Uganda formally notified the World Health Organization on Tuesday of a confirmed outbreak of Marburg disease in the country’s west, a Geneva-based World Health Organization spokesperson told STAT. The development could further complicate efforts to contain Central Africa’s already third-largest Ebola outbreak on record. Both diseases are viral hemorrhagic fevers.
The Ugandan government has not yet announced the outbreak in Marburg. But the U.S. Embassy in Uganda’s capital, Kampala, issued a health alert on Monday, saying it was aware of the possibility of Marburg disease cases in the country. The alert was a Level 4 advisory warning Americans not to travel to Uganda.
Uganda’s notification to WHO pertained to one case. However, a well-placed source who answered questions from STAT on condition that his name and place of work not be identified said that as of Monday, Uganda had indeed detected two cases of Marburg disease. The person said the outbreak appears to be localized at this time.
The official said the WHO also cited two confirmed cases in its efforts to inform other countries of the information it is receiving about the outbreak. The notification was sent through a password-protected disease news-sharing network operated through the International Health Regulations, to which most countries, including the United States, are signatories.
“We continue to seek further information and will continue to update member states and the broader public as soon as we receive information from Ugandan health authorities,” WHO said in a statement to STAT.
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STAT has contacted Uganda’s Ministry of Health for comment, but has not yet received a response.
Nahid Bhadelia, director of the Center for Emerging Infectious Diseases at Boston University, suggested that the U.S. embassy’s warning was an attempt to force the country to publicly acknowledge what has likely been known for several days.
“Now that the embassy has announced this, I feel like this is a little more certain,” she said.
Marburg disease is caused by filoviruses, a broad family that includes the Ebola virus. These viruses cause the same type of disease and are spread in the same ways, including through contact with an infected person’s bodily fluids and through the preparation of infected corpses for traditional burial.
Of the approximately 20 Marburg disease outbreaks recorded since the virus was identified in 1967, five have occurred in Uganda, two in tourists infected locally but confirmed after returning home, and one involving a laboratory worker who infected a monkey from Uganda.
There is currently no licensed vaccine to prevent Marburg infection, but several candidates are in various stages of testing. And Marburg’s vaccine development efforts are further along than those testing a vaccine against Bundibugyo, the cause of Ebola, which is still circulating in the Democratic Republic of the Congo, where the outbreak originated. Although several are in development, the companies developing these vaccines currently do not have doses available to begin clinical trials. Trials for these vaccines are several months away.
Uganda is known to be highly effective in containing Ebola and Marburg disease outbreaks. However, there is also known reluctance to disclose much information during such outbreaks, perhaps due to the important role tourism plays in the economy. The detection of the Marburg disease outbreak in Uganda comes at a time when the Ugandan government is trying to get other countries, including the United States, to lift entry restrictions on Ugandans or travelers who have been to Uganda within the past 21 days, the incubation period for Ebola and Marburg disease.
“We need to review these restrictions,” Uganda’s Minister of Health Chris Baryomunshi said at a recent press conference, which was reported on the country’s NBS television.
He maintained that with appropriate public health measures, including strict airport screening, the risk of Ebola being exported from Uganda is very low. There was no mention of the spread of infection in Marburg.
Mr Baryomunshi also claimed that Uganda’s Bundibugyo outbreak is under control. In the current outbreak, the country has recorded 20 Ebola cases, 15 of which were Congolese who had traveled to Uganda. Among the other infected people were health workers in Uganda who contracted the virus from these travelers. The country has not confirmed any new Ebola cases for more than two weeks.
This article has been updated with a statement from WHO.
Correction: An earlier version of this article incorrectly identified Ugandan Minister of Health Chris Baryomunshi..
