There's a growing Ebola outbreak in Uganda. We've been watching it and I've gotten an email or two wondering why we weren't posting on it. There are a lot of nasty disease outbreaks in the world and we don't cover most of them. Ebola gets news because it is a hideous disease with high fright value but it isn't alone in that department. Ebola also isn't very contagious and like SARS, is mainly so in the later stages of the disease so less likely to spread worldwide. We discuss bird flu here because it is a way for us to talk about public health more generally. But we do talk about other diseases from time to time, although usually in a larger public health context, as we did recently with measles. And it seems Ebola is something that can and should have our attention now, if only as a reminder there are people in this world, in this case in Uganda, who fight a terrible desperate fight against diseases whose names we barely know or have hardly ever heard of.
And like SARS, Ebola is a special threat to health care workers:
Health workers are among the dead in an Ebola outbreak in Uganda, spreading panic among doctors and nurses needed to help treat victims of the highly contagious disease, officials said Thursday.Doctors and nurses did not at first know what they were facing, so they failed to protect themselves, according to a lawmaker representing the western region at the center of the outbreak. Experts say the Ebola subtype that sparked the outbreak is new and the classic Ebola symptoms were not always present, slowing diagnosis. (Washington Post)
There are reports this is a new strain of Ebola and while its case fatality rate is horrendous (currently about 25%) this is much lower than previous experience which usually exceeded 50%. There are now over 100 cases in this outbreak and 25 deaths. Seven years ago another Ebola outbreak in Uganda caused 170 deaths, so this is not the largest, but there is as yet no sign it has been contained.
Unlike other diseases, an Ebola outbreak is not likely to slip under the radar. But we'll continue to keep an eye on it.
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reveres,
Racism is a public health issue. We don't hear much about a lot of horrible diseases lurking in Africa and South Asia because Brown and Black people don't count in our media unless they are sports or entertainment stars.
The discrepancy in life spans and health outcomes between white and black Americans doesn't get much play in our press, either. And then there is that whole class and social inequality problem which we aren't allowed to talk about in polite society. That isn't a public health issue, either, hmmmm?
It's got peoples attention because it's a brand new strain of ebola. Since it's an all new strain, they should determine as quickly as possible if this new strain is more contagious to humans than the others. There has never been a previous outbreak with this particular strain before so it's hard to compare it with anything. There are 10 healthcare workers sick, which seems uncommon for the normal ebola.
You can't calculate a fatality rate of 25% from the information provided. So far you know that 25% of the people who have become sick have died, but many more of the sick are still in hospital and their outcomes are in question.
Joe: You are correct. But it seems CFR is less but your point is well taken. The question of transmissibility of this strain raised by Brad is pertinent, however. We'll have to wait and see.
The stress put on a health care system by this kind of new ebola strain that masquerades as something harmless could prove a horrific burden for Africa.
This new mutated ebola is presenting with the same symptoms as any number of mild to serious maladies that frequent the African continent. It may look like malaria, or simple flu, in its early presentation of headache and fever. Later in the course of the disease, the new variant seems to present with a measles-like rash, in a place with too little vaccination for measles.
How will any health care worker be able to determine whether the headache/fever case in front of them should be sent home, or is harboring this new strain of ebola?
There is not enough PPE in all the world for Africa to be able to handle a fatal and highly contagious disease masquerading as a common ailment. There is not enough PPE here in my state to handle that sort of problem. Imagine the stress on health care workers who don't know what's in front of them.
With a lowering CFR, this ebola strain may prove that dead men can walk - and the rubric that dead men can't walk has been held out time and again as the reason that ebola has not, and cannot, become pandemic.
This is the kind of tradgedy that begs the question: how much can one impoverished continent's health care structure take?
I've been watching ebola with more dread than the bird flu. Thank you for writing this article, ebola needs more attention in the media. Most of the bathrooms in some villages are shared, so one infected person using a public toilet possibly can spread this to the whole village. It is interesting that the Queen of England and other diplomats were in Uganda around November 20. They seemed to have ebola under control before she came and then after she left ebola returned. The largest crowds ever gathered in Uganda when she came to visit and meet with the locals. All the while this was raging 200 KM away.
Pixie/RH: Most viral diseases start the same way as they are activating the innate immune system. So Ebola, this strain or not, isn't very different. I think we need to keep an eye on it to see if its epidemiology is markedly different, something we don't know yet. Ebola isn't contagious when asymptomatic so it doesn't sprrad in the same way as flu or other diseases that are (more like SARS in that regard). Ebola isn't the only viral hemorrhagic fever but it seems to have claimed a special place psychologically. Remember another filovirus, Marburg, caused a severe outbreak in Angola in 2005 and Uganda had Marburg in August. Fruit bats have been discovered to be one reservoir of Marburg. So whenever someone says "Ebola" our antennae go up but there is a lot else out there, too. This is one of many.
Revere, discussions on ProMed suggest that there is far too much emphasis on the "new" strain: "There is much understandable but sometimes inaccurate commentary in
the reports on recent Ebola virus outbreaks on ProMED. One error concerns the amount of gross hemorrhage in previous epidemics with both the Zaire and Sudan species of the agent. Despite lay reports of major bleeds from nose, other orifices and eyes, the amount of blood lost externally in the syndrome has never been significant. Indeed,
this fact frequently produces difficulty in making a probable clinical diagnosis in the early phase of febrile illness.
I do not think that the putative clinical differences cited in the current Uganda outbreak should be used in any way to give support to the notion of a new viral species.
Communicated by: Karl Johnson [Karl Johnson's experience extends back to the 1st outbreaks of Ebola hemorrhage fever in Sudan and Zaire, and ProMED-mail welcomes the opportunity to pass on his comment. - Mod.CP]"
I agree. Maybe it is slightly different, but we will have to await sampling, and characterization.
Confident statements about what "ebola" does or doesn't do, as for example how contagious it might be and when, are unsound. Clearly this ebola has not behaved like its cousins. And the comments above on 'dead men walking' are exactly right.
Further, at the paradoxuganda blog one can get an impression of what things are like at the center of the outbreak. They apparently lacked basic supplies - gloves for instance.
The 'don't panic, wait and see' attitude hasn't gotten them what they needed, apparently.