Every year, World Toilet Day is observed to raise awareness about the global sanitation crisis and encourage action to solve it. The goal set by the United Nation is to achieve safe toilets for all by 2023, as a part of their Sustainable Development Goals.

The UN also states that 3.5 billion people live without proper sanitation and many children also lose their lives due to poor sanitation and unsafe water. This is why World Toilet Day is observed to raise awareness on this issue.

Theme

This year, the theme for World Toilet Day 2024 is "Toilets - A Place for Peace'. This focuses on the growing threat to sanitation that is caused by conflict, climate change, disaster and neglect. When there is a threat to using toilets, it can lead to many health risks.

Not using toilets for too long may lead to Urinary Tract Infection or UTI. For many who do not have access to clean toilets do not drink enough liquid or hold pee for too long. Doctors suggest that holding in pee for too long can cause bacteria to multiply and lead to UTI. By not drinking enough water, your bladder fails to tell the body to pee often, and can cause the bacteria to spread through the urinary tract, which can lead to infection.

Symptoms of UTI:

• Burning or stinging feeling while urinating
• Pain in pelvis or lower abdomen
• Constant urge to empty the bladder
• Strong or foul smelling urine
• Consistently dark urine
• Blood in urine

Holding in pee for too long can also cause your bladder to stretch, making it difficult or even impossible for the bladder to contract and release pee normally. It can also damage your pelvic floor muscles or could lead to kidney stones.

World Toilet Day History And Significance

To prevent such conditions, it is important that everyone has access to clean and safe toilets. In terms of history, the day was established in 2001, by the World Toilet Organization (WTO), which was founded by Jack Sim. However, it was officially recognised by the UN in 2013. The Government of Singapore worked with WTO to create the first UN resolution called Sanitation for All.

India too promotes safe and hygiene toilet through its Swachh Bharat Yojna.

The 17th outbreak of Ebola virus in the Democratic Republic of the Congo has claimed over 130 lives, with more than 513 suspected cases, local officials have said.

A spokesperson for the DR Congo government said cases were now being reported across a wider area, according to the BBC. Cases are now being identified in new areas, including Nyakunde in Ituri Province, Butembo in North Kivu, and the city of Goma.

As per the US Centers for Disease Control and Prevention (CDC), there are also two confirmed cases and one death in Uganda.

The World Health Organization (WHO) has declared the current outbreak, caused by the Bundibugyo virus, an international emergency. The agency has also warned that it could potentially become “a much larger outbreak” than what is currently being detected and reported, with a significant risk of local and regional spread. However, it does not meet the criteria of a pandemic.

Meanwhile, an American doctor in the DR Congo who was caring for patients also tested positive for Ebola Bundibugyo disease on May 17.

“The person developed symptoms over the weekend and tested positive late on Sunday,” the CDC said, adding that the agency is working to move the patient to Germany for treatment and care.

CBS News also quoted sources as saying that at least six Americans have been exposed to the Ebola virus during the outbreak in the DR Congo.

The CDC noted that "high-risk contacts associated with this exposure are also being moved to Germany".

The Bundibugyo Virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognised outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality rate of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the fatality rates seen in many outbreaks caused by other Ebola strains, but they are still extremely serious.

Also read: Ebola Outbreak: University of Glasgow Researcher Explains Why Bundibugyo Virus Is Concerning

The largest outbreak of the Ebola virus since its discovery in 1976, took place in 2014–2016. The outbreak infected more than 28,600 people in West Africa.

The disease also spread to several countries within and outside West Africa, including Guinea, Sierra Leone, the United States, the United Kingdom, and Italy, killing 11,325 people.

How Does Ebola Bundibugyo Spread?

The Bundibugyo virus spreads through contact with the blood or bodily fluids of a person infected with, or who has died from, the rare Ebola strain.

It can also spread through contact with contaminated objects such as clothing, bedding, needles, and medical equipment, or through infected animals such as bats and nonhuman primates.

Historically, Bundibugyo virus outbreaks have recorded fatality rates ranging from 25 per cent to 50 per cent.

Symptoms To Watch For

Symptoms of Bundibugyo virus disease are similar to other forms of Ebola and include:

• Fever
• Headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Unexplained bleeding or bruising, usually in later stages of illness.

The ongoing Ebola virus outbreak in the Democratic Republic of Congo, which has also spread to Uganda, has been identified as caused by the rare Bundibugyo strain.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are subject to change as the outbreak evolves.

Speaking exclusively to HealthandMe, Professor Emma Thomson, Director of the Centre for Virus Research (Virology) in the School of Infection and Immunity at the University of Glasgow, shared why the virus outbreak, which has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), is of concern.

While the Bundibugyo virus, a member of the species Orthoebolavirus bundibugyoense, is closely related to the Ebola virus (species Orthoebolavirus zairense), it is still different and currently has no treatment or vaccine.

Professor Emma told HealthandMe that “there are several reasons for concern".

Ebola Outbreak: Likely Went Undetected For Some Time

The expert noted that "the reports that initial GeneXpert Ebola testing was negative suggest that the outbreak may have gone undetected for some time, with early diagnostic blind spots delaying recognition".

There have also been reports of infections in healthcare workers, which is "a serious warning sign in any filovirus outbreak, because they indicate unrecognized transmission in healthcare settings and gaps in infection prevention and control", the Professor said.

Notably, Ebola cases have been identified in Kinshasa and Kampala. These are "hundreds of kilometres from Ituri province, and it shows that the virus has already moved through human mobility networks before full containment was in place," Professor Emma said.

