This Marburg outbreak...

Going 'semi-postal'?

I'm cobbling this together from various reports too long to post as they are. I'll reference them & post snippets from a few though...

The outbreak of Marburg Fever which seems to have begun in Angola, Uige province), in late October is taking a very worrisome turn - maybe. First a basic review. Marburg Hemorrhgaic Fever is the 'nice' one of the five known filoviruses with a death rate of between 23-25%. A short synopsis of the disease, symptoms, what it does, etc. can be found here:

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

We know no more about where it comes from & how outbreaks begin than we do of the other filoviruses. We learn of outbreaks when news invariably comes out of affected areas. It's grossly ironic that it's sporadically endemic in the really badly off areas of Africa.

This is the first time it's been seen in Angola - that's the 'wrong' part of the continent for that illness & couldn't have picked a worse place to make a reappearance. Angola has a population of 11 million & only 1200 doctors nation wide. Health care is almosty non-existent outside some of the larger cities & within those cities, I'm being charitable to say it's poor.

Currently, as of a few hours ago, ProMed is reporting 142 fatalities from 150 cases - yeah you read that right. That makes it a few increments worse than the nastiest known substrain of Ebola - Ebola Zaire Mayinga. Now it may not be entirely the 'fault' of the virus. Angola has an average life expectancy of 37:

***Life expectancy at birth:
total population: 36.79 years
male: 36.06 years***
female: 37.55 years (2004 est.)


http://www.odci.gov/cia/publication.../ao.html#People


That's one of the worst on the planet & implicates a lousy basic state of health for most. That may be contributing to the extreme death rate being seen. Lack of any surveillence infrastructure may also be contributing. It's my bet that plenty of cases are being missed due to no one reporting them. And certainly the experts in that part of the world are of that opinion. Most of the cases are being reported among young children & ProMed had this opinion on the possibilities there posted a few days ago:

http://www.promedmail.org/pls/prome...L_ID:1000,28540

***I suspect that the age distribution of cases in Angola will ultimately turn
out to have more of a behavioral basis, as opposed to biological. The most
common point source when a cluster of VHF is seen is the hospital. It is
not clear from the ProMED-mail listings how many of the children might have
been seen and potentially exposed at the same health facility. An outbreak
of Lassa fever in Sierra Leone in 2004 in which pediatric cases
predominated was ultimately thought to be linked to contaminated multi-dose
vials (2). If the hospital can reasonably be excluded, less obvious sources
need to be considered. Do children enter for play or work (even very young
children often help with family chores in sub-Saharan Africa) into caves
where bats, a leading reservoir candidate, roost? Do children find and eat
fruit that could be contaminated by bat guano? Sequence data, no doubt
forthcoming, should shed light on whether this appears to more of a point
source outbreak or multiple introductions, facilitating the generation of
hypotheses to be investigated.***

I saw reference, (which I can't back up at the moment), that often children in Angola are given injected meds because it's easier. If syringes, etc are reused after only rinsing, which is a comon practice in poor African nations; that might explain it at least partially as well.

Now this outbreak has been slowly simmering but if memory serves me right, this is fairly common with the filoviruses. A few cases brew up & take time to really 'take off'. Every report I've glanced at in the past few days is really hiking the numbers. I'm hoping, (& it's likely), that this is due to the urgent interest being shown to that country & this outbreak. Everybody & his dog is showing up to work this one. You'll see why in a minute.

It started in Uige province in the north of the country & some cases are being reported in Luanda now, the capitol city. These are reported to be cases which came INTO the city from Uige province, not cases which have transmitted within the city but I'm betting that's next. In total now, cases are being reported in 4 Angolan provinces. It gets 'better'. It's now crossed into the Democratic Republic of Congo. Furthermore, 9 people are in isolation in Italy after reported exposure to a case. Absolutely no details there & I'm trying. No clue as to where they might have been exposed, how they got to Italy, how they were spotted, what symptoms or how 'strong' suspicions of a filovirus might be or if this an excess of caution. Here's a potential guess. The Pope has been ill for over a week. It's possible missionaries in Angola due for a break chose to go to Rome rather than home? Hey, I know, left field country here but as Italy is the place to be for many of the world's Catholics right now, THIS is not what they need. 2 cases suspected in Portugal have been ruled out after testing. Testing is quite specific for this & results accurate.

I mentioned everyone is getting in on this one. Canada has sent a team & a mobile lab & we generally don't work filovirus outbreaks in terms of national level resources. Mind you, we've got the virus at our lab, have the reagent kits - this is an unfortunately timely way to confirm training & strengthen skills by our lab folks. The WHO & CDC are there & Doctors Without Borders have been from the word go. But only now are gloves, gowns, masks & vital necessaities such as these getting into the country.

Those who know the area & filoviruses are warning this is going to get bad, possibly very bad with possibly 2 more larger waves coming, especially if it 'takes off' in the capital. This appears to easily be heading towards the worst outbreak of a filovirus ever.

So do we need to worry? No. Here's why.

Filoviruses, (so far in humans), are transmitted ONLY by direct contact with body secretions & inhaling coughed up nasties. By the time the patient is at that point, you KNOW you've got something awful on your hands & are well protected with barrier gear. Family memebers generally form the next risk group as they care for the sick & when dead, manually, (literally), clean & prepare the body for burial. The other high risk route for infection is reusing syringes & needles which have simply been rinsed - automatic death sentence with a filovirus.

We do none of these things in the west & I imagine every flight from Africa is being scrutinized for ANYTHING. This is a disease where suspect cases are immediately quarantined & other passengers watched like hawks until the incubation period, (5-10 days for Marburg), is over. They err on the long side, usually going at least 2 weeks. Should we get a case here, we might see a few health care workers or family/friends who've cared for cases contract it but by then we'd know what we were dealing with & it would end there. But in Africa, man this is a hard hit.

This still bears very close watching.

I'm looking to see as well if they're looking at the virus itself to see if mutation has or is occurring. Like I said, that's a death rate at least triple the norm & that implies a whole lot of something...

A bit more...

--------------------------------------------------------------------------------

I checked the CDC Marburg page:

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


and currently NO travel restrictions apply in the US. I expect though, passengers coming from anywhere near there are being asked questions & LOOKED at.

Of known deaths, 75% are under 5. Got that at Recombinomics:

http://www.recombinomics.com/News/0...mographics.html


***Initial cases were 75% children under the age of 5.***

That is now changing with older teens & young adults falling victim & the fear there is that these older people, younger & more mobile, will spread it faster. As Recombinomics states, each of the regions now affected has a person in this age cohort as the index case. 12 health care workers, (including 1 each Italian & Vietnamese), doctor & 2 policemen have died.

2 cases in Portugal came in negative but results on a THIRD have not yet been reported.

Italy is implementing a 21 day quarantine on their suspected cases/contacts.

BBC:

http://news.bbc.co.uk/2/hi/africa/4397891.stm

is reporting that in Angola, most have died between 3 - 7 days after the onset of symptoms. That is right fast, even for a filovirus. It suggests either a group of victims in poor health and/or a more robust virus.

Rome is expecting up to 2 million pilgrims over the next few weeks. While the chances of spread via this 'clustering' of mourners is really not high, I'd be very careful if I were there. Crowds I've seen so far have been enormous - much crowding & imagine the nightmare if someone just about to break with symptoms dipped their hand/finger into Holy Water and... yeah.

Hoping ProMed has more tonight. WHO only very rarely puts out reports on Sundays.

Thanks Sue.

I had read confusing reports that a pediatrician (maybe Italian) had flown from Angola into Portugal...later reported flown into Italy. Some reported that the Dr. had a suspected case of Marburg, not Marburg, had died even.

The press seems to be having trouble getting clear info.

It was distrubing to read the WHO report that it was NOT an outbreak of Ebola without making any reference to Marburg. It opens up the possibilty that if it is Marburg, WHO thinks they are seeing a new and very deadly strain.

For the rest of the world, here's hoping that the death rate is due to poor medical care and not a new strain.

what about those cases reported in florida a few days ago?

But wait...worst case scenario? Say somebody has this...and alot of us here in the states are notorius for 'riding out colds' till we're half dead...imagine if just one person has this thing...goes to the grocery store, coughs all over the cart, the food, etc. Next person comes along and grabs the same cart. A week or so later, same thing. I'm not in panic mode, but I just don't think it would take much to spread given the way our society is.
By the time its discovered in just one person, many could be infected and think its just a 'flu' that they can ride out at home.
Good info by the way.

