Is there a medical treatment available for the Sudan strain of Ebola?

Clinical trials conducted in DRC from 2018-19 have identified treatments based on the use of monoclonal antibodies, which are specific to a virus strain: Mab114 and regn-eb3. These allow a significative improvement in a patient’s chances of survival.

However, these antibodies are not effective against the Sudan strain of the disease. In the absence of this tool, treatment involves managing the symptoms of the disease and providing intensive care (including compensating for fluid loss, supplying oxygen, monitoring blood and cardiac parameters etc) in order to improve patients' chances of survival.

As in all Ebola epidemics, protective measures and infection control within health centres are of paramount importance.

"The protection of frontline health workers is a major concern for Doctors Without Borders,” says Dr Guyguy Manangama, Doctors Without Borders' deputy head of emergency programmes. “We need to protect health workers to ensure the continuity of the health system by training them in infection prevention and control standards and by providing them with protective equipment."

Since the outbreak was declared, the Ugandan authorities have confirmed the deaths of two health workers, a doctor and a midwife.

What kind of Ebola treatment facilities are available in Uganda?

During an Ebola outbreak, it is important that the medical response take place close to the affected communities. "We know that the earlier patients receive medical attention, the greater their chance of survival,” says Dr Guyguy Manangama. “As the initial symptoms of Ebola are not distinctive, being similar to those of malaria or other febrile viruses such as typhoid, the main issue is rapid access to information, diagnosis and care. In Ebola outbreaks, too many people still arrive at health centres with advanced disease or even die at home, infecting others in the process. This is what we need to avoid." 

Doctors Without Borders, recommends setting up small centres or isolation units where patients can receive first aid as close as possible to where they live. Meanwhile, larger referral centres can provide a wider range of care for patients in the advanced stages of the disease.

In past outbreaks, patients were often taken straight to large case management centres outside their communities, which in many instances led to rumours circulating within the community, hostility towards health workers and the rejection of the response.  

Doctors Without Borders, plans to support the response in Uganda by setting up small centres in affected sub-districts such as Madudu (the epicentre of the outbreak, located 20 km from the district capital Mubende), and setting up a larger 36-bed isolation unit with intensive care capacity for suspected and confirmed patients in Mubende.

Doctors Without Borders, teams also plan to work with hospitals to enable them to become referral centres for health workers infected by the disease.

What is known about the spread of the epidemic?

To bring an Ebola outbreak under control, it is essential to be able to rapidly detect infected people and identify their contacts, who may have travelled far from the outbreak’s epicentre. In the current outbreak, cases have been confirmed in five districts of Uganda, so patients and contacts will need to be identified and followed up across a relatively large area.

Although the outbreak was officially declared on 20 September, a number of suspected deaths potentially linked to the disease were recorded as early as August in the affected region. As is often the case at the beginning of an Ebola outbreak, case-finding and contact-tracing lag behind the spread of the epidemic. It is vital to reconstruct the early stages of the epidemic as accurately as possible in order to screen people for the disease and provide medical care in the right locations.

To tackle an outbreak effectively, it is also essential that people in affected areas have knowledge and understanding of the disease and are cooperative and involved in the response. Community-based surveillance activities and contact-tracing are needed to rapidly identify potentially infected people. Once identified, they and their families need to access appropriate healthcare or isolate themselves for 21 days. To facilitate this, social and economic barriers (such as the cost of transport to health centres, or costs linked to not being able to go out to work) need to be removed. This can be done by helping with transport costs, distributing food or kits to people self-isolating at home etc, and by offering psychological support to patients and their families.

IT tools can also facilitate real-time monitoring of the epidemic. During the 2018-20 Ebola outbreak in DRC, Epicentre (Doctors Without Borders' epidemiological wing) developed new tools to facilitate the coordination of epidemiological activities, including tools for systematic monitoring and collection of patient data, automated reports, and a web-based platform to visualise data on case management and the evolution of the epidemic. For the first time in an outbreak of this magnitude, the same surveillance tool was used at all patient sites, allowing for the efficient creation of a combined and comprehensive dataset on Ebola health facilities. Doctors Without Borders is ready to make these tools available to the Ugandan health authorities.