This post was the intial report coming from WHO. As the rest of the thread indicates WHO was wrong in their assessment.

April 1, 2005
WHO Downplays Fears of Virus in Angola
By THE ASSOCIATED PRESS

Filed at 6:36 p.m. ET

GENEVA (AP) -- The World Health Organization on Friday played down the danger of a wide spread of an Ebola-like virus that has killed 127 people in Angola, including 12 health workers.

Although it is the deadliest recorded outbreak of the rare Marburg disease, WHO spokeswoman Fadela Chaib said it can be controlled.

``Marburg is less severe than Ebola,'' she told reporters, saying an Ebola sufferer is capable of infecting about a dozen people but someone with Marburg infects only about four others.

``So we certainly can control this disease if people sick with it are put in isolation and if we identify all their contacts,'' Chaib said.

WHO said Italian authorities had isolated nine people who came in contact with a sufferer in Angola, but none had shown any symptoms of Marburg. No other details were released about the nine.

Like Ebola, which also has hit Africa, Marburg is a hemorrhagic fever. It spreads through bodily fluids and can kill rapidly. There is no vaccine or cure.

Angola has recorded 132 cases, about three-quarters of them in children younger than 5, since the virus was identified there last week, Chaib said.

The worst previously recorded outbreak of the virus killed 123 people in neighboring Congo between 1998 and 2000. That was also the last known outbreak.

Almost all the Angola deaths occurred in the northern province of Uige, on the border with Congo. A 15-year-old boy died of the disease in the capital, Luanda, Chaib said.

WHO, Angola's Health Ministry and the aid group Doctors Without Borders have sent medical teams to Uige to try to identify and isolate all sufferers, and the U.S. Centers for Disease Control and Prevention said it also was sending experts. A mobile laboratory provided by Canada was set to start work Friday, Chaib said.

http://www.nytimes.com/aponline/internatio...la-Illness.html?

Marburg virus in Angola not under control: WHO People's Daily Online
The World Health Organization (WHO) warned Friday that the outbreak of the deadly virus Marburg which has killed 174 people in Angola is not yet under control.
Marburg Outbreak Kills 174 in Angola Los Angeles Times (subscription)
Fear and Violence Accompany a Deadly Virus Across Angola New York Times
Financial Times - CNN - Voice of America - Blogger News Network - all 279 related »

Marburg virus - WHO: Marburg haemorrhagic fever in Angola - update 9

Wow. I had always been under the impression that Marburg was not as deadly as Ebola (although not by much). I thought the death rate for Ebola was around 90% and the death rate for Marburg was lower (80 - 85%). The epidemiologist quoted in the NYT story said that Marburg surpassed previous ebola epidemics??

I had always thought that the Ebola Zaire strain was the worst. Looks like the Marburg Angola strain may be just as bad and possibly worse. I guess we will know more once the outbreak is contained.

Commentary

Marburg Case Fatality Rate of 93% in Angola Exceeds Ebola Virus

Recombinomics Commentary
March 27, 2005

>> Marburg is similar to the deadly Ebola virus. Dr. Michael Bell a Marburg specialist at the CDC says that Marburg is less deadly than Ebola, but spread in the same way, through bodily fluids. About 25 % of those infected with Marburg die, usually from shock or liver failure. <<

The larger outbreaks of Marburg Virus (MBGV) and Ebola Virus (EBOV) have similar case fatality rates. Like influenza (type of Orthomyxoviridae), they are single stranded negative sense RNA viruses. MBGV and EBOV are the two types of Filoviridae.

There have been several large outbreaks involving the two viruses, and most of the larger outbreaks have been characterized by a high case fatality rate. In 1976 there were two large EBOV outbreaks. In southern Sudan 117 out of 284 patients died, giving a case fatality rate of 42%. In adjacent Zaire 280 out of 318 patients died, case fatality rate of 88%.

The largest MBGV outbreak was between 1998 and 2000 in the Democratic Republic of the Congo where 123 out of 149 patients died, case fatality rate of 83%.

For the current outbreak, a retrospective analysis by the WHO, after the causative agent was identified, indicated 95 out of 102 patients died, case fatality rate of 93%. Recently updated figures of 115 out of 123 deaths, also generates a case fatality rate of 93%, which is the highest rate recorded for larger EBOV and MBGV outbreaks.

http://www.recombinomics.com/News/03270501...Angola_CFR.html

Marburg vs. Ebola
Ebola wins.
By Daniel Engber
Posted Tuesday, March 29, 2005, at 3:19 PM PT


More than 100 people in Angola have died so far in an outbreak of the deadly Marburg virus, a close relative of Ebola. If you have to fall sick with a viral hemorrhagic fever from the Marburg-Ebola family, which one should you choose?

Go with Marburg. Though we don't know very much about how these viruses work, history suggests that between a quarter and half of all people who get Marburg die from it; there is a 90 percent mortality rate among those who contract Ebola. These numbers may be revised in light of the Marburg outbreak in Angola, however. Early reports indicate a mortality rate of nearly 100 percent.

Symptoms of the two diseases are very similar. Both begin with the sort of muscle pain, fever, headaches, and nausea that you might see in response to any viral infection. About five days later, a rash appears on the chest and back, and the victim's face may appear vacant and expressionless, as the virus begins to affect the brain. Both Marburg and Ebola are hemorrhagic fevers, which means they cause bleeding from multiple organs within the body. In the grisly later stages of the illness, the victim may start to ooze blood from orifices or the sites of injections.

Hemorrhagic fevers come in four basic flavors, the most deadly of which—Filoviridae—comprises the four known subtypes of Ebola as well as the Marburg virus (each of these has its own sequence of genetic material). These "filoviruses" have a shape that differentiates them from the other types of viral hemorrhagic fevers, which include dengue and yellow fever. A filovirus particle consists of a strand of RNA and some viral proteins wrapped in a long, skinny package made of fatty membrane. (The elongated shape gives it a "filamentous" appearance; particles from the other families are smaller and more spherical.) Filovirus particles can come in one of several varieties: straight, U-shaped, ring-shaped, curled over, or shaped like a "shepherd's crook." Some scientists surmise that certain shapes are more infectious than others; some assume the differences are random and of little consequence.

You can't treat Ebola or Marburg with any antiviral drug; the only thing a doctor can do is keep the patient hydrated and provide drugs that help blod clot. To make matters worse, both viruses reproduce rapidly all over the body, and they produce proteins that dampen the immune response. No one knows why Marburg outbreaks have been less deadly than Ebola outbreaks. It could be something about the virus itself—i.e., the Marburg virus may not be as effective at countering the body's immune response—or it could be something about the available medical care at the site of the outbreak.

A significant amount of the data on Marburg virus, for example, comes from Europe, where the first known cases turned up in 1967. Several dozen researchers contracted the illness at around the same time in three different cities—Belgrade, Frankfurt, and, naturally, Marburg. The virus appeared to have come from a set of green monkeys that had been captured in Uganda and sent to Europe for laboratory use.

Next question?

Explainer thanks Graham Simmons of the University of Pennsylvania and Michael Bell of the Centers for Disease Control and Prevention.


Daniel Engber is a writer in New York City.

Photograph of magnified ebola virus on the Slate home
http://slate.msn.com/id/2115923/

Published online: 7 April 2005; | doi:10.1038/news050404-12
Marburg's behaviour bewilders scientists
Helen Pearson
Rising death toll flags unexplained character of killer virus.

The Marburg virus has infected mostly children in this outbreak.

© SPL

The current outbreak of the deadly Marburg virus in Angola is raising difficult questions about this enigmatic pathogen and its origins.

As of 5 April, Angolan health officials had reported 181 cases of Marburg haemorrhagic fever, of which 156 have been fatal. The outbreak of the rare but lethal virus, which causes fever and circulatory collapse, is the worst ever recorded.

Health workers' primary concerns are treating those infected and blocking the further spread of the virus. The World Health Organization and other medical groups have set up five mobile surveillance teams in Uíge province, where the outbreak originated, to identify rumours of cases. "Everyone is focused on the cases in front of them," says WHO spokesman Dick Thompson, who is working in Angola.

Researchers interested in the disease are focusing on some unusual features of the latest outbreak. For one thing, the probability of dying from Marburg disease once you've caught it, currently more than 85%, is higher than in previous events. In the first recorded incidence of the disease, which stemmed from infected monkeys shipped from Uganda to Europe in 1967, some 23% of those infected were killed.

Deadlier enemy

The high death toll parallels that of the only other large outbreak of the disease, in the Democratic Republic of Congo between 1998 and 2000. There, more than 80% of infected patients died, according to analyses carried out by Daniel Bausch, of the Tulane School of Public Health and Tropical Medicine in New Orleans, and his colleagues.

It is not clear why the death rate should differ from one outbreak to the next. Some think the various events involved strains of different ferocity. Marburg's cousin Ebola, for example, is known to have strains with widely varying fatality rates.

It is also possible that patients involved in the different outbreaks received varying doses of the virus, Bausch suggests. Patients may also have been infected by different routes, or those in Africa may have suffered from poorer medical care or general ill-health.

A second puzzle raised in Angola is why an estimated three-quarters of those affected have been children under five years of age: a pattern of infection not seen in earlier epidemics.

Again, this might be explained by the possibility that the latest outbreak is caused by a slightly different strain. But experts favour an alternative explanation: that children have something in common that helped them pick up the infection. They might, for example, have received childhood vaccinations from re-used needles contaminated with the virus.

Bats to blame?

The situation in Angola may also shed light on one of the most baffling questions about Marburg and Ebola: where do these viruses spring from? Because Marburg has triggered only a handful of recognized cases since it was discovered, researchers have had little opportunity to get to grips with the disease.

In their studies of the Congolese outbreak, Bausch and his team traced almost all cases to people who had entered a local gold mine. They suspect that the patients picked up the disease from cave-dwelling animals harbouring the virus, perhaps bats.

In the present outbreak, the children may also have come into close contact with bats, Bausch speculates. They might work or play in local caves, or eat fruit from trees in which bats sleep.

Such questions will only be answered once the current situation is under control, and public-health investigators can begin tracing the virus to its source. Researchers will then be able to determine the viral genetic sequences from those infected, to see if all cases stemmed from one patient.

These types of investigation must wait, however, until the public-health threat has eased, says infectious-disease specialist Bob Swanepoel of the National Institute for Communicable Diseases in Sandringham, South Africa

http://www.nature.com/news/2005/050404/full/050404-12.html

These are some scary diseases. I remember reading the book "Hotzone" and being scared to death. It is so easy for these diseases to potentially spread to the U.S. All that it requires is being infected and getting on a plane for the U.S. As the other article about Avian Flu that appears in our healthcare thread suggests, maybe we should be looking for more than weapons on planes. Maybe we should be making sure that people are healthy when they arrive in the U.S.

The situation in Angola sounds really bad. I hope that the healthcare workers get some assistance soon. It is hard enough to work with these horrific diseases without having the community fighting you too.

New Marburg fears in SA
07/04/2005 23:01 - (SA)

Port Elizabeth - New fears were expressed on Thursday that the Marburg virus had reached South African soil when a child in Morningside Clinic in Johannesburg showed symptoms of the infection.

Steps have been taken to prepare provincial hospitals in case haemorrhagic fever is diagnosed.

