Ebola virus disease outbreak in Uganda: the way forward

Abstract

Ebola virus disease (EVD) is one of the world’s most deadly infectious diseases. The first species of Ebola virus was discovered in 1976 in the Democratic Republic of the Congo, near the Ebola River, from which the disease took its name1. EVD is a viral hemorrhagic fever, an infection caused by a filovirus with symptoms that appear very quickly in humans2. The virus is transmitted by wild animals (often by bats) through contact with their secretions, organic fluids, and blood3. EVD has a very high case fatality rate and is characterized by fever, gastrointestinal signs, and multiorgan dysfunction syndrome; its diagnosis requires laboratory tests or rapid diagnostic tests to detect antigens of the Ebola virus4. In Uganda, the health situation is deteriorating with the cases of EVD that the WHO announced on 19 October 2022, with 64 confirmed cases of EVD, including 25 deaths, and a very high case fatality rate5. On Tuesday, 20 September 2022, the Ugandan health authorities declared an outbreak of EVD, which is caused by the virus from Sudan, following the confirmation by laboratory tests of a patient victim of the disease and originating from a village in the district of Mubende, in central Uganda6. This is the first outbreak of EVD caused by the Sudan virus in Uganda since 20127. In 2018, in Uganda, the Ministry of Health set up a public health emergency operations center and a national task force to plan, guide, and coordinate the eradication of the EVD. In the country, this action that was developed and implemented should be useful and serve as a reference during this new epidemic, which has been destabilizing the country in recent days8. To eradicate this outbreak of EVD and bring stability to Uganda, the Ugandan authorities responsible for the health system must put in place strategies to control and prevent the uncontaminated population from being exposed to this EVD epidemic. They must strengthen the laboratory and diagnostic equipment, which will be used to search for new cases and monitor the epidemic. They must also strengthen the personnel responsible for response and care. During these last outbreaks of the EVD observed in West African countries around the years 2013 and 2016, improvements and innovations have been made in understanding, in surveillance (control, communication, and prevention), and in the management of the EVD. The results of these strategies should be used by the health authorities of Uganda for the clinical management of this new epidemic4. There are now 115 confirmed cases and 32 deaths of the EVD in Uganda as of 26 October 20225. Uganda struggled to boost its economy after the COVID-19 pandemic before the cases of EVD arose because Uganda is ranked as one of the least developed countries in the world9. Though the government confirmed the preparedness of the healthcare system to handle Ebola, cases are still on the rise due to misinformation and superstitious beliefs. Schools and businesses will be affected, as the government has warned against overcrowded areas and issued lockdowns in areas mostly affected by the disease. There have also been issues concerning the safety of medical practitioners and students. This is after the death of four of them due to the disease. There is a lack of protective gear and equipment needed by healthcare workers. These cases of Ebola may again dampen an already struggling economy. The current situation might lead to a total lockdown due to the increasing number of cases. As experienced during COVID-19, lockdown leads to a negative impact on the economy. Lockdown affects all members of society. Children and youths not being able to go to school and the limitations of businesses. It has an adverse effect on getting necessities like food and healthcare, which causes an increase in morbidity and mortality. This may also lead to a loss of income for many, thereby increasing crime. Lockdown also causes a lack of focus on other health issues, like maternal health. The restrictions across the border due to the disease might affect businesses in these communities and limit their interactions across the border. This also extends to interactions with other countries. The WHO Emergency Contingency Fund has recently donated $2 million to aid in the purchase of supplies needed to combat this disease. There have also been efforts to come up with a vaccine for the disease. The available vaccines were for the Zaire strain of EVD, and there are none for the Sudan strain. Mobile laboratories have also been used to reach areas that may be far from the testing centers. Though cases are on the rise, experts are hopeful the outbreak will end. These are among many efforts taken to tackle the outbreak. EVD is one of the world’s most deadly infectious diseases, including in the Republic of Uganda. Thus, to eradicate this outbreak of EVD and bring stability to Uganda, the Ugandan authorities responsible for the health system must put in place strategies to control and prevent the uncontaminated population of this EVD epidemic, strengthen the laboratory and diagnostic equipment that will be used to search for new cases and monitor the epidemic, and strengthen the personnel responsible for the response and care. Ethical approval and consent Not applicable. Sources of funding No funding was received for this work. Author contribution Conceptualization: A.A. and M.O.O., Project administration: M.O.O., Project supervision: M.O.O., Writing of initial drafts: All authors, Review and editing: M.O.O., Data curation: A.A., Funding acquisition: A.A., Software and resources: M.O.O., All authors approved the final manuscript for publication. Conflicts of interest disclosures The authors declare that they have no conflicts of interest. Research registration unique identifying number (UIN) Not applicable. Guarantor Malik O. Oduoye. Provenance and peer review Not commissioned, externally peer reviewed.