Know what you mean

I'll admit to being puzzled when they first said: "NOT Ebola." If anything that was scarier than a positive ID for Ebola because as bad as that is, we more or less know how to contain outbreaks. It raised the possibility of 'something completely different' & my tolerance for new viruses is somewhat lowered lately.

Yes there was a dead Italian doctor, he did die of Marburg, (he was a pediatrician so there's some logic there with mainly kids affected so far), & you've heard more than I've been able to find. Trying to hunt through some Italian media here.

Needless to say, other pretty big media events are ongoing & these outbreaks tend to not get much press until they're really hairy.

It really isn't that easy to catch in the weat. The climate here is not condusive to the virus surviving. Bleach kills it easily & wearing gloves, gowns, masks & face shields covers your butt. We don't tend to personally clean out our loved ones' body orifices when they die & we don't bring extended family in to weep over the body, to kiss them & manually wash & dress the bodies.

I guess the mixed news now is that health care workers are fleeing hospitals. Bad because they're short to start with, good because they often serve as amplification points for such outbreaks.

CFI?

Complete news to me but if you can provide me any sort of reference...?

Yeah, the worst case scenario is always possible. But here's how this plays out. You break with initial symptoms - sudden fever, aching everywhere, much like flu & after 5 days, out comes a rash on the torso. Anything feverish & rashy these days after such initial symptoms gets a million alarm bells going. Believe me, that would be all over the news with very quick info on what to do/not do. Possibly you could get several dozen cases this way - outbreaks seem to begin slowly but after suspicions of a hemmorhagic fever, especially in light of what's happening in Angola, word would be out & ample precsutions taken.

The biggest risk at that point would be to health care workers, especially those drawing blood or doing IVs.

here ya go sis:

[snip]

Now following this blast over this Florida region we can read that a
number of children are in critical condition, and as we can read as
reported by the United States University of Pennsylvania Medical School,
"Fourteen children and three adults who visited agricultural fairs have
been confirmed by state health officials to have developed hemolytic
uremic syndrome from E. coli 0157:H7 infection. Suspicions are pointing
to petting zoos held recently at the Central Florida Fair in Orlando and
at the Florida Strawberry Festival in Plant City. It is possible that
visitors to these events may have come in contact with E. coli 0157:H7.

E. coli 0157:H7 can cause bloody diarrhea and other digestive problems,
such as cramps. Other symptoms may include unexplained bruises or
bleeding around the nose or mouth due to associated thrombocytopenia.
Blood pressure may rise and edema can occur secondary to renal failure."

But not to the E. coli bacteria do these symptoms alone reside, but also
to a strange virus called Marburg, and as we can read, “Symptoms of
Marburg virus: After an incubation period of 5-10 days, the onset of the
disease is sudden and is marked by fever, chills, headache, and myalgia.
Around the fifth day after the onset of symptoms, a maculopapular rash,
most prominent on the trunk (chest, back, stomach), may occur. Nausea,
vomiting, chest pain, a sore throat, abdominal pain, and diarrhea then
may appear. Symptoms become increasingly severe and may include
jaundice, inflammation of the pancreas, severe weight loss, delirium,
shock, liver failure, massive hemorrhaging, and multi-organ
dysfunction.”

The significance in this lies in the fact that not only was the Florida
Region of the United States hit by one of these energy ‘blasts’, but
also the Africa Region of Angola, and to which we can read in this
scientific report titled "Marburg Virus Spread Raising International
Concerns", and which says, "Concerns about Marburg transmission via air
travel were heightened by the death of a passenger returning to Portugal
from Angola. The virus has taken a toll on the population in Uige, the
epicenter of the infections. In the current outbreak in Angola, the case
fatality rate is near 100% and there is no known treatment."


http://www.timebomb2000.com/vb/showthread.php?t=144842&highlight=Marburg

Okay

First, a lot of diseases have such symptoms. Both E coli & Marburg are easily tested for & were it MNarburg, far more distinct symptoms would be showing by now. Actually, more would be dead & others grossly critical.

Secondaly, I can't fathom how energy from such a distance source could be so tightly focused as to only affect specific areas. Was it measured? Actually, I'll check that thread - thanx.

I'll have to do more reading...

Radiation IS a known mutagen & there DOES seem to be a relation between increased solar activity & surges in influenza as well as the more important pandemics. Hoyle has speculated that viruses may come from space but in this case, would radiation 'push' them here? It would seem more likely that radiation may have caused mutations & continue to do so in some pathogens.

Linking the E. coli outbreaks to Marburg is a huge stretch though & I'm far more inclined to think we're seeing simultaneous outbreaks of completely different illnesses. On any given day, new outbreaks of illness occur all over the world - we're simply picking up on & reporting more of them.

Another point about viruses raised in the referenced thread. We ARE finding a surprising number of bacteria/viruses in the upper atmosphere. Is this new? Don't know but if bacteria can grow in solid rock, albeit it at a very slow rate, why not? It might simply be a case of new extremophiles being noted & catalogued. Viruses frozen in ice? Why not? There's a theory about flu encompassing that notion - that old strains may be encased in ice, trapped in the bodies of dead birds. It MIGHT explain why some sea mammals have in recent years, contracted flu. The proof will consist in finding such a bird in melting ice, trying to culture out anything within it & seeing if it can still be 'caught' - if only by cells in a test tube.

WHO downplays Marburg worries

Article first:

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1112404486863_27/?hub=Health


***WHO downplays fears of virus in Angola
Associated Press

GENEVA — 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.***


The numbers are a bit out of date & I'm not sure I'm QUITE so relaxed about it. Certainly filovirus outbreaks can be controlled but doing so in a nation as desperately poor as Angola isn't that easy. While Marburg is USUALLY far less severe than Ebola, that's certainly not the case here. Infecting 4 others on average rather than 10 is only semi-comforting. I can only hope these patients get too sick too fast to have contact with others outside the family & also hope that there is growing awareness of the severe dangers here & that this is being kept in mind as people fall ill.

It's the part about putting people in isolation & tracing their contacts that's the big worry. First you have to FIND the cases. It often has happened in other nations that people 'KNEW' going to hospital was a death sentence. They equated THAT with death rather than the virus itself. So... how to avoid death? Don't tell a doctor or anybody from any health agency. If they don't know about you, they won't haul you off to hospital & your chances of death are lower? alse logic but we've seen it before.

If one of your contacts is your wife who, as you lie in a hospital bed is caring for the family & tending your small farm, are you going to even mention you have a family? The wife will be isolated as will other family members? Who'll work the fields, feed the kids, go to market? Not to mention, terrified neighbours might burn your hut & drive the family off. That's happened.

The biggest problem here, outside the panic engendered by the outbreak as it stands, will be educating people about what to do, what not to do. Most will have had little to do with real doctors & health care & I don't imagine the sight of fat western types in biosuits is going to make any feel the least bit reassured.

"sudden fever, aching everywhere, much like flu & after 5 days, out comes a rash on the torso. Anything feverish & rashy these days after such initial symptoms gets a million alarm bells going".


We just had something similiar here in NC...a couple people I know developed flu like symptoms..the one man had blisters on the palms of his hands, soles of feet, in the mouth and up the nose...they tested him for hand,foot and mouth wasn't that..tested for strep not that either...told him they weren't sure what it was...he did recover but took a while....another one developed blisters on the trunk area and she was told that there was some type of flu going around that had the blisters....it really doesn't seem like the dr's know what is going on...last week another girl I know was supposed to take her daughter to get school physical and the drs. office called and told her not to come in ot the office that there was a flu epidemic in this county...I know ALOT of people are sick.

an article posted to the other marburg thread stated their fear that this marburg had recombined with ebola and that this is the worst global outbreak ever....

canada sue are you a health care provider, physician or nurse?...just wondering....blessings T

Christian for Israel said:

here ya go sis:

[snip]

Now following this blast over this Florida region we can read that a
number of children are in critical condition, and as we can read as
reported by the United States University of Pennsylvania Medical School,
"Fourteen children and three adults who visited agricultural fairs have
been confirmed by state health officials to have developed hemolytic
uremic syndrome from E. coli 0157:H7 infection. Suspicions are pointing
to petting zoos held recently at the Central Florida Fair in Orlando and
at the Florida Strawberry Festival in Plant City. It is possible that
visitors to these events may have come in contact with E. coli 0157:H7.

