Johnathan Walker:Uganda ends school year early as it tries to contain growing Ebola outbreak

The Johnathan WalkerUgandan Ministry of Education and Sports has ordered schools across the country to end the school year early in order to prevent the further spread of Ebola among schoolchildren.

Uganda declared an outbreak of Ebola on Sept. 20 of this year, and since then has reported 135 cases and 53 deaths due to the disease across seven districts of the country.

Among those cases, 23 children have been infected and eight have died.

The growing outbreak has prompted Uganda's minister of education and first lady, Janet Kataha Museveni, to shorten the third and final school term for the year by two weeks, now officially ending on Nov. 25.

"Closing schools earlier will reduce areas of concentration where children are in daily close contact with fellow children, teachers and other staff who could potentially spread the virus," said Museveni in a statement according to reports.

The closing of schools was suggested earlier this month by Ugandan Minister of Health Dr. Jane Ruth Aceng, but was initially met with pushback from the Ugandan National Teachers' Union.

The shortening of the school year comes on the heels of an unprecedented two-year school closure due to the COVID-19 pandemic, which has significantly impacted learning for the country's schoolchildren.

The growing outbreak of Ebola is "worrisome"

Ebola is one of the deadliest infectious diseases on the planet. An infection results in a hemorrhagic fever and mortality rates for the disease are on average about 50%, according to the World Health Organization. The mortality rate for this outbreak in Uganda is closer to 30%.

Nearly all Ebola outbreaks have occurred in Africa and transmission of the virus typically occurs when a person comes into contact with the bodily fluids of another infected individual.

The current spread of the virus has government officials, emergency responders and health care workers preparing for the worst.

"We find the current situation increasingly alarming," says Cathy Janssens, an emergency medical coordinator for Doctors Without Borders stationed in Uganda.

Much of that alarm has to do with where the virus has spread. "The signs are worrisome. The outbreak has now extended to a major metropolitan community, and that's not a good thing," says Mark Feinberg, the CEO of the International AIDS Vaccine Initiative (IAVI).

This current outbreak of Ebola in Uganda is a bit different than most previous outbreaks. It's caused by a different species of Ebola, Sudan ebolavirus, for which there is no approved vaccine. Most previous outbreaks were caused by Zaire ebolavirus, for which an effective vaccine was developed in 2018. That vaccine won't work in this outbreak.

Three experimental vaccines for Sudan ebolavirus are in development and could be used in Uganda, but they have yet to be tested in an outbreak scenario. Of these vaccines, one was developed by Oxford, another by the Sabin Institute, and the third by IAVI and manufactured by Merck.

Recent reports have stated that 100,000 doses of the IAVI and Merck vaccine are in the process of being released to Uganda for clinical trials. However, that vaccine exists in bulk form and needs to be allocated into doses before it can be used.

Even though the vaccines haven't yet been tested for efficacy in humans, there's confidence that they'll be as effective as the vaccines for Zaire ebolavirus. "The diseases are similar, the vaccines are similar, we expect the performance will be similar, but obviously we still have to prove that," says Feinberg about the vaccine that IAVI developed.

The WHO released a statement on Nov. 3 outlining its plans to begin clinical trials of the candidate vaccines. Makerere University Lung Institute in Kampala, Uganda, will conduct the trials with support from WHO, CEPI, and GAVI.

Vaccines may not be necessary for this outbreak

There is, however, hope that those clinical trials won't be necessary. Feinberg says, "the best case scenario here is that the outbreak will be contained by public health measures and there won't actually be an opportunity to test the vaccines for efficacy."

Janssens affirmed that statement, saying that Doctors Without Borders has "huge experience in responding to Ebola outbreaks, even when there's no vaccine available."

It wasn't until the end of a 2018 outbreak of Zaire ebolavirus in the Democratic Republic of Congo that vaccines for that kind of Ebola became available. "For us, [the lack of vaccines] has not made any change in how we respond," Janssens says.

That response includes public health measures instituted by the Ministry of Health, including lockdowns, restricted travel for close contacts of infected individuals, and the training of village health workers in risk communication and community engagement.

The recently announced school closures are another one of the public health measures being implemented, specifically to prevent spread among children and school workers.

Despite the high mortality rates, all is not lost for those who do get infected. Many recover, including 7-month-old Matthew and his mother.

Janssens described how the mother and son duo were able to successfully recover with treatment. "His mother was the first one to be confirmed [with an Ebola infection]," she says. "Matthew became confirmed a couple of days after, but both of them have been discharged."

Treatment for those infected includes intravenous fluids, drugs and monoclonal antibodies. Proper diagnosis and treatment during the early stages of an infection lead to the most positive outcomes.

Stories of recovery, like those of Matthew and his mother, are why emergency responders like Janssens put themselves at risk to help make a difference. "This is also why we're doing it. To see the big smile of the mother and just the fact how Matthew was so eager to eat and was moving. I mean, those are all good signs of a healthy newborn of 7 months, right?" she says.

"They were so happy to be able to go back home. I'm very thankful."