Country: Uganda Source: World Health Organization Please refer to the attached file. Situation at a glanceAs of 20 February 2025, a total of nine confirmed cases of Sudan virus disease, including one death have been reported from Uganda, since the outbreak was declared on 30 January 2025. Eight cases received care at treatment centres in the capital Kampala and in Mbale and were discharged on 18 February after two negative tests 72 hours apart. As of 20 February 2025, 58 contacts that have been identified are still under follow up in designated quarantine facilities located in Jinja, Kampala,and Mbale. Sudan virus disease belongs to the same family as Ebola virus disease. It is caused by Sudan virus (SUDV). It is a severe disease with high case fatality ranging from 41% to 70% in past outbreaks. In the absence of licensed vaccines and therapeutics for the prevention and treatment of SVD, the risk of potential serious public health impact is high. Early detection, diagnosis, and optimized supportive care may increase the chance of survival.Description of the situationSince the first disease outbreak news on this event was published on 1 February 2025, additional eight laboratory-confirmed cases of Sudan virus disease (SVD) have been reported in Uganda. As of 20 February 2025, a total of nine confirmed cases, including one death have been reported with a case fatality ratio (CFR) of 11%. Cases ages range from 1.5 to 49 years, with a mean age of 27 years and males accounted for 56% of the total cases. The cases were reported from four districts in the country which include Jinja, Kampala, Mbale, and Wakiso (Figure 1).The first reported case, who was a health worker, had symptom onset on 19 January in epidemiological week 3 (Figure 2). The case initially self-medicated with antimalarials and sought care in different health facilities located in Wakiso, Kampala and Mbale districts, as well as a traditional healer in Mbale, before being referred to Mulago referral hospital, where he died on 29 January 2025. Following the detection and confirmation of SVD on 29 January, the case was accorded a safe and dignified burial on 31 January in Mbale.Following the prompt declaration of the outbreak by the Ministry of Health on 30 January, a detailed case investigation was conducted on the first case including comprehensive contact listing in all the districts where the case travelled. Contacts were quarantined in a designated facility and monitored for 21 days. The other eight reported confirmed cases were among the listed contacts and include family members (five cases) and health workers (three) who had direct contact with the first case as they provided care during his illness. The secondary cases had symptom onset between 29 January to 6 February. All were detected at early onset of their disease by contact tracing team while in quarantine. They were referred to Mulago National Referral Hospital (seven cases) and Mbale Regional Referral Hospital (one case) for optimized supportive care and received Remdesivir under the Monitored emergency use of unregistered and experimental interventions (MEURI) protocol. All eight cases were discharged on 18 February 2025 after two negative tests carried out 72 hours apart.Based on the WHO criteria to declare the end of a filovirus outbreak, a countdown to the end of the human-to-human transmission can be started from the day after the last possible exposure, in this case, the day following negative tests. Should no additional cases be reported, the outbreak will be declared over in 42 days, that is two incubation periods. Several activities including heightened surveillance for a period of 42 days is recommended to ensure that there are no missed chains of transmission.As of 20 February, a cumulative of 299 contacts have been listed from affected districts in the country since the start of the outbreak. Over 75% of contacts have completed the 21-day follow-up period. However, 58 are still being monitored in institutional quarantine facilities to complete a 21-day since the last contact with a confirmed case.Alert levels both from the community and the health facilities have been low. Several activities, including training and active case search are ongoing during the 42-day countdown to strengthen surveillance with integrated approach and increase the number of alerts and suspected cases reported, investigated and tested. Mortality surveillance has also been set up since the declaration of the outbreak and will continue in Jinja, Kampala and Mbale.In addition, retrospective investigations are ongoing to find the source of the outbreak through active case search in and around the community and health facilities where the first case was residing and working.This is the sixth outbreak of SVD in Uganda, the most recent outbreak was reported in September 2022 with 164 cases and 55 deaths.EpidemiologySudan virus disease is a severe disease, belonging to the same family as Ebola virus disease. It is caused by Sudan virus (SUDV) and can result in high case fatality. It is typically characterized by acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. Hiccups may occur. Severe illness may include haemorrhagic manifestations (e.g., bleeding from puncture sites, ecchymoses, petechiae, visceral effusions), encephalopathy, shock/hypotension, multi-organ failure, spontaneous abortion in infected pregnant women. Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., CNS, eyes, testes). Person-to-person transmission occurs by direct contact with blood, other bodily fluids, organs, or contaminated surfaces and materials with risk beginning at the onset of clinical signs and increasing with disease severity. Family members, healthcare providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk. The incubation period ranges from 2 to 21 days, but typically is 7–11 days.Public health responseHealth authorities are implementing public health measures, including but not limited to the following:Coordination:The Ministry of Health (MoH) has activated the coordination structures at national and subnational levels, including the Incident Management Team and dispatched Rapid Response Teams to the affected districts. Regional Emergency Operation Centers are being activated in Kampala and Mbale districts.In addition, the country has developed a National Response Plan (February - April 2025). The response plan builds on lessons learned from previous outbreaks and deploys the basic minimum packages of activities across the districts according to risk.Surveillance and contract tracing:MoH with support from WHO and partners are conducting alert management including the setup of an alert desk with toll free numbers to detect and verify alerts from all over the country that meet the case definition. Since 30 January, 138 alerts have been reported and discarded following negative laboratory testing.MoH with support from partners has allocated teams to conduct detailed case investigations around the first reported case and the eight additional cases to identify the source of the outbreak and the chains of transmission.MoH has allocated teams to conduct contact listing of confirmed cases with overall daily contact follow-up rates in the last seven days improving to 100%. Following the declaration of the outbreak, MoH with support from WHO has established mortality surveillance with over 400 non-trauma deaths tested in communities and health facilities located in the affected districts and all have tested negative.MoH set up a hotline for notification of suspected cases.MoH is conducting exit screening of SVD signs and symptoms among travelers at Uganda’s 13 high volume points of entry (POE) including Entebbe International Airport.Case Management:MoH with support from WHO and partners have set up three designated isolation and treatment units in Jinja, Kampala and Mbale where the confirmed cases received optimized supportive care and Remdesivir under the Monitored emergency use of unregistered and experimental interventions (MEURI) protocol.Suspected SVD cases are also isolated and receiving care at the isolation units while awaiting test results.Patients who recovered from the disease will be included in survivor care programme for support and care.Laboratory:MoH and partners have strengthened laboratory capacities and deployed a mobile laboratory to Mbale to reduce turnaround time for laboratory results. MoH has performed a full genome sequencing on the sample of the first confirmed case and findings indicating the outbreak is most likely the result of a spillover event.Infection prevention and control:MoH organized a safe and dignified burial of the first reported case.In their official press statement, the MoH provided recommendations to health workers, district leaders, and the public to strengthen detection of suspected cases and implement appropriate infection, prevention and control measures.WHO is supporting the national authorities, including through:Risk assessment and investigation.Providing operational, financial and technical support to the Ministry of Health to ensure swift response. A total of US$ 3.4 million was released from the Contingency Fund for Emergency for the three levels of WHO to support the government-led SVD response.Supporting the national laboratory system to implement sample collection, transport and diagnostic testing.Facilitating access to candidate vaccines and therapeutics and supporting launch of the vaccine trial. Rings have been defined around all confirmed cases and their contacts have been invited to consent in the trial. As part of this support, the "TOKEMEZA SVD" vaccine trial was launched on 3rd February 2025.Providing technical and operation assistance for the setup of isolation centers for suspected cases and two Ebola treatment units in Kampala and Mbale.Mobilizing logistics to complement government supplies, including IPC supplies, drugs, resuscitation and monitoring equipment, admission packages, and mattresses.Deploying a team of 47 experts to Mbale, Kampala, Wakiso and Jinja districts to support across different response pillars including coordination, surveillance, laboratory, logistics, IPC, RCCE, and case management pillars.Supporting RCCE efforts to counter misinformation and enhance community engagement through the deployment of two anthropologists.Intensified and integrated risk communication and community engagement, including sensitization and training of Village Health Teams, traditional healers, religious leaders and teachers.Collecting social and behavioural data and using evidence to respond to communities’ anxieties and concern, rumours, misinformation and disinformation.WHO risk assessmentSudan virus disease (SVD) is a severe, often fatal illness affecting humans. Sudan virus (SUDV) was first identified in southern Sudan in June 1976. Since then, the virus has emerged periodically and up to now and prior to this current one, eight outbreaks caused by SUDV have been reported, five in Uganda and three in Sudan. The case fatality rates of SVD have varied from 41% to 70% in past outbreaks.SUDV is enzootic and present in animal reservoirs in the region. Uganda reported five SVD outbreaks (one in 2000, one in 2011, two in 2012, and one in 2022). The current outbreak is the sixth SVD outbreak in Uganda. Uganda also reported a Bundibugyo virus disease outbreak in 2007 and an Ebola virus disease outbreak exported from the Democratic Republic of the Congo in 2019. The latest SVD outbreak in Uganda was declared over on 11 January 2023. A total of 164 cases with 55 deaths were reported in nine districts.Uganda has experience in Ebola disease outbreaks including SVD, and in the ongoing outbreak, necessary actions have been initiated and implemented quickly for effective control.In the absence of licensed vaccines and therapeutics for the prevention and treatment of SVD, the risk of potential serious public health impact is high. Community deaths, care of patients in private facilities and