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CDC Health Update:
Update on Ebola Virus Disease (Sudan ebolavirus) Outbreak in Central Uganda
November 7, 2022
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The CDC has issued an update 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 United States (U.S.) or other countries outside of Uganda to date. However, as a precaution because of increasing cases in Uganda, CDC is communicating with clinicians, public health departments, and public health laboratories in the U.S. to provide an update and raise awareness of this outbreak and the potential for importation of cases.
Clinicians should contact Public Health immediately if a patient who is concerning for Ebola is identified:
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Los Angeles County DPH Acute Communicable Disease Control
- Weekdays 8:30am–5pm: call 213-240-7941.
- After-hours: call 213-974-1234 and ask for the physician on call.
Long Beach Health and Human Services
- Weekdays 8am-5pm: call 562-570-4302.
- After hours: call the duty officer at 562-500-5537.
Pasadena Public Health Department
- Weekdays 8am-5pm: call 626-744-6089.
- After hours: call 626-744-6043.
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The CDC communication is below and online.
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This is an official CDC HEALTH UPDATE
Distributed via the CDC Health Alert Network
November 7, 2022, 9:15 AM ET
CDCHAN-00480
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| Update on Ebola Virus Disease (Sudan ebolavirus) Outbreak in Central Uganda
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Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update as a follow-up to a HAN Health Advisory (Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda) issued on October 6, 2022. This Health Update serves to inform public health departments, public health laboratories, and clinicians in the United States 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 United States (U.S.) or other countries outside of Uganda to date. However, as a precaution because of increasing cases in Uganda, CDC is communicating with public health departments, public health laboratories, and healthcare workers in the United States to provide an update and raise awareness of this outbreak and the potential for importation of cases.
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Background
On September 20, 2022, the Ministry of Health of Uganda officially declared an outbreak of EVD caused by Sudan virus (species Sudan ebolavirus) in Mubende District, Central Uganda.
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.
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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.
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Recommendations and Resources for Public Health Departments
CDC’s Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations about Ebola or other viral hemorrhagic fevers by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB’s on-call epidemiologist or by e-mailing spather@cdc.gov.
On October 7, 2022, as part of the U.S. domestic response to the outbreak of EVD caused by Sudan virus in Uganda, CDC provided updated interim guidance for health departments on risk assessment and management of people with potential ebolavirus exposure. The interim guidance recommends follow-up measures for travelers who have been in Uganda in the prior 21 days. In managing travelers from Uganda, health departments should establish contact with travelers arriving in their jurisdictions, conduct an initial assessment of exposure risk, provide health education, and conduct symptom monitoring based on travel history and exposure risk. CDC is sharing travelers’ contact information with health departments in travelers’ final destinations to facilitate these activities. The initial assessment should occur as soon as possible, ideally within 24 hours of receiving CDC’s notification of the traveler’s arrival.
If a suspect EVD case is identified in the United States, testing for Sudan virus and other ebolaviruses is available at CDC (Atlanta, Georgia) and within the Laboratory Response Network (LRN). To date, twentyfive geographically diverse LRN laboratories are able to test using the Biofire FilmArray NGDS Warrior Panel, with several more LRN laboratories working toward testing capability. The Warrior Panel can detect Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses.
CDC and the Administration for Strategic Preparedness and Response (ASPR) are working with U.S. jurisdictions, starting with states with the highest likelihood for detecting a suspect EVD case, to review plans for (a) identifying and managing suspect cases locally, and (b) coordinating transportation in the event that a patient requires transfer to another facility for evaluation or treatment, such as a Regional Ebola and Other Special Pathogen Treatment Center (RESPTC).
CDC is also able to deploy CDC Ebola Response Teams (CERT) made up of highly trained public health and healthcare infection control experts—including medical officers, epidemiologists, infection control specialists, and analysts—who can be anywhere in the United States within hours of a request from a jurisdiction with a highly concerning suspect or confirmed domestic case of EVD. The teams do not provide direct medical care to patients but coordinate response activities with state and local health departments and provide guidance and recommendations on how to prepare a healthcare facility to prevent spread and provide safe and effective care for patients with EVD.
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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.
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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, rVSVΔGZEBOV-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 currently no FDA-approved treatment for Sudan virus.
In the absence of early diagnosis and appropriate supportive care, EVD is a disease with a high mortality rate. Occasional outbreaks have occurred mostly on the African continent. With intense supportive care and fluid replacement, mortality rates may be lowered. EVD most commonly affects humans and nonhuman primates, such as monkeys, gorillas, and chimpanzees. The genus Ebolavirus is known to comprise the following six species:
- Ebola virus (species Zaire ebolavirus)
- Sudan virus (species Sudan ebolavirus)
- Taï Forest virus (species Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus)
- Bundibugyo virus (species Bundibugyo ebolavirus)
- Reston virus (species Reston ebolavirus)
- Bombali virus (species Bombali ebolavirus)
Of these, only four (Ebola, Sudan, Taï Forest, and Bundibugyo viruses) are known to cause EVD in humans. Infection with any Ebola species presents as clinically similar disease. Previous outbreaks of Sudan virus have had a mortality rate of approximately 50%.
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.
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For additional resources see the CDC HAN.
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The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.
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Categories of Health Alert Network messages:
Health Alert Requires immediate action or attention; highest level of importance
Health Advisory May not require immediate action; provides important information for a specific incident or situation
Health Update Unlikely to require immediate action; provides updated information regarding an incident or situation
HAN Info Service Does not require immediate action; provides general public health information
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##This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, epidemiologists, HAN coordinators, and clinician organizations##
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