2012: Marburg Hemorrhagic Fever Outbreak in Uganda
As of October 28, 2012, the Ugandan Ministry of
Health reported 14 cases (probable and confirmed) of Marburg virus
infection, including 6 deaths, in the Kabale District of southwest
Uganda. Testing of samples by CDC's Viral Special Pathogens Branch is
ongoing at the Uganda Virus Research Institute in Entebbe. Working with
the Ministry's National Task Force, a CDC team is on site to assist in
the diagnostic and ecological aspects of the outbreak. Note that Kabale
District, on the border with neighboring Rwanda, is distinct from
Kibaale District, the site of the recently-ended Ebola outbreak; both
districts are in Uganda's Western Region.
A recent history of Marburg cases and outbreaks in Uganda includes:
- a fatal case in 2008 of a Dutch tourist who visited the Python Cave, a bat cave in Queen Elizabeth National Park (QENP);
- a non-fatal case in 2008 of an American tourist who visited the same cave in QENP; and,
- a 2007 small outbreak of Marburg HF among miners working in the Kitaka lead and gold mine in Kamwenge District.
For more information on Marburg HF, see:
2012: Ebola Hemorrhagic Fever Outbreak in Democratic Republic of Congo
According to the DRC Ministry of Health report on
October 27, 2012, a total of 35 confirmed cases (12 of them fatal), all
from the Isiro area in DRC's Province Orientale, were reported. The case
count also includes 17 probable and 25 suspect cases, with 24 deaths in
these 2 categories. CDC is assisting the Ministry of Health in the
epidemiologic and diagnostic aspects of the investigation. Laboratory
support was provided both through CDC's field laboratory in Isiro, and
through the CDC/UVRI lab in Uganda. The Public Health Agency of Canada
(PHAC) also provides diagnostic support through its field lab in Isiro.
The outbreak in DRC is not linked epidemiologically to the
recently-ended Ebola outbreak in the Kibaale district of Uganda.
2012: Ebola Hemorrhagic Fever Outbreak in Uganda
On July 28th, 2012, the Uganda Ministry of Health
reported an outbreak of Ebola Hemorrhagic fever in the Kibaale District
of Uganda. A total of 24 human cases (probable and confirmed only), 17
of which were fatal, have been reported since the beginning of July.
Laboratory tests of blood samples, conducted by the Uganda Virus
Research Institute (UVRI) and the U. S. Centers for Disease Control and
Prevention (CDC), confirmed Ebola virus in 11 patients, four of whom
have died.
On October 4, 2012, the Uganda Ministry of Health declared the outbreak ended.
2012: Lymphocytic choriomeningitis virus (LCMV) at a rodent breeding facility in Indiana
In late April 2012, CDC was notified about a patient
with aseptic meningitis who worked at a rodent breeding facility in
Indiana. Testing revealed that the cause of the patient's illness was
Lymphocytic choriomeningitis virus (LCMV). Further testing at the rodent
breeding facility showed evidence of current or past LCMV infection in
13 out of 52 employees. Of the five employees who sought medical
treatment, four were diagnosed with aseptic meningitis.
The rodent breeding facility bred and raised mice
and rats primarily for sale as frozen feeder animals for reptiles or
birds of prey, with regular shipments of live mice. Testing at CDC of
frozen mice from the facility indicated evidence of LCMV infection in
20.8 percent of the mice. Rats sampled for testing showed no signs of
LCMV infection. In May 2012, a quarantine prohibiting shipping of mice
and rats from the facility was enacted and all live mice at the facility
were subsequently depopulated; all frozen product was safely disposed
of.
Shipping records indicate that live mice were
shipped to distributors, pet stores, breeders and individuals in 21
states. The affected states are currently conducting traceout activities
to detect any infected mice that were shipped to purchasers before the
quarantine. To date, no subsequent human cases of LCMV infection have
been reported.
People using frozen or live rodents for feeding
to other animals should always follow safety precautions, including
wearing gloves when handling animal product, and washing hands with soap
and water after handling animal products.
2011: Confirmed Case of Ebola Hemorrhagic Fever in Uganda
On May 14, 2011, the Ugandan Ministry of Health
informed the public that a patient with suspected Ebola Hemorrhagic
fever died on May 6, 2011 in the Luwero district, Uganda. CDC-Uganda
confirmed a positive Ebola virus test result from a blood sample taken
from the patient. The quick diagnosis of Ebola virus was provided by the
new CDC Viral Hemorrhagic Fever laboratory installed at the Uganda
Viral Research Institute (UVRI).
Experts from the CDC have arrived in Entebbe,
Uganda to actively assist the Ugandan Ministry of Health, local health
officials, and international organizations in disease response. At the
present time, there are no other known cases.
