulago hospital. http://allafrica.com/stories/201210251188.html

Add two provinces appear PRRS in pigs

Thursday 17:12 10.25.2012

(HNMO) - 25-10, Department of Animal Health (Ministry of Agriculture and Rural Development), said last PRRS in pigs appeared in two provinces: Khanh Hoa and the Pacific, bringing the total number of the local epidemic 5 provinces.
Accordingly, in Thai Binh province, on the last 18-10, PRRS has occurred on the North Sea in the commune, Tien Hai district, more than 60 infected pigs total herd of 225. At the same time, Khanh Hoa Province People's Committee has decided to publish the reproductive and respiratory disorders in pigs in the city of Nha Trang. Earlier, blue ear disease in pigs occurred in the city of Nha Trang and Ninh Hoa town, with the total number of pigs than 560 children, including 35 deaths. 

According to the Department of Animal Health, 12 -10 recently, avian influenza has occurred in Do Luong commune, Dien Bien district, Dien Bien province, more than 1,100 children infected poultry, including more than 950 ducks, nearly 130 chickens. Test results are positive for the H5N1 flu virus.Department of Animal Health, in collaboration with local governments destroy all infected poultry, and implementation of preventive measures prescribed. Thus, at present, there are 3 provinces : Quang Ngai Peace and Dien Bien avian less than 21 days; 5: Dak Lak, Quang Nam, Phu Yen, Khanh Hoa and the Pacific PRRS in pigs less than 21 days.  http://hanoimoi.com.vn/Tin-tuc/Doi-song/563669/them-2-tinh-xuat-hien-dich-tai-xanh-tren-lon

These Are The Airports Most Likely To Start A Pandemic

Jennifer Welsh | Oct. 24, 2012, 11:32 AM

When a new or dangerous virus breaks out in a small town in Africa, it isn't likely to go far. But, if that same disease travels through a large international airport, there's no way to stop it from spreading to multiple cities.

In 2002 the new coronavirus SARS spread to 29 countries in the seven months since the first person was infected. Air travel played an important part in that spread.

Ruben Juanes, a researcher at MIT, published the first model of how a disease would spread through airports in the journal PLoS ONE in July of this year. From that report these are the top 8 airports most likely to fuel a pandemic:

1. New York (JFK)
2. Los Angeles (LAX)
3. Honolulu (HNL)  
4. San Francisco (SFO)
5. Newark, NJ (EWR)
6. Chicago (ORD)
7. Washington, D.C., Dulles (IAD)
8. Atlanta (ATL)  

Interestingly, the number of passengers per day isn't the most important feature for an airport to be able to spread disease. Find out why in Discover Magazine.  http://www.businessinsider.com/airports-most-likely-to-start-pandemic-2012-10

Read more: http://www.businessinsider.com/airports-most-likely-to-start-pandemic-2012-10#ixzz2AJPFSZBC

Deadly Marburg virus kills six in Uganda

Sapa-dpa | 25 October, 2012 13:51

Marburg virus hits Uganda. File photio

The number of people who have died from a Marburg virus outbreak that started in the south-west of Uganda and has now reached the capital has risen to six, the country's health ministry said Thursday.

The highly-infectious disease has spread to three districts - including the capital, Kampala - after it struck in early October in the south-western Kabale district.

Nearly 200 people believed to have been in contact with the Marburg victims have been placed under surveillance, Health Minister Christine Ondoa told reporters.

She said that 10 per cent of those under surveillance were in Kampala...

http://www.timeslive.co.za/africa/2012/10/25/deadly-marburg-virus-kills-six-in-uganda

Marbug vids

Uganda: Conservationists Call for Ugandans to Stop Eating Chimps

BY HENRY WASSWA,
25 OCTOBER 2012

Albertine Rift Region — Conservationists struggling to protect the remaining population of Ugandan chimpanzees have raised concerns that people around wildlife reserves in the west of the country have taken to eating the primates.

"There is now an issue of eating bush meat. We did not think Ugandans were eating primate meat but we are starting to observe that monkeys and chimps are being eaten. This is scary. The threat to their survival has been growing bigger," according to Lily Ajarova who runs the Ngamba Chimpanzee Sanctuary, located on an island of the same name in Lake Victoria in the Albertine Rift region.

