May 22, 2008
Uganda set for haemorrhagic fever centre
By Moses Talemwa

The World Health Organisation has approved the establishment of a regional centre in Uganda to test and determine the presence of hemorrhagic fevers in the East and Central Africa region. This will lead to a significant upgrade of the facilities at the Uganda Virus Research Institute (UVRI).

The development will also stop epidemiologists from Uganda, Kenya, Tanzania, Rwanda, Burundi South Sudan and Democratic Republic of Congo taking samples to the US, before determining a disease outbreak.

According to a senior epidemiologist at the WHO, Dr. William Mbabazi, the development follows the persistent outbreaks of severe fevers such as Ebola, Marburg and Hepatitis-E in the region.

The new centre, to be named the ‘Regional Centre for Epidemic and Ecological Surveillance’, will be established in the present premises of the UVRI, at Entebbe, over the next three years.

This follows regular disease surveillance studies which showed that five new diseases have emerged in Uganda over the last two years alone.

These are; new strains of Meningitis in Yumbe and Nakapiripirit, Ebola in Bundibugyo, Hepatitis-E in Lira and Pader, as well as Marburg fever in western Uganda.
The initial government response was to establish an epidemic surveillance department in the Ministry of Health, with senior epidemiologist Dr. Oscar Kamukama as head. He was deputised by three other epidemiologists, and a bio-statistician.

However, Dr. Kamukama died last year, and two of the three epidemiologists resigned, leaving the department originally meant to have seven specialists with just one epidemiologist and the bio-statistician.

To make matters worse, the department, which is supposed to monitor disease outbreaks across the 80 districts in the country on a daily basis, had been running on a miniscule Shs 70 million budget, so most of the work reverted to the World Health Organisation, in coordination with the US-based Centre for Diseases Control.
“You see medical work is by nature labour-intensive, so the lack of manpower was a major impediment in the implementation of the department’s efforts.” Dr. Mbabazi said.

By coincidence, the WHO surveys also showed that there were similar disease outbreaks in Kenya, Angola and the DR Congo over the same period.
Dr. Mbabazi’s office began looking at new strategies to deal with a common problem.

“We realised that if we established a regional hub to deal with hemorrhagic fevers, it would allow us to tap into the available manpower in the region, with each country contributing,” he explains.

Dr. Mbabazi is particularly keen that more trained personnel be made available to augment the WHO efforts in disease surveillance and detection.
According to the Ministry of Health spokesman, Paul Kaggwa, Uganda had to deal with insufficient technical expertise in diagnosing Ebola last September, so it was at the forefront in lobbying to have the equipment brought into the country permanently.

“During the first Ebola outbreak, they had brought the equipment from the US, and after the epidemic was tackled that equipment went back. But this time it is here, and will be used to detect all sorts of hemorrhagic fevers, right from Bird Flu to Ebola,” Kaggwa said.

But that is only the first stage of the process. The second process involves upgrading the present laboratory at UVRI from its present state of Bio Safety Plus-Level-2 to a higher level called Bio-Safety Plus Level-3.
Africa has only one laboratory elevated to Bio-Safety Plus Level-3, able to carry out specialised investigations, like those involved in the detection of hemorrhagic fevers in specimens, and it is in South Africa.

Maintaining such a facility requires a capital injection of $1million per annum, excluding remuneration of staff manning it.

According to the WHO, the Uganda Virus Research Institute is only at Bio Safety Plus-Level-2, but also requires some refurbishment. Maintaining the refurbished facilities would require up to $150,000 per annum.

By offering the UVRI for upgrade to Bio-Safety Plus Level-3, the government is hoping that the centre will benefit from resources available in the region, including monetary contributions for the construction, as well as manpower and more resources for maintenance.

Presently the UVRI is already carrying out regional surveillance and research on Polio, HIV and Measles among other diseases in collaboration with the CDC and the Medical Research Council of UK, as well as Kenya, Tanzania, Rwanda, Congo Republic and the Democratic Republic of Congo.

The move to expand UVRI into a regional hub to look at hemorrhagic fevers will see the new centre expand its scope into looking at various human diseases, as well as other diseases that may result from human interaction with ecological agents such as birds (bird Flu) and other animals.

For now the effort to upgrade the facilities in Entebbe has already received both the Uganda Government and WHO support. The design stage is presently underway at the Regional WHO office in Brazzaville.