2010: Rift Valley Fever (RVF) - Republic of South Africa
In February 2010, South Africa's National Institute
of Communicable Diseases (NICD) informed CDC of an ongoing outbreak of
Rift Valley Fever affecting both animals and humans in seven provinces
in that country. As of May 3, 2010, NICD has reported a total of 172
humans cases of RVF and 15 deaths. Hemorrhagic complications and
hepatitis were noted in patients with severe disease. Occupation data
for 139 of the 172 indicates that 81% had direct contact with animals
through their work with RVF-infected ruminants.
2008: Marburg hemorrhagic fever, imported case - United States
On January 22, 2009, CDC's Viral Special Pathogens
Branch retrospectively diagnosed a case of Marburg hemorrhagic fever in a
U.S. traveler, who returned from Uganda in January, 2008. The patient
developed illness four days after returning to the U.S., was
hospitalized, discharged, and fully recovered. Initial testing of
samples collected during the patient's acute illness in January, 2008
did not initially show evidence of Marburg virus infection. Testing of a
convalescent sample indicated a possible previous infection, and more
detailed testing of both samples at CDC confirmed that the patient's
illness was due to Marburg hemorrhagic fever.
The recovered patient had visited the "python
cave" in Maramagambo Forest, Queen Elizabeth Park, western Uganda. This
is a popular destination among tourists to see a cave inhabited by
thousands of bats; a fatal case of Marburg hemorrhagic fever occurred in
a Dutch tourist in July 2008 who had entered this cave. Both patients
likely acquired their infections as a result of contact with
cave-dwelling fruit bats, which are capable of harboring Marburg virus.
Marburg virus is a zoonotic virus that occurs in tropical areas of
Africa, and causes a severe, often fatal, hemorrhagic fever in humans
and nonhuman primates. It can also be transmitted through direct contact
with a symptomatic patient or materials contaminated with infectious
body fluids. The Ugandan Ministry of Health officially closed the cave
to visitors in August 2008, after the Dutch case.
The state and local health departments are
working with CDC's Special Pathogens Branch and Traveler's Health and
Animal Importation Branch to further investigate the circumstances of
this patient's case. This includes an assessment of any persons who may
have been at risk of exposure at the time the patient was ill, and an
investigation of travelers potentially exposed when visiting this or
other caves in Africa. There is no evidence of apparent transmission as a
result of this case.
Travelers should be aware of the risk of
acquiring Marburg hemorrhagic fever and other potentially fatal diseases
such as rabies after contact with bats. Healthcare providers should be
aware of the risk of viral hemorrhagic fever among travelers returning
from endemic countries, and should report any suspected cases
immediately to their health department and to CDC's Viral Special
Pathogens Branch Branch (Tel. 404-639-1115; 404-639-2888 after hours)
for diagnostic testing and further guidance.
For further information on Marburg hemorrhagic fever, please check
CDC information about Marburg virus and viral hemorrhagic fevers.
2008: Ebola-Reston virus detected in pigs in Philippines
On October 25, 2008, CDC received samples of pig
tissues, sera and cell cultures from FADDL, the Foreign Animal Disease
Diagnostic Laboratory on Plum Island, NY. The samples, originally
collected from pig farms outside Manila, were initially tested at the
Plum Island facility, which identified multiple swine pathogens,
including Porcine Reproductive and Respiratory Syndrome (PRRS) virus and
porcine circovirus type 2. Additional testing by molecular analysis
also tentatively identified, for the first time in pigs, Ebola-Reston
virus. Further testing of the samples at CDC's Viral Special Pathogens
Branch and Infectious Disease Pathology Branch confirmed the presence of
Ebola-Reston virus. Sequence analysis conducted at FADDL and CDC
revealed that the virus is similar to the Ebola-Reston virus that
infected macaques from the Philippines imported into the US for research
in 1989, 1990 and 1996, and into Italy in 1992.
The clinical significance of Ebola-Reston in pigs
is unknown, since many of the samples were obtained from pigs with dual
PRRSV and Ebola-Reston virus infections. Epidemiologic investigations
by Philippine authorities are continuing to look for evidence of human
disease associated with infected pigs. Ebola-Reston virus is of unknown
pathogenicity in humans. Recent studies of small numbers of Philippine
slaughterhouse workers revealed antibodies to Ebola-Reston virus, with
no clinical disease.
