Since the declaration of a rare Ebola outbreak in Uganda on September 20, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has been working with the ministry of health to set up an initial emergency response to prevent the virus from spreading and treat people who are sick.
The Ugandan ministry of health has confirmed 43 cases of Ebola and reported 29 deaths across five districts. Ebola is a serious and often deadly viral disease with a mortality rate of up to 90 percent, and its symptoms can range from fever to kidney and liver failure to internal and external bleeding. The last Ebola outbreak in Uganda was in 2019.
MSF has a long history of responding to various Ebola outbreaks, including in West Africa from 2014 to 2016 and in the Democratic Republic of Congo (DRC) from 2018 to 2020. These outbreaks were caused by the Zaire strain of the virus, for which there are now two approved vaccines and a treatment. However, the current outbreak in Uganda is caused by a relatively rare variant of the virus known as the Sudan strain, for which there is no approved vaccine or treatment.
Given this, traditional methods of fighting the virus are critical, including ensuring that supportive care and testing are available close to people's homes through a decentralized approach, proper infection prevention and control measures are implemented in health facilities, and community-based surveillance of the virus and contact tracing are carried out.
1. What’s the status of vaccines against the Sudan strain of Ebola?
While two vaccines exist to help prevent the spread of and protect people against the Zaire strain of Ebola, there is no vaccine approved for the Sudan strain reported in Uganda.
Discussions are underway at the World Health Organization to determine whether—and which—any of the six current vaccine candidates could be deployed in a new clinical trial. This could potentially pave the way for it to be licensed and approved for use during this outbreak.
As with the clinical trials conducted for the Johnson & Johnson vaccine—one of the two vaccines approved for the Zaire strain—in DRC in 2019, MSF stands ready to assist in this research.
2. Is there a specific treatment available for people who fall ill?
Clinical trials conducted in DRC from 2018 to 2019 identified that monoclonal antibody treatments improved the chances of survival for a person with the Zaire strain of Ebola. However, these antibodies are not effective against the Sudan strain of the disease. In the absence of a specific treatment, health workers can help a person manage the symptoms of their disease by providing intensive care like intravenous fluids and oxygen.
The lack of vaccines and treatments make implementing proper infection prevention and control measures to avoid contamination inside health facilities and educating health care workers about how Ebola spreads especially critical. Since the outbreak was declared, Ugandan authorities have confirmed the deaths of two health workers, a doctor and a midwife.
“The protection of frontline health workers is a major concern for MSF,” said Dr. Guyguy Manangama, MSF’s deputy head of emergency programs. “We need to protect health workers to ensure the continuity of the health system by training them in infection prevention and control standards and by providing them with protective equipment.”
3. Why is decentralized care so important in this outbreak?
To help ensure that care is available close to the people who are affected, MSF has set up a 36-bed Ebola treatment unit at the Mubende hospital, in the town where the first case was detected. In Madudu—the epicenter of the outbreak—MSF has started setting up an additional treatment unit.
"We know that the earlier that patients receive medical attention, the greater their chance of survival,” Manangama said. “As the initial symptoms of Ebola are not distinctive—being similar to those of malaria or other viruses that cause fever such as typhoid—the main issue is rapid access to information, diagnosis, and care. In Ebola outbreaks, too many people still arrive at health centers with advanced disease or even die at home, infecting others in the process. This is what we need to avoid."
In past outbreaks, people with Ebola were often taken straight to large case management centers outside their communities, which in many instances led to rumors circulating within the community, hostility towards health workers, and the rejection of the outbreak response. Smaller centers or isolation units where people can receive first aid as close as possible to where they live can help prevent this and make people feel more comfortable seeking care.
4. What else can be done to help prevent the spread?
To bring an Ebola outbreak under control, community-based surveillance and contact tracing are essential to rapidly detect infected people and identify their contacts to track and prevent further spread of the disease.
Although the current outbreak was officially declared on September 20, a number of suspected deaths potentially linked to the disease were recorded as early as August in the affected region. As is often the case at the beginning of an Ebola outbreak, case-finding and contact tracing lag behind the spread of the outbreak. It is vital to reconstruct the early stages of the outbreak as accurately as possible to screen people for the disease and provide medical care in the right locations.
Once contacts that have contracted Ebola are identified, they and their families need to access appropriate health care or isolate themselves for 21 days. To facilitate this, social and economic barriers like the cost of transportation to health centers or costs linked to not being able to take time off from work need to be removed. This can be done by helping with transportation costs and distributing food or other necessities to people self-isolating at home, as well as by offering mental health support to patients and their families.
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