Outbreaks

2014 Marburg Outbreak in Uganda (Initial Announcement: October 2014)

2014 Ebola Outbreak in Democratic Republic of the Congo (Initial Announcement: August 2014)

2014 Ebola Outbreak in West Africa (Initial Announcement: March 2014)

As of August 29, 2013, the Uganda Ministry of Health reported 5 laboratory-confirmed cases of Crimean-Congo Hemorrhagic Fever, including 3 cases (no deaths) from Agago District and 2 cases (1 death) from Wakiso District. CDC is assisting the Ministry of Health in the epidemiologic and diagnostic aspects of the outbreak. Testing of samples by CDC’s Viral Special Pathogens Branch is taking place at the Uganda Virus Research Institute in Entebbe.

For more information, see:

• Crimean-Congo Hemorrhagic Fever (CCHF)

As of December 2, 2012, the Ugandan Ministry of Health reported 7 cumulative cases (probable and confirmed) of Ebola virus infection, including 4 deaths, in the Luwero District of central Uganda. CDC is assisting the Ministry of Health in the epidemiologic and diagnostic aspects of the outbreak. Testing of samples by CDC’s Viral Special Pathogens Branch is taking place at the Uganda Virus Research Institute in Entebbe.

For more information, see:

• Ebola Virus Disease

As of November 29, 2012, the Ugandan Ministry of Health reported 15 confirmed and 8 probable cases of Marburg virus infection, including 15 deaths, in the Kabale, Ibanda, Mbarara, and Kampala Districts of Uganda. Testing of samples by CDC’s Viral Special Pathogens Branch is ongoing at the Uganda Virus Research Institute in Entebbe. Working with the Ministry’s National Task Force, a CDC team is assisting in the diagnostic and epidemiologic aspects of the outbreak. Note that Kabale District, on the border with neighboring Rwanda, is distinct from Kibaale District, the site of the recently-ended Ebola outbreak; both districts are in Uganda’s Western Region.

A recent history of Marburg cases and outbreaks in Uganda includes:

• a fatal case in 2008 of a Dutch tourist who visited the Python Cave, a bat cave in Queen Elizabeth National Park (QENP);
• a non-fatal case in 2008 of an American tourist who visited the same cave in QENP; and,
• a 2007 small outbreak of Marburg HF among miners working in the Kitaka lead and gold mine in Kamwenge District.

For more information, see:

• Marburg hemorrhagic fever

The DRC Ministry of Health has declared an end to the most recent Ebola outbreak in DRC’s Province Orientale. The November 26 Press Release reports a final total of 77 cases, including 36 laboratory-confirmed cases, 17 probable and 24 suspect cases, with a total of 36 deaths. CDC assisted the Ministry of Health in the epidemiologic and diagnostic aspects of the investigation. Laboratory support was provided both through CDC’s field laboratory in Isiro, and through the CDC/UVRI lab in Uganda. The Public Health Agency of Canada (PHAC) also provides diagnostic support through its field lab in Isiro. The outbreak in DRC has no epidemiologic link to the near contemporaneous Ebola outbreak in the Kibaale district of Uganda.

For more information, see:

• Ebola Virus Disease

As of November 1, 2012, the National Park Service (NPS) has announced a 10 confirmed cases (including 3 deaths) of hantavirus infection to visitors to Yosemite National Park since June of this year. Nine of the ten individuals with hantavirus infection stayed in Yosemite’s Signature Tent Cabins in Curry Village. The tenth person hiked and camped in Tuolumne Meadows and the High Sierra Camps, located about 15 miles from Curry Village.

For more information, see:

• Outbreak of Hantavirus Infection in Yosemite National Park
• National Park Service (NPS): Hantavirus in Yosemite
• Hantavirus Pulmonary Syndrome (HPS)

In late April 2012, CDC was notified about a patient with aseptic meningitis who worked at a rodent breeding facility in Indiana. Testing revealed that the cause of the patient’s illness was Lymphocytic choriomeningitis virus (LCMV). Further testing at the rodent breeding facility showed evidence of current or past LCMV infection in 13 out of 52 employees. Of the five employees who sought medical treatment, four were diagnosed with aseptic meningitis.

The rodent breeding facility bred and raised mice and rats primarily for sale as frozen feeder animals for reptiles or birds of prey, with regular shipments of live mice. Testing at CDC of frozen mice from the facility indicated evidence of LCMV infection in 20.8 percent of the mice. Rats sampled for testing showed no signs of LCMV infection. In May 2012, a quarantine prohibiting shipping of mice and rats from the facility was enacted and all live mice at the facility were subsequently depopulated; all frozen product was safely disposed of.

Shipping records indicate that live mice were shipped to distributors, pet stores, breeders and individuals in 21 states. The affected states are currently conducting traceout activities to detect any infected mice that were shipped to purchasers before the quarantine. To date, no subsequent human cases of LCMV infection have been reported.

People using frozen or live rodents for feeding to other animals should always follow safety precautions, including wearing gloves when handling animal product, and washing hands with soap and water after handling animal products.

For more information, see:

• Lymphocytic Choriomeningitis (LCM)

On July 28, 2012, the Uganda Ministry of Health reported an outbreak of Ebola Hemorrhagic Fever in the Kibaale District of Uganda. A total of 24 human cases (probable and confirmed only), 17 of which were fatal, have been reported since the beginning of July. Laboratory tests of blood samples, conducted by the Uganda Virus Research Institute (UVRI) and the U.S. Centers for Disease Control and Prevention (CDC), confirmed Ebola virus in 11 patients, four of whom have died.

On October 4, 2012, the Uganda Ministry of Health declared the outbreak ended.

For more information, see:

• Ebola Virus Disease

On May 14, 2011, the Ugandan Ministry of Health informed the public that a patient with suspected Ebola Hemorrhagic fever died on May 6, 2011 in the Luwero district, Uganda. CDC-Uganda confirmed a positive Ebola virus test result from a blood sample taken from the patient. The quick diagnosis of Ebola virus was provided by the new CDC Viral Hemorrhagic Fever laboratory installed at the Uganda Viral Research Institute (UVRI).

Experts from the CDC have arrived in Entebbe, Uganda to actively assist the Ugandan Ministry of Health, local health officials, and international organizations in disease response. At the present time, there are no other known cases.

For more information, see:

• Ebola Virus Disease

In February 2010, South Africa’s National Institute of Communicable Diseases (NICD) informed CDC of an ongoing outbreak of Rift Valley Fever affecting both animals and humans in seven provinces in that country. As of May 3, 2010, NICD has reported a total of 172 human cases of RVF and 15 deaths. Hemorrhagic complications and hepatitis were noted in patients with severe disease. Occupation data for 139 of the 172 indicates that 81% had direct contact with animals through their work with RVF-infected ruminants.

For more information, see:

• Rift Valley Fever (RVF)

On January 22, 2009, CDC’s Viral Special Pathogens Branch retrospectively diagnosed a case of Marburg hemorrhagic fever in a U.S. traveler, who was hospitalized, discharged, and fully recovered. Initial testing of samples collected during the patient’s acute illness in January, 2008 did not initially show evidence of Marburg virus infection. Testing of a convalescent sample indicated a possible previous infection, and more detailed testing of both samples at CDC confirmed that the patient’s illness was due to Marburg hemorrhagic fever.

The recovered patient had visited the “python cave” in Maramagambo Forest, Queen Elizabeth Park, western Uganda. This is a popular destination among tourists to see a cave inhabited by thousands of bats; a fatal case of Marburg hemorrhagic fever occurred in a Dutch tourist in July 2008 who had entered this cave. Both patients likely acquired their infections as a result of contact with cave-dwelling fruit bats, which are capable of harboring Marburg virus. Marburg virus is a zoonotic virus that occurs in tropical areas of Africa, and causes a severe, often fatal, hemorrhagic fever in humans and nonhuman primates. It can also be transmitted through direct contact with a symptomatic patient or materials contaminated with infectious body fluids. The Ugandan Ministry of Health officially closed the cave to visitors in August 2008, after the Dutch case.

The state and local health departments are working with CDC’s Viral Special Pathogens Branch and Traveler’s Health and Animal Importation Branch to further investigate the circumstances of this patient’s case. This includes an assessment of any persons who may have been at risk of exposure at the time the patient was ill, and an investigation of travelers potentially exposed when visiting this or other caves in Africa. There is no evidence of apparent transmission as a result of this case.

Travelers should be aware of the risk of acquiring Marburg hemorrhagic fever and other potentially fatal diseases such as rabies after contact with bats. Healthcare providers should be aware of the risk of viral hemorrhagic fever among travelers returning from endemic countries, and should report any suspected cases immediately to their health department and to CDC’s Viral Special Pathogens Branch (Tel. (404) 639-1115; (404) 639-2888 after hours) for diagnostic testing and further guidance.

For more information, see:

• Marburg hemorrhagic fever

On October 25, 2008, CDC received samples of pig tissues, sera and cell cultures from FADDL, the Foreign Animal Disease Diagnostic Laboratory on Plum Island, NY. The samples, originally collected from pig farms outside Manila, were initially tested at the Plum Island facility, which identified multiple swine pathogens, including Porcine Reproductive and Respiratory Syndrome (PRRS) virus and porcine circovirus type 2. Additional testing by molecular analysis also tentatively identified, for the first time in pigs, Ebola-Reston virus. Further testing of the samples at CDC’s Viral Special Pathogens Branch and Infectious Diseases Pathology Branch confirmed the presence of Ebola-Reston virus. Sequence analysis conducted at FADDL and CDC revealed that the virus is similar to the Ebola-Reston virus that infected macaques from the Philippines imported into the U.S. for research in 1989, 1990 and 1996, and into Italy in 1992.

