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World Health Organization is on high alert about new Ugandan outbreak, cause is not fully known
Added commentary from Jason Oh, aJohns Hopkins Univ. public health studies student who is currently in Uganda studyingthe disease post-conflict transformation. Mr. Oh described some of the symptoms in more detail, and offered different perspective from the CNN reporters’ experience.
CNN has also reworded their report to tone down the suggestion of violent behavior.
It’s called the “nodding disease” and it’s a baffling illness that has struck thousands of children in northern Uganda. The illness brings on seizures, violent behavior in some (debated), personality changes, and a host of other unusual symptoms.
I. Mental Degradation: Child Victims Have no Cure, no Future
Grace Lagat, a northern Uganda native, is mother of two children – Pauline Oto and Thomas — both of whom are victims of the disease. For their safety, when she leaves the house, she now ties them up, using fabric like handcuffs. She recalls, “When I am going to the garden, I tie them with cloth. If I don’t tie them I come back and find that they have disappeared.”
Reportedly the children gnaw at their fabric restraints, like a rabid animals — or “zombies” of popular fiction — in an attempt to escape. (This is based on CNN‘s commentary.)
(Jason Oh points out that the restraints are intended to protect the chidlren from harm, and from starting fires.)
The effort to restrain the children is not unwarranted. In one of the most bizarre symptoms of this tragic illness, children with the disease are reportedly setting fire to buildings in their communities. Coupled with the aimless wandering this disease provokes in victims, this is a deadly combination. More than 200 people have been killed in fires believed to be set by the zombified children.
(According to Jason Oh, there have been few reports of violent behavior. It is unclear where our primary source CNN received this information, though a reader suggested that a CDC report indicated that 10 to 15 percent of children were found to exhibit increased aggression. We were unable to locate this report.)
The disease leaves child victims in an often-violent “zombiefied” state. [Image Source: CNN]The disease is not new. It popped up in the 1960s in Sudan. From there it slowly spread to Libya and Tanzania.
The Uganda infections, though, are a new outbreak — a troubling sign. The jump into a new region could be pure coincidence, or it could indicate the disease has become more virulent or found a new transmissions vector.
Uganda is located in central Africa [Image Source: U of Tex., Modifications: Jason Mick]Infected children typically have regular seizures, which are proceeded by a repetitive nodding of the head. This characteristic symptom has given rise to the unofficial title for the malady.
II. World Medical Organizations Racing for a Cure
The Center for Disease Control (CDC) and World Health Organization (WHO) have been tracking the spread of this frightening ailment. Dr. Joaquin Saweka says the scene in Uganda is horrific, stating, “It was quite desperate, I can tell you. Imagine being surrounded by 26 children and 12 of them showing signs of this. The attitude was to quickly find a solution to the problem.”
Yet the WHO and CDC are not fully sure what is causing the illness, which cripples children and turns them into mindless, violence-prone zombies. The best clue they have is that most of the cases occur in regions inhabited by “Black flies”, which carry the parasitic worm Onchocerca Volvulus. That worm is responsible for another dangerous disease dubbed “river blindness”, the world’s second leading cause of infectious blindness.
(Jason Oh states that CNN misunderstood this reference. While it’s true the cause of the disease is unknown and the literature papers on the topic indicate an overlap with part of the river blindness afflicted regions, but he feels this reference was only intended to “state the obvious”, not hypothesize causation.)
The illness may have something to do with Black flies (left, center) and their parasitic worm (right). [Image Source: WHO (left), Wikimedia Commons (center), Human Healths (right)]However 7 percent of infected children live in regions not inhabited by the Black fly, so a link is speculative at best.
Children with the disease also frequently exhibit vitamin B6 deficiency, leading medical experts to believe that the disease may be nutrition related. However, infections by microbes, parasites, fungi, or even fungi/microbes carried by a parasitic host, can all lead to nutritional deficiencies.
Dr. Scott Dowell, director of global disease detection and emergency response at CDC, says the race is on to determine the cause and a cure. He states, “At first we cast the net wide. We ruled out three dozen potential causes and we are working on a handful of probabilities. We know from past experience an unknown disease could end up having more global implications.”