Solly Mabotha, spokesperson of the national health department, said isolation wards had been prepared in hospitals in all nine provinces and health practitioners had been thoroughly briefed on the symptoms of haemorrhagic fever.

The deadly virus has killed 159 people in Angola, so far, and a man is believed to have died of it in South Africa.

Mabotha said the child "has ties with Angola".

He said, however, that a thorough investigation had indicated that she did not show symptoms of the untreatable haemorrhagic fever, which is caused by the Marburg virus.

There is no laboratory in South Africa that can perform tests for the Marburg virus, it was learned on Thursday.

Mabotha said tissue from the body of Elijah Nongqo, 50, who is believed to have died of the virus infection last week, was sent on Thursday to a laboratory in Atlanta, America, where tests will be carried out.

Laboratories for Angola

The result of these tests will be known only in the next week or two.

Mabotha acknowledged that a Johannesburg laboratory could not handle such tests at present.

Sapa reports that laboratories will be set up in Angola to test for the virus, which means results will be available within two days rather than three weeks, as at present.

Mabotha said the cases involving the disease did illustrate that good communication existed between all role players in the country.

Examination for symptoms

Travellers arriving in South Africa from the high-risk areas are exposed to thorough questioning and examination to ensure they do not have symptoms.

Mabotha said: "It is important that cases are treated immediately as there is no vaccination against the virus."

The Marburg virus is similar to Ebola and is passed through contact with body fluids such as blood, urine or faeces.

Mabotha also said Nongqo's relatives and the health workers who treated him had not yet shown any signs of haemorrhagic fever.

Angola's neighbours on alert

Meanwhile, AFP reports that the World Health Organisation has recommended that four countries around Angola go on a Marburg alert.

Angola is the epicentre of the outbreak, which has so far claimed 174 lives.

"Everybody should be on alert. Not only other provinces in Angola, but all its neighbouring countries - the Congo, the Democratic Republic of Congo, Namibia and Zambia," said Anarfi Asamoa-Baah, the Geneva-based UN health organisation's assistant director general of communicable diseases. - Beeld/AFP

Edited by Iaine Harper




http://www.news24.com/News24/South_Africa/...1686757,00.html

'No Marburg in SA'
08/04/2005 14:37 - (SA)


Johannesburg - There were no confirmed cases of the Marburg virus in South Africa, according to the national department of health, SABC reported on Friday.

The department reacted to speculation in the media that a girl "with Angolan ties" was in a Johannesburg hospital with signs of the virus, which has so far claimed the lives of 159 people in Angola.

Solly Mabotha, spokesperson for the department, said the department received information about the girl, who was admitted to hospital with a fever, from the National Institute of Communicable Diseases (NICD) on Thursday.

However, she displayed no symptoms of the Marburg virus, he said.

Mabotha confirmed a man had died in the Eastern Cape last week after returning from Angola, where he had been working.

He said a post-mortem had been performed and samples sent overseas for testing.

The department was waiting for the results, he said.

South Africa has no facilities to test for the virus.

He said until a case of Marburg had been confirmed, it was premature for anyone to draw the conclusion that the virus had spread to South Africa.

The World Health Organisation suggested on Thursday that Angola's neighbouring countries go on high alert for the highly contagious disease.

These countries include Namibia, Zambia, the Democratic Republic of Congo (Kinshasa) and the Republic of Congo (Brazzaville).

Marburg fears in Italy
01/04/2005 14:06 - (SA)


Geneva - Italian hospital staff have put nine patients in isolation after they had been suspected of having contact with the Marburg virus, an Ebola-like killer which has broken out in Angola, the United Nations health organisation said on Friday.

World Health Organisation (WHO) spokesperson Fadela Chaib said two other suspected cases had been reported in the Democratic Republic of Congo (DRC), across the border from the north Angola area where the outbreak began and has claimed 127 lives out of 132 cases.

"Nine people who were in contact with an ill person were isolated in an Italian hospital," Chaib said, without giving details of in which town or what nationality the suspected fever patients were.

Last week, an Italian paediatrician died of haemorrhagic fever in Angola, according to Medici con Africa, the relief organisation for which she worked. The WHO was unable to say whether the nine patients in Italy had been in touch with this woman.

The death toll of 127 out of the 132 people who contracted Marburg in an outbreak that started six months ago in the north of Angola came from data given by the WHO on Friday.

Angola on Thursday officially put the toll from the virus at 126, the world's highest, as Canada sent a mobile laboratory to help investigate suspected cases.

A severe form of haemorrhagic fever akin to Ebola, the Marburg virus was first identified in 1967. It spreads on contact with the fluids the body produces in reaction to it, such as blood, urine, excrement, vomit and saliva.

The Marburg virus causes a nameless disease with symptoms like those of Ebola. The epicentre of the outbreak is Angola's northern Uige province.

U.S. team sent to Angola to fight Marburg virus outbreak
CDC, NIH offer technical help for investigations, infection control

The U.S. Department of Health and Human Services (HHS) has sent specialists from the Centers for Disease Control and Prevention (CDC) to work with the Ministry of Health in Angola after an outbreak of Marburg viral hemorrhagic fever.

According to an April 4 HHS press release, the specialists are providing technical assistance to conduct epidemiological investigations, infection control and laboratory diagnosis of Marburg cases.

The National Institutes of Health is also participating in the effort.

As of April 5, the Angolan Ministry of Health has reported 181 cases of Marburg hemorrhagic fever, according to the Word Health Organization (WHO), and of those cases, 156 people have died. Most cases were in children under age 5. Health care workers and other adults have also fallen ill.

Historically, mortality rates of Marburg have ranged from 25 percent to 80 percent making this outbreak the deadliest on record, according to the HHS press release. Supportive care is needed and no vaccine or treatment is available.

One goal for the U.S. team in Angola will be to enhance the laboratory capacity for local confirmation of the Marburg virus to strengthen the public health response for the epidemic.

The HHS group will join the WHO-coordinated Global Outbreak Alert and Response Network. HHS is also providing protective equipment, including masks, face shields and gowns to the Republic of Angola.

Marburg hemorrhagic fever is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever.

Addition information is available online, including:

- A CDC Marburg virus Q&A,

- WHO Marburg virus outbreak news,

- A CDC Travel Advisory related to the Marburg virus, and

- More news about the outbreak.

Text of the HHS press release follows:

(begin text)

Department of Health and Human Services
[Washington, D.C.]
Press release, April 4, 2005

HHS Sends Team to Angola to Fight Marburg Virus Outbreak

April 4, 2005 - From October 1, 2004 to April 1, 2005, 140 cases of Marburg Virus Hemorrhagic Fever (VHF) were identified in Angola; of these, 132 were fatal. Approximately 75 percent of the cases were in children under age five. Health care workers and other adults have also fallen ill. Historically, mortality rates of Marburg have ranged from approximately 25 percent to 80 percent making this outbreak the deadliest on record. Supportive care is needed, and to date, no vaccine or curative treatment is available.

HHS is sending Centers for Disease Control and Prevention (CDC) specialists to work with the Ministry of Health in Angola providing the technical assistance to conduct epidemiological investigations, infection control, and laboratory diagnosis of cases of the Marburg VHF. Experts in risk communication and media outreach are on the team. One goal is to enhance the laboratory capacity for local confirmation of the Marburg virus to strengthen the public health response for the epidemic. The National Institutes of Health is also participating in this effort. At the request of Dr. Luis Sambo, the World Health Organization (WHO) Regional Director for Africa, this group will join the World Health Organization-coordinated Global Outbreak Alert and Response Network (GOARN). HHS is also providing protective equipment, including masks, face shields and gowns to the Republic of Angola.

Marburg VHF presents as an acute febrile illness and can progress within six to eight days from onset with a headache and malaise to hemorrhaging. It is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever. These viruses are among the most virulent pathogens known to infect humans. Both diseases are rare, but have a capacity to cause dramatic outbreaks with high fatality rates.

CDC Marburg Virus Q & A: www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/qa.htm

WHO Marburg Virus Outbreak News: www.who.int/csr/disease/marburg/en/

CDC Travel Advisory - VHF: www.cdc.gov/travel/

More VHF News: www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg.htm

(end text)

(Distributed by the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

http://www.reliefweb.int/rw/RWB.NSF/db900S...L7?OpenDocument

Commentary

Marburg Virus Spreads to Zaire

Recombinomics Commentary
April 8, 2005

>> The Health Ministry said they control 230 people who had contact with infected people.

Luanda province registered eight cases, being two confirmed, two suspects and six deaths. Twenty people are also being monitored after having contacted affected people.

Uige received 11 alerts from different municipalities and two deaths and 200 contacts being monitored.

Kwanza-sul province is investigating six deaths that occurred from March 20 to April 02 who presented suggestive symptoms, in the municipalities of Amboim and Kilemba.

Zaire registered six deaths including one that happened today. <<

The above detail demonstrates why the Marburg outbreak will not be quickly contained. The outbreak originated in Uige, where there are the most cases and the largest number being monitored. However, the virus has radiated out from Uige, and there is little monitoring in the outlying regions. Thus, the monitoring is chasing the virus, which continues to transmit ahead of the monitoring.

Warnings last week indicated Uige was the Marburg epicenter, and all cases originated in Uige. This week warnings have gone out to countries adjacent to Angola (Congo, Democratic Republic of Congo, Namibia, and Zambia), warning that Angola is the epicenter. There are already reports of suspect cases in South Africa, including one death.

The above update indicates Marbug has now spread to Zaire. WHO just announced Kwanza-sul yesterday, although the above report indicates there have been deaths there since March 20, and the spread to Kwanza-sul was reported earlier. Provinces previously reported, but not listed above include Cabinda, Kwanza-Norte, and Malange.

The update on Luanda is most alarming because there is a population of 4 million and an international airport.

There have been two widely reported cases in Cacuaco, a slum on the outskirts of Luanda. The first case was a 12 year-old, who began to hemorrhage badly two days after admission. She was then transferred to Americo Boa Verde in Luanda. There would have been many contacts at the clinic alone, because she did not initially present as a Marburg case, and when she was admitted March 25, the staff was poorly equipped with gloves, masks, and gowns. At that time there were already 6 other cases in Luanda, and since only 20 people are being monitored, many contacts of these initial cases are not being found.

A 22 year-old patient was admitted April 6, and she too was hemorrhaging badly. Her transfer to Luanda was delayed because only one ambulance was available and risk of contamination of the vehicle was too high.

These two cases highlight the difficulties in treating these patients and monitoring contacts. Controlling the spread of the virus in the slums near Luanda will be particularly challenging because of a high population density, and an increase in the number of people who want to leave the area.

Thus, as the virus radiates out from Uige, controlling spread via contact tracing and quarantine will be increasingly difficult.

http://www.recombinomics.com/News/04080501...burg_Zaire.html

I can find no updates on the suspected Marburg cases in Italy. Pretty scary considering all of the people who were in Italy for the Popes funeral. Let's hope no news is good news.

This is an ABC Australia article that came out on the same day as the South African Story.

Suspected Marburg cases hospitalised in Italy, DR Congo

Italian hospital staff have put nine patients in isolation, suspected of contact with the Marburg virus, an Ebola-like killer which has broken out in Angola, the UN health organisation has said.

World Health Organisation (WHO) spokeswoman Fadela Chaib said two suspected cases had also been reported in the Democratic Republic of Congo (DRC), across the border from the north Angola area where the outbreak began six months ago.

