WHO Releases UGX 2.2 Billion for Marburg Emergency Top story

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In short
The funds according to a statement on Thursday will be used rapidly mobilize, equip and deploy WHO and Global Health Emergency Workforce assets for control and containment of a disease outbreak.



The World Health Organization says it is has released over 2.2 billion shillings for health emergency against Marburg outbreak in Uganda.
The WHO which has been implementing the Emergency Response Plan since 20 October 2017 it has released US$ 624 000 from the Contingency Fund for Emergencies (CFE) to rapidly respond and help contain the outbreak.

The funds according to a statement on Thursday will be used rapidly mobilize, equip and deploy WHO and Global Health Emergency Workforce assets for control and containment of a disease outbreak.

The statement says extensive surveillance is currently on-going and there has been search for new cases and active contact tracing.

The Ministry of Health officially declared the outbreak on October 20 following a reported case in Kapchorwa district.

Both the Health Ministry and WHO had developed an Emergency Response Plan based on several assumptions. WHO says the Emergency Response Plan may now need to be revised.

It says as of 8 November, the outbreak has had three cumulative cases which include one probable and two confirmed. Uganda and Kenya are following contacts in four different districts.
WHO says it cannot exclude the possibility of unknown chains of transmission given that the first Marburg case died on 25 September 2017 and his unsafe funeral was attended by more than 200 people from Uganda and Kenya.

It says not all the contacts from this funeral could be traced, allowing the possibility of unknown chains of transmission.

WHO statement says if there are no more alerts or cases in the next week, the 21-day contact tracing period will end by 17 November 2017.

The funds are Emergency Response Plan expected to be used during the further 21-day intensive surveillance period until 8 December 2017, and the human-to-human transmission of the Marburg outbreak could be declared stopped on 9th December 2017.

Active case search, death surveillance, safe and dignified burials and community mobilization are ongoing in Kween and Kapchorwa districts.

In Uganda, of the 339 contacts listed, 283 have completed 21 days of follow-up and 56 are still being monitored. Contact follow-up is ongoing in Kween for the 56 contacts, while In Kapchorwa District, all the listed contacts have completed the 21 days follow-up period.

WHO says should there be no further cases, then according to the plan, an additional US$1.29 million is needed to run the tail end of the response to  cover the full response in Uganda and Social Mobilization in Kenya.
 
The first reported probable case was an approximately 35-year-old male who worked as a game hunter and lived near a cave populated by Rousettus bats.

He was admitted to Kaproron Health Center IV with high fever, vomiting and diarrhoea, on 20 September, which did not respond to antimalarial treatment. He was transferred to Kapchorwa Hospital where he died.

The man's sister, 50, had nursed him and participated in the burial rituals. She was admitted to Kaproron Health Center IV on 5 October 2017 with fever and bleeding.
 
She was transferred to Kapchorwa  Hospital, where she died on the evening of 11 October. She was also given a traditional burial, on 13 October. Posthumous samples were collected on 11 October and sent to the Uganda Virus Research Institute (UVRI). On 17 October, Marburg virus infection was confirmed.

 
The third case was the brother of the first two cases who had helped  transport his sister to hospital and participated in the burial rituals.
 
The man initially refused to be admitted, and he, along with several family members, was treated by two traditional healers, one in Kween district, Uganda, and another near Kitale town in Trans Nzoia County, Kenya. On 25 October, he was admitted to Kween Treatment Centre, and died there, on 26 October. WHO says the current outbreak remains localized in the two districts of Kapchorwa and Kween.

WHO advice
Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and body fluids, of infected symptomatic persons, and Marburg virus transmission associated with provision of health care has been reported when appropriate infection control measures have not been observed.
Health-care workers caring for patients with suspected or confirmed Marburg virus should apply infection control precautions to avoid any exposure to blood and body fluids, and unprotected contact with possibly contaminated environment.
Surveillance activities, including contact tracing and active case search must be strengthened within all affected health zones.
Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key measures to reduce human infections and deaths. Key public health communication messages include:
  • Reducing the risk of bat-to-human transmission arising from exposure to mines or caves inhabited by fruit bats colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).
  • Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home.
  • Communities affected by a Marburg outbreak should make efforts to ensure that the population is well informed about the nature of the disease , both to avoid community stigmatization, and to encourage early presentation to treatment centres and to support other necessary outbreak containment measures, including burial of the dead. People who have died from Marburg virus disease should be buried promptly, safely, and with dignity.
Restrictions of international travel
WHO advises against the application of any travel or trade restrictions on Uganda or the affected area based on the current information available on this event. Travelers to the Mount Elgon bat caves are advised to avoid exposure to fruit bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks.