Direct contact with wounds, body fluids like blood, saliva, vomitus, droplets, stool and urine of a person suffering from Marburg.

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1 Introduction The Ministry of Health declared an outbreak of Marburg in Kabale district on October 19 th 2012 after receiving laboratory results from the Uganda Virus Research Institute (UVRI) confirming that two family members had died of the highly infectious viral hemorrhagic fever. Three other members of the same family had earlier died of a strange disease in a period of one month. The death of these people prompted the District Health Office to undertake further investigations of this strange disease that had ravaged Kitumba parish in Kitumba sub-county, Kabale district. According to the reports, the patients presented with symptoms of diarrhea, vomiting, fever, headache, dizziness and generalized convulsions. Initial samples of blood and cerebral spiral fluid taken from the sick people ruled out Malaria and Meningitis. The family then invited a cult leader, a retired Reverend from Rukungiri, district to visit their household and pray for the sick. Because of this, the sick people and those who died were not immediately reported to the health authorities at the onset of the strange disease. Later due to the vigilance of the district health office, cases were identified and followed up. The index case is believed to have been a member of a family in Rwabirondo village, Kitumba parish in Kitumba sub-county which occurred on 20 th September After the death of the index case, two other people, a sister and mother reportedly got sick and died. This outbreak comes barely two weeks after the Ministry declared an end to another viral Hemorrhagic Fever (Ebola) on October 4 th The last Marburg outbreak was witnessed in October 2007in Kamwenge district. 1

2 Marburg disease Marburg is a highly infectious viral hemorrhagic fever which kills in a short time but can be prevented. Marburg is spread through direct contact with, body fluids like blood, saliva, vomitus, stool and urine of an infected person. A person suffering from Marburg presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains and bleeding through the body openings, i.e. eyes (red eyes), nose, gums, ears, anus and the skin. How is Marburg Spread? It is spread through; Direct contact with wounds, body fluids like blood, saliva, vomitus, droplets, stool and urine of a person suffering from Marburg. Unsterilised injections, contaminated linen, beddings and clothes. Using skin piercing instruments that have been used by an infected person. Direct physical handling of persons who have died of Marburg Signs and Symptoms of a person suffering from Marburg A person suffering from Marburg presents with sudden onset of high fever with any of the following: Headache Vomiting blood Joint and muscle pains 2

3 Bleeding through the body openings, i.e. eyes, nose, gums, ears, anus and the skin. Reduced urine What should be done to someone suspected to be suffering from Marburg Patients should be handled with care, avoiding contact with their body fluids e.g. blood, saliva or sweat. The person should be taken to the nearest health unit immediately for proper assessment and management. The clothing and beddings of the person should be disinfected with JIK to avoid infecting others in a home. Who is at risk? Since the virus spreads through direct contact with blood and other body secretions of an infected person, people living with and caring for the patients are at a high risk of getting infected. Always use protective materials like gloves when handling these patients to avoid contact with their body fluids. During feeding, holding or caring for the patient, family members and friends come into contact with the body secretions, and can also get infected if not properly covered with protective wear, such as gloves. Persons involved in a cleaning and dressing of the body of a person who has died due to Marburg can also get infected if not properly covered with protective wear. Spouses of patients through unprotected sex Who is at risk? 3

4 Since the virus spreads through direct contact with blood and other body secretions of an infected person, people living with and caring for the patients are at a high risk of getting infected. Always use protective materials like gloves when handling these patients to avoid contact with their body fluids. During feeding, holding or caring for the patient, family members and friends come into contact with the body secretions, and can also get infected if not properly covered with protective wear, such as gloves. Persons involved in a cleaning and dressing of the body of a person who has died due to Marburg can also get infected if not properly covered with protective wear. Spouses of patients through unprotected sex Points to remember Marburg is a serious disease, kills in a short time BUT can be prevented. Marburg spreads from one person to another through physical contact with body fluids of an infected person. Marburg can be prevented through: Regular washing of hands with soap and water after touching a suspected person. Proper protection using protective wear like gloves, when handling patients suffering from Marburg. Prompt management of all persons suffering from Marburg, by seeking early medical help. Burying people who have died of Marburg immediately. Body bags or polythene sheets should be used where available Reporting of any suspected cases of Marburg to the nearest health unit as soon as possible. 4

5 Avoid communal washing of hands during funerals and any other public gatherings Current Status of the situation (Update) To date, the death toll is five with only two confirmed to have died of the deadly virus. The three cases were buried before samples were taken. These include the index case, his mother and sister. There are currently two confirmed cases admitted in Kampala and Kabale district. One is admitted at Mulago National Referral Hospital isolation facility while the other is at Rushoroza Health Center III. Special teams of doctors and nurses have been assigned to attend to the patients in both the isolation facilities. The patient admitted at Mulago National Referral Hospital is from Kitumba sub-county and is a relative of the index case. Three suspected cases are currently admitted at Rushoroza Health Center III bringing the total number of admissions in Kabale to four. The cases presented with a three-day history of fever, mid headache and vomiting a day to admission. The case is a resident of Nyamuhindura village in Kicumbi parish in Kamuganguzi sub-county) near Kitumba sub-county. The Ministry of Health surveillance team has listed up a total of 149 contacts for close monitoring. These contacts are mainly in Kablae, Rukungiri and Ibanda districts while 26 are from Kampala. who reportedly got in touch with the dead and confirmed cases. The contacts reportedly got into contact with the dead and confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 10 days without showing any signs and symptoms. 5

6 An isolation facility has been established up at Rushoroza Health Center III to accommodate both the suspect and confirmed cases. Rushoroza Health Center III is a PNF facility that was built with the support of the Ministry of Health but has been non-functional pending equipping. This center has now been beefed with five health workers for case management; four from Kagadi Hospital, two from Bundibugyo and one from Mulago National referral Hospital. A team of experts from the Ministry of Health, U.S Center for Disease Control and Prevention and World Health Organization have so far collected a total of seven samples from suspected cases for further investigations. The samples are being analyzed at the Uganda Virus Research Institute, Entebbe. The Ministry is conducting an orientation of local healthcare workers in Kabale Regional Referral Hospital, Rushoroza Health Center III and subsequently in the other peripheral health facilities on infection prevention and control, barrier nursing, surveillance and clinical case management. This is being done to build health workers capacity to handle such cases. The National Medical Stores over the weekend delivered assorted emergency medicines and supplies to Kabale Hospital and Rushoroza Health center III. The World Health Organization and the Centers for Disease Control have dispatched an assortment of Personal Protective Equipment (PPEs) and body Bags to the district. Rushoroza Health Centre has set up burial committees to manage burials of people suspected to have died of Marburg. The committee has been oriented on burial procedures and infection prevention and control. This is one of the 6

7 control measures to curb the spread of the highly contiguous disease. The committee has so far supervised two burials. A team from the Centers for Disease Control (CDC) is expected in the country to undertake anthropological studies Conclusion Marburg is a very contagious disease with a very high potential to cause death if it is not well managed. Its prevention requires raising community awareness on prevention measures and implementing adequate infection control measures in health facilities. Appropriate control measures require early identification of cases through community sensitization and contact tracing and linking them to health facilities. Prepared by; Ministry of Health Headquarters P. O. Box 7272 KAMPALA October