2008: Hemorrhagic fever due to novel Old World arenavirus, Zambia and South Africa
On October 2, CDC-Zambia notified CDC's Viral
Special Pathogens Branch about a cluster of 2 cases of a fatal febrile
illness suspected to be a viral hemorrhagic fever, with probable
person-to-person transmission. Both patients were medevaced from Zambia
to South Africa and died there. During hospitalization, further
transmission occurred in three other hospital workers, two of whom also
subsequently died. Preliminary results indicate that the causative agent
is a novel Old World arenavirus distinct from other arenaviruses such
as Lassa and LCM. CDC's Viral Special Pathogens Branch and Infectious
Diseases Pathology Branch have been working closely with colleagues in
CDC-Zambia, the Viral Special Pathogens Unit, National Institute of
Communicable Diseases (NICD) in South Africa, and CDC-South Africa as
well as the respective National Ministries of Health to provide
laboratory and epidemiologic support.
2008: Marburg hemorrhagic fever, imported case - Netherlands ex Uganda, July
On July 10, 2008 CDC was notified by the European
Centre for Disease Control (ECDC) about a case of Marburg hemorrhagic
fever (MHF) in a woman from The Netherlands. The woman had recently
returned from traveling in Uganda. On one occasion the woman had contact
with a bat in a cave in the Maramagambo forest in Western Uganda (at
the southern edge of Queen Elizabeth National Park), and became ill
after returning to The Netherlands. Laboratory testing at the Bernhard
Nocht Institute in Hamburg, Germany revealed evidence of Marburg virus
infection by polymerase chain reaction (PCR). The patient died on
Thursday July 11, 2008 in the morning.
ECDC is working with health authorities in The Netherlands and the World Health Organization (WHO) to respond to the situation.
For additional information, please see the following websites:
2007: Ebola Hemorrhagic Fever Outbreak in Uganda
On November 26, 2007, CDC received blood samples
from the Ugandan Ministry of Health, taken from 20 of the 49 patients
involved in an outbreak of an unknown illness in Bundibugyo district in
western Uganda. Patients reported fever, enteritis, and bleeding. Of the
49, 14 have died. Genetic sequencing of a small segment of viral RNA
from samples indicated the presence of a previously unknown strain of
Ebola virus. At the invitation of the Ugandan Ministry of Health, CDC,
WHO, MSF and other collaborators deployed field investigators to the
affected region; additionally, a laboratory was set up in Entebbe at the
Uganda Virus Research Institute (UVRI). As the outbreak neared
conclusion in January 2008, the total number of suspected cases was 149,
with 37 deaths.
2007: Ebola Hemorrhagic Fever Outbreak in the Democratic Republic of Congo (DRC)
On August 28, 2007, CDC was notified of cases of an
unidentified disease in a remote area of Kasai Occidental Province in
the Democratic Republic of Congo (DRC). Clinical samples were sent to
the CDC Viral Special Pathogens Branch laboratory for testing, as well
as to the Centre International de Recherches Médicales de Franceville
(CIRMF) laboratory in Gabon. Results obtained by both Real Time PCR and
viral antigen assay were positive for infection with Ebola virus. The
presence of other diseases in the same area of the country contributing
to the outbreak cannot be ruled out. At the invitation of the DRC
Ministry of Health, CDC, WHO, MSF and other collaborators have deployed
field investigators to the region. The onset of the latest
laboratory-confirmed case was on September 29, 2007. On October 1, 2007,
the total of suspected cases was 249 with 183 deaths.
2007: Marburg Hemorrhagic Fever Outbreak in Uganda
On July 27, 2007, CDC was notified of a suspect case
of Marburg hemorrhagic fever in Uganda by the Uganda Virus Research
Institute (UVRI). A blood specimen taken from the only fatal patient, a
miner at a local lead and gold mine, was received by CDC on Friday, July
27, 2007. The specimen tested positive for Marburg virus.
A 6-person CDC team consisting of three medical
officers, a mammologist, and two microbiologists arrived in Uganda on
August 10, traveling to the town of Ibanda in Kamwenge province, near
the site of the mine where the exposures are believed to have occurred.
WHO, the Ugandan Minsistry of Health, and other collaborators have also
deployed personnel. The team has initiated an investigation by capturing
bats and other animals at the site of the mine in an effort to further
identify the animal host of the Marburg virus, and by tracing human
contacts in communities near the mine.
2006-2007: Rift Valley Fever in Kenya, Tanzania, and Somalia
In December 2006, the Kenya Ministry of Health
received reports of unexplained fatalities associated with fever and
generalized bleeding from Garissa District in North Eastern Province.
The outbreak was confirmed by isolation of RVF virus from 10 patients.
