Posted Nov. 18, 2022. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.
Summary
This Health Update from the Centers for Disease Control & Prevention (CDC) serves to inform clinicians in the United States (U.S.) about the ongoing outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species Sudan ebolavirus). No suspect or confirmed EVD cases related to this outbreak have been reported in the U.S. or other countries outside of Uganda to date. However, as a precaution because of increasing cases in Uganda, CDC urges clinicians to be aware of this outbreak and the potential for importation of cases.
As of November 5, 2022, a total of 132 confirmed cases of EVD have been identified in Uganda; 39% of confirmed cases have died. To date, there have been a total of 61 patients with confirmed EVD that have recovered from illness and been discharged. Seven districts in Uganda have reported cases since the outbreak began, including Mubende, Kassanda, Kyegegwa, Bunyangabu, Kagadi, Wakiso, and the capital city of Kampala. Two of these districts (Bunyangabu and Kagadi) have completed 21 days of monitoring of all identified contacts of confirmed cases and have had no new EVD cases identified since. CDC is working closely with the Ministry of Health of Uganda, the World Health Organization, and other partners to support the response to this outbreak.
Travel volume from Uganda to the United States is low, and there are no direct flights from Uganda to the U.S. Since October 7, 2022, U.S.-bound air passengers who have been to Uganda in the prior 21 days are being redirected to five U.S. airports where they undergo entry health screenings as part of a layered mitigation approach that, in combination with other public health measures already in place to detect ill arriving travelers, are designed to reduce the risk of introduction and spread of disease in the U.S.
Locally, Spokane Regional Health District is monitoring travelers who have had recent travel from Uganda. Symptoms are monitored for 21 days. Return travelers are reported to SRHD through the Washington State Department of Health. However, if providers learn of any recent travel from Uganda, please contact Spokane Regional Health District Duty Officer at 509-869-3133 to be certain SRHD is aware of the traveler.
Recommendations for Clinicians
Early consideration of EVD in the differential diagnosis is important for providing appropriate and prompt patient care and to prevent the spread of infection. It is important to systematically assess patients for the possibility of EVD through a triage and evaluation process. In the absence of concern for a suspect EVD case, prior travel to Uganda should not be a reason to defer standard laboratory testing needed for routine patient care.
Given the early non-specific symptoms of EVD, all patients should be asked about recent travel history. EVD should be included as a differential in patients with travel to Uganda in the past 21 days who have clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. If EVD is suspected, patient(s) should be isolated in a private room with a private bathroom or covered, bedside commode. Clinicians should wear appropriate personal protective equipment (PPE) and limit the number of personnel who enter the room for clinical evaluation and management.
Importantly, alternative diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in a patient with recent travel should be considered, evaluated, and managed appropriately.
Healthcare personnel can be exposed by touching a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material or create aerosols should be minimized. CDC recommends a combination of measures to prevent transmission of EVD in hospitals including PPE, patient placement, and patient care considerations.
Clinicians with concerns about a patient with suspect EVD or potential EVD exposures should contact SRHD Epidemiology immediately at 509-869-3133 and follow jurisdictional protocols for patient assessment. Early recognition and identification of a suspect EVD case is critical. If a diagnosis of EVD is considered, clinical teams should coordinate with SRHD to ensure appropriate precautions are taken to help prevent potential spread and coordinate care.
Clinical and Laboratory Biosafety Considerations
All personnel handling specimens from patients with suspect EVD, especially patients with travel history to Uganda within 21 days before symptom onset, should adhere to recommended infection control practices to prevent infection and transmission among laboratory personnel.
Under the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens Standard, laboratories handling blood and body fluids must have a written Exposure Control Plan in place to eliminate or minimize employees’ risk of exposure to blood or other potentially infectious materials.
Laboratories that may receive or handle clinical specimens including blood or other potentially infectious materials should conduct extensive risk assessments to identify and mitigate hazards associated with handling the specimens to create the safest environment. The proper PPE needs to be available and staff trained to properly don and doff their PPE. Staff need to be specially trained, have passed competency testing, and attended drills to safely receive, handle, and process these specimens.
A laboratory should have dedicated space, equipment for handling, testing, and transporting specimens from ill patients, and plans for minimizing specimen manipulation.
A waste management plan needs to be in place for laboratory reagents and Category A waste, including PPE and sample material.
If a facility does not have the appropriate risk mitigation capabilities, then the specimen should be forwarded to another facility that does.
More About Ebola Virus Disease
A person infected with EVD is not contagious until symptoms appear. Symptoms may include fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Sudan virus is spread through direct contact (through broken skin or mucous membranes) with the body fluids (blood, urine, feces, saliva, droplet, or other secretions) of a person who is sick with or has died from EVD, with the body fluids of infected animals (including those that died from EVD), or with objects like needles that are contaminated with the virus. EVD is not spread through airborne transmission.
There is currently no Food and Drug Administration (FDA)-licensed vaccine to protect against Sudan virus infection. The Ebola vaccine licensed in the United States (ERVEBO,® Ebola Zaire Vaccine, Live, also known as V920, rVSVΔG-ZEBOV-GP or rVSV-ZEBOV) is indicated for preventing EVD due to Ebola virus (species Zaire ebolavirus), and based on studies in animals; it is not expected to protect against Sudan virus or other viruses in the Ebolavirus genus. There is also currently no FDA-approved treatment for Sudan virus.
The current outbreak in Uganda is the fifth outbreak of EVD caused by Sudan virus in Uganda since 2000. The current outbreak is in the same area as Uganda’s most recent EVD outbreak caused by Sudan virus, which occurred in 2012. During that outbreak, limited secondary transmission was reported, and the outbreak was effectively contained.
For More Information
General Ebola Information
Clinician Resources
Infection Prevention Resources