The sanctuary, which houses 48 primates rescued from human captivity, was set up with the help of the Jane Goodall Institute and is managed by the Chimpanzee Sanctuary and Wildlife Conservation Trust.

Decades ago, tens of thousands of chimpanzees roamed the thick tropical forests that then covered a vast tract of land in Uganda's Albertine Rift region. The area covers the western arm of the Great East African Rift Valley from north-western Uganda to the extreme southwest, along the border with the Democratic Republic of Congo (DRC).

But according to the World Wildlife Fund, chimpanzees have already disappeared from four African countries, and are nearing extinction in many others largely due to deforestation and the hunting of the primates for bushmeat. Currently there are only an estimated 5,000 chimpanzees in Uganda, conservation officials say.

Most of the remaining chimpanzees in this country are protected in six main game and forest reserves in the Albertine Rift region, while others are trapped in forests owned by individuals.

Ajarova told IPS that although her team of conservationists had first noticed people eating primate meat in western Uganda two years ago, those engaging in the practice had mostly been immigrants or refugees from neighbouring DRC. It was rare for locals in this East African nation to eat primate meat, she said.

"There are many other parts of the world where primate meat is eaten but this had not been happening in Uganda. We began witnessing this over time. It has been developing slowly and we ourselves only got wind of it when we were in the field two years ago," she said, adding that it was now "an emerging problem."

The recent arrivals of immigrants from the DRC have created a shift in the population balance of the area and have had an effect on local culture, she said. In July the Minister for Relief, Disaster Preparedness and Refugees Musa Ecweru said that Uganda was struggling to feed the large number of Congolese fleeing the fighting in North Kivu Province in neighbouring DRC. There are an estimated 16,000 Congolese refugees in western Uganda.

"There are lots of Congolese refugees in the area and they may have influenced the local people to eat monkeys and chimpanzees," Ajarova said. "This has not been a part of Ugandan culture in the past, but now it is becoming an issue. We have found that the habit is now rife in the whole (western) region. It is rampant in almost all the villages we visit.

"We have from time to time seen villagers carrying carcasses of monkeys and, on occasion, chimps," Ajarova said.

Officials also believe that people have taken to eating primates because the Albertine Rift region is poverty-stricken and people mostly depend on forest resources for survival, as they cannot afford to purchase meat.

"People are desperate, they are poor as this is an underdeveloped region. They mostly depend on forest resources, including game meat, and this may have forced them to resort to eating primate meat," Ajarova said.

Experts are now worried that the new trend could lead to a possible outbreak of Ebola, a haemorrhagic fever that is often fatal, which is believed to be transferred to humans through contact with an infected animal.

"This is a serious problem. Any meat that is eaten has to pass through proper veterinary inspection, even if it is from farms. People eating primate meat run a risk of getting infected with zoonotic diseases, including Ebola," said Andrew Seguya, the executive director of the Uganda Wildlife Authority.

"There is no Ugandan tribe that traditionally eats primate meat, but there are many Congolese refugees in that area and the Congolese may have spread the habit to locals," he said.

"Ebola is spread through direct contact and it's thought that these primates are carriers of the disease and may transmit it to humans through other ways, including faecal matter. There is even a school of thought that AIDS might have been transmitted from primates," Seguya, a veterinary surgeon, told IPS.

The western district of Kibaale, in the Albertine Rift region, was hit by a suspected Ebola epidemic in July. Health officials are yet to confirm that it was an Ebola outbreak. But according to media reports 17 people died.

Meanwhile, Ajarova said efforts are being made to change people's attitudes towards eating primate meat through education programmes and the setting up of animal-rearing projects among villagers.

"We are telling people to stop eating primate meat, informing them that it is dangerous to their health as they will get diseases like Ebola. This is one of the key messages in our education programmes," she said.