E. coli 0157:H7 can cause bloody diarrhea and other digestive problems,
such as cramps. Other symptoms may include unexplained bruises or
bleeding around the nose or mouth due to associated thrombocytopenia.
Blood pressure may rise and edema can occur secondary to renal failure."

But not to the E. coli bacteria do these symptoms alone reside, but also
to a strange virus called Marburg, and as we can read, “Symptoms of
Marburg virus: After an incubation period of 5-10 days, the onset of the
disease is sudden and is marked by fever, chills, headache, and myalgia.
Around the fifth day after the onset of symptoms, a maculopapular rash,
most prominent on the trunk (chest, back, stomach), may occur. Nausea,
vomiting, chest pain, a sore throat, abdominal pain, and diarrhea then
may appear. Symptoms become increasingly severe and may include
jaundice, inflammation of the pancreas, severe weight loss, delirium,
shock, liver failure, massive hemorrhaging, and multi-organ
dysfunction.”

The significance in this lies in the fact that not only was the Florida
Region of the United States hit by one of these energy ‘blasts’, but
also the Africa Region of Angola, and to which we can read in this
scientific report titled "Marburg Virus Spread Raising International
Concerns", and which says, "Concerns about Marburg transmission via air
travel were heightened by the death of a passenger returning to Portugal
from Angola. The virus has taken a toll on the population in Uige, the
epicenter of the infections. In the current outbreak in Angola, the case
fatality rate is near 100% and there is no known treatment."


http://www.timebomb2000.com/vb/showthread.php?t=144842&highlight=Marburg

Click to expand...

Ok, did not really know where to put this...here's a snip from an update on the e-coli situation..I don't know how long it would take to culture for results but it sure sounds like they are very puzzled by this illness and its source....blessings T

~~snip ~Florida health officials started investigating the outbreak when several children developed symptoms of hemolytic uremic syndrome, which is usually a result of E. coli. When two cases were confirmed, they learned both children had been to a county fair. By Monday, the state knew of 14 people, including 12 children and two adults, who had tested positive for E. coli and had also attended county fairs or festivals. By Wednesday, they knew of 22 cases, including three children, and another 24 suspect cases.

By Thursday, the number of confirmed cases hadn't changed, but the number of suspect cases was up to 33. Several patients were in critical condition, and all had attended one of three county fairs or festivals.

Most E. coli strains are harmless and live in the intestines of healthy humans and animals. However, E. coli O157:H7 can cause severe illness and can be transmitted through contaminated water, eating undercooked meat or consuming raw milk. But the Florida patients had not eaten similar foods or drunk from the same sources; some had not eaten at the fairs, health officials said. Medical detectives soon zeroed in on the petting zoo as the possible infection source, since the same company supplied animals at all three fairs.

An array of theories

Late last week, health officials said DNA analysis of E. coli samples found that in at least five patients the bacteria were genetically identical, a sign they came from the same source, Agwunobi said. "They got it from the same place is the bottom line," he said. "What's interesting is ... they got it from the same place - but they didn't all attend the same fair.

"The only bridging event at each of these three fairs appears to be a very specific petting zoo," with animals from Ag-Venture Farm Shows of Plant City, Fla., Agwunobi said.

So far, none of Ag-Venture's animals has tested positive for an E. coli strain linked to the human patients, he said. But animals periodically "shed" bacteria, so they may test negative but harbor the illness. Also under investigation is possible contaminated equipment or surfaces, or even a contaminated individual. Agwunobi cautioned, "We don't have a definite link but a strong suspicion," adding later, "This is a working premise."~snip


http://www.newsday.com/news/health/ny-hspet034202004apr03,0,2930598.story?coll=ny-health-headlines

Canada Sue- The implications of what is happening over there are quite sobering. ANY society having only a life expectancy of 37 which simultaneously is subjected to any serious threat to their children is on the brink of becoming utterly wiped from the face of the earth. The few surviving stragglers will migrate to join other viable peoples and be absorbed into an increasingly scrambled genetic pool.

Gee, Africa, a land rich in oil, gold, diamonds, and minerals is increasingly looking like it might be inherited by anyone but Africans. Hmm, nothing to see here.

Ain't, the overall situation

in Africa is appalling to begin with. Talk about a thoroughly raped continent. I do think this outbreak is far from over. They will be throwing everything they can at it but what means 'everything'? Filoviruses aren't something a lot of people want to work around & the toughest part here will be educating people. For this outbreak to be controlled, some very long standing cultural practices will have to be halted until this is over & there will be a lot of resistence. We've seen that in Sudan & Zaire - as it was known at the time.

The fact that gloves, gowns, masks & bleach are just arriving now, coupled with an incubation period of 5-10 days leads me to think that all week, case numbers will be jumping - especially as epidemiologists fan out & start checking out villages & people. Even there, gaining the trust of the people they're speaking with may prove difficult. If village leaders & elders aren't on side - forget it.

msswv123 I was an RN umpteen moons ago but NOT in infectious disease, rather general medical/surgical & a small amount of psych with the military. It was an interest I developed later & I limit it to potential pandemic flu, filoviruses & a few more of the more exotic illnesses. Not nearly enough time to properly keep up with any aspect of any one of these though...

More info at previous marburg thread...



http://www.timebomb2000.com/vb/showthread.php?t=144623&highlight=marburg

Ouch...

reading the reports from the area point out the problems. Blaming the Congolese is... perhaps understandable but inaccurate. There's an obvious lack of knowledge of what this is in Angola which to be fair, has had no experience with Marburg.

Apparently in its last stages, this can be a terrifying illness to witness - certainly some of the first hand accounts I've read would indicate that.

I read the book The Hot Zone by Richard Preston a few years ago. It will certainly open your eyes to this problem. This disease is a species killer if it ever to evolve to the point that it doesn't burn out so quickly. Scary stuff.

Marburg Hemorrhgaic Fever is the 'nice' one of the five known filoviruses with a death rate of between 23-25%.

Click to expand...

And this is the NICE one???

Apparently in its last stages, this can be a terrifying illness to witness - certainly some of the first hand accounts I've read would indicate that.

Click to expand...

I pray for those poor, poor people in Africa and for us as well and hope this doesn't get out of hand unless it's already too late.

Africa ; Angola's Marburg death toll climbs:
2 Hour,19 minutes Ago


[Africa News] Angola's Marburg epidemic has claimed 14 more lives, taking the death toll in the worst recorded outbreak of the virus to 146, the country's health ministry said on Sunday.



While the outbreak has been confined to the northern province of Uige, residents in the capital Luanda were taking no chances as they scrambled for supplies to disinfect their homes, emptying store shelves of household bleach.



"They've literally bought us out. We don't have a single bottle of bleach left," apologised one sales assistant in a small Portuguese-run grocery shop in the teeming city centre.



"People are really scared about catching this horrible disease so they're trying to disinfect everything," said another shop worker in a large supermarket.

Many of the measures the government has promoted to avoid catching the rare hemorrhagic fever involve respecting basic rules of hygiene.


The World Health Organisation (WHO) said on Friday Angola's outbreak was the deadliest ever from the disease, which is related to Ebola.

The previous record was 123 deaths among 149 cases during an epidemic from late 1998-2000 in the neighbouring Democratic Republic of Congo. Most of the victims were gold miners.



The WHO has deployed 20 experts to help combat the viral fever, characterised by headaches, nausea, vomiting and bloody diarrhoea. It is spread through close contact with bodily fluids including saliva and perspiration.

The victims have included an Italian doctor who was treating people with the virus. (Agencies)

http://www.keralanext.com/news/readnext,1.asp?id=172405&pg=2

TerriAnnie, yeah

The various Ebola strains & substrains run from a 'low' 50% mortality rate up to 92%. This Marburg outbreak is closing in on 96% of known cases. THAT falls under slate wiping numbers if this were airborne.

They'd better get this sucker sequenced & FAST. If it hasn't mutated, I'd love to know that. It's easy to conclude conditions in country are leadibng to such a high death rate but Zaire was never a bed of roses to live in either & few Ebola outbreaks have gone over an 88% final death rate. The 90% numbers are generally found within the first few generations of transmission. It seems to weaken after that, thank God.

Martin said:

The WHO has deployed 20 experts to help combat the viral fever, characterised by headaches, nausea, vomiting and bloody diarrhoea. It is spread through close contact with bodily fluids including saliva and perspiration.

