Clinician Alert – Outbreak of Ebola virus in Central Uganda

On September 20, 2022, the Ministry of Health of Uganda officially declared an outbreak of Ebola virus disease (EVD) due to Sudan virus (species Sudan ebolavirus) in Mubende District, Central Uganda. As of October 6, 2022, no suspected, probable, or confirmed EVD cases related to this outbreak have been reported in the United States or other countries outside of Uganda.

Recommendations for clinicians

It is important for clinicians to be aware the cases of EVD could present in the United States and to consider EVD in patients with compatible symptoms and a relevant travel history. Early consideration of EVD in the differential diagnosis is important for providing appropriate and prompt patient care, diagnostics, and to prevent the spread of infection.

A person infected with EVD is not contagious until symptoms appear (including fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding). The 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, infected animals, or with objects like needles that are contaminated with the virus. EVD is not spread through airborne transmission.

Healthcare personnel can be exposed to Ebola virus 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.

Idaho providers with concerns about a patient with suspected EVD should contact Central District Health at (208) 327-8625 immediately and will be provided with guidance and support for infection control and further assessment, as appropriate.

• Patients presenting with clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding should have travel history taken. Clinicians should consider possible viral hemorrhagic fever (VHF) or EVD on the differential diagnosis based on travel history.

• If EVD is suspected, patients should immediately be placed in a private room with the door closed, appropriate PPE protocols should be immediately instituted, and only essential personnel necessary to address the patient’s immediate needs should be permitted to enter the room. Aerosol generating procedures should be avoided, and, if must be conducted, should take place in an Airborne Infection Isolation Room, if feasible. Contact Central District Health immediately to plan for further assessment and collection of laboratory specimens.
  • All personnel handling specimens from patients with suspected EVD (especially patients with travel history to Uganda three weeks before symptom onset) should adhere to recommended infection control practices to prevent infection and transmission among laboratory personnel.

There is currently no 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 the prevention of 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. Also, 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.

Eight laboratories within the Laboratory Response Network (LRN) are able to test using the Biofire FilmArray NGDS Warrior Panel, with more LRN laboratories working toward the ability to test.

Summary of Outbreak

This 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 the 2012 outbreak, limited secondary transmission was reported, and the outbreak was effectively contained. The geographic scope of this outbreak in Uganda is currently limited to five districts in central Uganda and not the capital Kampala or the travel hub of Entebbe. While there are no direct flights from Uganda to the United States, travelers from or passing through affected areas in Uganda can enter the United States on flights connecting from other countries. As a precaution, CDC is communicating with public health departments, public health laboratories, and healthcare workers in the United States, and educating travelers, to raise awareness of this outbreak. Healthcare providers should be alert for and evaluate any patients suspected of having EVD, particularly among people who have recently traveled to affected areas in Uganda.

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%.

For More Information

General Ebola Information

General Resources for Ebola Virus Disease

Clinician Resources:

• Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings
• Screening Patients for Ebola Virus Disease
• Considerations for Discharging People Under Investigation (PUIs) for Ebola Virus Disease 

Infection Prevention Resources:

• Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease  
• Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals
• Personal Protective Equipment (PPE) | Public Health Planners | Ebola (Ebola Virus Disease) | CDC Cleaning and disinfecting
• Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
• Procedures for Safe Handling and Management of Ebola-Associated Waste

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