"Nine people who were in contact with an ill person were isolated in an Italian hospital," Ms Chaib said, without giving details of in which town or what nationality the possible victims were, or of they were ill.

Last week, an Italian paediatrician died of haemorrhagic fever in Angola, according to Medici con Africa, the relief organisation for which she worked. The WHO was unable to say whether the nine patients in Italy had been in touch with this woman.

The WHO ruled out two other suspected cases reported in Portugal earlier this week following medical tests.

The WHO and Angola's health ministry on Friday increased the nationwide death toll from the disease to 130, out of a total of 137 cases, and said the virus had reached a fourth province near the capital Luanda.

Angola had given the death toll from the virus as 126 on Thursday, already the world's highest, as Canada sent a mobile laboratory to help investigate suspected cases.

A severe form of haemorrhagic fever akin to Ebola, the Marburg virus was first identified in 1967. It spreads on contact with the fluids the body produces in reaction to it, such as blood, urine, excrement, vomit and saliva.

The Marburg virus causes a nameless disease with symptoms like those of Ebola. The epicentre of the outbreak is Angola's northern Uige province.

The outbreak was only identified as Marburg virus on March 22.

Ms Chaib said Marburg was regarded as "a little less severe than Ebola because the chain of transmission is shorter".

The virus can be passed on to four people on average, while Ebola is more resistant and can be passed on to 12 more victims.

Secondary transmission of Marburg is also less severe than the initial case, she added.

"The disease can be controlled if those who are ill are isolated and the people they have been in direct touch with are found," Ms Chaib said.

More WHO specialists were due in the region over the weekend to help track down cases of the disease.

Twelve of the deaths in Angola were medical staff who treated patients with Marburg, she said.

The WHO has sent half a tonne of protective gear for health workers to Angola as well as an isolation unit.

http://www.abc.net.au/news/newsitems/200504/s1336669.htm

Lack of Marburg Virus Survivors Creates Civil Unrest in Angola Recombinomics
Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said. The case fatality rate for Marburg in Angola is above 99.4%. There is at most 1 survivor out of 181 outcomes. Thus, hospitalization offers little hope for survival, which has led to mistrust by local residents. Mobile surveillance operations in Uige have ceased because of damage to vehicles and threats of violence. It is unclear if health care workers have been killed because of the unrest, but clearly contact tracing has been limited in the Uige, which is the epicenter of the outbreak.
Fear and Violence Accompany a Deadly Virus Across Angola New York Times
Marburg virus death toll hits 180 CNN
Los Angeles Times (subscription) - Financial Times - Voice of America - Reuters - all 287 related »

Virus Claims 174 Lives So Far Security Pronews
An epidemic of a virus similar to Ebola has claimed 174 lives in Angola so far as frightened people attacked aid workers. The virus is called Marburg, and this is the biggest outbreak ever recorded.
Attacks stall surveillance for Marburg cases CIDRAP
Attacks Halt WHO Campaign Against Marburg in Angola Reuters
Blogger News Network - Recombinomics - New York Times - CNN - all 297 related »

WHO suspends count of Marburg deaths CBC News
Fear and misinformation are compounding a health crisis in northwestern Angola, where Marburg fever is now blamed for at least 183 deaths.
Attacks halt virus work in Angola BBC News
Attacks Halt WHO Campaign Against Marburg in Angola Reuters
Security Pronews - CIDRAP - New York Times - Recombinomics - all 303 related »

April 10, 2005
To Stop Deadly Virus in Angola, Group Seeks Hospital's Closing
By SHARON LAFRANIERE

UIGE, Angola, April 9 - An international medical charity battling a hemorrhagic fever that so far has killed 181 Angolans has urged the government to close the regional hospital here, at the center of the outbreak, saying the medical center itself is a source of the deadly infection.

Doctors Without Borders, the global relief organization that runs an isolation ward at the hospital for victims of the deadly fever, Marburg virus, told Angolan officials on Friday that the hospital should be closed if the rapidly spreading epidemic was to be contained.

Two other hospitals within 60 miles of Uige may also have to be shut down, said Monica de Castellarnau, the organization's emergency coordinator in Uige, the provincial capital, where the outbreak was first reported.

That possibility raises the prospect of a second health care crisis, one in which hundreds of thousands of people already facing a disease that is almost always fatal may suddenly have no access to hospital care. But in an interview in the streets of Uige, where an intensive effort is under way to find and isolate new cases of the virus, Ms. Castellarnau said there might be no alternative.

"The hospital has been the main source of infection," she said. "We have to break that chain somehow. It is a massive public health decision, and it must be taken by the government."

Angola's outbreak of Marburg virus, a close and equally deadly relative of the better-known Ebola, is the largest ever recorded, and continues to spread. The disease, which causes a high fever, diarrhea, vomiting and bleeding from bodily orifices, has no effective treatment. Nine out of every 10 victims here have died, usually within a week of falling ill.

Uige, a town of roughly 200,000 set in the idyllic green hills of northern Angola, has become a surreal backdrop to a public-health disaster as medical workers swathed head-to-toe in spacesuit-style garb roam neighborhoods in trucks, trying to round up the sick. Because Marburg virus is so dangerous and so contagious, spread by contact with almost any bodily fluid, from blood to sweat, the workers are encapsulated in air-filled white suits, white aprons, green gloves, face masks and face guards.

On their backs they wear battery packs to keep the suits inflated. Some carry canisters of bleach or chlorine on their backs and hose sprays so they can disinfect the homes of the sick. A few have sprayed so much bleach that the buckles on their shoes are rusting.

Medical workers warn visitors not to shake hands with anyone and not to stand directly in front of residents when talking to them, for fear that a cough could release an infectious spray of spittle.

Silo Margarita is one of the few nurses still working at the 500-bed regional hospital here, a sprawling collection of well-kept, one-story concrete buildings that appeared almost deserted on Saturday afternoon. Wearing a surgical mask and plastic wrapped on her boots, she continued to care for 12 patients despite the fact, she said, that as many as 15 of the hospital's nurses and two doctors have died from the Marburg virus. Two nurses died only last Thursday, she said.

"Of course I am afraid," she said. Asked why she still comes to the hospital when many co-workers have stopped, she replied, "It's an order."

Medical workers here are scrambling to persuade a terrified public to alert them to sick relatives so patients can be isolated in a ward before still more people become infected. Suspected cases have already been identified in seven of Angola's provinces. In the capital, Luanda, two cases have been confirmed and one is suspected.

On Saturday, medical workers seeking to build cooperation in one neighborhood here faced angry residents, even though they were accompanied by government officials and police officers. Officials have ruled out surveillance efforts in that neighborhood, saying it has become too dangerous.

Often in epidemics of such lethal diseases, medical workers become the focus of the public's fear, frustration and anger, according to officials of the World Health Organization, which is organizing the emergency response to the outbreak.

Dr. Heinz Feldmann, a Canadian with the World Health Organization who has set up a laboratory at the hospital to test for the virus, said he could check as many as a 100 samples a day. But because the medical teams were forced Thursday to suspend their community searches for new cases, he said, he was now getting only four samples a day.

http://www.nytimes.com/2005/04/10/internat...print&position=

Angola Marburg outbreak "wake up call" to world - UN

Fri April 8, 2005 12:03 PM GMT+02:00
By Zoe Eisenstein

LUANDA (Reuters) - Angola's lethal Marburg virus outbreak, one of several animal-borne diseases to jump to humans, should be a "wake up call" to the world to invest more in research, a senior U.N. official said on Friday.

Anarfi Asamoa-Baah, the World Health Organisation (WHO) assistant director general for infectious diseases, told Reuters Marburg was one of more than 30 viruses to jump inexplicably from animals to humans.

"The last 30 years we have seen at least 30 new diseases and most of those have been animal diseases that have jumped into human beings. They include HIV, SARS, BSE," he said in an interview in Angola's capital Luanda.

"We don't really know how they jump," he added.

The current Marburg epidemic in Angola has so far claimed at least 174 lives from a total of 200 cases, the health department said, making it the worst outbreak of the disease to date.

The previous worst recorded Marburg outbreak was during a 1998-2000 epidemic in the Democratic Republic of Congo when 123 people died.

There is no specific cure for Marburg, which was first contracted by researchers in the German town of the same name from African monkeys. The monkey-to-human transmission is similar to the Ebola virus.

HIV, which 25 million Africans alone are carrying and which continues to spread worldwide, is believed to have passed into people from chimps.

Severe Acute Respiratory Syndrome, or SARS, originated in Guangdong in China in 2002 and went on to kill hundreds around the world. It is a type of atypical pneumonia and is believed to have jumped to people from animals sold as delicacies in a southern Chinese market.

Bovine spongiform encephalopathy, or BSE, can pass on to people who eat infected beef products, causing a related disease called variant Creutzfeldt-Jakob disease. More than 100 people have been killed of made ill from BSE.

Asamoa-Baah said Angola's Marburg outbreak could provide scientists with an opportunity to learn more about these diseases. He said it is only possible to study them properly during epidemics.

"That is one of the reasons why WHO is interested in this outbreak," he said. "So that we can learn how these diseases come about, we need to learn a little more how they are spread, how they can be prevented and how you can treat (them)."

Marburg is characterised by headaches, nausea, vomiting and bloody diarrhoea and is spread through contact with bodily fluids.

Asamoa-Baah hoped that this outbreak would draw attention to the seriousness of the virus and attract the larger investments needed to develop vaccines and medicines to combat it.

"In terms of the numbers infected, this does not compare with HIV or malaria or tuberculosis. But the bigger problem is that this is new and when something is new and you still don't know how it is spread, you need to pay a lot more respect to it than you have in the past," he said.

"But hopefully this will be a wake-up call to the world that we need to take this more seriously than we have done in the past," he added.

http://www.reuters.co.za/locales/c_newsArt...storyID=8125424

Hunting a killer virus

As more Angolans die from an Ebola-type virus, Fred Bridgland in Johannesburg talks to one of the scientists who risk everything to seek the origins of this horrific and terrifying disease

They are the Indiana Joneses of virus hunting. As the death toll mounts in the rare but deadly Marburg fever outbreak in northern Angola, they are winging in from Geneva, Atlanta and Johannesburg and other points on the compass where virologists maintain their labs.
Their mission initially is to stem the flow of deaths from the haemorrhagic fever, which causes uncontrollable and massive bleeding and for which there is no known cause or cure. Some 180 people have died so far, including a 51-year-old Italian paediatrician, Maria Bonino, who was at the heart of the initial effort to save lives in the Angolan town of Uige.

Red-headed and bear- hugging Mike Ryan, director of the World Health Organisation’s (WHO) alert and response operations, is on his way. So is Bob Swanepoel, director of South Africa’s National Institute for Communicable Diseases. They are among the world’s leading virus-busters and will be hoping to meet up with their old buddy Dr Anthony Sanchez, a quiet Texan who has spent most of his career studying the Marburg virus and its close virus relative, Ebola, in his laboratories at the United States Centres for Disease Control and Prevention in Atlanta, Georgia.

They have all worked together in the field before in Uganda and the Congo in the most trying of circumstances, because Marburg and Ebola seem to break out in the most remote, undeveloped, war-torn and corrupt parts of Africa.

