Community & Health Sector Cooperation Contains Ebola Threat In Uganda; Epidemic Simmers On In DRC

Nairobi, Kenya – The World Health Organization has commended efforts by the government of Uganda for keeping the deadly Ebola virus from spreading eastwards into the country from the Democratic Republic of the Congo (DRC), where a prolonged outbreak has claimed approximately 1,600 lives since last August.

The East African country has recorded only three confirmed cases of the disease since 11 June – when the first case was reported by WHO – linked to three people who had crossed the border into western Uganda from the DRC.

Another three suspected cases were being treated at a hospital near the DRC border, where health-workers have concentrated treatment facilities so as to contain the spread of the disease farther east in Uganda and the broader East Africa region.

Surveillance for ebola virus disease at the border between DR Congo and Uganda. Photo: WHO/Matt Taylor

The ability to check the spread of the highly contagious virus with a 68% fatality rate has so far been enabled by a good disease surveillance system managed by well-trained teams of health workers, according to Matshidiso Moeti, WHO Regional Director for Africa. Strong community-backed surveillance has also been critical, said Uganda’s Health Minister Jane Ruth Aceng.

“I commend Uganda for its quick response to the Ebola outbreak,” said Moeti to UN TV, when she toured western Uganda near the DRC border late last month (25-26 June). “I spoke with health authorities who told me how the training they had received in detecting the disease” enabled them to be “on high alert for patients with any signs of infection. They were able to move swiftly when the first Ebola cases arrived in their health facility,” she said, according to a WHO news release.

Uganda and the DR Congo share a porous 900 kilometre border – running through fertile and mineral-rich jungles. The rough terrain makes control over civilian crossing challenging. And on the DRC side, armed militias that oppose the DRC central government operate with relative impunity, particularly in the areas of Kivu. Nearby, Rwanda and Burundi also share a significant border with DRC, making Ebola surveillance by neighbouring countries even more important for the broader region.

Rapid Health Sector Mobilization & Ring Vaccination Strategy

Since the outbreak was declared in Uganda in early June, 1,063 ‘high risk individuals’ have been vaccinated Moeti said, adding that vaccination of contacts and contacts of contacts, a strategy known as ‘ring vaccination’, has shown good results in the DRC, and previously in other countries of West Africa.

The ring vaccination strategy has also contributed to the fact that there have been no new cases of Ebola in Uganda since 12 June, the latest WHO situation report noted.

Uganda has trained more than 9,000 of its health workers in detecting symptoms of Ebola, and has vaccinated nearly 5,000 workers against the disease.

Additionally more than 100 people who had contacts with people confirmed to have Ebola in Uganda are being monitored to enable a quick response if symptoms of the illness develop.

Community Leadership Key to Surveillance

With support from WHO and partners, another 16,000 community leaders and volunteers have been trained in remote border areas to help with disease surveillance; provide medical attention to potential patients; and alert authorities of suspected cases of infections, according to the WHO release.

The local teams, it said, serve as the “eyes and ears” of local and national emergency response systems supporting “surveillance, infection prevention and control, patient care, cross-border activities and coordination with communities.”

As a result of such community cooperation, all high-risk districts in the west of Uganda are able to screen people, identify suspect cases and trace the contacts of potential patients whenever needed, Uganda’s Health Minister Aceng said. “As of now we remain in a high alert, we will continue with our risk communication and sensitizing the population,” she said in a video of her visit to the field with Moeti.

She added that due to these efforts, there were no further known cases of Ebola transmission in Uganda presently, but monitoring efforts will continue until the pathogen was completely brought under control in the DRC.

In DRC, Community Mistrust & Unrest Continue to Fuel Ebola 

The 4 July situation report issued by the WHO indicated that in DRC, the epicentre of the outbreak, there were 285 new confirmed cases of Ebola during the 12 June – 2 July period, marking a trend of decreasing cases since the height of the epidemic in mid-April. A total of 2,369 cases have so far been recorded, with 2,275 confirmed cases resulting in 1,598 deaths, since the outbreak began in August of last year.

Source: WHO

The eastern DRC city of Butembo in DRC’s North Kivu region has borne the brunt of the outbreak, made worse by conflict and political instability that has seen health workers unable to reach patients, and in some cases lose their lives.

Teams of responders in the city of one million inhabitants have often faced community mistrust, fuelled by misinformation spread by politicians in the general elections that took place in late 2018.

Over the past six months, armed groups active in the area attacked health workers while looting and destroying Ebola treatment centres, during which frontline responders and security forces protecting them lost their lives, according to WHO reports.

WHO and Congolese authorities have been conducting awareness-raising activities for teams working in treatment and vaccination sites, aimed at helping to build community support and trust to ensure the safety of responders.

Unlike in the earlier outbreak in West Africa, the WHO and agencies involved in the current campaign have been relying heavily on vaccinations of people who have come into contact with victims, focusing on first and second degree contacts, demonstrating some success in containing the spread of the virus.

Despite this progress, the international NGO Médecins Sans Frontières (MSF/Doctors Without Borders) in its latest update lamented that attacks on health personnel have continued to date, which, coupled with inter-communal violence, contributed to the failure to end the outbreak – now more than ten months strong.

“Vaccination of contacts, contacts of contacts and frontline workers in Butembo and Katwa (the epicentre of the outbreak) is sometimes temporarily suspended because of threats to the safety of vaccination teams,” the organisation said.

However, it added that as a frontline entity involved in combating the disease, it now has the facilities, skills and scientific capacity to better manage the current outbreak, as compared to previous ones.

“We have new tools and improvements in the medical management of this epidemic, compared to previous Ebola epidemics, such as new developmental treatments; a vaccine that has given indications of being effective; Ebola treatment centres are more open and accessible for the families of patients; and provision of a higher level of supportive care,” it noted.

In Uganda, MSF declared that it will collaborate with health authorities “to improve the hygiene and infection prevention and control measures in Kagando and Bwera hospitals, where the confirmed Ebola cases were first admitted,” and would also “support the safe provision of care for medical needs unrelated to Ebola in these facilities, should the need arise.”

Image Credits: WHO/Matt Taylor, WHO.

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