"We also use FM radios to pass on conservation messages to the communities. These reach out to large numbers of people at one go," Ajarova said.http://allafrica.com/stories/2012102...html?viewall=1

PRESS STATEMENT ON THE UPDATE ON THE MARBURG OUTBREAK

October 25th 2012 

MINISTRY OF HEALTH 
P. O. BOX 7272, 
KAMPALA - UGANDA
PRESS STATEMENT ON THE UPDATE OF MARBURG OUTBREAK 

The Ministry of Health declared an outbreak of Marburg in Kabale district on October 19th 2012 after receiving laboratory results from the Uganda Virus Research Institute (UVRI) confirming that two family members had died of the highly infectious viral hemorrhagic fever. Three other members of the same family had earlier died of a strange disease in a period of one month. 
The death of these people prompted the District Health Office to undertake further investigations of this strange disease that had ravaged Kitumba parish in Kitumba sub-county, Kabale district. 
According to the reports, the patients presented with symptoms of diarrhoea, vomiting, fever, headache, dizziness and generalized convulsions. Initial samples of blood and cerebral spiral fluid taken from the sick people ruled out Malaria and Meningitis. The family then invited a cult leader, a retired Reverend from Rukungiri, district to visit their household and pray for the sick. 
The index case is believed to have been a member of a family in Rwabirondo village, Kitumba parish in Kitumba sub-county which occurred on 20th September 2012. After the death of the index case, two other people, a sister and mother reportedly got sick and died. 
This outbreak comes barely two weeks after the Ministry declared an end to another viral Hemorrhagic Fever (Ebola) on October 4th 2012. The last Marburg outbreak was witnessed in October 2007in Kamwenge district. 
Marburg is a highly infectious viral hemorrhagic fever which 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. 
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 (red eyes), nose, gums, ears, anus and the skin. 
How is Marburg Spread?
It is spread through;
• Direct contact with wounds, body fluids like blood, saliva, vomitus, droplets, stool and urine of a person suffering from Marburg. 
• Unsterilised injections, contaminated linen, beddings and clothes.
• Using skin piercing instruments that have been used by an infected person. 
• Direct physical handling of persons who have died of Marburg

Current Status (Update) 
The Ministry of Health has developed a response plan and budget for the Marburg control amounting to sh2.3b of which sh1.75 is for central level activities including Ministry of Health, six general hospitals and Kampala Capital City Authority. This will be majorly for case management, surveillance, research and social mobilisation and procurement of protective gears. The district budget totals 651,047,576 and it covers case management, surveillance, research and social mobilisation. 

• Out of the six people who have died so far, only three were confirmed positive for Marburg. 

• Currently, there is only one confirmed case admitted in our isolation facility at Mulago National Referral Hospital. One convalescent case is detained at Rushoroza Health Center III while five suspect cases linked to the initial cases are admitted there awaiting blood results. Special teams of doctors and nurses have been assigned to attend to the patients in both the isolation facilities. The patient admitted at Mulago National Referral Hospital is from Kitumba sub-county and is a relative of the index case. 

• The Ministry of Health surveillance team has listed up a total of 196 contacts for close monitoring. These contacts are mainly in Kabale, Rukungiri and Ibanda districts while 29 are from Kampala. Those being monitored reportedly got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 10 days without showing any signs and symptoms. 

• A team of experts from the Ministry of Health, U.S Center for Disease Control and Prevention and World Health Organization have so far collected a total of 18 n samples from suspected cases for further investigations. The samples are being analyzed at the Uganda Virus Research Institute, Entebbe.

• The Ministry is conducting an orientation of local healthcare workers in Kabale Regional Referral Hospital and in the other peripheral health facilities on infection prevention and control, barrier nursing, surveillance and clinical case management. This is being done to build health workers’ capacity to handle such cases. 

• In Rushoroza Health Centre, a burial committee has been set up to manage burials of people suspected to have died of Marburg. The committee has been oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly contiguous disease. The committee has so far supervised two burials.
• A team from the Centers for Disease Control (CDC) is expected in the country to undertake anthropological studies.
The Ministry of Health once again urges the public to take the following measures to avert the spread of the disease.
• Report immediately any suspected patient to a nearby health unit
• Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks
• Persons who have died of Marburg must be handled with strong protective wear and buried immediately
• Avoid eating dead animals
• Avoid unnecessary public gathering especially in the affected district
• Burial of suspicious community deaths should be done under close supervision of well trained burial teams
• Report all suspicious deaths to a nearby health facility 

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

Hon. Dr. Christine Ondoa 
Minister of Health 

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