Click to expand...

... reconsidering panty-dropping as a Panic response ...

... sweaty palms on the money, the grocery cart, the elevator button ...

... sneezes blowing droplets of saliva into the air ...


Panic Sex Lady recoils ...

Marburg was covered in a book, The Coming Plague, in the early to mid 90's. So the news of how dread this disease is really insn't news to the powers that be in the US, or anywhere else for that matter. Says a lot about us world power folks that nothing was done about it way back when because it was only in isolated corners of the world. So what if those poor, ignorant, and politically unimportant people died?

But now that this thing threatens to go global, boy!, just look at the dust fly!

Reposting this article from another thread so it did not get lost in the shuffle~..blessings T

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/Marburg_Recombinant.html

That's not entirely fair

they've tried to 'do something about it' for a long time. The site of infection - or suspected site of infection - of 2 patients - Kitum Cave on Mount Elgon in Kenya was sampled to the max - sentinal animals & insects left there, everything nearby trapped & sampled &... nothing. We have not idea where this virus lives when it's not scaring us to death in outbreaks, bad movies & books.

As part of every outbreak, a frustrating amount of time/resources are spent trying to figure out where the filoviruses hang out - nothing. We know where to find them geographically only because of outbreaks which have occurred. But hosts, reservoirs? It's still a complete mystery.

People have been reported to be arouind bats, have had insect bites, scratches, yet HOW it gets into humans is unknown. By the time we learn of outbreaks, the index case is often weeks or even months in the past so if there's a connection between more than 1 species & man, we haven't figured it out. Viruses don't have cycles such as malaria parasites or others do where several species are involved - not that we know of but it can't be ruled out.

The host can't be species which are sickened by it, so that lets out primates & some rodents. A recent article shares a finding that Ebola antibodies have been found in dogs in areas where Ebola is known to occur. Does this mean canines were never tested? Or perhaps tested in the wrong places at the wrong times? Do they get ill or transmit the virus to humans or should we look at them simply as sentinals? So many questions...

Helen - those who've recovered from Ebola have been known to shed virus in sperm for weeks. This is not a suitable candidate with which to justify panic sex... unless Johnson & Johsnson makes biohazard suits for johnsons...

Gabon issues maximum alert against Marburg


Libreville, Gabon,04/03 - The ministerial council in Gabon has placed the epidemiological surveillance services on maximum alert" since Thursday throughout the country following reports that Marburg virus recently killed over 100 persons in Angola.

Marburg virus, which was once reported in Zimbabwe, Kenya and DR Congo, was identified in 1967 when laboratory workers in Germany and in Yugoslavia developed an acute viral bleeding fever after being in contact with green monkeys imported from Uganda.

The virus reappeared in 1975 when it struck a traveller reportedly exposed to it in Zimbabwe, infecting in turn his companion as well a nurse who treated him in South Africa.

The traveller died of the disease, but his companion as well as the nurse survived from it.

As for the Ebola bleeding fever, epidemic experts had to stop traditional practices such as ritual bathing of corpses, which is reported to fuel the spread of the yet uncontrolled epidemic in Angola.

The Ebola bleeding fever has killed about thirty people in the northeastern Gabonese locality of Mékambo and in villages along the border with Congo since it struck in December 2002.

Ebola was identified in Gabon for the first time in 1994, followed by explosions of fever in February and July 1996 that killed 86 people.

The Ebola virus is still among those under tight surveillance in Central Africa and especially in Gabon. Since 1976 when the Ebola virus struck for the first time, the virus has appeared as mysteriously as regularly in central Africa



http://www.angolapress-angop.ao/noticia-e.asp?ID=330532

bump for the evening shift.

Title : Fear stalks Angolan capital, as Ebola-like bug marches on
By :
Date : 04 April 2005 0456 hrs (SST)
URL : http://www.channelnewsasia.com/stories/health/view/140775/1/.html


LUANDA : Fear was stalking the streets of the Angolan capital Luanda as the deadly Ebola-like Marburg virus rampaging through northern provinces moved closer to the city despite frantic efforts by authorities and international experts to contain it.

"Up until now, a 145 people died out of 154 taken ill," vice health minister Jose Van Dunem told AFP late Saturday, adding "fortunately we have had no new cases reported in Luanda."

All fatalities and those who have been taken ill were from Uige province, the epicentre of the outbreak some 300 kilometres (180 miles) northeast of this seaboard capital.

The official death toll stood at 126 on Thursday, making it the worst ever recorded outbreak of the disease, for which there is no known cure.

Field teams which included experts from the World Health Organisation and Medecins Sans Frontieres (Doctors Without Borders) have been deployed to inform people and look for suspected cases around Uige, the WHO's representative in Angola said.

"We have now started to deploy teams in the problem area (in Uige), we can get a real sense of the depth and the width of the problem," said Fatoumata Diallo.

Asked how serious the problem was, Diallo said: "it's important to realise that Marburg is very new for us. It is serious since it is not well known."

"It is a threat because its symptoms are not well known. It has symptoms similar to malaria, amoebic dysentry or TB, making it difficult to identify," she said.

"In Uige the conditions are starting to change with the isolation and the treatment of the patients that the teams are looking after on the ground," said Quila Godi, of the provincial health department.

"The situation is close to improving," he told AFP by phone from Uige.

But in Luanda, where an Italian doctor, a 15-year-old boy and another man -- all of whom had been to Uige -- died of the disease earlier, emergency measures have been put into place.

Even security guards at Luanda's main Josina Machel Hospital were decked out in protective theatre clothing, wearing face masks, surgical coats and rubber gloves.

"Be alert to the Marburg haemorrhagic fever. No unauthorised persons allowed inside," read a sign, written in Portuguese on the doors to the entrance to the hospital's emergency section.

On national radio, a message accompanied by dramatic music declares every 10 minutes or so: "Alert, Marburg. Don't touch any corpse. Inform the health authorities about any suspicious illnesses or death due to bleeding."

But fear was still palpable in the streets of Angola's premier port city, a day ahead of the third anniversary of the ceasefire which ended a bloody 27-year-long civil war.

"Everybody is afraid of this virus. We don't know what it will do to us," said Antonio, a young Angolan garage worker living in the capital.

"We are being told what it is, but I don't think it is enough," he told AFP.

Reports here said shops were running out of household bleach, which locals were adding to their water supply, while parents were reportedly keeping their children out of school for fear of them contracting Marburg.

A severe form of haemorrhagic fever akin to Ebola, the Marburg virus spreads on contact with body fluids such as blood, urine, excrement, vomit and saliva.

The Marburg outbreak has claimed a record number of lives, overtaking an earlier peak in the Democratic Republic of Congo (DRC), Angola's neighbour.

Diallo said the WHO could not say when the virus would be brought under control.

"This is not like a football game. This is a virus, we don't know what the response of our measures will be, but we have really mobilised everybody and are working hand-in-hand with the Angolan government," she told AFP.

Marburg virus claims 20 lives in three days

April 04 2005 at 12:24PM

Luanda - An outbreak of the deadly Ebola-like Marburg virus has intensified in Angola, claiming more than 20 lives over the past three days and taking the nationwide toll to 150, early on Monday.

"In total we have registered 163 cases among them 150 dead," Angola's vice health minister Jose Van-Dunem said late on Sunday.

"A fourth person has died in Luanda, but all of them came from the province of Uige", the epicentre of the outbreak about 300km north of the coastal capital.

The official toll had stood at 130 on Friday.

A combined statement by the World Health Organisation and the Angolan government meanwhile said 80 percent of the cases involved children under 15.




A severe haemorrhagic fever akin to Ebola, the Marburg virus spreads on contact with body fluids such as blood, urine, excrement, vomit and saliva.

The disease was first identified in 1967 in Germany after laboratory workers were infected by monkeys from Uganda.

The Marburg outbreak has claimed a record number of lives in Angola, overtaking an earlier peak in the neighbouring Democratic Republic of Congo. - AFP



http://www.iol.co.za/index.php?set_id=1&click_id=84&art_id=qw1112602862695A524

Marburg haemorrhagic fever, Angola - 163 cases, 150 fatal
05 Apr 2005

As of 2 April, the Ministry of Health, Angola has reported 163 cases of Marburg haemorrhagic fever. Of these, 150 have been fatal. Cases have been identified in Uige, Luanda, Cabinda, Malange, and Kuanza Norte provinces. Uige remains the epicentre of the outbreak. To date, all cases detected in other provinces are thought to have originated in Uige.

