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Deaths of Uganda Ebola Health Care Workers Cause Concern
Recombinomics Commentary
December 6, 2007

4 B'gyo hospital health care workers quarantined 1/12/07, following complaints of fever (Med Sup Bundibugyo, Dr Sesana, Dr Kule, Clinical officer, and 1 Nurse. So far all improving. Dr Kule in Mulago Isolation unit.

The above comments are from a December 3 weekly update of the Bundibugyo Ebola situation in Uganda.  Earlier reports included concerns about hospitalized health care workers, and the above comments paint a fairly benign clinical course.

However, within 24 hours of the release of the report, three of the four health care workers were dead, as were two additional workers not mentioned in the report.  The deaths of five health care workers raise serious questions about earlier reports on a low case fatality rate and potential containment due to virus burn-out.

Ebola was first identified as the etiological agent for the current outbreak, but the isolates were a new species that was had only 75% identity with earlier strains, suggesting that the new strain was a recombinant.  Since new primers are under development, the lab confirmation of Ebola is far from ideal.  Similarly, identification of four other infectious disease outbreaks in the area hamper identification of true Ebola cases, and the large number of cases that are still hospitalized limits the reliability of the case fatality rate, which is said to be low for Ebola, which can kill up to 90% of infected patients.

Although Ebola was not identified until Friday, the health care workers knew that patients were dying from an infectious disease, so they did take precautions, although full PPE’s were not available.  Thus, the deaths of five health care workers within a 24 hour period raises concerns that transmission is relatively efficient, and suspect cases at additional locations raises concerns that the virus has already significantly spread.

Tracking down additional patients is hampered by community concerns of the deaths of hospitalized patients, which has greatly reduced the number of patients and workers in local hospitals.

The establishment of a local testing lab should clarify questions on the transmissibility and case fatality rate for the new species of Ebola in Uganda.

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