8/4/2005
Deadliest Ever Outbreak Of Marburg Disease In Angola

Faced in Angola with the largest, deadliest and most intense outbreak of Marburg disease ever recorded, and the first in an urban area, the United Nations this weeklaunched a three-month $3.5 million flash appeal to contain the rare but highly lethal haemorrhagic illness with epidemic potential, for which there is no cure or treatment.

With 181 cases already reported, 156 of them fatal, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said the most urgent needs are protective clothing for health care workers, disinfectants, body bags, emergency kits and essential drugs in fighting the outbreak, at present centred on Uige province in the north.

The World Health Organization (WHO) remains confident the disease, of the same family as the deadly Ebola, can be brought under control. But the agency warned that rapid detection, isolation of victims and speedy tracing of contacts are vital to breaking the train of transmission, above all in urban settings where it is now occurring. An international network of expert laboratories set up by the World Health Organization (WHO) in Canada, Germany, South Africa and the United States to diagnose such viral haemorrhagic fevers is helping Angola fight the outbreak.

The legacy of Angola’s three decades of civil war – from a hospital system in dire need of basic equipment and supplies to poor communication and transportation to a population weakened by economic hardship – poses significant challenges, and WHO and other organizations are rushing in experts, supplies and equipment.

Close contact with bodily fluids of infected people, as in medical care or burial, appears to increase the risk of infection. With cases among health care workers underscoring the need to greatly increase supplies of protective equipment, a top priority is to prevent the virus from establishing a foothold in densely populated urban or peri-urban areas. Uige, epicentre of the outbreak, has some 500,000 inhabitants, but Luanda, the capital, where cases have been reported, has close to 3 million.

The only other large outbreak, infecting 149 people, 123 of them fatally, occurred in two sparsely populated and isolated villages in the Democratic Republic of Congo (DRC), causing sporadic cases with small chains of transmission over a two-year period, and never reaching the intensity of transmission seen in just the past few weeks in Angola.

“The outbreak in Angola is not only the largest on record, with the highest fatality, but is also the first to occur in an urban setting,” WHO said in its latest update on the disease, which begins with severe diarrhoea, abdominal pain, nausea, vomiting and chest and lung pains, with a high proportion of victims developing severe haemorrhage in the gastrointestinal tract and lungs.

Based on experiences with Ebola, control measures can have an immediate impact by interrupting chains of transmission, but eventual success depends on their sustained application and requires very good communication and transportation systems, which cannot be established quickly. Moreover, hundreds of thousands of landmines seeded during the recently ended civil war make transportation by rail and road precarious, necessitating air transport of staff and equipment.

Marburg occurs very rarely and appears to be geographically confined to a few countries in southern Africa. It was first identified in 1967 during simultaneous outbreaks affecting laboratory workers in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia. The outbreaks, which
involved 31 cases and seven deaths, were subsequently linked to contact with infected monkeys imported from Uganda. A longer-term objective is to determine where the virus hides in nature between outbreaks.