Five mobile surveillance teams in Uige continue to investigate rumours and search for additional cases. More than 100 contacts are being followed up.

WHO is working with the Ministry of Health to finalize a national plan of action for control of the outbreak, including sustained technical and operational support from WHO and international partners in GOARN. WHO anticipates that implementation of this plan will require significant assistance from the international community.

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=22288

China takes preventive action against deadly Marburg disease

www.chinaview.cn 2005-04-05 00:30:13


　 　BEIJING, April 4 (Xinhuanet) -- China on Monday took action to prevent a deadly outbreak of Marburg virus in Angola from entering the country.

The State Administration of Quality Supervision, Inspection andQuarantine (AQSIQ) has issued a notice requesting all local quarantine departments to strengthen checks on tourists from Angola.

If local quarantine departments spot confirmed or suspected Marburg cases, they should set up a special isolation ward for the carriers and treat their articles carefully, said the notice.

Tourists from Angola, if experiencing bellyaches, diarrhea, eruption and related phenomena, should report to the local quarantine departments, according to the notice.

The notice also required China's International Travel Healthcare Center and local quarantine departments to provide adequate information about the virus to Chinese citizens who plan to travel to Angola.

The World Health Organization said that as of the end of March 23, Angola had reported 102 cases of Marburg virus infection, of which 95 have been fatal. There is no vaccination for the virus oreffective medicine to cure the disease, said AQSIQ. Enditem

http://news.xinhuanet.com/english/2005-04/05/content_2786318.htm

Here's something about Marburg & bioweapons:

http://cryptome.org/bioweap.htm

Don't Be surprised if it shows up in India and Belgium

Oh @@@@! Just read through these articles, and am seeing the death tolls, which are very high. Their water supplies may not be as sanitary as ours, and I don't know about the exact quality of their medical care. Could some of these factors account for the high death tolls?

suzy

Martin said:

Africa ; Angola's Marburg death toll climbs:
2 Hour,19 minutes Ago



"They've literally bought us out. We don't have a single bottle of bleach left," apologised one sales assistant in a small Portuguese-run grocery shop in the teeming city centre.

Click to expand...

Just the reason my B/F and I keep not only a case or so of bleach on hand but a bottle on pool chlorine...actually hot tub chlorine...I forget how many gallons that little bottle will make but it is easy to carry and will last quite a while.

If ANYTHING breaks out here expect the shelves to empty of as disinfectants pretty rapidly.

Dark

Commentary

Marburg Fatality Rate Above 99% - Case Count Accelerates to 175

Recombinomics Commentary
April 5, 2005

The Red Cross monthly breakdown of cases and deaths indicate that the case fatality rate for Marburg was greater than 99% at the end of March. For the first four months of the outbreak (Oct 2004 - January 2005), there were 34 cases and 34 deaths for a case fatality rate of 100%.

In the month of February there were 31 cases and 30 deaths. It is not clear if the 1 person alive was discharged or still in the hospital when the table was compiled. There is no column for discharged patients, possibly because there were none.

In the month of March there were 53 cases in Uige and 22 more cases in other provinces. 68 of these 75 patients had died. However, at the end of March media reports described 7 newly admitted cases, accounting for the 7 patients listed as alive. Thus, there was no outcome yet for those 7. Therefore, for known outcomes, assuming the February patient was discharged, there were 132 deaths among the 133 outcomes for a case fatality ratio of 99.3 %. If the patient from February has not been discharged, the fatality rate is 100%.

The data also show the dramatic increase in the number of monthly cases. In January there were 20, 31 in February, and 75 in March.

However, the case count is growing even faster in April with 35 cases in the first four days.

http://www.recombinomics.com/News/04050508/Marburg_Rate_Accelerates.html

Angola virus workers 'need masks'
Health workers in the Angolan capital, Luanda, are complaining of not having enough protective clothing to combat the deadly Marburg virus.

They say there is a serious shortfall of goggles, face masks and headgear.

The death toll has now risen to 155 people, from a total of 175 cases, the country's health ministry has said.

The outbreak, which began in October in Uige province, is the most serious ever recorded of the virus - which is spread through contact with bodily fluids.

The virus is a fast-spreading haemorrhagic fever related to Ebola and causes headaches, nausea, vomiting and bloody diarrhoea.

New campaign

The government is stepping up a public awareness campaign toinform health workers and the population at large about the disease.

Many people say hospital is the last place they would go to if they fell ill, because they fear they could pick up the deadly virus there, reports BBC correspondent Zoe Eisenstein in Luanda.



But specialists say this attitude could help the disease spread.

A nationwide campaign specifically targeting health workers and children is being launched this week.

Most of the victims are children - and the UN children's agency Unicef says vast resources are being put into fighting the outbreak.

"If I look to the mobilisation of technical resources, of a lot of brains that came here and the energy that the ministry is putting into that fight, I'm very confident that it will succeed in the end," Unicef representative Mario Ferrari told the BBC.

Several countries have taken measures to try to halt the spread of the virus.

But there is still a long way before this outbreak of Marburg can be stamped out, our correspondent says.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/africa/4413651.stm

ProMED-AHEAD Digest Wednesday, April 6 2005 Volume 2005 : Number 092

----------------------------------------------------------------------

Date: Wed, 6 Apr 2005 19:46:46 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Marburg hemorrhagic fever - Angola (18)

MARBURG HEMORRHAGIC FEVER - ANGOLA (18)
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Tue 5 Apr 2005
From: ProMED-mail <promed@promedmail.org>
Source: National Geographic, Tue 5 Apr 2005 [edited]
<http://news.nationalgeographic.com/news/2005/04/0405_050405_marburgangola.html>


Angola: Marburg outbreak is deadliest on record
- -----------------------------------------------
An outbreak of Marburg hemorrhagic fever had killed at least 150 people in
Angola as of yesterday [Mon 4 Apr 2005], making it the deadliest outbreak
of the rare Marburg virus infection ever recorded. Scientists are puzzled
by the epidemic's remarkably high fatality rate. So far, the Angolan
Ministry of Health has reported 163 cases of the hemorrhagic fever, putting
the fatality rate at around 90 percent. In previous outbreaks, the disease
has had a fatality rate as low as 25 percent. This time, at least 75
percent of the victims have been children under the age of 5. "This is
something we haven't seen in previous Marburg outbreaks," said David
Daigle, a spokesperson for the infectious disease program at the U.S.
Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

There is no known cure for the virus, which spreads on contact with body
fluids such as blood, urine, excrement, vomit, and saliva. Symptoms include
diarrhea, stomach pains, nausea, and vomiting, which give way to bleeding.
Efforts at containing the Angolan epidemic have been complicated by the
country's poor health care system. Officials worry that the epidemic will
spread from its epicenter in the remote, northern Uige province to more
densely populated areas. So far, 2 deaths have been confirmed in Luanda,
the Angolan capital, according to Dick Thompson, the spokesperson for the
World Health Organization (WHO) in Geneva, Switzerland.

Marburg virus was named after the German town where it was 1st identified
in 1967, when monkeys, imported from Uganda, infected laboratory workers.
Before the current epidemic in Angola, the worst Marburg outbreak occurred
between 1998 and 2000 in the neighboring Democratic Republic of Congo,
where it killed 123 people. That was also the last known outbreak until the
latest flare-up.

Marburg is a relative of Ebola (both viruses are in the family
_Filoviridae_), and Marburg is believed to primarily inhabit countries in
East and Central Africa. The current outbreak marks the 1st time the virus
has struck Angola, which is in southwestern Africa. There are at least 4
different strains of Ebola virus, with different degrees of lethality,
ranging from 50 to 90 percent. Although no separate strains of Marburg
virus have been identified, experts speculate that a particularly virulent
strain of the virus could be behind the Angolan outbreak. "Indeed, there
could be different pathotypes [degrees of virulence] of Marburg virus,"
said Fred Murphy, a virologist at the University of California in Davis.
But, he added, "when you see the pathology of human infections caused by
Ebola virus or Marburg virus, the question becomes: How does anyone
survive? The infection is devastating and rapid with extreme damage to key
tissues."