The virus-busters have buried nurses after they died in agony. They have seen fellow doctors die because of a split second of slackness while fighting these gruesome diseases which liquefy the internal organs. Marburg and Ebola do not forgive even the tiniest mistake. Bodies of their victims have been described as the most lethal things on Earth: touching one can be like slapping a live grenade.

Goatee-bearded Swanepoel, among the most swashbuckling of the virus-busters and still energetic at the age of 66, was arrested by police in the Congo while trapping bats he thought might carry the Ebola virus: he was able to get out of jail only after the army colonel who could vouch for him had been hauled from the local brothel.

As they don their white space suits to fight Marburg in the forests and abandoned coffee plantations of northern Angola, they are also excited about another rare opportunity to find the cause of the disease. While burying the dead they will be drawing blood and taking skin samples with a special biopsy punch to be sealed in sterile bottles and sent, packed in dry ice, to their laboratories thousands of miles away.

Swanepoel, despite decades spent tramping through the jungles and savannahs in search of the original reservoirs from which the Marburg and Ebola viruses emerge, still does not know the answer.

“Is it in bushmeat? A monkey? A bat? You could test 100,000 mosquitoes or even a million mosquitoes before you find it, because perhaps it’s only a limited number of the little brutes that carry the virus,” he said. “The fact is that we’ve discovered 500 known viruses since we began isolating them in the last century, and we’ve pegged only 26 to disease.

“But the unknown ones in Africa’s forests run into the tens of thousands. Africa is going to keep us busy for a while yet.”

Swanepoel has collected thousands of monkey, bat, rat, insect and plant samples in search of the scientists’ Holy Grail – the “reservoir” where the Marburg and Ebola viruses lurk, dormant and hidden, waiting for the right moment for their next deadly attack.

He thought he was close to locating the precise hiding place of the Marburg virus in 1999 when it killed scores of people in Durba, a rebel-held town in northeast Congo where a hardly legal Canadian gold-mining operation had disturbed huge swathes of rain forest. Miners were dropping dead in tunnels fouled with bat excrement and their surviving colleagues were working right on top of the bodies, which had been buried on the spot.

Swanepoel is known as “Batman” among the virus-busters because he is convinced the winged mammals are crucial to the transmission of the Marburg and Ebola viruses, but has yet to prove his theory. He has caught and tested thousands of bats in Africa hasn’t located either of the killer viruses. He believes they may lurk in bats in very precise conditions – for example, bats hanging from a cave roof at a critical temperature. Or they may be hidden in a particular insect – of which there are trillions in Africa – that the bats eat from time to time.

Still the search goes on, and Dr Pierre Rollin, a colleague of Dr Sanchez in Atlanta, has observed: “We don’t know where the viruses hide. It may turn out to be something right under our noses. There are different schools of thought, and Bob is in the bat school. The problem is that the viruses just vanish as soon as a short and deadly epidemic burns itself out.”

So the virus-busters are searching hard as the death toll from Angola’s Marburg outbreak increases by the day.

Quite apart from the risk of proximity to the dead and dying, they face the usual cocktail of hazards found in outlying areas of Africa. Some of WHO’s mobile surveillance teams in Uige province have been forced to suspend operations after their vehicles were attacked and damaged by local residents, who are accusing the virus-busters of killing people who had been taken away sick and returned to them dead.

The Angolan government in the capital Luanda, 200 miles away, has dispatched soldiers to the province but they have neither the knowledge nor the skills to educate an increasingly terrified populace.

Marburg is a rarer but deadlier relative of the better-known Ebola virus. It was named after the German town where it was first identified in 1967, when monkeys imported from Uganda infected and killed scientists researching TB.

Before the present crisis, the worst outbreak of Marburg occurred between 1998 and 2000 in DR Congo, where it killed 123 people. That was also the last known outbreak before the latest flare-up, which is bigger than any known Ebola attack.

“This one is becoming a huge problem,” said Dick Thompson, a WHO spokesman whose surveillance teams have fanned out all across northern Angola. “We clearly don’t know the dimensions of the outbreak.”

The secret in stopping the epidemic is to prevent as many person-to-person contacts as possible. The virus spreads on contact with bodily fluids such as blood, urine, excrement, vomit, saliva and even perspiration.

Symptoms include diarrhoea, stomach pains, nausea and vomiting, giving way to death by massive, uncontrollable and widespread bleeding.

Bob Swanepoel and the rest of the virus-busters may or may not find the virus reservoir this time, but a frightening prospect is that WHO and other global authorities are certain that new Marburg and Ebola-like diseases are on the way.

The reason? As we begin cultivating even the most inaccessible and unspoilt regions, we disturb viruses that have been isolated for hundreds of thousands of years.

As Africa’s growing population continues to push into tropical eco systems, encouraged by ruthless international logging firms, then countless more people will flounder into the ancient webs of parasitism long established between unknown viruses and animals, and thus unwittingly become hosts themselves.

As he set out again with his vast array of trapping nets, UV light traps, fogging machines, slingshots and live traps, Batman Swanepoel said: “I sure hope one of us finds out where these diseases hide in the forests when they’re not out killing people. It’d be a hell of a relief. We could all get a life.”

10 April 2005

http://www.sundayherald.com/49046

This is INSANE that hospitals are considered the means of transmission and must be closed to contain this virus. uh.....maybe sick and dying people turn up at hospitals BECAUSE they are sick and dying?How lacking in humanity, compassion, and charity to close hospitals and leave NO CARE for these people. As someone living with AIDS I recall when hospitals and hospices, and even mortuaries wouldn't help AIDS patients, SHAME, SHAME, SHAME!

It sounds insance but it actually isn't insane. What is insane is that they do not have the resources for alternative care until they can get this under control and reopen the hospitals. The hospitals are not equipped to truly isolate the people with Marburg which is causing others that come to the hospital for other illness to be infected. This in turn spreads the infection to even more people.

Marburg team assaulted in Angola, WHO halts campaign Medical News Today

Marburg Virus Hitting Angola Worse than Ebola Prensa Latina

Actually one off the greatest dangers whit HIV, is that lokal diseases can gets loads of more bodies to develop in that they didn't have before, simply becourse millions of people has a reduced immune system, in the worst case scenario you can get a lokal diseases like Marburg to thrive in several bodies were they otherwise would have a hard time getting a place to grow, and just ONE of those unfortunates have to develop an airborne version of the virus, (Not unlikely given time and numbers), before we have the greatest Viral disaster since the Spanish Flu in 1918-20 which coursed more deaths than WW 1 in a shorter period of time.
This is why it is (Unorfficially) forbidden to have AIDS patient on the same lokales as others whit deadly diseases, NOT becourse said diseases would make short work off AIDS patients, but becourse many are afraid what MIGHT develop if the vira, bacteria & fungi might gets hundres, thousend or tens of thousend new bodies whit human DNA to develop in!

I posted a comment in another thread where I said the worst case scenario was that the disease would mutate and become an airborne strain. I just found this opinion piece that suggests that it may have already happened. I hope that they are wrong. My god, that would be a disaster of immense proportions.

Marburg Spread Inside and Outside Angola

Recombinomics Commentary
April 10, 2005

>> "The hospital has been the main source of infection," said MSF emergency co-ordinator Monica De Castellarnau.

She said people infected by the virus went to the hospital where they infected doctors and nurses, who in turn infected other patients.

"We have to break that circle," she said, adding that MSF was recommending that the hospital be closed "because it was still contaminated." <<

Although the main hospital in Uige may have been the main source of Marburg infections at one time, the situation in Angola has clearly changed. The news coming out of Angola clearly lags the true spread of Marburg hemorrhagic fever, but it provides some information on where the virus was and where it might be now.

The difference between the number of cases diagnosed and the number dead identifies the most advanced hospitalized patients. Last week that number was between 5-8 and now it is up to 30 out of 213 diagnosed patients. However, only 12 of these 30 patients are in the main hospital in Uige, so clearly most of the advanced patients are now elsewhere. Two other hospitals in Uige province are also under consideration for closure, but these closings seem to be related somewhat to staffing issues. In the past several weeks, 17 health care workers have died. This total included two nurses who died last Thursday, indicating that tightened infection control and more gloves, gowns, and masks failed to prevent transmission to at least two more health care workers.

These transmissions raise the issue of airborne transmission, which increases the likelihood of transmission outside of the hospital setting. Since there are no survivors, relatives are reluctant to send sick patients to the hospital, and are hiding such patients from contact tracers. Thus, the actual number of deaths and infected contacts is not well known.

Since Marburg cases have been acknowledged in seven provinces in Angola, repeats of the situation in and around the city of Uige can be expected. Since the surrounding area probably has smaller hospitals or clinics, with poorly trained and equipped staff, new centers of transmission are likely.

This has happened in Cacuaco, a slum just outside of Luanda. On March 27 a 12 year-old patient began to hemorrhage and was transferred to the Americo Boa Vida hospital in Luanda. However, she had been admitted in Cacuaco two days earlier, so multiple transmissions were possible prior to her transfer. There was no indication the patient had ties to Uige.

A week later the scene was repeated in the same slum. This time a 22 year-old patient was admitted and was hemorrhaging badly. Transfer to Luanda was delayed because the hospital had only one ambulance. Two patients in the same slum admitted a week apart is an indication of transmission within the slum, and linked cases are not likely to be in the totals of dead or diagnosed.

Thus, the spread within Angola is accelerating at multiple transmission sites, and most of these transmissions are not being tallied or monitored. The relative ease of transmission, even at a hospital facility on alert, should fuel the spread, which will likely lead to transmission outside of Angola.

Cases are being investigated in Democratic Republic of Congo and South Africa. In South Africa there are no "confirmed" cases in part because there is no Marburg test in South Africa. Samples are shipped to the CDC in Atlanta. This leads to delays in diagnosis and potential false negatives because of added complications involved in collection and international shipment of samples.

Marburg virus is clearly flying around the world, and where it lands is largely a matter of chance.

http://www.recombinomics.com/News/04100503...Spread_213.html

WHO resumes work in Angolan province stricken by Ebola-like virus
02:44 PM EDT Apr 10
JOANA MATEUS

LISBON, Portugal (AP) - The World Health Organization has resumed operations in a western Angolan province hit by a deadly Ebola-like virus, after suspending work last week when residents attacked its teams, the WHO said Sunday.

Residents in Uige province had mistakenly feared the WHO teams were spreading - instead of helping contain - the rare Marburg virus, which has killed 184 people out of a total 200 people infected, WHO's spokesman in Angola Dave Daigle told the Associated Press by phone.

"Three teams have already resumed activities and are now following up on anyone who had contact with infected people recently," Daigle said.

Daigle said the WHO had launched an education campaign to help contain the virus and prevent a recurrence of Thursday's attacks.

"We're doing radio announcements, meeting with Church leaders and local authorities, to reach out to people and not only explain to them what we're doing but get their support," Daigle said.

Meanwhile Doctors Without Borders, a global relief organization that runs an isolation ward at the hospital for victims of the virus, has advised that the hospital should be closed to contain the spreading of the virus.

The organization's emergency co-ordinator in Uige, Monica de Castellarnau, who characterized the situation as "very worrying," said on Sunday the recommendation stood. "We have been talking to the health minister and making a strong recommendation that the hospital be shut down temporarily, until the outbreak is controlled," Castellarnau said.

She said Doctors Without Borders was also attacked on Thursday and said hostility toward medical workers was due to a lack of information.

