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MSF wraps up its intervention in response to a Marburg fever outbreak

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Ugandan authorities have declared the end of the Marburg outbreak that affected the Eastern part of the country since October. Médecins Sans Frontières/Doctors Without Borders (MSF) provided support to local authorities, notably in case management capacities and epidemic surveillance. MSF, the Ministry of Health and their partners have also introduced new tools which could improve case management during the next hemorrhagic fever outbreaks.

    Uganda declared on Friday 8 December the end of the Marburg outbreak, 42 days since the death of the last confirmed case in the country. In total, three deaths related have been declared (one suspect case and two confirmed cases), on 25 September, 13 October and 26 October respectively, in Kween and Kapchorwa districts, in the East of the country.

    MSF intervened in the area end of October, in close collaboration with the Ugandan Ministry of Health, and has been in charge of leading the response for the case management. MSF teams set up two treatment centres, with a capacity of 10 beds each, in the premises of Kapchorwa district hospital and near the Kaproron Health Centre, to ensure adequate capacity and preparedness to manage a large-scale epidemic. These two centres will now be decommissioned.

    Healthcare staff in the district was trained in these centres by MSF staff experienced in hemorrhagic fevers outbreaks. The main fields of training included the safe management of suspect and confirmed cases, collection of laboratory samples and community surveillance. MSF also assisted the Ministry of Health and World Health Organization with epidemiological surveillance, community health promotion and mapping activities during the epidemic. An MSF ambulance with isolation capacities was also deployed to the field.

    “This is the first time that Marburg fever has been diagnosed in these districts of Uganda, but strong national surveillance meant that the epidemic was noticed and confirmed early enough to allow for a rapid and effective collaborative response," said Dr. Natalie Roberts, head of MSF’s Emergency operations. "Health promotion activities within the communities of the districts were also crucial to increase their understanding of this disease and raise acceptance for our intervention."

    Health promotion activities within the communities of the districts were also crucial to increase their understanding of this disease and raise acceptance for our intervention.

    Viral hemorrhagic fevers, including Marburg and Ebola, are endemic in Uganda. The risk of outbreaks in the future is high, and it is therefore crucial that surveillance mechanisms and emergency preparedness are maintained.

    During this outbreak, MSF, the Ministry of Health and other partners have also introduced and run real-scale tests of new tools, which might improve the response to new outbreaks in the future. This included a mobile laboratory, conceived to allow for testing on high-risk samples, deployed by the European Union. The deployment of such testing devices can significantly reduce turn-around time to receive confirmation of suspect cases via blood testing - the national laboratory is in Kampala, a 10-hour drive away.

    MSF has also been supporting the use of antiviral drugs in the treatment and prophylaxis of Marburg, with the objective of reducing the mortality of the disease. The limited scope of the outbreak fortunately didn’t require the use of these antivirals, but regulatory and clinical discussions held with Ugandan Ministry of Health and other partners over their use should be useful to improve access to these medications in future outbreaks.

    “We are very keen to continue to collaborate closely with Ugandan Ministry of Health, the World Health Organization and other partners in Kampala, in order to improve our response to similar epidemics time after time," added Dr. Roberts. "This includes provision of quality patient care for confirmed and suspect cases, and support to health promotion within Ugandan communities to help with their understanding of this disease.”

    MSF also intervened on the other side of the border, in Kenya, to conduct contact tracing, training of health staff and set up a small treatment centre, which fortunately wasn’t used as no cases were declared in the country.

    MSF first intervened in Uganda in 1980. The medical humanitarian organization currently runs emergency programs to assist South Sudanese refugees in the North of the country, as well as longer-term programs in Arua and Kasese districts. Here, focus is put on HIV, tuberculosis, malaria, and other infectious diseases, as well as access to healthcare for populations with specific needs (adolescents, fishermen communities, sex workers, amongst others).