But some scientists suggest that the lethality of the virus may be due to
the overreaction of the innate human immune system -- our 1st line of
defense -- rather than the virus itself. "Any virus worth its salt causes
as little damage as possible to its host," said David Sanders, a biologist
and Ebola virus expert at Purdue University in West Lafayette, Indiana. "We
run around with viruses all the time. [They are] adapted to us and in
equilibrium with our immune system, which doesn't get too aggressive about
trying to eliminate them." Sanders suggests that when a new virus, such as
Marburg virus, enters humans, it may provoke an overreaction of our innate
immune system, which in turn causes harm to the body. "Humans are not a
natural host of this virus, so [the virus] wouldn't have evolved to provoke
this response," he said. "Instead, it may be that the immune system
responds inappropriately."

The theory does not explain why most of the victims in the Angolan outbreak
have been children. While the innate immune system is, as the name implies,
present from an early age, the adaptive immune system develops slowly. "I
would hypothesize that an inappropriate response is responsible for the
pathology, while an appropriate response can allow one to survive," Sanders
said. "Stopping viral multiplication can reduce the triggering of the
harmful reaction."

There is also the possibility of a difference in the susceptibility of
individuals due to general health status and nutrition, scientists say.
Angola is one of the poorest countries in the world. Its infrastructure was
wrecked by a 2-decade civil war that ended in 2002. Sanitation facilities
are inadequate or non-existent, and hospitals are understaffed and poorly
equipped. The prospect of the virus gaining a foothold in Luanda -- almost
4 million people live in the Angolan capital -- is ominous. "The 1st thing
that comes to mind is the international airport," said Daigle, the CDC
spokesman. "We saw with SARS how fast it was able to spread to Canada and
other countries once people started getting on planes."

Containing an outbreak is more difficult in a densely populated area where
people are crowded together. The virus has the potential to rapidly spread
to other people, especially health-care staff and family members who care
for patients. At Americo Boa Vida, Angola's largest hospital on the
outskirts of Luanda, a special isolation ward has been created to treat
incoming cases from around the country. Volunteer workers have been
outfitted with special suits to work as cleaners and washers. "The
practices needed to contain the virus in the hospital setting are rather
simple and can be quickly introduced by international teams," Murphy, the
UC Davis virologist, said. A team of CDC scientists will arrive in Angola
this week [2nd week April 2005] to assist WHO officials already there with
outbreak investigation, infection control, and laboratory diagnosis. "Our
guys are very anxious to get on the ground and start doing some testing and
contact-tracing to find out if this is a case of an unusually high fatality
rate, or if we're just not able to track all those who are sick," Daigle said.

The outbreak also presents a valuable opportunity for scientists to learn
more about the virus. Scientists don't know the environmental reservoir for
either Marburg virus or Ebola virus. (A reservoir is where a virus hides
between outbreaks.) But most experts believe the 2 viruses share the same
host. "We got some evidence, but not conclusive, that bats may have been
the source of the Marburg outbreak in the mining village of Durba in the
Congo," said Bob Swanepoel, who heads the Special Pathogens Unit at the
National Institute for Communicable Diseases in Sandringham, South Africa.
"Genetic evidence of the virus was found in cave-dwelling bats in the mine
where primary human cases arose, but we were not able to isolate live
viruses from bats, and the outbreak stopped when the mine flooded," he said.

[Byline: Stefan Lovgren]

- --
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Wed 6 Apr 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Australian Broadcasting Corporation online, Wed 6 Apr 2005 [edited]
<http://www.abc.net.au/news/newsitems/200504/s1339373.htm>


Angola: new suspected Marburg case in township near Luanda
- -----------------------------------------------
Angolan health workers in a slum outside Luanda were treating a new
suspected case of Marburg virus infection, as a senior United Nations
official warned that the outbreak of the Ebola-like epidemic was not yet
under control. Nurses at a clinic in the township of Cacuaco, some 18 km
north of the capital, were scrambling to help the 22-year-old woman, who,
they feared, may be the latest casualty of the hemorrhagic fever that has,
so far, claimed 156 lives in the biggest outbreak ever of the disease,
which has spread to a 5th province.

"We have a suspected case of Marburg virus infection; she arrived here an
hour ago complaining of a fever and anal bleeding," clinic administrator
Analdina Chivukuvuku said. "She is bleeding quite badly," she told Agence
France Presse (AFP) at the clinic, one of 3 that serve the township with a
population of some 613 000 residents on the Atlantic coast's Baia do Bengo.
"Maybe it's a case of typhoid or a parasitic illness, but, at the moment,
we don't know; we have alerted the authorities in Luanda," she said.

Nurses were putting a drip into the young woman, whose legs and feet were
covered in blood. They wore only face masks and rubber gloves and said they
feared the virus because of a lack of proper protection. "Before the
Marburg alert, we worked only in a simple blouse. Now we have received
paper face masks and rubber gloves, but it is not sufficient to protect the
149 staff working here," she said.

The Angolan government has started an awareness campaign featuring radio
broadcasts warning: "Alert, Marburg; don't touch any corpse; inform the
health authorities about any suspicious illnesses or death due to
bleeding." But, despite a dramatic rise in the death toll in the last 4
days -- some 29 people have died between Thursday and Monday [31 Mar - 4
Apr 2005] -- there has been almost no mention of the virus in the
state-controlled print media.

- --
ProMED-mail
<promed@promedmail.org>

******
[3]
Date: Wed 6 Apr 2005
From: Felicia Nutter <felicia_nutter@hotmail.com>
Source: UN Office for the Coordination of Humanitarian Affairs, Integrated
Regional Information Network (IRIN), Wed 6 Apr 2005 [edited]
<http://www.irinnews.org>


Angola: life goes on at epicenter of the Marburg outbreak
- -----------------------------------------------
Residents of Angola's northern Uige province, the epicenter of a
hemorrhagic fever outbreak that has killed more than 150 people, are trying
as best they can to get on with their lives, despite living under the
shadow of the epidemic. Teca Garcia, the resident program officer in Uige
for the UN Children's Fund (UNICEF), told IRIN that the horror that had
enveloped the provincial capital in the days after Marburg virus was
identified had eased, as the local population learned more about the
[virus]. "There is still a lot of fear among the people, but the panic has
to some extent passed, thanks to the social mobilization officers getting
information to the people," he said in a telephone interview from the
provincial capital, also called Uige.

"There are people in the streets, in shops and at work; they are walking
around; they are very quiet, but they are going about their daily lives,"
he said. Terrified that they might catch the disease just by breathing the
Uige air, some residents had taken to wearing masks, fueling the atmosphere
of panic. But Garcia said this alarmist behavior had stopped after
intensive campaigns to spell out the exact facts of the disease: how it is
spread, and how to prevent contamination. "The masks are now confined to
the hospital. People are not wandering around the streets wearing them;
this is not the situation," he said.

With the challenge now to actively survey the municipalities for cases of
the disease and corpses, it was common to see those in charge of
surveillance and removing bodies wearing masks, gloves and protective
suits. But these workers were moving discreetly from their vehicles to
hospitals and morgues and not parading through the town, Garcia said.

The Angolan epidemic, which has steadily escalated since October 2004, is
the world's worst, with 156 deaths from 181 cases. The previous record was
in the neighboring Democratic Republic of Congo, where an outbreak in
1998-2000 claimed 123 lives. Garcia said the efforts to educate Uige's
population had proved effective, but much more needed to be done. Conveying
the hard facts of the disease, while remaining sensitive to traditional
customs, burial rights and even views on witchcraft, required a delicate
balance. "We need more people on the ground to talk to everyone; to provide
information to the people in all 16 municipalities of Uige," Garcia said.

UNICEF's country representative, Mario Ferrari, said earlier this week [2nd
week April 2005] that his agency was spearheading a nationwide poster,
pamphlet, TV and radio campaign to inform the Angolan public at large about
the virus, its symptoms and prevention methods. Garcia and his UNICEF
colleagues in Uige, who assist the social mobilization units by collecting
and providing information from various communities in the area, are also
taking their own personal precautions, in line with the stringent health
and hygiene guidelines laid down by the Angolan Ministry of Health and the
World Health Organization. "We are taking special care with the preparation
of food, and we are [chlorine-treating] our water for drinking, washing and
household cleaning. We're not wearing protective clothing, because we don't
go into the isolation ward, but we are doubling our hygiene efforts," he said.

