[afro-nets] Marburg haemorrhagic fever in Angola, 266 cases, 244 deaths

[Leela McCullough <leela@healthnet.org>]

Marburg haemorrhagic fever in Angola, 266 cases, 244 deaths
-----------------------------------------------------------

23 April 2005

As of 20 April, the Ministry of Health in Angola has reported
266 cases of Marburg haemorrhagic fever. Of these cases, 244
were fatal. In Uige Province, which remains the epicentre of the
outbreak, 253 cases, of which 233 have been fatal, were reported
as of 21 April.

Assessment of the outbreak

The international response to the outbreak in Angola began one
month ago, on 22 March. The features of Marburg haemorrhagic fe-
ver, and the conditions in Angola, have been an extreme test of
international capacity to hold emerging diseases at bay. The
outbreak in Angola is the largest and deadliest on record for
this rare disease, which is presently showing a case fatality
rate higher than 90%. For comparison, outbreaks of the closely
related Ebola haemorrhagic fever have shown mortality rates
ranging, according to the virus strain involved, from 53% to
88%. The only other large outbreak of Marburg, in the Democratic
Republic of Congo from 1998 through 2000, had a case fatality of
83%.

Two factors make the rapid detection of outbreaks of Marburg
haemorrhagic fever difficult: the extreme rarity of this disease
and its similarity to other diseases seen in countries where
deaths from infectious diseases are common. Neither the source
nor the date of the initial cases in Angola can be presently
identified with any certainty.

The number of cases began increasing in February and then, more
dramatically, in March. On 21 March, Marburg virus was detected
in patient samples sent to the Centers for Disease Control and
Prevention in Atlanta (USA), and WHO assistance was requested by
the Ministry of Health in Angola. The operational response began
the following day. As known from extensive experience with out-
breaks of other viral haemorrhagic fevers, including Ebola, out-
breaks of Marburg can be brought to an end using classic public
health interventions. In theory, the measures needed to end the
Angolan outbreak are few in number and straightforward in na-
ture. Rapid detection and isolation of patients, tracing and
management of their close contacts, infection control in hospi-
tals and protective clothing for staff work to interrupt chains
of transmission and thus seal off opportunities for further
spread.

Such straightforward measures are complicated by the distinct
features of this disease. The sudden onset, dramatic symptoms,
and rapid deterioration of patients, and the absence of a vac-
cine and effective treatment, invariably incite great anxiety in
affected populations. This anxiety, in turn, can interfere with
control operations, especially when communities begin hiding
cases and bodies because of suspicions about the safety of hos-
pitals.

In the current outbreak, such suspicions are understandable.
Very few patients with laboratory-confirmed Marburg haemorrhagic
fever have survived; most hospitalized patients have died within
a day or two following admission. For affected communities,
staff from the mobile teams, fully suited in protective gear,
are seen as taking away relatives and loved ones who may never
again be seen alive.

WHO staff in Uige have today reported further signs that commu-
nity attitudes are improving, though hostility towards the mo-
bile teams remains of concern in one area known to have recent
cases and deaths. Efforts to sensitize affected communities are
continuing, with local volunteers supported by Portuguese-
speaking experts from Brazil and Mozambique.....
http://www.who.int/csr/don/2005_04_22/en/index.html

CONTINUES...... www.who.int


--
Leela McCullough, Ed.D.
Director of Information Services

SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +1-617-926-9400
Fax: +1-617-926-1212
mailto:leela@healthnet.org
http://www.healthnet.org