Since the last report on 28 October 2022, there have been 16 additional confirmed cases and 16 additional confirmed deaths reported, the majority of which occurred up to week 43. There are currently seven Ugandan districts affected by this outbreak: Bunyangabu, Kagadi, Kampala, Kassanda, Kyegegwa, Mubende and Wakiso. Bunyangabu and Kagadi have not reported any cases since 20 September 2022. Although data are incomplete, the majority of new cases appear to be epidemiologically linked to known cases.
There was a large increase in cases in Kassanda district in week 43, however only one new case was reported during week 44. Since the last ECDC update on 28 October 2022, only one new case has been reported in Kampala, bringing the total to 18 cases.
Health officials have identified 3 794 contacts of cases from 14 districts in Uganda (51% of identified contacts have completed 21 days of monitoring). The proportion of registered contacts who were followed up in the previous 24 hours was 93% on 2 November 2022. This is an increase compared to previous reports, particularly in Kampala, where the rate has increased from 52% on 30 October to 90% on 2 November.
Background
On 20 September 2022, the Ministry of Health in Uganda, together with the World Health Organization – Regional Office for Africa (WHO AFRO) confirmed an outbreak of EVD due to Sudan ebolavirus in Mubende District, Uganda, after one fatal case was confirmed.
The index case was a 24-year-old man, a resident of Ngabano village of Madudu sub-county in Mubende District. The patient experienced high fever, diarrhoea, abdominal pain, and had been vomiting blood since 11 September 2022. Samples were collected on 18 September 2022 and EVD was laboratory-confirmed on 19 September. The patient died on the same day, five days after hospitalisation.
On 15 October 2022, the President of Uganda imposed a 21-day lockdown on Mubende and Kassanda districts to contain the outbreak of EVD. Measures include an overnight curfew, closing places of worship and entertainment, and restricting movement in and out of the two districts.
On 28 October 2022, the Ministry of Health in Uganda implemented measures to restrict travelling of contacts of confirmed Ebola cases during the follow-up period (21 days).
The Ugandan government is carrying out community-based surveillance and active case finding. An on-site mobile laboratory has been established in Mubende and risk communication activities are ongoing in all affected districts. Africa Centres for Disease Control and Prevention (Africa CDC), WHO, Global outbreak alert and response network (GOARN), and other partners have teams in Uganda to support the coordination of the response.
Previously, EVD in Uganda was reported in 2019 due to Zaire ebolavirus, which was imported from the Democratic Republic of the Congo. EVD outbreaks caused by Sudan ebolavirus have previously occurred in Uganda (four outbreaks) and Sudan (three outbreaks). The last outbreak of EVD due to Sudan ebolavirus in Uganda was reported in 2012.
ECDC Assessment
Risk to EU/EEA citizens living in or travelling to affected areas in Uganda
Despite the increase in number of cases and the transmissions reported in the densely populated capital city of Kampala, the current probability that EU/EEA citizens living in or travelling to EVD-affected areas of Uganda will be exposed to the virus is very low, provided that they adhere to the recommended precautionary measures (see further information below). Transmission requires direct contact with blood, secretions, organs or other bodily fluids of dead or living infected people or animals; all unlikely exposures for the general EU/EEA tourists or expatriates in Uganda.
Considering that infection with Sudan ebolavirus leads to severe disease but that the probability of exposure of EU/EEA citizens is very low, the impact for the EU/EEA citizens living and travelling in affected areas in Uganda is considered low. Overall, the current risk for EU/EEA citizens living or travelling to affected areas in Uganda is considered low.
Risk of introduction and spread within the EU/EEA
The most likely route by which the Ebola virus could be introduced to the EU/EEA is through infected people from affected areas travelling to the EU/EEA or medical evacuation of cases to the EU/EEA. According to the International Air Travel Association, in 2019, there were about 126,000 travellers arriving in the EU/EEA from Uganda. Based on experience from the largest EVD outbreak in West Africa to date (2013-2016), where thousands of cases were reported, with transmission in large urban centres, and hundreds of EU/EEA humanitarian and military personnel deployed to the affected areas, importation of cases by travellers is considered unlikely.
The likelihood of secondary transmission of Ebola virus within the EU/EEA and the implementation of sustained chains of transmission within the EU/EEA is very low as cases are likely to be promptly identified and isolated and follow up control measures are likely to be implemented. During the large EVD outbreak in West Africa in 2013–2016, there was only one local transmission in the EU/EEA (in Spain) in a healthcare worker who had attended to an evacuated EVD patient. The impact for the EU/EEA citizens living in the EU/EEA is considered low and overall, the current risk for the citizens in the EU/EEA is considered very low.
Healthcare providers in the EU/EEA should be informed of and sensitised to:
- the possibility of EVD among travellers returning from affected areas;
- the clinical presentation of the disease and need to enquire about travel history and contacts in people returning from EVD-affected countries;
- the availability of protocols for the ascertainment of possible cases and procedures for referral to healthcare facilities;
- the imperative need for strict implementation of barrier management, use of personal protective measures and equipment and disinfection procedures in accordance with specific guidelines and WHO infection control recommendations when providing care to EVD cases.
Vaccines
The licensed vaccines available, protect against EVD due to Zaire ebolavirus. There are no licensed vaccines against EVD due to Sudan ebolavirus, and there are no available data on the level of cross-protections. The availability of a vaccine was proven to be very helpful in the control of the recent outbreaks in the Democratic Republic of the Congo. The unavailability of vaccines will be an additional challenge in the control of this outbreak.
ECDC actions
ECDC is monitoring this situation through its epidemic intelligence activities and will report relevant updates on a weekly basis.