The Bundibugyo virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognized outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality proportion of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the case fatality rates seen in many outbreaks caused by the Ebola virus, but they are still extremely serious. "Bundibugyo virus disease is not a mild infection," the expert said.

Ebola virus: Vaccine And Therapeutics

Currently, there is a licensed vaccine that targets the Ebola virus from the species Orthoebolavirus zairense (rVSV-ZEBOV).

"Experimental non-human primate work suggests that rVSV-ZEBOV may provide partial heterologous protection against Bundibugyo virus, but this cannot be assumed to translate into reliable protection in people during an outbreak," Professor Emma noted.

"Adenovirus- and MVA-vectored vaccine platforms may offer broader possibilities, particularly where multivalent constructs are used, but recent immunological data suggest that some licensed or advanced platforms still induce responses that are predominantly directed against the Ebola virus rather than broadly cross-reactive across all ebolaviruses," she added.

In other words, "we do not currently have a proven, licensed, Bundibugyo-virus-specific vaccine available for outbreak control," the Professor said, stressing the need for "urgent research" on vaccines.

Similarly, she stressed the need to boost "therapeutics" against the Ebola virus.

"Approved monoclonal antibody treatments such as Inmazeb and Ebanga were developed for the disease caused by the Ebola virus, not Bundibugyo virus, and their efficacy against other ebolaviruses has not been established," Professor Emma told HealthandMe.

"There are promising experimental broad-spectrum antibodies, but these are not yet a substitute for rapid detection, high-quality supportive care, infection prevention and control, and contact tracing," she added.

Bundibugyo-virus OutbreaK: What Should Be Prioritized?

Professor Emma further called for ramping up practical and scientifical priorities. These include:

• the Bundibugyo-virus-capable diagnostics,
• rapid genomic sequencing,
• strong infection prevention in healthcare settings,
• safe clinical pathways,
• contact tracing,
• community engagement,
• treatment centres able to deliver high-quality supportive care.

The expert also stressed the importance of genomic sequencing as it can:

• confirm the virus species,
• Identify whether cases are linked,
• reconstruct transmission chains,
• Detect whether the outbreak reflects sustained human-to-human transmission or multiple introductions.

“This outbreak also highlights a persistent weakness in epidemic preparedness. We tend to build tools around the best-known outbreak pathogens, but rarer viruses such as Bundibugyo virus can still cause severe disease and international spread," Professor Emma said.

The expert also highlighted the essential need for

• sustained investment in high-containment laboratories,
• diagnostic development,
• genomic surveillance,
• vaccine platforms,
• therapeutics and international research partnerships.

There is no case of Ebola reported in India, said the government today, while stepping up surveillance in the country at key places such as airports and seaports.

The government has also "initiated precautionary public health measures", following the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).

A senior official in the Ministry of Health clarified that "there is no reported case of Ebola in India and the current risk to the country remains minimal".

However, India is closely monitoring the outbreak that has so far 336 suspected cases, including 88 deaths, in DR Congo; and

2 confirmed cases, and 1 death in Uganda.

"Senior officials of the Ministry, including officials from the National Centre for Disease Control (NCDC), Integrated Disease Surveillance Programme (IDSP), ICMR, and other concerned divisions, have reviewed the evolving situation and initiated precautionary public health measures," said the Ministry.

Key preparedness measures include:

• Review of SOPs for screening, surveillance, quarantine , and case management;
• Strengthening laboratory preparedness, with NIV Pune designated for testing and additional laboratories being onboarded in phases;
• Enhanced coordination with relevant Ministries and agencies for monitoring international travel from affected regions;
• Identification and readiness of isolation and quarantine facilities at major airports and ports.

"India’s public health system remains vigilant and fully prepared to respond to any emerging situation,” it said, adding that “citizens are advised to follow official updates issued by the Ministry of Health & Family Welfare and WHO”.

The official asserted that India continues to maintain close coordination with international health authorities and will take all necessary measures to safeguard public health.

The Ebola Outbreak

On May 17, the WHO declared the Ebola outbreak in Central Africa a "public health emergency of international concern."

According to the Africa CDC, the outbreak is caused by a rare strain of the Bundibugyo virus, for which there is no vaccine available currently.

Bundibugyo virus disease is a rare and deadly illness that has caused outbreaks in several African countries in the past. It is different from other known ebolaviruses such as the Zaire ebolavirus and the Sudan ebolavirus.

How Does Ebola Bundibugyo Spread?

The Bundibugyo virus spreads through contact with the blood or bodily fluids of a person infected with or who has died from the rare Ebola strain.

It can also spread through contact with contaminated objects such as clothing, bedding, needles, and medical equipment, or through contact with infected animals such as bats and nonhuman primates.

Historically, Bundibugyo virus outbreaks have recorded fatality rates ranging from 25 per cent to 50 per cent.

Symptoms To Watch For

Symptoms of Bundibugyo virus disease are similar to other forms of Ebola and include:

• Fever
• Headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Unexplained bleeding or bruising, usually in later stages of illness

Prof Trudie Lang from the University of Oxford also described dealing with Bundibugyo as “one of the most significant concerns” in the current outbreak, the BBC reported.

Symptoms are believed to appear between two and 21 days after infection.

With no approved drugs specifically targeting the Bundibugyo virus, treatment currently depends on supportive care, including managing pain, treating secondary infections, maintaining fluids, and ensuring adequate nutrition. Early medical care improves survival chances.