"We are doing the best to inform people because they are afraid and not only become hostile but fail to report cases of the disease to us, making it harder to contain the virus," she said.

Like Ebola, which also has hit Africa, Marburg is a hemorrhagic fever. It spreads through contact with bodily fluids and can kill rapidly. There is no vaccine.

Several deaths attributed to the virus have been reported in four other provinces, but the only confirmed Marburg deaths can be traced back to Uige.

Two cases have been confirmed in Angola's capital, Luanda, but there has been no transmission of the virus there. The WHO, the U.S. Centers for Disease Control and Prevention and Doctors Without Borders have deployed teams in Uige to combat the virus.

The worst previously recorded outbreak of the virus killed 123 people in neighbouring Congo between 1998 and 2000, the last known outbreak of Marburg.

http://www.cbc.ca/cp/world/050410/w041036.html

Right WHO resumes work in Angolan province stricken by Ebola-like virus CBC News

Commentary

Marburg Seeding Linked to Childhood Vaccine Program?

Recombinomics Commentary
April 10, 2005

>> Most of the affected persons are children under one year old. Three nurses were also infected. This week, 12 samples tested positive for Marburg fever by the US Centers for Disease Control and Prevention (CDC). <<

The above comments by Medecins Sans Frontieres (MSF) on March 25 suggest that the Marburg outbreak in Angola was initiated via a childhood vaccine program. The initial WHO announcement indicated around 75% of the cases were in children under the age of 5. The comments by MSF indicate that more than 67% of the cases under 5 year-of-age were under children uner 1 year-of-age..

Since Marburg hemorrhagic fever is now readily transmitting to teenagers and adults, including 17 health care workers, it seems that the concentration of cases in children under 1 was not due to a lack of immunity found in adults. Indeed, the case fatality rate has been at or near 100% for all cases, regardless of age, with few if any survivors.

Unfortunately, the cases in Angola did not receive significant attention until health care workers were infected about a month ago. Within 1-2 weeks the Marburg virus was detected in 9 of 12 fatal cases, and resources began to flow into Angola.

However, it now seems that the effort failed to interrupt transmission when the virus was largely confined to the city of Uige, and now cases in seven provinces have been reported. The number of cases has more than doubled in the past few weeks.

Prior Marburg and Ebola hemorrhagic fever outbreaks had been largely limited to rural areas. However, the cases in the Angola capital of Luanda, and associated slums like Cacuaco, threaten to create a novel transmission setting in a densely populated urban area. This setting could magnify the number of cases, which could lead to a much broader outbreak inside and outside of Angola, potentially leading to a pandemic

http://www.recombinomics.com/News/04100504...rg_Seeding.html

This website seems to have the most scary scenarios so I checked to see who the person is that puts out the material --

Founder

Recombinomics, Inc. Founder and President, Henry L Niman earned a PhD at the University of Southern California in 1978. His dissertation focused on feline retroviral expression in tumors in domestic cats.

He took a postdoctoral position at Scripps Clinic and Research Foundation where he developed monoclonal antibody technology. He fused monoclonal antibody and synthetic peptide technologies and accepted a staff position at Scripps.

In 1982, he developed the flu monoclonal antibody, which is widely used throughout the pharmaceutical, biotech, and research industries in epitope tagging techniques. He also produced a broad panel of monoclonal antibodies against synthetic peptides of oncogenes and growth factors. These monoclonal antibodies were distributed worldwide to researchers by the National Cancer Institute. The antibodies identified novel related proteins which correlated with clinical parameters.

This technology was used to form ProgenX, a cancer diagnostic company that became Ligand Pharmaceuticals. Dr Niman subsequently identified protein expression patterns at the University of Pittsburgh. More recently, he became interested in infectious diseases while at Harvard Medical School. He then founded Recombinomics and discovered how viruses rapidly evolve. These latest findings are the subject of recent patent filings

This is an older article but very interesting. I said in an earlier post that it had always been my understanding that Ebola had historically had the higher death percentage and that I was surprised that Marburg in this outbreak was now being said to be much worse than Ebola. It looks like others far more qualified than I are wondering the same things.

Commentary

Is Marburg Virus in Angola a Recombinant?

Recombinomics Commentary
April 2, 2005

Comments by WHO on the recent Marburg outbreak in Angola, cited some historical information of Marburg that does not match the current data from Angola. The Marburg virus is acting much more like Ebola than with Marburg associated characteristics seen in prior outbreaks. Although both viruses are closely related Filovirdae, they are readily distinguishable. Initial data on the isolates from Angola indicated that they were not Ebola. This was confirmed by sequence data showing that the Marburg was in the samples from Angola.

However, Marburg is more frequently found in eastern Africa. The initial Marburg isolate was from African green monkeys shipped to Europe from Uganda. The largest Marburg outbreak prior to the current outbreak in Angola was in adjacent Democratic Republic of Congo, but it was in the northeast corner of the country, not far from Uganda. It had a case fatality rate of 82%, but the rate was lower for the smaller outbreaks.

In contrast, the largest Ebola outbreak was also in the Democratic Republic of Congo (Zaire), but it was in the southwestern portion of the country, not far from the current outbreak. That outbreak had the highest case fatality rate (88%), but the outbreak in Angola, is even higher, currently at 100%.

Thus, the size of the outbreak, as well as location and case fatality rate all look like Ebola, yet the genetic sequence of the virus is Marburg.

Although quality medical care can influence the fatality rate and aggressive contract tracing and quarantine can limit the size of the outbreak, the current Marburg in Angola looks much more like prior large Ebola outbreaks.

These observations raise the possibility that the Marburg virus in Angola is a recombinant and has genetically picked up some of the traits associated with Ebola.

http://www.recombinomics.com/News/04020503...ecombinant.html

Commentary

Marburg Airborne Transmission in Angola?

Recombinomics Commentary
April 10, 2005

<< Medical workers warn visitors not to shake hands with anyone and not to stand directly in front of residents when talking to them, for fear that a cough could release an infectious spray of spittle. …..

Silo Margarita is one of the few nurses still working at the 500-bed regional hospital here, a sprawling collection of well-kept, one-story concrete buildings that appeared almost deserted on Saturday afternoon. Wearing a surgical mask and plastic wrapped on her boots, she continued to care for 12 patients despite the fact, she said, that as many as 15 of the hospital's nurses and two doctors have died from the Marburg virus. Two nurses died only last Thursday, she said. <<

The deteriorating situation in Uige is raising the obvious question. Is Marburg transmitting through the air in Angola? Although there have always been warnings about transmission via contact with bodily fluids, the concern about coughing raises questions about ease of airborne transmission.

Initially most of the Marburg cases were children under the age of one, suggesting transmission via contaminated needles during childhood vaccinations. However, about 1 month ago the first health care worker died, and as noted above, that number has grown to 17. Although protective gear was in short supply initially, the deaths of health care workers are still being recorded.

The total number of Marburg cases alive is relatively small. When the WHO first announced the sequence results on March 23, there were only 7 Marburg patients alive. 95 out of 102 had died. The number diagnosed has risen to 213 and the number still alive has grown to 30. Tthe increase in patients alive simply reflects the fact that newly diagnosed patients are being tallied quicker than older existing cases are dying. As noted above, there are only 12 patients in the main hospital at the epicenter of the outbreak.

The ability of such a small number of patients to infect so many health care workers, especially after infection control efforts have been increased, raises the possibility that airborne transmission is fairly efficient. The current outbreak in Angola has a case fatality rate at or near 100%, higher than any prior large outbreak of Marburg or Ebola. It has now begun transmitting in Luanda, and will easily eclipse the old record of 280 deaths set for Ebola in 1967.

Marburg has now been reported in 7 provinces in Angola. All of these cases outside of Uige have happened in the past several weeks. The widespread transmission, coupled with the near 100% fatality rate, suggests the Marburg virus is a recombinant, and the new virus may have increased its ability to transmit and kill.

http://www.recombinomics.com/News/04100501...rborne_213.html

Commentary

Marburg Toll In Angola to 205 - Bodies in Uige Uncollected

Recombinomics Commentary
April 8, 2005

>> As of 7 April, 205 cases of Marburg haemorrhagic fever have been reported in Angola. Of these, 180 have died. Zaire Province has reported its first 6 cases, bringing the number of affected provinces to seven, all concentrated in the north-western part of the country......

WHO staff in Uige were notified today of several fatalities but teams were unable to investigate the cause of death or collect the bodies for safe burial. Discussions have been held with provincial authorities to find urgent solutions.

The dramatic symptoms of Marburg haemorrhagic fever and its frequent fatality are resulting in a high level of fear, which is further aggravated by a lack of public understanding of the disease. Moreover, because the disease has no cure, hospitalization is not associated with a favourable outcome, and confidence in the medical care system has been eroded. <<

Contact tracing has become more difficult because many victims have moved away from Uige because of the deaths of patients and health care workers. The case fatality rate of approximately 100% offers little incentive to visit medical facilities where there have been Marburg deaths.

These added difficulties will create challenges for just finding the victims. Tracing contacts will create additional problems. However, Marburg transmission will continue to accelerate, because the number of cases has grown substantially in the past few weeks. Now there are cases in 7 provinces. At least two countries, Democratic Republic of Congo and South Africa, have samples being tested by the CDC in Atlanta.

The testing capabilities were further eroded by damage to surveillance vehicles.

The above difficulties indicate a significant increase in WHO presence of the ground in Angola, and possible adjacent countries, is urgently needed.

http://www.recombinomics.com/News/04080505...g_Toll_205.html

Health Workers Race to Block Deadly Virus in Angolan Town
By SHARON LaFRANIERE

Published: April 11, 2005


UÍGE, Angola, April 10 - Larrinda Pinto died Thursday, probably unaware of the frantic effort that would follow by emergency medical workers hoping to block the spread of the Marburg virus that claimed her life.

Someone alerted one of the mobile teams of health workers that scour neighborhoods here daily that Mrs. Pinto, a 42-year-old pediatric nurse, appeared to have become another victim of the Marburg epidemic, which is centered in this northern province, also called Uíge.



Her death was quickly noted in white chalk on a blackboard hung on the second-story landing of the run-down, salmon-colored building where World Health Organization workers with two-way radios try to track the deadly virus's spread.

By Friday, workers clad in white protective suits located Mrs. Pinto's small mud-brick home, festooned with clotheslines, and persuaded her family to let them wrap her body in plastic and bury it immediately in the town cemetery.

On Sunday morning, two World Health Organization workers were back, copying the names and ages of 14 relatives and 7 neighbors who had been in close contact with Mrs. Pinto. For the next three weeks, they promised, they would check on them daily. By Monday, they would disinfect the house.

The workers' effort is organized, determined, swift. But not as swift as the epidemic, which as of Sunday had claimed at least 193 lives, almost all in the past month. And possibly not effective enough - at least for now - to save families like Mrs. Pinto's.

The race to contain the outbreak of Marburg, a deadly relative of the better-known Ebola virus, is centered here in the town of Uíge (pronounced weezh), where health officials fear the makings of a public health disaster that could spread elsewhere in Angola and beyond.

The number of victims is already the largest ever recorded from a Marburg outbreak, and there is no effective treatment. Nine out of 10 people who get the virus die, usually within a week.