The clinical significance of Ebola-Reston in pigs is unknown, since many of the samples were obtained from pigs with dual PRRSV and Ebola-Reston virus infections. Epidemiologic investigations by Philippine authorities are continuing to look for evidence of human disease associated with infected pigs. Ebola-Reston virus is of unknown pathogenicity in humans. Recent studies of small numbers of Philippine slaughterhouse workers revealed antibodies to Ebola-Reston virus, with no clinical disease.

For more information, see:

• WHO information on Ebola-Reston virus in pigs, Philippines
• FAO (UN Food and Agricultural Organization) information on Ebola-Reston virus in pigs, Philippines

On October 2, 2008, CDC-Zambia notified CDC’s Viral Special Pathogens Branch about a cluster of 2 cases of a fatal febrile illness suspected to be a viral hemorrhagic fever, with probable person-to-person transmission. Both patients were medevac’d from Zambia to South Africa and died shortly thereafter. During hospitalization, further transmission occurred in three other hospital workers, two of whom also subsequently died. Further investigation revealed the causative agent to be a novel Old World arenavirus, genetically distinct from other arenaviruses such as Lassa and LCM. The novel arenavirus has been named Lujo virus. CDC’s Viral Special Pathogens Branch and Infectious Diseases Pathology Branch worked closely with colleagues in CDC-Zambia, the Viral Special Pathogens Unit, National Institute of Communicable Diseases (NCID) in South Africa, and CDC-South Africa, as well as the respective National Ministries of Health, to provide laboratory and epidemiologic support.

For more information, see:

• WHO information about new Arenaviridae family virus in South Africa and Zambia

On July 10, 2008 CDC was notified by the European Centre for Disease Control (ECDC) about a case of Marburg Hemorrhagic Fever in a woman from The Netherlands. The woman had recently returned from traveling in Uganda. On one occasion the woman had contact with a bat in a cave in the Maramagambo forest in Western Uganda (at the southern edge of Queen Elizabeth National Park), and became ill after returning to The Netherlands. Laboratory testing at the Bernhard Nocht Institute in Hamburg, Germany revealed evidence of Marburg virus infection by polymerase chain reaction (PCR). The patient died on Thursday July 11, 2008 in the morning.

ECDC is working with health authorities in The Netherlands and the World Health Organization (WHO) to respond to the situation.

For more information, see:

• WHO information about the imported case of Marburg in The Netherlands
• Marburg hemorrhagic fever

On November 26, 2007, CDC received blood samples from the Ugandan Ministry of Health, taken from 20 of the 49 patients involved in an outbreak of an unknown illness in Bundibugyo district in western Uganda. Patients reported fever, enteritis, and bleeding. Of the 49, 14 have died. Genetic sequencing of a small segment of viral RNA from samples indicated the presence of a previously unknown strain of Ebola virus. At the invitation of the Ugandan Ministry of Health, CDC, WHO, MSF and other collaborators deployed field investigators to the affected region; additionally, a laboratory was set up in Entebbe at the Uganda Virus Research Institute (UVRI). As the outbreak neared conclusion in January 2008, the total number of suspected cases was 149, with 37 deaths.

For more information, see:

• Ebola Virus Disease

On August 28, 2007, CDC was notified of cases of an unidentified disease in a remote area of Kasai Occidental Province in the Democratic Republic of Congo (DRC). Clinical samples were sent to CDC’s Viral Special Pathogens Branch laboratory for testing, as well as to the Centre of International de Recherches Médicales de Franceville (CIRMF) laboratory in Gabon. Results obtained by both Real Time PCR and viral antigen assay were positive for infection with Ebola virus. The presence of other diseases in the same area of the country contributing to the outbreak cannot be ruled out. At the invitation of the DRC Ministry of Health, CDC, WHO, MSF and other collaborators have deployed field investigators to the region. The onset of the latest laboratory-confirmed case was on September 29, 2007. On October 1, 2007, the total of suspected cases was 249 with 183 deaths.

For more information, see:

• Ebola Virus Disease

On July 27, 2007, CDC was notified of a suspect case of Marburg Hemorrhagic Fever in Uganda by the Uganda Virus Research Institute (UVRI). A blood specimen taken from the only fatal patient, a miner at a local lead and gold mine, was received by CDC on Friday, July 27, 2007. The specimen tested positive for Marburg virus.

