By: Makayla Swaciak
Photo courtesy of UNMEER; CC-BY-ND.
Since an outbreak of Ebola Sudan strain was declared on September 20, 2022, Uganda has reported a total of 142 confirmed cases, including 56 deaths (39% case fatality).1,2 Twenty-two probable fatalities have also been reported,3 which makes the overall case fatality ratio 47.6%.4 Cases are distributed across 9 districts: Kagadi, Mubende, Kyegegwa, Kassanda, Bunyangabu, Kampala, Masaka, Wakiso and Jinja.4 Mubende and Kassanda are the hardest hit districts, with 64 and 49 total confirmed cases, respectively.1 The Ugandan Ministry of Health reports a total of 86 recoveries;2 the last known Ebola patient was discharged from the hospital on December 2.5 While it appears significant progress has been made to curtail this outbreak, the World Health Organization (WHO) still requires a country to pass 42 days (twice the maximum incubation period for the virus) after the last confirmed case before it can be declared Ebola-free.5 In the current outbreak, the most recent reported case was on Nov 28 – a stillborn infant born to a mother who survived Ebola in Kassanda district.6
The magnitude of this outbreak has placed it within the top 10 Ebola outbreaks on record. For reference, an outbreak of Ebola in the Democratic Republic of the Congo earlier this year resulted in only 5 cases, all of which were fatal, and was declared over on July 4, 2022.7
A series of challenges have defined this outbreak in Uganda. First, it involves the Sudan ebolavirus strain, a rarer version of the virus that had only been recorded 7 times previously. 8 Four of these Ebola Sudan outbreaks were in Uganda, the last of which of which was in 2012.8 Since there is no vaccine currently approved to combat this strain, outbreak control has been much more difficult compared to recent outbreaks of the Zaire ebolavirus strain, which has 2 approved vaccines. The WHO and the government of Uganda have plans to test three candidate vaccines for Sudan ebolavirus during the ongoing outbreak; with case counts declining, these plans are still in place even though results from the clinical trial might be less informative at this point.9 Additionally, 19 (17 confirmed + 2 probable) cases among health care workers (HCWs) have been reported, including 7 deaths.4 On the front lines of Ebola response efforts, HCWs are at increased risk of exposure. Amid claims of limited personal protective equipment in some facilities, delays in receiving payment and limited access to food and accommodation in the hospitals where they’re working, there have been two instances of HCWs threatening to go on strike so far in this outbreak.10,11 Further, community fear and distrust have contributed to multiple reports of Ebola patients fleeing hospitals and spreading the virus to other areas.12,13 Lastly, controversial 21-day lockdowns in Mubende and Kassanda districts, which imposed bans on personal travel and closed markets, have been extended twice and have left many families with limited access to food and resources.14
Despite these challenges, the WHO reports that great improvements have been made in curtailing this outbreak.4 The WHO is working closely with the Ugandan government to implement intensified contact tracing, surveillance, infection, prevention and control initiatives as well as community education and engagement interventions.4
The Global.health team has been tracking this outbreak since the beginning. A line-list case dataset has been developed, which pairs with a map displaying the distribution of cases within the country. Both resources are publicly available and can be found here: https://global.health/about/.