Marburg (severe hemorrhagic fever) epidemic in Uige
An outbreak of Marburg that began in October 2004 in northwestern Angola is under control. The last confirmed patient died on July 21, and no new cases have been reported since then. As of August 23, only 57 possible contacts of infected people are being traced.
Marburg is a severe hemorrhagic fever in the same family as Ebola. This is the first time the disease has been confirmed in Angola. A total of 374 cases were confirmed to the World Health Organization and 329 people died. Infections initially appeared in the province of Uige, which saw the vast majority of cases in this outbreak.
Angola's government established a task force to deal with the outbreak. WHO and CDC supported investigative, surveillance and case management efforts. They also helped with contact tracing and further investigation of this rare disease.
A team from Medecins Sans Frontieres (MSF) provided assistance and established a functional isolation unit to treat the infected patients within Uige hospital. MSF has now handed over its activities to the local health system.
Early relief efforts met some resistance among local populations. People were wary of aid workers in "spaceman" looking protective suits, and in one instance residents attacked a health care workers' vehicle. Many families hid sick relatives to keep them from being sent to isolation units, which highly increased the risk of acquiring the deadly disease themselves.
WHO and other groups worked to decrease resistance by increasing public education, using a multi-lingual radio and TV campaign as well as door-to-door visits. They also enlisted traditional community leaders (Sobas), musicians and religious leaders to communicate information to the local populations. Community campaigns also stressed that home care should not be attempted, as some residents were injecting sick people with syringes of an unidentified substance. Such injections absolutely cannot cure Marburg and the practice substantially raises the risk of passing along infection.
Uige is located in northwestern Angola on the border of the Democratic Republic of the Congo (DRC). Recently, tens of thousands of Angolan refugees have returned home from the DRC via the border in Uige.
The Disease
Marburg is a rare, severe hemorrhagic fever found in Africa. It infects humans and other primates. The largest outbreak occurred in 1998 in the Durba area of the Democratic Republic of the Congo and lasted until 2000. Then, 149 people were infected and 123 died. This is the largest and deadliest Marburg outbreak recorded since the disease was discovered in 1967, as it has infected people in urban areas. In the past, outbreaks have infected fewer people and have been limited to mostly rural areas.
The virus infects monkeys and may also infect bats. It is presumed that humans contract the virus though the secretions of infected animals, though this has not been scientifically proven. Infected people can spread the virus to other people through close contact, as the virus is present in body secretions including blood and other tissues.
The disease incubates for 5-10 days before symptoms develop suddenly. These include fever, chills, headache and muscle pain. A rash may appear on the patient's chest, back and stomach around the fifth day of illness, and nausea, vomiting, chest and abdominal pain, sore throat and diarrhea may develop.
As the disease progresses, increasingly severe symptoms occur such as jaundice, inflammation of the pancreas, severe weight loss, shock, delirium, massive hemorrhage and organ dysfunction. Hemorrhage is most common from the lungs and gastrointestinal tract. About 25 percent of those infected die of the disease.
There is no specific treatment, and no vaccine against the disease.
World Health Organization's website on Marburg
Centers for Disease Control website on Marburg
International SOS Comment
Travelers to Uige should follow strict hygiene procedures. Prevent tick and insect bites. Avoid contact with animals, rodents, and sick people.
Health care workers are advised to use strict universal barrier precautions when dealing with suspected cases.
Information by www.internationalsos.com