UN staff in the province have also been told to avoid physical contact with
people in general, particularly those in health facilities. For Garcia, who
is still extremely concerned about the situation, working in Uige during
this difficult time is tough, tiring and stressful. "Personally speaking,
we [humanitarian workers] have all had to adapt to the situation, and we
also feel a lot better now that we are well-informed of the facts," he
said. "I'm coping now with the situation. Now is not the right time to
leave Uige; our work is crucial to helping other actors in the field."

- --
Felicia B. Nutter, DVM
Regional Field Veterinarian
Mountain Gorilla Veterinary Project
BP 105
Ruhengeri, Rwanda
<felicia_nutter@hotmail.com>

[While it is useful to describe Marburg virus as "Ebola-like," because both
viruses are members of the family _Filoviridae_, it obscures the fact that
the 2 viruses are distinctly different in biological and physical terms and
that there is little if any antigenic cross-reactivity. The Ebola viruses
are a heterogenous group, such that the International Committee on Taxonomy
of Viruses (ICTV) in its 7th Report, published as "Virus Taxonomy" by
Academic Press in 2000, recognized 13 distinct strains grouped into 4
distinct virus species. By contrast, the 6 isolates of Marburg virus that
have been characterized (Ratayczak, West Germany, 1967; Popp, West Germany
1967; Voege, Yugoslavia 1967; Ozolin, Zimbabwe, 1975; Musoke, Kenya, 1980;
Ravn, Kenya, 1987) show remarkably little variation and are grouped as a
single virus species. The Ebola virion is about 970 nm in length, whereas
the Marburg virion is about 790 nm in length. The genomes of the 2 virus
species differ slightly in size, and the Ebola virus genome has several
gene overlaps, in contrast to the single overlap of Marburg virus. - Mod.CP]

[see also:
Marburg hemorrhagic fever - Angola (17): S. Afr. c... 20050405.0984
Marburg hemorrhagic fever - Angola (16) 20050404.0972
Marburg hemorrhagic fever - Angola (15) 20050404.0969
Marburg hemorrhagic fever - Angola (14) 20050403.0961
Marburg hemorrhagic fever - Angola (13) 20050402.0951
Marburg hemorrhagic fever - Angola (12) 20050401.0939
Marburg hemorrhagic fever - Angola (11): age distribution 20050331.0935
Marburg hemorrhagic fever - Angola (10) 20050331.0934
Marburg hemorrhagic fever - Angola (09) 20050330.0919
Marburg hemorrhagic fever - Angola (08) 20050329.0911
Marburg hemorrhagic fever - Angola (07): RFI 20050328.0902
Marburg hemorrhagic fever - Angola (06) 20050328.0893
Marburg hemorrhagic fever - Angola (05) 20050326.0874
Marburg hemorrhagic fever - Angola (04) 20050325.0862
Marburg hemorrhagic fever - Angola (03) 20050324.0849
Marburg Hemorrhagic fever - Angola: confirmed (02) 20050323.0837
Marburg Hemorrhagic fever - Angola: confirmed 20050322.0831
Undiagnosed hemorrhagic fever - Angola: RFI 20050315.0751
Undiagnosed hemorrhagic fever - Angola (02) 20050317.0780
Undiagnosed hemorrhagic fever - Angola (03) 20050318.0791
Undiagnosed hemorrhagic fever - Angola (04) 20050321.0820
Undiagnosed hemorrhagic fever - Angola (05) 20050322.0827
Marburg hemorrhagic fever - Angola (07): RFI 20050328.0902
2001
- ----
Undiagnosed deaths, hospital - Angola (Luanda): RFI 20010121.0165
Marburg hemorrhagic fever, 1967 to the present 20010207.0242
Hemorrhagic fever - Congo, DR 20010105.0034
Hemorrhagic fever - Congo, DR (03) 20010107.0056
2000
- ----
Marburg hemorrhagic fever - Congo, DR 20000212.0194
Marburg hemorrhagic fever - Congo, DR (06) 20000331.0477
Marburg hemorrhagic fever - Congo, DR: confirmation 20000506.0697
1999
- ----
Marburg hemorrhagic fever - Congo, DR 19990915.1641
Marburg hemorrhagic fever - Congo, DR (04) 19991209.2137
1995
- ----
Ebola - Africa 19951221.1305
Ebola - Angola? 19951215.1256]
....................mpp/cp/msp/dk

------------------------------

Date: Wed, 6 Apr 2005 19:52:51 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Avian influenza, human - East Asia (66): Viet Nam

AVIAN INFLUENZA, HUMAN - EAST ASIA (66): VIET NAM
***********************************************
ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Wed 6 Apr 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: BBC News Online, Wed 6 Apr 2005 [edited]
<http://news.bbc.co.uk/2/hi/asia-pacific/4415231.stm>


Viet Nam: 10-year-old Vietnamese girl becomes 50th death
- -----------------------------------------------
A 10-year-old Vietnamese girl is reported to have died from avian
influenza, local health officials say. The girl, who lived in Hanoi, is
believed to be the 50th recorded death from the virus in Asia since the
latest outbreak hit in January 2004. Viet Nam has seen 36 of those deaths,
while Thailand has lost 12 people and Cambodia 2. The 10-year-old girl died
on 27 Mar 2005 in St. Paul's Hospital in Hanoi, a local doctor told
reporters on condition of anonymity. He said test results by the National
Institute of Hygiene and Epidemiology were released on Mon 4 Apr 2005.

The government last week [1st week April 2005] announced a nationwide
clean-up of poultry farms to try to stop the spread of bird flu. The
Ministry of Health said that large commercial operations and small local
farms in every village in Viet Nam would be disinfected. North Korea is the
most recent addition to the list of Asian countries hit by avian influenza.
But its poultry have been infected with the H7 strain of avian influenza
virus, which is less deadly to humans. The strain that has decimated
poultry stocks and caused recent human deaths in Cambodia, Thailand and
Viet Nam is the more virulent H5N1 strain.

- --
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Wed 6 Apr 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Malaysia Star online, Associated Press report, Wed 6 Apr 2005 [edited]
<http://thestar.com.my/news/story.asp?file=/2005/4/6/latest/20050406141405&sec=latest>


Viet Nam: 2 additional deaths confirmed; total now 50
- -----------------------------------------------
Asia's [human] death toll from avian influenza rose to 50 on Wed 6 Apr
2005, when Vietnamese health officials and a hospital doctor confirmed 2
additional deaths in Viet Nam. A 10-year-old girl, who tested positive for
the H5N1 virus, died of lung failure hours after she was admitted to St.
Paul's Hospital in Hanoi on 27 Mar 2005, a hospital doctor said on
condition of anonymity. Test results by the National Institute of Hygiene
and Epidemiology were released on Monday [4 Apr 2005], the doctor said. In
addition, Viet Nam's Health Ministry confirmed one other previously
unreported death, though officials there gave no details about when the
patient died, where the patient was from, or age and gender.

Viet Nam has reported a total of 16 deaths from avian influenza since the
country's latest outbreak began in late December 2004. Since a severe stain
of the disease started surging through poultry farms in Asia in December
2003, a total of 50 people have died in the region, 36 from Viet Nam, 12
from Thailand and 2 from Cambodia.

- --
ProMED-mail
<promed@promedmail.org>

******
[3]
Date: Wed 6 Apr 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Bloomburg.com News, Wed 6 Apr 2005 [edited]
<http://www.bloomberg.com/apps/news?pid=10000080&sid=a0oeK3MR8vMs&refer=asia>


Viet Nam: death of hospital doctor still under investigation
- -----------------------------------------------
Another human fatality in Viet Nam has been attributed to avian influenza,
while health officials investigate the death last weekend [Sun 3 Apr 2005]
of a doctor who worked in a hospital where avian influenza patients have
been treated. Test results showed that a 10-year-old girl, who died on 27
Mar 2005 in a hospital in the Vietnamese capital of Hanoi, was infected
with the H5N1 avian influenza virus, according to Le Van Diem, director of
St. Paul's Hospital in Hanoi. The girl is the 16th Vietnamese, at least, to
have died from avian influenza since December 2004.

A male doctor, who worked at the Viet Nam-Sweden hospital in Uong Bi in
northern Viet Nam's Quang Ninh province, died on Sun 3 Apr 2005, 2 days
after falling ill at work, the Tien Phong newspaper reported yesterday [Tue
5 Apr 2005]. Tests for the H5N1 virus are being performed on samples from
the doctor, said Pham Ngoc Dinh, deputy director of Viet Nam's National
Institute of Hygiene and Epidemiology. If the doctor's samples test
positive for avian influenza, it would mark the 2nd known case of avian
influenza in a health-care worker. A male nurse from the northern province
of Thai Binh tested positive for the H5N1 virus last month [March 2005].

"Suspicions that human-to-human transmission may have taken place usually
arise when cases occur close together in time and place among persons, such
as family members or health-care workers, known to have [had] close contact
with a case," the WHO stated in a January 2005 report on avian influenza to
its executive board. 2 patients who have received treatment at the Viet
Nam-Sweden hospital in Quang Ninh province have also tested positive for
the H5N1 virus, while a 3rd patient is classified as a suspected case,
according to Le Quang Dang, deputy director of the Quang Ninh provincial
health department. 2 of the 3 Quang Ninh patient cases are now hospitalized
in Hanoi, he said. At least 2 of the 3 patients were known to have had
contact with poultry, while the deceased doctor had no known contact with
poultry, Dang said. The doctor was also not known to have had contact with
any of the 3 patients, he said. "He worked in a different ward," Dang said.
"We don't think there's any connection between the doctor's case and the
cases of these 5 other people."

- --
ProMED-mail
<promed@promedmail.org>

[The male doctor who is one of the subjects of these reports appears to be
the same doctor who was being investigated as a suspected case of SARS in
the previous post; see: Avian influenza, human - East Asia (65): Viet Nam
20050405.0985. Clarification is still awaited. - Mod.CP]

[see also:
Avian influenza, human - East Asia (40): Viet Nam 20050301.0633
Avian influenza, human - East Asia (41): Viet Nam 20050302.0647
Avian influenza, human - East Asia (42): Viet Nam 20050307.0682
Avian influenza, human - East Asia (43): Viet Nam 20050307.0683
Avian influenza, human - East Asia (44): Viet Nam 20050309.0697
Avian influenza, human - East Asia (45): Viet Nam 20050310.0712
Avian influenza, human - East Asia (46): Viet Nam 20050311.0718
Avian influenza, human - East Asia (47): Viet Nam 20050312.0733
Avian influenza, human - East Asia (48): Viet Nam 20050314.0743
Avian influenza, human - East Asia (49): Viet Nam 20050314.0747
Avian influenza, human - East Asia (50): death rate 20050315.0753
Avian influenza, human - East Asia (51): death rate 20050317.0773
Avian influenza, human - East Asia (51): treatment 20050316.0765
Avian influenza, human - East Asia (53): Viet Nam 20050320.0813
Avian Influenza, Human - East Asia (54): Viet Nam 20050322.0826
Avian influenza, human - East Asia (55): Viet Nam 20050323.0839
Avian Influenza, human - East Asia (56): Cambodia 20050325.0867
Avian influenza, human - East Asia (57): Viet Nam 20050324.0850
Avian influenza, human - East Asia (58): Viet Nam 20050325.0871
Avian influenza, human - East Asia (59): CDC guide... 20050328.0892
Avian influenza, human - East Asia (60): Viet Nam 20050328.0897
Avian influenza, human - East Asia (61): Viet Nam 20050329.0909
Avian influenza, human - East Asia (62): Viet Nam & Cambodia 20050330.0916
Avian influenza, human - East Asia (63): Viet Nam 20050402.0953
Avian influenza, human - East Asia (64): Viet Nam 20050404.0971
Avian influenza, human - East Asia (65): Viet Nam 20050405.0985]
........................cp/msp/dk

------------------------------

End of ProMED-AHEAD Digest V2005 #92
************************************

Bio-Suits, Fear at Centre of Angola Marburg Outbreak



LUANDA - Swathed head-to-toe in protective medical gear, doctors fighting Angola's deadly Marburg virus swelter in an isolation unit at the epicentre of the worst-ever outbreak of the deadly disease.
"These are difficult working conditions, especially with the heat," Monica Castellarnau, Medecins Sans Frontieres (MSF) emergency coordinator for the outbreak, said by telephone from Uige, about 225 km (140 miles) miles north of the capital Luanda.

"They must have short shifts, usually every three hours they have a break," she said on Wednesday. "The hardest thing for the medical people is their feeling of helplessness. They know there is no cure for the disease."

So far at least 156 people have died of the disease in Angola. The previous record was 123 deaths during a 1998-2000 epidemic in the Democratic Republic of Congo.

Doctors and nurses treating Marburg patients can offer little beyond treatment to ease the pain -- and even that is limited by the fact that patients are rarely given injections to avoid accidental infection of health staff.

The rare hemorrhagic fever, which is related to Ebola, is characterised by headaches, nausea, vomiting and bloody diarrhoea. It is spread through close contact with bodily fluids including blood, saliva and semen.

Known as one of the most virulent diseases affecting mankind, Marburg has a fearsome reputation and is known to bring an exceptionally gruesome death.

Faced with this enemy, medical staff working at the specially-set up isolation unit at Uige's provincial hospital are taking no chances and are using "full bio-protection suits" that take half an hour to put on and a gruelling 45 minutes to take off, a procedure that presents the most risk of contamination.


POPULATION TRAUMATISED

Castellarnau, who has been in Uige for 10 days, said while many people in the city had no choice but to go on with their daily lives, it was clear the population was traumatised.

"They're very scared. Now we have a big problem in town because people don't want to touch dead bodies," she said.

"We mustn't underestimate the trauma this has created among the population. People are scared to the point that even a dead husband or father is someone to stay away from," she added.

Some local residents contacted by telephone said they had already lost friends to the epidemic and the hospital had become a focus of fear for the city of about 500,000.

"One of my close friends was a nurse working in the pediatrics ward when it all started. She died from the virus," said Amelia Manuel, who lives near the hospital.

"People are scared to go to hospital because that's where it all started," she said.

Castellarnau said it would take more resources and commitment to stamp out an epidemic she said was "far from being contained".

"It's like a big puzzle where all the pieces need to be in place if we don't want all the efforts to go to waste," she said. "We don't know if we're at the peak of the epidemic or if it's still going up. But it's not going down," she said.


Story by Zoe Eisenstein

Story Date: 7/4/2005

http://www.planetark.com/avantgo/dailynewsstory.cfm?newsid=30270

Well about half way down in this article it sounds like it's getting better. However it sounds to me more like wishfull thinking and a dose of "don't panic your all going to die anyway" .

http://news.bbc.co.uk/1/hi/world/africa/4407461.stm

April 3, 2005
BBC

The death toll in Angola from an outbreak of the rare Marburg virus has risen sharply to 146 people, the country's health ministry has said.

Twenty of the deaths have been reported since Thursday.

The outbreak, which began last October in Uige province, is the most serious ever recorded of the virus, a fast-spreading haemorrhagic fever.

Correspondents say there is a palpable fear in the capital Luanda that the Ebola-type disease could spread there.

Everybody is afraid of this virus - we don't know what it will do to us — Antonio Luanda garage worker

The World Health Organization has sent 20 medical experts to Angola and is deploying field teams in the area of the outbreak.

Almost all the deaths took place in Uige, a northern province which borders the Democratic Republic of Congo.

About 75% of the cases involve children under the age of five. The victims include an Italian doctor who was treating people with the virus.

The Marburg virus has a high fatality rate and there is no known cure.

'CLOSE TO IMPROVING'

There are fears it could spread to Luanda, 300km to the south-west, where several of the victims died after arriving from Uige.

Reports say shops in the city are running out of household bleach, and parents are keeping their children out of school.

"Everybody is afraid of this virus. We don't know what it will do to us," a garage worker named as Antonio told AFP news agency.

But WHO Angola representative Fatoumata Diallo told AFP patients in Uige were now being isolated and treated.

"The situation is close to improving," he said.

The toll now exceeds the previous worst outbreak recorded in Angola's neighbour, DR Congo, in 1998, when 123 people died.

Several countries have taken measures to try to halt the spread of the virus.

Early symptoms of Marburg are diarrhoea, stomach pains, nausea and vomiting, which give way to bleeding.

But experts say the symptoms are similar to those of malaria, amoebic dysentery or tuberculosis, making it difficult to identify.

Most of the Angolan deaths occurred between three and seven days after the onset of symptoms, the WHO said.

Marburg, a severe form of haemorrhagic fever, has no known vaccine or medical treatment.

The infection was first identified in 1967 among laboratory workers in Europe who had been working with monkeys.