The Ugandan government has remained silent about the deadly Marburg virus outbreak it reported late last month, with the World Health Organization acknowledging on Thursday that it had repeatedly requested updates on the status of investigations into how the virus started and how far it may have spread.
“We have sent several additional requests for information and are waiting to hear from them specifically about the results of the investigations that we know they are conducting,” Chikwe Ihekweazu, executive director of the Geneva-based agency’s health emergencies program, said in a new briefing.
Ihekwazu said the WHO had formally submitted a request for updated information through the International Health Regulations, a treaty that requires countries to notify each other through the WHO of disease threats that may cross their borders.
“We have sent frequent and repeated requests to the Ugandan government and are waiting for the government to respond to the IHR requests we have sent,” he said.
Marburg disease is a viral hemorrhagic fever caused by a virus related to the Ebolavirus family. Although it causes an illness similar to Ebola and can have a similarly high mortality rate, the Marburg outbreak has never reached the scale (thousands of cases) of the largest Ebola outbreaks. The largest recorded case occurred in Angola in 2004-2005, when 252 people were infected, of whom 227 died.
What Ebola and Marburg disease are telling us about the next pandemic
An outbreak of Marburg disease in Central Africa at the same time that neighboring Democratic Republic of the Congo is battling an Ebola outbreak would make it even more difficult for Uganda, which has extensive experience and success in containing these types of diseases, to deal with both.
The Marburg disease outbreak came to light in an unusual way in late June, when the U.S. Embassy in Uganda’s capital Kampala issued an alert saying it was aware of reports of Marburg disease in western Uganda. The country’s Ministry of Health subsequently confirmed to the WHO that an infant who was said to have lived in a camp for displaced persons had been diagnosed with the virus.
A well-informed source, who spoke on condition that his identity and place of work not be disclosed, told STAT that there were actually two confirmed cases at the start of the outbreak.
Infants are very rarely the first or last infected persons in such outbreaks. People who care for infected babies are at very high risk of contracting the virus.
However, to date, there has been no confirmation of a second case or additional information from Uganda.
In related news, WHO Director-General Tedros Adhanom Ghebreyesus said the last Ebola case diagnosed in Uganda was discharged from hospital on Thursday, beginning a 42-day countdown to declare the country Ebola-free. (An Ebola outbreak is declared over when two full 21-day incubation periods have passed without any new cases.)
In the current outbreak, Uganda has reported 20 cases in people either infected after entering the country from the Democratic Republic of the Congo or infected after arrival.
However, efforts to contain the outbreak in the Democratic Republic of Congo have not been very successful, with the number of confirmed cases now approaching 2,100, of which nearly 800 have died. The outbreak, declared just two months ago, is the third largest on record and is growing faster than previous outbreaks.
Efforts to expand treatment facilities have made significant progress, but people continue to refuse treatment. This trend is fueled by years of political instability and violence in the region, large numbers of displaced people, and deep-rooted mistrust within communities.
Tedros said two-thirds of Ebola deaths to date have occurred in communities where people have never sought treatment for the disease. Not only does it greatly reduce the chances of survival, but it also perpetuates the spread of the virus.
“So what all partners are doing right now to stay ahead of this situation is to focus on getting patients into treatment as quickly as possible,” Ihekweazu said. “And that’s the most important message we’re getting across.”
