- Source: World Health Organisation (WHO)
- CSR, Disease Outbreak News
- Fri 22 Apr 2005
- Angola: Marburg Haemorrhagic Fever Outbreak
- WHO Update 15
- The Ministry of Health in Angola has reported 266 cases
of Marburg haemorrhagic fever, 244 of them fatal. In Uige Province, which
remains the epicentre of the outbreak, 253 cases, 233 of which have been
fatal, were reported as of Thu 21 Apr 2005.
- Assessment of the outbreak
- The international response to the outbreak in Angola
began one month ago, on 22 Mar 2005. The features of Marburg haemorrhagic
fever, 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 per cent. 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 per cent.
The only other large outbreak of Marburg haemorrhagic fever, in the Democratic
Republic of Congo from 1998 through 2000, had a case fatality of 83 per
- 2 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 Mar 2005, 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 outbreaks of other viral haemorrhagic fevers,
including Ebola, outbreaks 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 nature. Rapid
detection and isolation of patients, tracing and management of their close
contacts, infection control in hospitals 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 vaccine 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 hospitals.
- 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 2 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
community attitudes are improving, though hostility towards the mobile
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.
- Conditions in Angola -- a country weakened by almost
3 decades of civil unrest -- have presented additional challenges. Supplies
of water and electricity are intermittent, also in health care facilities.
Weakened infrastructures, including those for communications and transportation,
are another problem. Yesterday, the WHO office in Uige was informed of
a death in another municipality, but was unable to collect the body for
safe burial because of poor road conditions.
- Fortunately, spread of the disease beyond Uige Province,
located in the interior of the country, has been limited. Of the 266 cases
and 244 deaths, 197 cases and 183 deaths occurred in Uige municipality.
Other municipalities in Uige Province account for an additional 56 cases
and 50 deaths.
- WHO believes that the risk of international spread is
low. No foreign nationals, with the exception of those involved in the
direct care of patients, have been infected. There is no evidence that
people can spread the virus before the onset of symptoms. Shortly after
symptom onset, patients become rapidly and visibly very ill WHO is optimistic
that the outbreak can be controlled if present activities continue with
sufficient vigour. All the essential containment measures are being applied
with extensive international support, including more than 60 international
staff drawn from institutions in the Global Outbreak Alert and Response
Network, and the cooperation of national authorities and experts.
- Tools and methods developed during international responses
to outbreaks of other diseases have all been brought to bear on the present
outbreak, and the success of this collaborative effort has surpassed initial
expectations. Needs, which have ranged from satellite telephones and hand-held
radio sets to vehicles, protective equipment, disinfectants, and specialized
staff, have been rapidly communicated and immediately met.
- WHO and its partners are nonetheless prepared and organized
to continue the outbreak response for several additional months, if this
is needed. An important present goal is to transfer skills and responsibilities
for outbreak response to national staff, and training efforts are under
way with this goal in mind.
- Patricia A. Doyle, PhD
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