Samuel Okware

By Samuel Okware

Five outbreaks of Ebola virus disease of the Sudan Ebola virus and the Bundibugyo Ebola virus occurred in Uganda from 2000 to 2012. The attack rates and the case fatality rates were much higher for the former than the later. Fever and bleeding manifestations associated with the clustering of cases were typical clinical features. Close contact with infected person was probably the major route of spread. Apparent asymptomatic and atypical Ebola infection was demonstrated in some close contacts, suggesting past unrecognised exposure or cross-reacting antibodies. A zoonotic connection was apparent in monkeys and asymptomatic villagers. The Ministry of Health together with its partners contained the outbreaks, sometimes with delays, but at least once promptly. Early detection and communication yielded the best ideal outcomes. A community-based response ensured timely case search and contact tracing for the isolation and management of patients. The syndrome-based EVD case definition and the laboratory screening tests for Ebola were used to detect cases. However, their unknown specificity and sensitivity and their low positive predictive values were a major weakness in the screening process. Validation of the criteria and the tests at the local level was essential. There were gaps in isolation procedures as 64% of the health care workers were infected after the isolation units were established. Palliative treatment was an important part of management as it improved survival and public confidence. Therefore, survival and not just quarantine must be emphasized and be a critical component of EVD management. Substantial investment in human resource for health is needed to attract, reward, retain and compensate health workers. Collaboration and partnerships at national and international level is vital in building health systems for early surveillance and management of emerging infections. The Uganda experience provides opportunities for further research on some of these strategies that could improve the management and control of Ebola in low resource countries.

Part of the book: Ebola

By Samuel Ikwaras Okware

Part of the book: Emerging Challenges in Filovirus Infections

By Samuel Okware

This chapter reviews the emerging challenges in the transmission and detection of Ebola and Marburg filoviruses since their identification in 1967 and 1976, respectively. Five known highly fatal Ebola species are examined. Ebola outbreaks comprising of 14 EBOV, 7 SUDV, and 4 BDBV infections are reviewed, including the largest West African Ebola outbreak. The ecology of filoviruses and the possible interactions with intermediate hosts and reservoirs is also examined. Evidence that bats are the principal reservoirs of these infections is reviewed. Surveys raise the possibility that other nonhuman primates including dogs may be involved. Challenges on the presumed modes of transmission are discussed with a possibility of droplet and aerosol routes. The discovery of Ebola virus in pigs and its potential impact on the food chain are discussed. The WHO Syndrome Case definition guidelines for diagnosis are examined and shortcomings discussed. However, the early case detection is undermined by the many tropical diseases with similar symptoms. The low positive predictive value for diagnosis based on the antibody antigen assays in outbreaks complicates early isolation and action especially in resource constrained settings. The chapter suggests improvements and areas for further research on the ecology, transmission, and management of filovirus infections.

Part of the book: Emerging Challenges in Filovirus Infections

By Samuel Ikwaras Okware

This Chapter reviews and discusses the experiences of Uganda and the lessons learnt during the successful implementation of its HIV/AIDS Control Program. The major mode of transmission was by the heterosexual route. Control measures thus emphasized behavior change and sexual discipline that promoted faithfulness and monogamous sexual relationships. This chapter examines the factors responsible for the positive outcomes in the implementation of the national AIDS control strategy. The review is based on literature, reports and personal experience. The Uganda Program AIDS in the Ministry of Health (MOH) was one of the earliest AIDS Control Programs in the world. A cumulative total of nearly 2 million people have been infected since the onset of the outbreak in 1982. Some one million HIV related deaths also occurred. When the National AIDS Control Program was initially rolled out in the country there was no cure and the disease was like a death sentence. The available evidence then demonstrated heterosexual transmission as the major mode of spread. Interventions based on the promotion of Abstinence, Being faithful, and Condom use (ABC strategy) were the main components of the strategy in the public campaigns. This complex disease also impacted society and the social fabric deeply. The activities were expanded to include the socio and economic dimensions of HIV/AIDS. Later on the combination strategy integrating biomedical and social behavior change strategies offered new and more encompassing opportunities. The introduction of the antiretroviral therapy (ART) and availability of simplified tests for detection of the viral load status improved treatment and restored hope. Social support and programs for reduction of stigma opened up participation by people living with HIV/AIDS. A community based intersectoral and decentralized strategy reached every village and assured community engagement and involvement. Drastic and steady declines in prevalence and incidence followed. Cases have been declining steadily and prevalence and incidence rates continue to drop and reverse the HIV status in the country. Community Engagement strategy to promote monogamous sexual behavior and the introduction of the highly active retroviral treatment significantly consolidated to the successful outcomes.

Part of the book: AIDS Updates

By Samuel Okware

Part of the book: Future Opportunities and Tools for Emerging Challenges for HIV/AIDS Control

By Samuel Okware

Part of the book: HIV Treatment