A 6-person CDC team consisting of three medical officers, a mammologist, and two microbiologists arrived in Uganda on August 10, traveling to the town of Ibanda in Kamwenge province, near the site of the mine where the exposures are believed to have occurred. WHO, the Ugandan Minsistry of Health, and other collaborators have also deployed personnel. The team has initiated an investigation by capturing bats and other animals at the site of the mine in an effort to further identify the animal host of the Marburg virus, and by tracing human contacts in communities near the mine.

For more information, see:

• Marburg hemorrhagic fever

In December 2006, the Kenya Ministry of Health received reports of unexplained fatalities associated with fever and generalized bleeding from Garissa District in North Eastern Province. The outbreak was confirmed by isolation of RVF virus from 10 patients. CDC deployed a 6-person team from the Viral Special Pathogens Branch to assist in outbreak response, diagnostic assays, database creation and management, technology transfer and public health messaging. The team, in collaboration with CDC’s International Emerging Infections Program (IEIP) Kenya, WHO, MSF and other partners, engaged in case finding, determination of risk factors, and a follow-up study. Like earlier outbreaks of RVF, this outbreak was also associated with recent heavy rainfalls.

For more information, see:

• Rift Valley Fever (RVF)

On March 25, 2005, CDC’s Viral Special Pathogens Branch reported that testing conducted by its laboratory had identified the presence of Marburg Hemorrhagic Fever in 9 of 12 specimens from patients who had died during an outbreak of suspected hemorrhagic fever in Angola. The testing, which was performed using a combination of RT-PCR, antigen-detection ELISAs and virus isolation, was carried out by CDC. The Viral Special Pathogens Branch is a World Health Organization (WHO) Collaborating Center on Viral Hemorrhagic Fevers.

CDC is working closely with WHO and other international partners to assist the Ministry of Health in Angola with the outbreak investigation and response. A CDC emergency response team consisting of experts in viral hemorrhagic fevers is expected to be deployed to the affected region in the next few days. CDC also has shipped preventive gear and supplies to officials in Angola. An outbreak notice was posted on CDC travelers’ health website on March 25.

For more information, see:

• Marburg hemorrhagic fever

According to the World Health Organization (WHO), 20 cases, including 5 deaths, from Ebola Hemorrhagic Fever have been reported from Yambio County in southern Sudan. EHF has been laboratory confirmed by both the Centers for Disease Control and Prevention (CDC) and the Kenya Medical Research Institute. CDC has confirmed that the virus is the Ebola-Sudan strain (incubation period: 2-21 days), one of three previously recognized Ebola virus strains known to cause human disease.

For more information, see:

• Ebola Virus Disease

On May 6, 2002, the Gabonese Ministry of Health declared that the Ebola hemorrhagic fever outbreak in the Ogooué-Ivindo province had ended. CDC participated with the Gabonese and Congolese Ministries of Health, the World Health Organization (WHO), the International Center for Medical Research in Franceville, Gabon, and other partners in an international response to the outbreak in the Ogooué-Ivindo province of Gabon and in neighboring villages in the Republic of the Congo.

Ebola hemorrhagic fever is a severe, often fatal viral hemorrhagic disease. The virus can be transmitted by close contact with persons symptomatic with the disease. On the basis of extensive studies of previous outbreaks of Ebola hemorrhagic fever, general travelers in the area are unlikely to contract the disease. However, travelers are advised to take appropriate precautions to prevent infection. These precautions include avoiding direct contact with people who have serious disease and their bodily fluids.

For more information, see:

• Ebola Virus Disease
• Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting

On February 27, 2001, Uganda was declared officially to be free of Ebola hemorrhagic fever, following a 42-day period, twice the maximum incubation period, during which no new cases had been reported.

Between October 2000 and February 2001, CDC participated with the World Health Organization (WHO), the Ugandan Ministry of Health, Medecins Sans Frontieres (MSF), and other partners in an international response to the outbreak.

For more information, see:

• Outbreak of Ebola Hemorrhagic Fever—Uganda, August 2000—January 2001 Source: MMWR
• Ebola Virus Disease
• Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting

In September 2000, the Ministry of Health of the Kingdom of Saudi Arabia, and subsequently the Ministry of Health of Yemen received reports of unexplained hemorrhagic fever in humans and associated animal deaths from the southwestern border of Saudi Arabia and Yemen. CDC confirmed the outbreak to be caused by Rift Valley fever virus.

For more information, see:

• Update: Outbreak of Rift Valley Fever—Saudi Arabia, August—November 2000  Source: MMWR
• Outbreak of Rift Valley Fever—Saudi Arabia, August—October, 2000  Source: MMWR
• Rift Valley fever (RVF)