The first cases of the virus were identified in the pediatric ward where Mrs. Pinto had worked. Despite incessant warnings on local radio that families of the sick should neither treat them at home nor touch them if they die, Mrs. Pinto's family cared for her in their house and prepared her for burial. The virus is spread by bodily fluids, and even stray drops of spittle or beads of sweat can lead to death.

"We heard on the radio that we were not supposed to do it, but out of emotion, we touched the body," said her husband, Antonio, 53. "We washed her when she was alive and after she died."

He also knew about the isolation unit set up at Uíge's regional hospital, where Mrs. Pinto had worked for 20 years. But he refused to take her there, he said, because "people believe the isolation unit is making people die."

Cases like this, epidemiologists here say, show how much remains to be done before the Marburg virus is contained here. But Dr. Nestor Ndayimirije, an epidemiologist and leader of the World Health Organization's efforts in Uíge, said he that believed headway was being made.

"If we compare with previous weeks, when we had 10 to 15 cases a day, now we have 4 to 5 cases a day," he said. "I am certain we will control this epidemic if we work more with the communities."

Antonio Pinto has now taped two photos of his wife, the mother of his six children, on his home's wall. In one, she wears a long rose-colored dress. In the other, she stands proudly before a medical cabinet, wearing her white nurse's uniform.

Yolanda, her 20-year-old daughter, described her as a devoted, sympathetic nurse who kept working in the pediatric ward long after the virus began claiming hospital workers as well as patients.

The two say they are not afraid. "Even though we held her, did everything for her, I don't fear," said Mr. Pinto, dressed in black as he sat Sunday morning in his dirt yard. "I trust in God."

But he is also filled with questions. Why is there no vaccine? What precautions can his family take now? How long will the epidemic last?

Dr. Ndayimirije's answer to the last query is not comforting. "Usually three months," he said.

The virus is named for the town in Germany where it was first identified in 1967 after laboratory workers were infected by monkeys from Uganda.

Scientists do not know the source of the virus or how this outbreak began. But the Centers for Disease Control and Prevention in Atlanta confirmed the first Marburg case in Uíge on March 8. That suggests that two months more of illness and deaths like Mrs. Pinto's lie ahead.

http://www.nytimes.com/2005/04/11/internat...artner=homepage

I sure wish that the World Health Organization would update this story. They have not updated their website since April 8. The CDC has not updated since April 5 and is pretty much useless. Get a load of this travel advisory from the CDC website....I sure don't thnk it is a good idea to allow people to travel to Angola. That is all we need is for them to travel, get infected and fly back home. Sheesh. This is what happens when you cut the CDC budget. They can't even properly update their website

Interim Guidance about Marburg Virus Infection for U.S. Citizens Living Abroad

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U.S. citizens living abroad should be aware that on March 23, 2005, the World Health Organization (WHO) confirmed Marburg virus (family Filoviridae, which includes Ebola virus) as the causative agent of an outbreak of viral hemorrhagic fever (VHF) in Uige Province in northern Angola. Testing conducted by CDC’s Special Pathogens Branch identified the virus in 9 of 12 specimens from patients who died during the outbreak. According to WHO reports, a total of 140 cases (with 132 deaths) were identified during October 1, 2004–April 1, 2005. (For current numbers of cases, see WHO’s website.) Approximately 75% of the reported cases occurred in children younger than 5 years of age; cases also have occurred in adults, including health-care workers. Predominant symptoms have included fever, hemorrhage (bleeding), vomiting, cough, diarrhea, and jaundice (yellow skin and eyes).

As part of the public health response, CDC has sent personnel to join the WHO-coordinated international response team to assist with epidemiologic investigation, infection control, and laboratory diagnosis. CDC in Atlanta also will continue to provide laboratory and other scientific and logistical support to the Ministry of Health of Angola. In addition, on March 25, CDC posted an outbreak notice on its website to inform travelers about the outbreak (available at www.cdc.gov/travel). This website will be updated regularly as new information becomes available. No U.S. travel restrictions to the affected area are recommended at this time.

Overview of Marburg Hemorrhagic Fever

Marburg hemorrhagic fever is a rare viral disease that occurs primarily in countries in East and Central Africa. The current outbreak in Angola is the first report of Marburg hemorrhagic fever since 1998–2000, when the largest known outbreak occurred in the Democratic Republic of Congo, resulting in 149 cases and 123 deaths.

The virus has the potential to spread from person to person, especially among health-care staff and family members who care for patients with Marburg VHF. After an incubation period of 5-10 days, the disease usually presents with sudden fever, chills, and muscle aches. Around the fifth day after onset of symptoms, a skin rash can occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may follow. Symptoms become increasingly severe and may include jaundice, severe weight loss, mental confusion, shock, and multi-organ failure.

The virus is believed to be transmitted from an unknown animal host to humans. Humans can infect other humans through contact with blood or body fluids (e.g., saliva, urine). People who have close contact with a human or nonhuman primate infected with the virus are at risk. Such persons include laboratory or quarantine facility workers who handle nonhuman primates that have been associated with the disease. In addition, hospital staff and family members who care for patients with the disease are at risk if they do not use proper barrier nursing techniques. These precautions include wearing protective gowns, gloves, and masks, in addition to wearing eye protection (e.g., eye glasses) or a face shield.

The likelihood of contracting any VHF, including Marburg, is considered extremely low unless there has been direct contact with the body fluids of symptomatic infected persons or animals, or objects that have been contaminated with body fluids. The cause of fever in persons who have traveled or live in areas where VHF is present is more likely to be a common infectious disease, but such persons should be evaluated by a health-care provider to be sure.

CDC Recommendations
Persons living in areas affected by Marburg hemorrhagic fever should observe the following measures to help avoid illness.

As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often, using soap and water (or waterless alcohol-based hand rubs when soap is not available), removes potentially infectious materials from your skin and helps prevent disease transmission. When wearing gloves, wash the gloves with soap and water before removing them, and then wash your hands.
Avoid contact with dead animals, especially primates.
Do not eat “bushmeat” (wild animals, including primates, sold for consumption as food in local markets)
To minimize the possibility of infection, observe barrier techniques when in close contact with a person or an animal suspected of having Marburg virus infection. These precautions include wearing protective gowns, gloves, and masks, in addition to eye protection (e.g., eye glasses) or a face shield. Sterilization and proper disposal of needles and equipment, and proper disposal of patient excretions are also important to prevent the spread of infection.
If you think you have Marburg virus infection or symptoms compatible with Marburg VHF

If you or your family members become ill with fever or develop other symptoms such as chills, muscle aches, nausea, vomiting, or rashes, visit a health-care provider immediately. The nearest U.S. Embassy or Consular Office can help you find a health-care provider in the area. You are encouraged to identify these resources in advance. When traveling to a health-care provider, limit your contact with others. All other travel should be avoided.

After your return

Persons returning from the affected area should monitor their health for 10 days. Any traveler who becomes ill, even if only a fever, should consult a health-care provider immediately and tell him or her about their recent travel and potential contacts. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.

Additional Information

For more information about the outbreak in Angola, see the MMWR report at www.cdc.gov/mmwr/preview/mmwrhtml/mm54d330a1.htm and the WHO website.
For more information about CDC’s health recommendations for travel to Central Africa, see www.cdc.gov/travel/cafrica.htm.
For more information about Marburg hemorrhagic fever, see www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg.htm.
For information about viral hemorrhagic fevers and precautionary measures, see www.cdc.gov/ncidod/dvrd/spb/mnpages/disinfo.htm.
For health-care workers who will be working with VHF patients in African healthcare settings, CDC in conjunction with the WHO has developed practical, hospital-based guidelines, entitled “Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting”

http://www.cdc.gov/ncidod/dvrd/spb/mnpages...ges/marburg.htm

Fear, Ignorance Fuel Marburg Outbreak in Angola Reuters

Marburg toll tops 200 News24

Marburg haemorrhagic fever in Angola - update 10

11 April 2005

As of 9 April, 214 cases of Marburg haemorrhagic fever have been reported in Angola. Of these, 194 have died. Uige Province remains the epicentre of the outbreak, accounting for almost 90% of the cases and deaths.

In Uige, mobile surveillance teams resumed operations on Saturday following intensive campaigns to improve public understanding of the disease. Campaigns have benefited from support by the provincial governor and officials from the health department, who have made personal visits to affected communities. Religious leaders are also helping to sensitize the public.

Some improvements are already apparent. More alerts to suspected cases and deaths are being reported directly by residents. Some 360 contacts are being followed up by the teams in Uige, but more improvements are needed to detect cases earlier, ensure their isolation and supportive care, and find and manage contacts.

WHO is concerned that deaths are continuing to occur within the community, as care of patients by family members without adequate protective equipment greatly increases the risk of further transmission. Staff at Uige’s large provincial hospital also need training and equipment to reduce the risk that routine surgical and laboratory procedures might endanger staff and other patients.

An isolation ward, dedicated to the care of Marburg haemorrhagic fever patients, has been established at this hospital by Médecins sans Frontières. Concern arises from the risk that persons infected with the virus might be admitted for another suspected illness and undergo testing or treatment procedures without adequate precautions.

WHO experience with outbreaks of viral haemorrhagic fevers, including the closely related Ebola, underscores the importance of rapidly sealing off opportunities for the amplification of transmission within health care settings.

http://www.who.int/csr/don/2005_04_11/en/

Marburg Disease Fear Mounts in North

New Era (Windhoek)
NEWS
April 11, 2005
Posted to the web April 11, 2005

By Nampa
Ohangwena

HEALTH and Social Services Minister Richard Kamwi said no case of the Ebola-like Marburg fever, which has killed more than 150 people in neighbouring Angola, has been recorded in Namibian hospitals so far.

Kamwi said this here in response to speculation that two cases of Marburg virus infection were recorded at Oshakati State Hospital in the Oshana region and Engela District Hospital in the Ohangwena region at the weekend.

The Health and Social Services Minister admitted that he was also aware of the allegations and, as such, he personally visited Engela hospital on Saturday to monitor the situation.

"It is not yet a Marburg virus disease infection case, because it is not laboratory confirmed," Kamwi said, adding that symptoms of Marburg fever have similarities with those of other diseases.

In the early stages of infection, Kamwi said, symptoms of the Marburg virus are non-specific and may be easily confused with more common diseases such as malaria, yellow fever and typhoid fever.

A severe watery diarrhoea, abdominal pain, nausea and vomiting are early symptoms of the disease, said Kamwi.

He stated further that severe chest and lung pains, sore throat and cough are the other symptoms of the Marburg virus. Said Kamwi: "The disease has an incubation period of three to nine days." He thus called on Namibians, especially those living along the Namibia-Angola borders in the Kavango, Ohang-wena, Omusati and Kunene regions, to hold on and/or refrain from visiting Angola until such a time the government gives them a go-ahead.

Asked whether Angolan nationals should also be barred from entering Namibia, Kamwi noted that it is a sensitive situation that does not warrant extreme measures like closing the borders with Angola.

He, however, appealed to the people to remain calm and not to panic but rather to report all suspected Marburg fever cases to the nearest health facilities and clinics without delay.

"We have developed the national Emergency Preparedness and Response Plan.

This plan details the objectives, the national emergency management and monitoring and evaluation," Kamwi emphasized.

He further stated that health workers have been trained to deal with the issue of virus outbreaks while workers at ports of entry were also alerted on how to deal with such incidences.