CDC deployed a 6-person team from the Viral Special Pathogens Branch to
assist in outbreak response, diagnostic assays, database creation and
management, technology transfer and public health messaging. The team,
in collaboration with CDC's International Emerging Infections Program
(IEIP) Kenya, WHO, MSF and other partners, engaged in case finding,
determination of risk factors, and a follow-up study. Like earlier
outbreaks of RVF, this outbreak was also associated with recent heavy
rainfalls.
2005: Marburg Hemorrhagic Fever Outbreak in Angola
On March 25, 2005, CDC's Viral Special Pathogens
Branch reported that testing conducted by its laboratory had identified
the presence of
Marburg virus
in 9 of 12 specimens from patients who had died during an outbreak of
suspected hemorrhagic fever in Angola. The testing, which was performed
using a combination of RT-PCR, antigen-detection ELISAs and virus
isolation, was carried out by CDC. The Viral Special Pathogens Branch is
a World Health Organization (WHO) Collaborating Center on Viral
Hemorrhagic Fevers.
CDC is working closely with WHO and other
international partners to assist the Ministry of Health in Angola with
the outbreak investigation and response. A CDC emergency response team
consisting of experts in viral hemorrhagic fevers is expected to be
deployed to the affected region in the next few days. CDC also has
shipped preventive gear and supplies to officials in Angola. An outbreak
notice was posted on CDC travelers' health website on March 25.
For additional information, visit the following websites:
2004: Ebola Hemorrhagic Fever Outbreak in south Sudan
According to the World Health Organization (WHO), 20 cases, including 5 deaths, from
Ebola hemorrhagic fever (EHF)
have been reported from Yambio County in southern Sudan. EHF has been
laboratory confirmed by both the Centers for Disease Control and
Prevention (CDC) and the Kenya Medical Research Institute. CDC has
confirmed that the virus is the Ebola-Sudan strain (incubation period:
2-21 days), one of three previously recognized Ebola virus strains known
to cause human disease.
For related information regarding travel, please see the
CDC Travelers' Health Web site.
For information regarding the recent cases of Ebola hemorrhagic fever syndrome in south Sudan, please refer to the
World Health Organization's (WHO) Communicable Disease Surveillance and Response page.
2003: Ebola Hemorrhagic Fever Outbreak in The Republic of the Congo
For information regarding cases of Ebola hemorrhagic fever syndrome in The Republic of the Congo, please refer to the
World Health Organization's (WHO) Communicable Disease Surveillance and Response page.
2002: Ebola Hemorrhagic Fever Outbreak in Gabon and The Republic of the Congo
On May 6, 2002, the Gabonese Ministry of Health
declared that the Ebola hemorrhagic fever outbreak in the Ogooué-Ivindo
province had ended. CDC participated with the Gabonese and Congolese
Ministries of Health, the
World Health Organization (WHO),
the International Center for Medical Research in Franceville, Gabon,
and other partners in an international response to the outbreak in the
Ogooué-Ivindo province of Gabon and in neighboring villages in the
Republic of the Congo.
Ebola hemorrhagic fever is a severe, often fatal
viral hemorrhagic disease. The virus can be transmitted by close contact
with persons symptomatic with the disease. On the basis of extensive
studies of previous outbreaks of Ebola hemorrhagic fever, general
travelers in the area are unlikely to contract the disease. However,
travelers are advised to take appropriate precautions to prevent
infection. These precautions include avoiding direct contact with people
who have serious disease and their bodily fluids.
For more information about the outbreak, please refer to the
World Health Organization's (WHO) Communicable Disease Surveillance and Response page.
For more information on the disease, please refer to the
Fact Sheet on Ebola Hemorrhagic Fever.
For basic recommendations on VHF infection control, please refer to the CDC and WHO manual:
Infection Control for Viral Hemorrhagic Fevers In the African Health Care Setting.
2000-2001: Ebola Hemorrhagic Fever Outbreak in Uganda
On February 27, 2001, Uganda was declared officially
to be free of Ebola hemorrhagic fever, following a 42-day period, twice
the maximum incubation period, during which no new cases had been
reported.
Between October 2000 and February 2001, CDC participated with the
World Health Organization (WHO), the
Ugandan Ministry of Health,
Medecins Sans Frontieres (MSF), and other partners in an international response to the outbreak.
For more information about the outbreak in Uganda or about viral hemorrhagic fevers in general, please refer to the following:
2000-2001: Rift Valley Fever Outbreak in Saudi Arabia and Yemen
In September 2000, the Ministry of Health of the
Kingdom of Saudi Arabia, and subsequently the Ministry of Health of
Yemen received reports of unexplained hemorrhagic fever in humans and
associated animal deaths from the southwestern border of Saudi Arabia
and Yemen. CDC confirmed the outbreak to be caused by Rift Valley fever
virus.
For additional information, see the following:
