Experts: Marburg Outbreak Could Become Long-Term Crisis

Sci-Tech Today ^ | April 123 2005

[Dog Gone]

The outbreak, which involves 214 known cases so far, is the largest Marburg outbreak recorded to date. The focus is on detecting infections early, isolating those infected, training local hospitals on infection control and removing dead bodies, which can spread the disease, said WHO spokeswoman Maria Cheng.
Disease experts struggling to contain an outbreak of the Marburg virus that has killed at least 194 people in Angola say it will take weeks to determine whether the disease can be stamped out before it becomes a long-term crisis.

Meanwhile, they say they are recruiting tribal elders and a music band to help educate villagers who are hiding infected family members and have attacked aid groups sent to check the virus' spread.

The U.N. health agency, which already has 50 experts in the field helping local authorities tackle the disease, is continuing to bolster its team by flying in more high-level specialists.

The medical aid group Doctors Without Borders also has a heavy presence on the ground, and the U.S. Centers for Disease Control and Prevention has sent experts to Uige.

The outbreak, which involves 214 known cases so far, is the largest Marburg outbreak recorded to date. The focus is on detecting infections early, isolating those infected, training local hospitals on infection control and removing dead bodies, which can spread the disease, said WHO spokeswoman Maria Cheng.

Neighboring countries have been advised by the WHO to step up surveillance efforts because some of the areas affected in Angola are close to borders, she added.

"The next couple of weeks are crucial," said Dr. Mike Ryan, the World Health Organization's top outbreak specialist.

Meanwhile, scientists at the U.S. Army Medical Research Institute of Infectious Diseases are investigating whether a drug that has shown promise against the related Ebola virus might work against Marburg.

In a 2003 study, the drug cured Ebola in one-third of the monkeys it was tested on.

U.S. scientists have received samples from the Angola Marburg outbreak and are investigating whether the drug might work in monkeys infected with the virus, Ryan said.

However, even if it looks promising in monkeys it may take months before the drug can be tried on people, Ryan said.

"There are complex ethical issues. This is an unlicensed drug and the ethics will have to be looked at extremely carefully," Ryan said. "There may be a case for compassionate use, but we can't just give it to people just like that."

In Angola, fear of the disease is rife. Panicked locals are hiding infected family members, fearing they might never see them again if they are taken to isolation units, said Doctors Without Borders emergency coordinator Monica de Castellarnau.

"It's understandable," Castellarnau said by telephone from Uige. "They don't really understand the illness or our role in providing care."

"Whole families have died. This is very traumatic for the local population," she said.

Marburg hemorrhagic fever is a rare but highly deadly disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever. It spreads through contact with bodily fluids and can kill rapidly, usually around nine days after the first symptoms.

Deputy Health Minister Jose Van Dunem said Tuesday the death toll has climbed to 203. Almost all the deaths have occurred in Uige, where the outbreak began six months ago.

However, in Geneva, the WHO put the toll at 194. There is often a lag between a country announcing its figures to the public and reporting them to the WHO.

Some in Uige have also insisted on performing ritual burial ceremonies which involve touching the body, according to Jose Caetano, a Luanda-based spokesman for the WHO.

Some locals threw stones last week at a WHO team which wanted to place a body in a plastic bag and take it away for immediate burial, Caetano said. Workers from Doctors Without Borders also were attacked by locals who feared the teams had brought the virus with them and were responsible for spreading it.

"There's a lot of cultural resistance," Caetano said.

Officials are recruiting Roman Catholic Church officials, tribal elders and a Uige music group, which is writing a song that is to be played on a local radio station, to help inform people about the disease and persuade them to cooperate with the foreign medical teams.

"Uige should be sealed off," said Fatima Rodrigues, who was selling fish at Luanda's Sao Paulo market Tuesday. "They shouldn't be allowed to leave."

Facts About Marburg Hemorrhagic Fever

• Marburg hemorrhagic fever is a rare but extremely lethal disease caused by a virus from the same family as Ebola.
• Symptoms of Marburg hemorrhagic fever and Ebola hemorrhagic fever are virtually indistinguishable.
• It is possible to become infected with the Marburg virus but not get sick. Scientists don't know what proportion of people who get infected become ill, but the chances of dying from the disease once it develops is usually higher than 90 percent.
• There is no vaccine or treatment. Scientists don't know where the virus comes from or exactly how it gets into humans, but people who have handled infected monkeys have contracted the virus.
• The first outbreaks occurred in 1967, in Germany and the former Yugoslavia, and were linked to lab work involving African green monkeys imported from Uganda. Subsequent cases have been recorded in Africa.
• The virus is spread only by extremely close contact with body fluids. Certain burial practices are common routes of infection.
• It cannot be spread during the incubation period, which lasts from three to nine days.
• Illness begins abruptly, usually with a high fever, followed by progressive and rapid debilitation. Severe watery diarrhea, abdominal pain, nausea and vomiting begin about the third day. Many patients have severe bleeding after five or seven days.
• Fatal cases usually involve bleeding, often from multiple sites such as the nose, gums and vagina. Death occurs usually after eight or nine days, usually after severe blood loss and shock.

[Buggman]

Where are Frank Black and Peter Watts when you need them?

[TonyInOhio]

[Covenantor]

This outbreak differs from previous ones in that the epicenter in Uige is very near the coast, unlike the ones deeper in the interior. It is also I believe the first to have victims in a major city, Luanda with a pop. of approx. 3.5 to 4 million.

The previous highest Marburg toll occurred from 1998 to 2000 in the Democratic Republic of the Congo (DRC), when 123 people died out of 149 cases over a two-year period.

But the current outbreak has spread and killed more in just a few weeks.

Given the notorious propensity for bribery any quarantine in Luanda will be as effective as cheesecloth in containing further spread.

[ordinaryguy]

they are recruiting tribal elders and a music band to help educate villagers

Yes, a music band. Why didn't we think of that before?

[FourtySeven]

U.S. scientists have received samples from the Angola Marburg outbreak and are investigating whether the drug might work in monkeys infected with the virus, Ryan said.

Where are they investigating this? Here in the U.S.? Have they brought a seemingly highly infectious strain into the U.S.?

I know I know, BSL III, IV (maybe even higher) and all that. Still, to me, this seems to have the makings of a real life "The Stand".

I'm off to adjust my tinfoil biosafety suit! (two birds with one stone dontcha know :) )

[atomic_dog]

Anyone interested in starting a "Marburg Pool?" We all put in $20 and pick a month and a year. Whoever gets closest to the actual date that Marburg shows up in the US (thanks to the lax entry and screening procedures) wins the pot.

/S

[redgolum]

LOL!
Love that pic.

[FreedomPoster]

I'm wondering why midnight basketball isn't involved.

[Lou L]

If I guessed a month in 1967, would I win? I'm pretty sure that after that original Marburg outbreak in 1967, the Army brought some over here for analysis.

[Scythian]

Sure, joke about it now, but soon, you're all gonna be scared out of your wits, society will collapse, and it's going to be dog-eat-dog. Oh, and if you see my on the street don't assume I'm friendly ...

[Dog Gone]

Have they brought a seemingly highly infectious strain into the U.S.?

They've been conducting the tests primarily in US labs, although some German labs have been mentioned as well. There's no doubt we're going to infect some monkeys here and see how that antiviral drug works.

So, if you've got loose monkeys in your neighborhood, try not get too intimate with them.

[2ndreconmarine]

IIRC, EBH is handling the Marburg ping list for all of us. We need to always ping him when a new Marburg article appears so everyone has a chance to see it.

Or, did I get this wrong and someone else is doing this??

Thanks,

[null and void]

ping

[null and void]

December 2005...

[EBH]

see the reply in your freepmail.

[2ndreconmarine]

It cannot be spread during the incubation period, which lasts from three to nine days.

I didn't know this. It is what could give us a chance to stop this.

It is possible to become infected with the Marburg virus but not get sick.

I didn't know this either. What is the percentage of cases for which this applies??

[Dog Gone]

What is the percentage of cases for which this applies??

That's a real good question. Hopefully, it's something like 99%.

[EBH]

3-9 day issue is not holding up as far as I know on this. Remember when they sweat it is spreading the disease...?

In the past it has been possible to get sick with Marburg or Ebola and not get sick or get sick and recover. So far we haven't seen this as evident in this outbreak either.

[Covenantor]

What's ominous in all the news is the notable lack of mention of suvivors. None that I can recall.