Reports of some Angolans from the disease-affected areas apparently fleeing into Namibia for safety were yet to be confirmed.

The Uige province in Angola, which is situated 300km north of Luanda, is the epicentre of the Marburg fever outbreak.

http://allafrica.com/stories/200504110900.html

South Africa protects itself against Marburg virus
Disease/Infection News
Published: Monday, 11-Apr-2005

The Marburg virus has already killed 193 people since the outbreak began in northern Angola in October and now South Africa is taking precautions to prevent the spread of the Marburg virus into the country.
Although health officials believe the risk of the disease reaching South Africa a small one, health department spokesman Solly Mabotha says they cannot afford to underplay the severity of the disease and although not overly concerned at this stage they are taking the possible threat seriously.

Both public and private hospitals have been warned to look out for patients coming from high-risk areas in Angola and certain of its neighbouring countries.

Mr Mabotha says they must be aware and alert the Health Department because in the past private patients have come into South Africa and put health workers at risk.

Dr Lucille Blumberg of the National Institute for Communicable Diseases in South Africa said the risks of importing Marburg into South Africa are small, but the country needs to be on the alert because although Marburg has not been reported in the capital of Angola there is a high flow of travel between Luanda and South Africa and cases which originated in or around Uige have been treated in various provinces.

Passengers who arrive at airports in South Africa from Angola will be asked about their travel history and whether they have been in contact with people recently hospitalised.

South Africa does not mean to treat every Angolan as a potential disease carrier but Mr Mabotha says they have to narrow the list down, and the process does appear to be working, because no cases of Marburg have been reported in South Africa.

Hospitals in all nine provinces of South Africa have been identified as isolation sites to deal with people suspected of carrying the virus.

Mr Mabotha says the best way to manage the disease is through isolation.

The South African National Defence Force has also been advised by the Health Department to screen South African soldiers serving in countries where a risk was present.

Marburg carriers do not start showing symptoms for at least four days - and sometimes as long as three weeks - after contracting the virus, which makes it possible for someone to enter another country without being aware they are carrying the virus.

http://www.news-medical.net/?id=9146

With all due respect to the Tanzania "Ministry". I think their statement that Tanzania is safe because Angola is too far away is just plain stupid.

Tanzania is safe from Marburg "Ministry"

The deadly Marburg virus, a fatal disease resembling Ebola, causes severe hemorrhagic fever. Victims bleed, often from every orifice and every organ, to death. Few infections are as deadly.

Marburg is caused by an animal-borne RNA virus of the filovirusfamily that has an incubation period of between five and 21 days.

Tanzanian Ministry of Health had taken necessary precautions & confirmed that Marburg is not a threat to Tanzania.

Nsachris Mwamwaja ministry communication officer said, "Angola is too far from here, we have no doubt whatsoever about the chances of the disease occurring here. We have a strong team of experts who deal with outbreaks (of pandemics)."

World Health Organization report said, Marburg in Angola has allready claimed 184 lives, mostly children, and sickened at least 213 so far.

Early symptoms of the Marburg fever include stomach pain, nausea and vomiting. Victims then encounter fever, chills, headache, chest pain and internal bleeding.

http://www.moneyplans.net/newsroom/news.ph...ullnews&id=1261

April 12, 2005
In Angola's Teeming Capital, a Suspected Virus Carrier Dies Alone
By DENISE GRADY

UANDA, Angola, April 11 - Bonifácio Soloca, 61, was alone when he died here Monday evening at Américo Boavida Hospital, in an isolation unit for patients suspected of being infected with the Marburg virus.

He was admitted Saturday, the unit's first patient, and never saw his family again. While doctors and nurses disinfected his lifeless body, his wife stood outside a fence on the grounds, waiting patiently for someone to come and get the dinner she had brought him.

The prospect of the Marburg virus spreading through this teeming capital city, with four million inhabitants and an international airport, inspires dread among health officials. Though the virus does not spread through the air like influenza - Marburg requires contact with infected bodily fluids - health officials believed Luanda had to be prepared for the worst.

So Doctors Without Borders created the isolation unit, with room for 30 to 40 patients, by clearing out a building that had been an H.I.V. clinic.

The few patients who have turned up in Luanda contracted the disease about 180 miles away in Uíge, the province at the center of the outbreak, and are not thought to have passed it one to anyone else.

It is not known whether Mr. Soloca had the Marburg virus - one blood test was negative, but a second must still be done. He was admitted because he had some Marburg-like symptoms - fever, and blood in his urine and vomit - and he might have been exposed to the virus while being treated for malaria at another Luanda hospital where a Marburg patient had died. Because of that, his doctors said, they had to treat him as if he did have the virus.

Once in the isolation unit, Mr. Soloca probably received less medical attention than he would have gotten had he been on a normal ward where doctors and nurses could easily look in on him on the spur of the moment, without having to put on layer upon layer of protective gear first.

Relatives were discouraged from visiting because the precautions needed to enter are so arduous. Anyone who goes in must spend a half-hour or more suiting up in surgical scrubs, overalls, rubber boots, a hood, goggles, and double masks and gloves.

Keeping the family away poses a hardship for patients. Hospitals do not provide meals or much nursing, so patients depend on their families to bring food and take care of them. Mr. Soloca's family brought his meals to the hospital, but he spent much of his time alone.

Doctors and nurses generally suited up and visited him as a group three times a day, once during each of three daily shifts, and stayed in the room for an hour or two each time - as long as they could stand to wear the stifling suits. The rest of the time, he was by himself. There were no monitors. He had lost control of his bodily functions and often lay in his own wastes between their visits.

Dr. Benjamin Ip, a Doctors Without Borders volunteer from Las Vegas who had spent hours tending to Mr. Soloca the day before, emerged from the unit looking troubled after the man's death on Monday.

Earlier in the day, he said, he had considered starting an intravenous line but did not, because it would increase the nurses' risk of being exposed to Mr. Soloca's blood or being stuck by a contaminated needle.

"I don't know whether it would have made a difference," he said. "It's a fine line to balance care for the patient and risk to yourself."

A psychiatrist walked Mrs. Soloca to a tent used for counseling, to tell her that her husband had died, and to explain that the family would not be allowed to claim his body. Rather, it would be buried in a special cemetery designated by the Ministry of Health for Marburg victims.

But the doctors said one important custom would be respected. When someone dies in Angola, tradition says it is essential that the family see the person's face, to know for sure that their loved one is dead.

So, in the dark, Dr. Ip and an assistant, in full protective gear once again, carried Mr. Soloca, zipped into two body bags, to a patch of bare dirt outside the isolation unit and set him down on the ground.

The bags were open just enough to reveal his face, and the doctor shone a flashlight on it. Mr. Soloca's wife and sons and his priest looked at him from the other side of a fence, said a prayer and left.

In a few days, they will learn whether he had the Marburg virus.

http://www.nytimes.com/2005/04/12/internat...print&position=

Deadly virus, anger take hold in Angola
By John Donnelly, Globe Staff | April 12, 2005

JOHANNESBURG -- In the beginning, several months ago, the mysterious deaths were coming in one or two a day, and by the most horrible ways imaginable. People had high fevers, then diarrhea and vomiting, and finally they started bleeding from the nose and mouth until their systems collapsed. Almost all died days after taking ill.

The outbreak of Marburg hemorrhagic fever, a close relative of the Ebola virus, is stalking the northern Angola province of Uige, a 10-hour drive on broken roads from the capital, Luanda. Now, five or six people on average are dying each day from the virus, one of the most virulent pathogens known to infect humans.

This is the deadliest Marburg virus outbreak ever recorded, with Angola's government reporting yesterday that 193 people have died, nearly 90 percent of the 218 who were infected.

As sometimes happens with outbreaks of hemorrhagic fever, anger and fear also spread in the affected regions. Over the weekend, efforts to gauge the extent of the outbreak and coordinate relief efforts were dealt a setback when teams from the World Health Organization and Doctors Without Borders withdrew from the field after fearful residents threw rocks at them in an attempt to keep them away from their homes.

The health workers, wearing head-to-toe, air-filled outfits that resemble spacesuits, can appear to residents as harbingers of death.

Yesterday, teams of WHO workers were back out in force around the province, tracking rumors of more deaths, but they have not been able to determine the extent of the problem or whether they have seen the worst of it.

''I don't think we have a good grasp at the size of the outbreak yet," Dick Thompson, a spokesman for the WHO, said yesterday. ''There may have been a turning of the corner in terms of returning the [WHO] alert teams to the field, but I think that we don't have a good surveillance system elsewhere in the country."

The virus passes with the greatest of ease -- through any kind of bodily fluid, a bloody nose, a sneeze, a sweaty palm.

The disease is incredibly rare, but when it strikes, it can quickly be fatal. There is no vaccine, no specific treatment -- only isolation, to protect others, and the slim hope that a person's immune system will win.

The virus's exact origin is unknown. It was first detected in 1967 when German laboratory workers in Marburg were infected by monkeys from Uganda. It most recently struck in the Democratic Republic of Congo, killing 128 people from 1998 to 2000.

The health workers enter neighborhoods only after hearing reports of deaths or of people becoming suddenly ill. The workers' faces are barely visible inside the suits. They take people to an ''isolation center."

In this case, it is next to Uige's hospital, where the Marburg virus initially spread person to person, mostly among children, from an infected child admitted to the pediatric ward.

''Now, the population believes, if you go to the hospital, you're dead," said Dr. Pierre Rollin, head of the diagnostic group at the Centers for Disease Control and Prevention's special pathogen branch in Atlanta and a veteran of hemorrhagic fever outbreaks.

Rumors almost always spring up in these outbreaks, including the false theory that the foreigners have brought the virus.

Over the weekend in the province of Uige and the city of the same name, a densely packed municipality of 200,000 people surrounded by green hills, the province's governor and other top officials joined the WHO and Doctors Without Borders to tell residents that the health workers were there to stop the outbreak and people needed to cooperate.

Such persuasion apparently is beginning to work. Four WHO teams worked yesterday, and no incidents were reported.

Now, the job for the health specialists is to take control of the response.

Control has several facets:

Decontaminating Uige's hospital, which played a huge role in the initial spread of the virus.

Persuading residents to report anyone with Marburg-like symptoms so they can be isolated.

Stopping relatives from burying those who died from the Marburg virus because contact with any bodily fluids from the corpse could be deadly.

Getting a hastily constructed laboratory running at full speed in order to identify which deaths in the area are connected to the outbreak.

Now, the health teams are chasing down each death, a process that can be lengthy.

''Not every death is due to Marburg," Thomas Grein, 45, a WHO epidemiologist who has led teams in controlling previous hemorrhagic fever outbreaks, said in a telephone interview from Uige last night. ''Right now, we're pulling all these rumors and deaths together, and forming opinions if it could be hemorrhagic patients. We're seeing a lot of patients, and a lot of deaths."

When the WHO and Doctors Without Borders teams move from investigating mainly deaths to investigating cases of primarily the sick, they know they will have made progress and are possibly gaining control of the outbreak.

Grein, who also worked on the Marburg outbreak in Congo, the second largest, said that the health teams were following time-tested procedures in trying to contain the spread of the disease. He and others are confident they will eventually curtail the spread.

But no one feels too comfortable now. No one has a proper handle on whether the disease has spread to neighboring provinces; some blood and tissue samples of bodies have been sent to a laboratory in Luanda from neighboring provinces to see if the deaths were caused by the Marburg virus.