In the current cases children as old as 19 have been found to be stricken, with the majority of the worst symptoms being spread over the 3-11 age range.
One mystery surrounding the disease is the seizures themselves. While typically seizures are either randomly occurring or follow some singular cue/pattern, the nodding disease seems to have multiple triggers, including eating new foods, changing weather, and other changes.
(Jason Oh says CNN reporters messed up and that it’s familiar foods trigger the seizures, not unfamiliar ones like bars of chocolate.)
Seizure often leave the children soiled with urine and drooling. Local nurses are afraid to touch the infected. States local nurse Elupe Petua, “I feel, because I don’t know what causes it, I don’t even know how it transmits, when I touch them I feel that I can also get the infection because I don’t know what causes it.”
III. Medication is Ineffective
Anti-epileptic medication slows the onset of symptoms, but is unable to stop the progression of the disease. The seizures eventually leave many children unable to walk, only able to drag their bodies along the ground as flies tried to attack them.
The current treatment approach of anti-epileptics has done little to halt the illness.
[Image Souce: CNN](Jason Oh says that the diseases offers a tragic, slow mental degradation, taking years to develop. Affected children, embarassed about the nodding and afraid of infecting classmates often drop out of school, while still mentally capable. Eventually the seizures lead to the more severe symptoms mentioned in the intro — loss of speech, partial paralysis, personality changes, and — according to CNN — violence.)
The government of Uganda has come under criticism for not being vocal enough in addressing the tragedy and demanding foreign aid/research expertise. Local politicians have taken to transporting victims from affected villages by bus to city hospitals in order to force the issue into the eyes of the more affluent city-dwellers.
(Jason Oh adds some perspective writing, “Uganda had asked the CDC to investigate in 2009. Most of the backlash against the government is because the Ministry of Health has been slow to use emergency funds that the Parliament made available. They’ve established many local centers for Nodding Syndrome, but they are under-staffed and under-equipped. The kids are being referred to and transported to Mulago Hospital (famous for being in The Last King of Scotland) so the top doctors at Makerere University and in Kampala can monitor them.”)
The issue is yet another woe for a nation in which the impoverished majority was terrorized for years by warlord Jospeph Kony’s militia, dubbed the “Lord’s Resistance Army.”
Mr. Kony is currently wanted by the International Criminal Court on multiple counts of violent war crimes, including rape and murder. These offenses are punishable by death (life in prison), if he is ever brought to trial. (Jason Oh clarified that under the new Rome Statute of 2002, the ICC is not allowed to seek the death penalty, even in murder cases.)
IV. What if the “Nodding Disease” Found a Way to Reach the U.S.?
Dr. Saweka says that for all the hand-waving by the government about using better anti-epileptics and offering more funding, he appreciates and shares in the villagers frustration. He states, “People complain that it looks like the lives in developing countries have less value than the lives in the western countries. When you know the root cause, you address the cure. Now you are just relieving the symptoms. We don’t expect to cure anybody.”
Ugandans, grief stricken, feel somewhat abandoned by the government and the wealthy developed “First World”. [Image Source: CNN]While the “First World” may not be focused on — or even aware of — the zombification that is leaving children in these African nations violent (debated), crippled shells of their former selves — tied like dogs — it is an issue that must be addressed. After all, viruses, bacteria, parasites thanks to the wonders of evolution can mutate and adapt to new environments and new transmission vectors.
Thus this zombie virus While reports of violence or strange behavior — like biting — are disputed, the disease is very serious. It may seem like a foreign issue to regions like the U.S. and EU who are struggling with their own financial crisises. But if the illness finds a way to broaden its spread, this outbreak couldcripple children across the globe.
(A word of clarification… CNN has reworded their report slightly to tone down the suggestion of violent behavior. The reports of fire starting stand, but in the new context it’s possible these were just innocent accidents triggered by the childrens’ loss of coordination.
World Health Organization is on high alert about new Ugandan outbreak, cause is not fully known
August 19, 2012 – AFRICA – Nine people have died from an outbreak of the 
