2022–2023 Uganda Ebola outbreak

Uganda has previously had four outbreaks of Sudan ebolavirus; one outbreak in 2000 and 2011 and two outbreaks in 2012, as well as an outbreak of Bundibugyo virus disease in 2007 and an Ebola virus disease outbreak in 2019. ==Epidemiology==

No human outbreaks of the Sudan ebolavirus have been reported in the last 10 years. Given that this is significantly longer than any reported case of persistent infection in human survivors of ebolavirus infection, this lends weight to the theory expressed by Kyobe Henry Bbosa, Ebola incident commander at Uganda's Ministry of Health, that this outbreak was caused by an unobserved spillover event from a wildlife reservoir. However, this putative spillover remains unidentified. The first cases were detected in the Mubende District among people living around a gold mine. Whilst the mobility of gold traders has been suggested to play a role in onward transmission from the site where the outbreak was first detected, As of 8 November, 23 Ebola cases had been confirmed among pupils, hence education minister Janet Kataha Museveni announced schools across Uganda would close 25 November, two weeks before the scheduled end of term. Timeline On 11 September, the index case of the outbreak, a 24-year-old man in a village of the Mubende District developed symptoms of Ebola and died on 19 September. By 25 September, cases had been confirmed in Kyegegwa District and Kassanda District. On 29 September Kagadi District confirmed its first case. On 1 October, physician Mohammed Ali, one of six infected health workers who treated the index case, died as the first health worker. On 2 October, there were 41 confirmed cases and nine total deaths in confirmed cases. Furthermore, the Bunyanga District had its first confirmed case. On 5 October, there were 43 confirmed cases and 29 reported deaths. On 10 October, there were 63 confirmed or suspected cases and 29 reported deaths. On 20 October, there were 60 confirmed cases and 44 reported deaths. On 22 October Wakiso District had confirmed its first case. On 24 October, there were 90 confirmed cases and 28 confirmed deaths, with 14 confirmed cases reported in Kampala in the previous 48 hours. On 26 October, the Ugandan Ministry of Health confirmed that there were 6 cases in school-aged children who attended classes at 3 different schools in the Rubaga Division of Kampala. One of the children died from the disease and 170 contacts were identified from these cases. On 2 November Masaka District confirmed its first case and death after a 23-year-old woman came to Masaka from Kampala to be looked after by her parents and was admitted to a hospital on 31 October and later died after being transferred back to Kampala. On 13 November Jinja District confirmed its first case and death after a 45-year-old man died and was linked to a probable case connected to the Rubaga Division of Kampala. == Response ==

According to Jane Aceng, Uganda's health minister, local people initially believed the new Ebola outbreak was caused by witchcraft. Aside from this misinformation, there are also no effective vaccines against the Sudan ebolavirus, The World Health Organization (WHO) has been supporting the Ugandan Ministry of Health with surveillance, communication and coordination efforts. The International Federation of Red Cross and Red Crescent Societies (IFRC) has appealed for emergency aid to Uganda. On 6 October, the United States announced that they would begin screening air passengers from Uganda for cases of Ebola. According to Ana Maria Henao-Restrepo and her team in WHO's Health Emergencies Program, an adenovirus based vaccine developed by the Sabin Vaccine Institute in a partnership with the Vaccine Research Center at the US National Institute of Allergy and Infectious Diseases will be offered to contacts of known cases as part of a clinical trial. On 15 October, the first lockdown came into effect. The lockdown, affecting the Mubende and Kassandra districts, prevents anyone, except cargo trucks, from leaving or entering the districts for three weeks. Furthermore, bars, nightclubs, places of worship and entertainment venues are closed and a curfew is in place. On 17 October, president Museveni put Kampala under high response alert after two cases from Mubende reached the capital. One of the patients died. Museveni also warned that there had been contacts and risks of infections in the city. The United States has sent the antiviral drug remdesivir and the experimental combination of antibodies MBP134 to Uganda to help protect healthcare workers from the outbreak with CDC-responsible Joel Montgomery saying that if healthcare workers are at risk, then it will negatively impact the response to the outbreak. Supply shortages, for example inadequate PPE, and limited food for those in quarantine have meant that patients and contacts have escaped isolation; interns have only been paid every three months, meaning they were unable to cope with the rising cost of living, all of which are important issues in the response to stem the epidemic. == Transmission and virology ==

Ebola is mainly spread through contact with bodily fluids. The average case fatality rate of Ebola (all 4 viruses) is 50%. In this outbreak of Sudan Ebolavirus, the case fatality rate has been 39%. == Misinformation ==

Some politicians and other public figures opposed to the 36-year rule of President Yoweri Museveni declared that the Ebola outbreak was fake or exaggerated, and that Ugandans were being used as vaccine "lab rats" to enrich the ruling party. Individuals such as former presidential candidate Joseph Kabuleta further claimed that the Ebola vaccines undergoing clinical trial may have deadly side effects, similar to his earlier claims about COVID-19 vaccines. Other popularized theories have included that Ebola is caused by witchcraft and that burials of Ebola victims are closed so that their organs can be harvested and sold. A contributing factor in misinformation campaigns has been what researchers observed to be uneven application of public health measures during the COVID-19 pandemic, used by the ruling party to stifle dissent and shut down public discourse. An independent fact-checking organization in Uganda has found that a lack of community education regarding disease spread is more widespread than "targeted misinformation", which Ugandan Health Minister Margaret Muhanga had cited, saying opposition politicized the Ebola outbreak. Museveni locked down Mubende and Kassanda districts on 15 October, one month after the first case was reported, but promised no national lockdowns akin to those deployed for COVID-19, even when the virus had spread to Kampala and killed upwards of 77 people in the capital. In the districts undergoing lockdown, markets, bars, and churches were to be closed for the duration of the lockdown, together with travel bans and dawn-to-dusk curfews. Some citizens claimed that the districts placed under lockdown were being deliberately punished for their support of opposition politician Bobi Wine and that police had beaten locals to enforce overnight curfews. ==References==