''The main problem now is trying to have a grip on what is going on," said Rollin of the CDC in a telephone interview from Atlanta.

In Uige, Grein believes that is a matter of time.

''It's the same challenges as the other outbreaks, some local flavors added, of course," he said. ''Until we're 42 days after the last case, that being the incubation period of the disease, there's always a danger and we won't relax until that point in time.

''Now we need to get more cooperation from the community. We need to be alerted to cases more quickly and get those people into the isolation areas," Grein said. ''Then we'll eventually be in control."

John Donnelly can be reached at donnelly@globe.com.

http://www.boston.com/news/world/africa/ar..._angola?mode=PF

April 12, 2005
A Daunting Search: Tracking a Deadly Virus in Angola
By SHARON LAFRANIERE and DENISE GRADY

UÍGE, Angola, April 11 - The staff in the pediatric ward of Uíge's regional hospital suspected something was terribly wrong as early as October, when children who had been admitted with seemingly treatable illnesses began, suddenly and wrenchingly, to die.

But were those early deaths caused by the Marburg virus? If they were, and had they been diagnosed at the time, might the current epidemic have been averted?

The international health experts who have descended on Angola say they cannot pinpoint exactly when the largest outbreak of the deadly virus began.

"Nobody really has a sense of where or when it started," said Dr. Thomas Grein, a medical officer in the World Health Organization. "The widespread belief that it began in October is speculation."

But local officials in Uíge, the center of the outbreak, believe it began around that time, and then spread from the pediatric ward of the regional hospital, which has now been effectively closed except for emergency operations.

If they are correct and there was a delay in explaining the deaths, the reason may be that in Africa, sometimes the extraordinary is buried in the ordinary.

Children die at such an astonishing pace here and for any range of horrible reasons unknown to other parts of the world that it takes much more time for health workers to piece together if something as deadly as Marburg is at work.

In a country like Angola, where one in four children dies before the age of five, mostly from infectious diseases, crises like the one in the pediatric ward can easily be overlooked.

An outbreak of Marburg can look like a host of other illnesses to doctors and nurses who have never before encountered the disease.

"This is Africa," said Dave Daigle, the spokesman here for the World Health Organization. To be a health official here, he said, "is like being a fireman in a village with the whole village on fire."

Experts say at least 214 people have caught the virus and 194 have died. Marburg is spread by contact with bodily fluids, from blood to sweat, and kills with gruesome efficiency. Victims suffer from vomiting, diarrhea, high fever and bleeding from body orifices. Nine in 10 are dead within a week. There is no effective treatment.

When strange deaths first began to appear in October, mystified local health officials shipped samples of tissue and blood from four children to the United States.

In November, the Centers for Disease Control and Prevention tested them for at least three different types of hemorrhagic fever, including Marburg.

The results, which nearly all agree were accurate, came back negative. But in the tumult of deadly diseases and other health issues that plague this continent, it remains possible that Marburg was present in Uíge even then.

By the end of December, at least 95 children were dead, local health workers say.

How many deaths were Marburg-related is unknown, but even by the grim standards of the continent, it was an alarming number of deaths.

"In October, November, December, we were seeing so many children dying - just children," said Dr. Gakoula Kissantou, 31, the hospital's acting administrator. "It was becoming scarier."

He recalled the doctor in charge of the pediatric ward at the time, Dr. Maria Bonino of Italy, called a meeting with the staff and asked, "What is going wrong here in the hospital?" She herself died in March, a victim of the virus.

It was not until early March that the provincial health officials alerted a W.H.O. representative that they had found 39 suspected cases of Marburg. W.H.O. officials identified 60 possible cases. Angolan authorities then shipped more samples to the C.D.C. in Atlanta. On March 18, 9 of 12 came back positive for Marburg, which by then was claiming more victims by the day.

Since those new lab tests positively confirmed the virus, a growing number of epidemiologists, anthropologists, public health experts and emergency medical workers have descended on Uíge in a race to cut off the disease.

One thing is certain, scientists say: the epidemic began with just one infected person, and was then transmitted from one person to another.

That conclusion, based on finding only one strain of virus in all the samples tested, means the outbreak can be stopped if infected people are isolated.

Given the degree to which it has been contaminated, the regional hospital, which serves 500,000 people, has now been limited to emergency operations and an isolation ward where Doctors Without Borders, the international health charity, treats Marburg victims.

Eight pediatric nurses and the doctor in charge of the ward are dead, along with six other nurses and one other doctor, all Marburg victims. Every mattress, bed sheet and hospital uniform must be thrown out. Everything left must be disinfected.

On Monday, teams of soldiers and hospital personnel clad in bright yellow prowled the grounds, spraying grass, benches and dirt paths with a solution of diluted bleach. Afterward, they burned their uniforms.

At some point, said Dr. Kissantou, the hospital's acting administrator, normal operations will resume. He refused to hazard a guess as to when.

"I am upset that we are not serving patients," he said, plopping down on a wooden chair outside his office as two aides stood by. Barred from the hospital, he said, some of the sick are diagnosing their own illnesses and trying to treat themselves with medicine they buy at the local market, with disastrous results.

"Some people are dying because the medicine doesn't fit the illness," he said. "That's why we are asking for help, so people can come here to get treatment."

But to treat patients safely again, hospital officials need to address a range of problems. They must find ways to systematically isolate high-risk patients before they mix with other patients; to equip the medical staff with masks, gloves and other protective equipment; and to enforce sanitation measures, like proper hand-washing, even when there is no running water.

Dr. Kissantou, one of only two Angolan doctors at the hospital, says all that could be done, with enough money. The provincial governor has promised $1 million, he said, but more support is needed.

Yet the biggest challenge of all may be regaining the trust of the community after so many deaths. It is one reason why Dr. Kissantou, who took over the hospital after his predecessor was fired, still comes to work every day.

"I am a doctor," he said. "I will not flee, because I prefer to give my life to another."

http://www.nytimes.com/2005/04/12/health/1...print&position=

Angola Launches Marburg Campaign as Toll Tops 200 Reuters

ANGOLA-CONGO: Officials review fight against Marburg virus
12 Apr 2005 13:46:07 GMT

Source: IRIN

BRAZZAVILLE, 12 April (IRIN) - Angolan and Congolese medical officials, as well as representatives of two UN agencies, have reviewed ways to stop the spread of the deadly Marburg virus across their borders.

"As neighbouring countries, we need to continue working together, exchanging ideas and information in order to overcome this epidemic," the officials said on Friday at the ROC border town of Masabi.

The officials, who included representatives of the UN Children's Fund and the UN World Health Organization, discussed a report on the fight against the haemorrhagic fever, which started in the Angolan province of Uige, killing at least 200 people. It has spread to eight other provinces in Angola.

Marburg is an Ebola-like virus transmitted by direct contact with body fluids. Symptoms of the disease include high fever, haemorrhaging, vomiting and diarrhoea, which appear after an incubation period of two to 21 days. There is no known cure or vaccine.

The ROC doctors who participated in the Masabi meeting were from the capital, Brazzaville and the commercial port city of Pointe-Noire. They were led by the director-general of health, Dr. Damase Bozongo while the Angolan delegation was led by Dr Francisco Bungo, the chief representative of the health services in Angola's 2nd Region.

"We made all necessary provisions in the town of Cabinda [the northern Angola enclave] to stop the spread of this epidemic to neighbouring towns," Bungo said.

He added that sensitisation campaigns were being done at in the army, schools, churches and through political parties. Safety measures, including quarantining and testing, had been put in place at the country's airport and ports in order to avoid infections in or out of the country, he said.

"When we received the information of a case in Cabinda, we got together with medical authorities of our neighbouring countries in order to stop the spread," Bozongo said.

Commenting on the health safety measures so far, the WHO representative in ROC, Dr Adamou Alzouma Yada, said, "Collaboration between these two countries in fighting the virus was a very good initiative."

He added that the spread of the disease would be "very dangerous and fast" because of cross-border movement of people. He advised the two governments to improve their communication in order to monitor the virus better.

ROC has deployed teams in Pointe-Noire and in the towns of Banga-Ntaka, Kimpessi, Kimongo and Dolisie in the southwestern part of the country to monitor the situation.

http://www.alertnet.org/thenews/newsdesk/I...08876995cb2.htm

The healthcare workers who are entering an 93% fatality rate Marburg outbreak are some seriously dedicated (brave) people! I wonder if they are closely monitoring population movement from this area. Certainly anyone who has been to Uige needs to be quarantined for a period before being allowed on aircraft and other forms of mass transportation. Otherwise we could end up with a SARS like situation where we end up with pockets of Marburg in distant locales with the potential to infect the wider population.

Looks like they're controlling entry/exit points.

I don't think this could be a form of terrorism because nobody knows where this virus comes from. But I'm sure they'd love to get an al Qaeda martyr over there and then put him on a plane bound for NYC or DC. We've got to ensure those entry/exit points are locked down.

Angola Struggles to Contain Viral Outbreak ABC News

I don't think it is terrorist related either.

Let's hope that the WHO is correct on their assessment. They sure were wrong in the assessment that they gave in the article that started this thread.

Marburg Outbreak Not Likely a Global Threat - US
Tue Apr 12, 2005 07:13 PM ET

WASHINGTON (Reuters) - An outbreak of deadly Marburg virus in Angola is probably not a global threat but international experts are working to bring it under control, the head of the U.S. Centers for Disease Control and Prevention said on Tuesday.
The hemorrhagic fever, a relative of the Ebola virus, has killed some 200 people and terrified people in Uige province, northeast of Angola's capital Luanda.

It causes fever, vomiting and diarrhea and can cause internal and external bleeding. The virus can be found in all the bodily fluids so health care workers must take extreme care, CDC Director Dr. Julie Gerberding said.

"People are frightened and people are embarrassed to be associated with this but I think the important message is we need to identify those who are sick, get them into care and teach health care workers how to protect themselves from blood and body fluid exposure," Gerberding told CNN television.

There is no specific treatment for Marburg but putting patients on fluids and watching them in the hospital can help them survive.

The CDC chief said anyone who travels to the area and who is in contact with a Marburg victim needs to watch for symptoms for 10 days. But she said she did not believe the virus threatened to spread to the rest of the world.

"We're optimistic about this one," she said.

Gerberding said the CDC had sent eight staffers to Angola to join a World Health Organization team that is helping fight the virus, find and treat patients and, eventually, track down its source.

Scientists believe that Marburg, like Ebola virus, comes from an animal, possibly a monkey or other primate. Studies suggest that people become infected when they hunt and butcher monkeys, apes and other animals for the bush meat trade.

"There is a suspicion that there is some kind of primate source," Gerberding said.

At least 203 people have died from the Marburg virus in this latest outbreak out of a total of 221 known cases. Gerberding said this high mortality rate was unusual, as the virus killed about 25 percent of victims in previous outbreaks.

She said she suspected it was because people were not seeking medical care until they were very ill.

Marburg gets its name from the German town where it was first reported in the 1960s after researchers there caught it from monkeys imported from Africa. The previous worst recorded outbreak was during a 1998-2000 epidemic in the neighboring Democratic Republic of Congo when 123 people died.

http://www.reuters.com/newsArticle.jhtml?t...storyID=8161648

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