hospitals and other community health services as well as at traditional healers with limited protection and infection prevention and control measures entail a high risk of many transmission chains. An investigation is ongoing to determine the source and the scope of the outbreak and the possibility of spread from the capital city, Kampala, to other districts. Exit screening has been set up at different points of entry to reduce the risk of potential exportation of cases to neighbouring countries.WHO adviceEffective Ebola disease outbreak, including SVD, control relies on applying a package of interventions, including case management, surveillance and contact tracing, a strong laboratory system, implementation of infection prevention and control measures in health care and community settings, safe and dignified burials and community engagement and social mobilization.Risk communication and community engagement is crucial to successfully controlling SVD outbreaks. This includes raising awareness of symptoms, risk factors for infection, protective measures and the importance of seeking immediate care at a health facility. Sensitive and supportive information about safe and dignified burials is also crucial. Awareness should be built through targeted campaigns and direct work with affected and proximate communities, with special attention to engage with traditional healers, clergy, and community leaders, who are important sources of information for the community. Rapid qualitative assessments should be implemented to collect socio-behavioural data, which can then be utilized to guide the response. Misinformation and rumours should be addressed to foster trust and promote early symptom reporting. Early initiation of intensive supportive treatment increases the chances of survival. All above-mentioned interventions need to be thoroughly implemented in affected areas to stop chains of transmission and decrease disease mortality. Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definitions should be advised not to travel and seek early care at designated facilities to improve their chances of survival and limit transmission.WHO encourages countries to implement a comprehensive care programme to support people who recovered from Ebola disease with any subsequent sequelae and to enable them to access body fluid testing and to mitigate the risk of transmission through infected body fluids by adequate practices.Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real-time. Surrounding countries should enhance readiness activities to enable early case detection, isolation and treatment.A range of candidate vaccines and therapeutics are under different stage of development. Since 2020, WHO has convened scientific deliberations and set up an independent process to review candidate MCMS prioritization and clinical trial designs. One candidate vaccine and two candidate therapeutics (a monoclonal antibody and an antiviral) have been recommended and are available in country and are being assessed (clinical efficacy and safety) through randomized clinical trial protocols.Thanks to preparedness measures that the government took after the previous outbreak in 2022, and a global research collaboration led by WHO (first MARVAC now FILOVIRUS CORC), a trial of a candidate vaccine was launched just four days after the outbreak was declared. A therapeutics trial will start as soon as national authorities provide approval.The two vaccines licensed against Ebola virus disease will not provide cross protection against SVD and cannot be used in this outbreak.WHO advises against any restrictions on travel and/or trade to Uganda based on available information for the current outbreak.Further informationWHO African Region press release: WHO accelerates efforts to support response to Sudan virus disease outbreak in Uganda.The Ministry of Health Uganda confirms the outbreak of Sudan virus disease:Ebola virus disease fact sheetEbola and Marburg virus disease epidemics: preparedness, alert, control, and evaluationInfection prevention and control guideline for Ebola and Marburg diseaseA WHO-Strategic Research Agenda for Filovirus Research and Monitoring (WHO-AFIRM)CORE trial protocol for candidate therapeutics against Ebola diseaseCORE trial protocol for candidate vaccines against Ebola diseaseFiloviridae - Landscape of vaccines and therapeutics licensed or under developmentConsiderations for border health and points of entry for filovirus disease outbreaksSystematic review : Syndromic entry and exit screening for epidemic-prone diseases of travellers at ground crossingsEbola disease event management at points of entryEntry screening for Ebola disease at airports, ports and land crossings: Technical note for preparedness planningExit screening at airports, ports and land crossings: Interim guidance for Ebola diseaseDiagnostic testing for Ebola and Marburg diseases: interim guidanceHow to safely collect blood samples by phlebotomy from patients suspected to be infected with filovirusHow to safely collect oral swabs (saliva) from deceased patients suspected to be infected with filovirusHow to safely ship human blood samples from suspected EBOD cases within a country by road, rail and seaOptimized Supportive Care for Ebola Virus Disease. Clinical management standard operating procedures. WHO. 2019.ICD-11 2022 releaseNew filovirus disease classification and nomenclatureSudan Ebolavirus – Experts deliberations Candidate treatments prioritization and trial design discussions, 2022Uganda trains Community Health workers from Kole, Mukono and Wakiso districts on community-based approach to EbolaDiagnostic testing for Ebola and Marburg virus diseasesWHO R&D Blueprint for Epidemics and FilovirusesPathogens prioritization: a scientific framework for epidemic and pandemic research preparednessCitable reference: World Health Organization (21 February 2025). Disease Outbreak News; Sudan virus disease in Uganda. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON556