Travel warning as marburg virus toll rises

Travel warning as virus toll rises
AFP
29mar05

LUANDA: Another young woman has died of the Ebola-like Marburg virus in Angola, officials said.

The haemorrhagic virus has killed 121 people since it broke out in the northern town of Uige in October, and five more people, including a Portuguese citizen, have been taken to hospital, bringing the number of sick to 132.
The most serious recorded outbreak of the disease was in the Democratic Republic of Congo between 1998 and 2000 when 123 people died.

A South African travel company yesterday warned travellers planning to go to Angola to stay away from the country "for at least a week", quoting reports that residents of the capital Luanda, especially expatriates, were contemplating fleeing the country.

The Netcare Travel Clinic, which keeps tabs on outbreaks of diseases in Africa, told prospective travellers not to go to Angola for at least a week "unless it's absolutely necessary".

Andrew Jamieson, of the Johannesburg-based clinic, said many people, including expatriates, were considering evacuating their families from the country.

Yesterday's death, of a 19-year-old, was at a hospital in Uige, 300km north of Luanda, where three other people suffering with the disease were admitted, while in Luanda a 12-year-old girl and a Portuguese national were taken to hospital.

A severe form of haemorrhagic fever in the same family as Ebola, the Marburg virus was first identified in 1967. The disease kills about one in four who contract it, and a specific treatment is unknown.

http://www.theaustralian.news.com.au/printpage/0,5942,12686457,00.html

Marburg Monitoring Extends to Portugal

Recombinomics Commentary
March 28, 2005

>> Meanwhile in former colonial power Portugal a senior health official said authorities were protectively checking on the cause of death of a Portuguese on Saturday shortly after his return from Angola. <<

Infection control for Marburg virus is heavily dependent on contact tracing and quarantine. The above comments indicate this monitoring has expanded to Portugal.

Since the incubation time for development of symptoms is 3-9 days, there is an opportunity to control the disease via quarantine. In Cabinda, 14 contacts of the fatal case have been placed under hospital quarantine. The index case in Cabinda was infected after attending a funeral in Uige of another Marburg fatality.

Thus, clearing suspect deaths is important in the control of the disease. More details on the fatality mentioned above will be useful. Transmission of Marburg has been largely limited to Uige. Most of the cases in Luanda had been infected in Uige. However, a twelve-year old may have been infected in the Luanda suburb of Cacuaco. If confirmed, this would be cause for concern because her source of infection has not been identified. She had been admitted to the suburban hospital two days before she was transferred to Luanda's Americo Boa Verde.

The death toll increased by 1 to 122. The daily increases are small because most of the diagnosed cases have already died. Most of the patients hospitalized are for observation, as noted for the 14 patients in Cabinda. However, because of the large number of new cases in the past weeks, further transmission by these recent patients may not have been detected. Thus, additional contact tracing and monitoring of suspicious death will be critical in the control of the Marburg virus epidemic in Angola.


http://www.recombinomics.com/News/03280503/Marburg_Monitoring_Portugal.html

Marburg Virus Spread Raising International Concerns

Recombinomics Commentary
March 29, 2005

>> A potential access route for importation of Marburg hemorrhagic fever into Europe via travelers between Angola and Portugal, mentioned in the final paragraph, is an alarming development. Information on the cause of the death of the returning Portuguese national would be appreciated (at present there in no further information available in newswires).

In addition the possibility of introduction of Marburg virus into Europe,
the proximity of Uige Province to the Democratic Republic of the Congo
(DRC) leads to concerns across the border as well. Of note, there was an
outbreak of Marburg virus in the DRC during the period 1998 - 2000 in the northeastern part of the country, approximately 2000 kilometers from where Uige borders with the DRC in the southwest of the country. -




The above commentary by ProMed expresses some of the international concern over the Marburg situation in Angola and potential transmission worldwide. The virus has taken a toll on the population in Ugie, the epicenter of the infections. There have been reported deaths of 6 nurses, 2 physicians, and 2 policemen who appear to have been infected in Ugie. However, the infections of first responders and health care workers have produce a significant strain on the heath care system there. Many employees have avoid hospitals and all of the reported deaths in Luanda, including two physicians, are patients that came to Luanda from Ugie.

The movement of the virus out of Uige is cause for concern. Uige borders the Democratic Republic of the Congo, and there has already been a death in Cabinda of a resident who went to Uige for a funeral of a Marburg victim. 14 contacts in Cabinda have been placed in hospital quarantine. However, the transfer of a 12-year old Luanda resident from a Luanda suburb health care center to a larger hospital in Luanda raises concerns about transmission of the virus in luanda, the capital of Angola, which has an international airport.

Concerns about Marburg transmission via air travel were heightened by the death of a passenger returning to Portugal from Angola. Although the investigation was disclosed on Saturday, there have been no updates on the passenger's age, gender, flight, contacts, relatives, or clinical symptoms. Another passenger was quickly cleared, but the lack of information on the fatal case is causing concern.

The passenger's death shortly after arriving in Portugal would suggest significant risk to contacts if the passenger died from Marburg. The virus could be passed to airport personal handling baggage or providing on board service. Similarly, transmission at airport food courts would be a concern. Infections at international airports could quickly more the virus around the world. In the current outbreak in Angola, the case fatality rate is near 100% and there is no known treatment.

http://www.timebomb2000.com/vb/newreply.php?do=newreply&noquote=1&p=1329459

Marburg: panic grips Angolans
Tuesday, March 29, 2005
Panic and ignorance abounded Tuesday in Angola as the war-ravaged country's skeletal medical staff grappled with the worst outbreak of the Ebola-like Marburg virus, which has claimed a record toll.


The mood was sombre in hospitals in Luanda among doctors and nurses attending to patients who may or may not have the disease which has so far killed 126 people, mainly in the north of the country but including three in the seaside capital.

"The situation is serious. Really serious. It's a disease about which not much is known. It's worse than the Sars in Asia," said Margarida Correia, the head of the maternity department in a prominent Luanda hospital, referring to the severe acute respiratory syndrome virus that hit Asia in 2003.

"We are very worried because we are in direct contact with the ailing. We are tending to them without sufficient protection," she said.

Appeal for international assistance
Luanda's provincial health director Vita Mvemba on Monday appealed for international assistance, saying the southern African country, which only recently emerged from a brutal 27-year civil war, had only 1 200 doctors nationwide.

Conceicao Antonio, a 36-year-old health worker who registers and weighs the sick and also issues death certificates, said she had not been given any kind of equipment, masks or gloves to protect herself from the virus.

"Nobody wants to contract the disease," she said.

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

Mainly children affected
Three-quarters of the deaths in Angola have been children under the age of five, according to the World Health Organisation, but the virus has also started to claim adult victims including at least seven medical workers since it erupted in October.

Quiala Godi, the head of health services in the northern Uige province - the epicentre of the outbreak - said there was chaos in the provincial capital, also called Uige.

"The (sole) hospital is almost closed. The employees don't want to come to work. Everybody has fled."

Luanda midwife-***-nurse Maria Nsimba said the maternity home she worked in was on full alert. "Many of those who died in Uige were nurses like us," she said.

Hostility towards Congolese
The disease has also provoked a certain degree of hostility towards the Congolese.

"I heard that it's a disease the 'langas' (Congolese) brought to Uige to kill Angolans," said 42-year-old street vendor Eva Domingos Jinga. "I was told not to buy food sold by the langas if one wants to avoid the disease."

But Nzilambote Lumbu, a Congolese street seller, said she was not scared.

"These could be mere rumours. I have my Christ," she said simply.

Luandan Bela Paquete, however, predicted doom, saying she did not know what preventive measures to take.

"We are scared of this sickness," she said. "It's going to kill a lot of people."

Even educated people often know little about the Marburg virus, like 17-year-old economics student Natalia Ferreira who said it was "yellow fever".

Traditional healers consulted
Health ministry spokesman Carlos Alberto said many victims died because they consulted 'kimbandeiros,' or traditional healers, and only came to the hospital when it was too late to do anything.

"For example, the last nurse to die in Uige was first taken to a 'kimbandeiro' and only when her condition worsened was she brought to hospital," he said.

The previous most serious recorded outbreak of Marburg was in the neighbouring Democratic Republic of Congo between 1998 and 2000, when 123 people died. – (Sapa-AFP)

http://www.health24.com/news/Bacterial_diseases/1-894,31298.asp

Disease fears spread in Africa
30/03/2005 12:36 - (SA)




Luanda - At least three African nations are on alert after an outbreak of the Ebola-like Marburg virus claimed a record toll in Angola, as a senior official in the worst-affected area on Wednesday accused Luanda of apathy.

Health alerts have been issued in the Democratic Republic of Congo, which borders Angola and where the second highest number of deaths due to the virus was previously recorded, in Congo-Brazzaville and as far as the eastern African country of Kenya.

Kenya's health ministry said earlier on Wednesday it had set up a system at the country's two main airports in Nairobi and Mombasa to screen passengers arriving from Angola.

An alert was issued to all hospitals and clinics in Kenya, which recorded three cases of the disease in the 1980s. Angola's neighbour, the Democratic Republic of Congo (DRC) went on high alert on Tuesday, issuing protective kits.

Hospital closed down

Congo has also stepped up health controls along its border with DRC in order to reduce the possibility of the outbreak spreading, the health ministry said.

Meanwhile, Quiala Godi, the number two health official in the northern Angolan town of Uige - the epicentre of the virus - was critical of Luanda's response.

"We have reached the peak of the Marburg epidemic. What worries me is the lack of support from the government. We haven't received a single government team here in Uige," Godi said.

"The hospital is closed," he said speaking of the sole health facility there. "Even the emergency services are shut down. Here everything is politicised. Only international experts from the World Health Organisation and the Medecins sans Frontieres (Doctors without Borders) are here."

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.

Godi said there were four more deaths on Tuesday - two in Uige and two at the nearby town of Negage about 30km away - which take the unofficial toll to 130.

Provincial health official Godi meanwhile heaped scorn on government criticism.

"These are people who simply talk. The entire team sent by the health ministry has left leaving only international experts on the spot."

Luanda's provincial health director Vita Mvemba on Monday appealed for international assistance, saying the southern African country, which only recently emerged from a brutal 27-year civil war, had only 1 200 doctors nationwide.

Three-quarters of the deaths in Angola have been children under the age of five, according to the WHO, but the virus has also started to claim adult victims since it erupted in October.

http://www.news24.com/News24/Africa/News/0,,2-11-1447_1682673,00.html

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.


http://www.news24.com/News24/World/News/0,,2-10-1462_1684040,00.html

"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