Facing Ebola in Uganda

what is Ebola?

Ebola is a serious and often deadly disease with a mortality rate of up to 90 per cent. Initial symptoms are similar to those of many other illnesses: a sudden onset of fever, fatigue, muscle aches, headache and a sore throat. These initial symptoms may be followed by vomiting, diarrhoea, a rash, symptoms of kidney and liver failure and, in some cases, internal and external bleeding.   

Ebola was discovered in 1976 in Democratic Republic of Congo (DRC). There are several variants of the disease, with the Zaire strain being the most common over the past decade. The current outbreak in Uganda involves the Sudan strain. There have been seven outbreaks of the Sudan strain since the virus was discovered: four in Uganda and three in Sudan. The last Ebola outbreak in Uganda was in 2019; the last Ebola outbreak involving the Sudan strain was in 2012.   
 

Absence of a vaccine

There is no vaccine for the Sudan strain of the virus, which is responsible for the outbreak in Uganda. With no vaccine currently proven to be effective, much of the standard response needs to be rethought. However, two vaccines should enter soon into clinical trials under the management the World Health Organisation (WHO): one developed by Oxford University, which has shown to induce an immune response to both the Sudan and Zaire strains in Phase 1 trials. The other one has been developed by Sabin Vaccine Institute.   
   
With the current Ebola outbreak in Uganda, all health organisations involved in the response will have to do without this tool until trials have been conducted and an effective vaccine has been found. Médecins Sans Frontières (MSF) is ready to assist in this research and expressed its availability to the WHO.

Tackling Ebola

We already know that the fight against this Ebola outbreak will bring several challenges and it will require a response adapted to the relatively rare strain of Ebola Sudan.

From previous previous experiences, we know that other factors are of great influence on the epidemiologic trend and that this is crucial to work on these aspects to contain the disease.

• The sooner patients are admitted to a treatment centre, the better their chance of survival. It is therefore necessary to integrate our approach into the health system, close to patients' homes, for contact tracing, communication, the capacity to isolate and to deliver healthcare when needed.  
• Sampling and laboratory capacities should be close to where suspect cases are to enable rapid transportation of the samples and rapid results.
• Infection prevention and control measures must be taken to avoid contamination inside health facilities, along with the sensitisation of healthcare workers regarding the Ebola Virus Disease (EVD) and contamination route. 

A big issue is the late arrival of patients. This is why it’s important to receive people early and to be aggressive in their clinical management. This is key to the survival of the patient.

"If I can get you at day two or three of the disease, the studies show that the chance of survival increases," said Dr Ruggero Giuliani, MSF doctor at the Ebola treatment centre in Mubende, Uganda.

“It’s very hard when you realise that your patient will not survive. They are not going to make it. You can try your best, but when they have severe symptoms, there is no chance,” says Dr Giuliani.

“On the other hand, every time you have a survivor who comes out, it's joyous. We took out six survivors from the Ebola treatment centre the other day and it was amazing. In terms of a coping mechanism, this helps a lot.”

Our response

Since the beginning of the outbreak MSF has been working closely with the Ugandan Ministry of Health a large number of MSF staff are now tackling the virus.

MSF is focusing its intervention on the prevention of the spread of the outbreak via an outreach project in Mubende and surrounding districts to reduce the time between the onset of the symptoms and admission to a health facility. Similar work is also now being undertaken in Kampala.

MSF is also working to reduce mortality via case management with a a decentralised approach in one 40-bed Ebola Treatment Centre in Mubende, and a second 39-bed facility which received the first patient on 7th November. In addition, MSF has constructed an eight-bed Ebola Treatment Unit in Madudu and Bweyongedde, and an isolation unit in Kasanda close to the epicetre of the outbreak.