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.

[Fitzcarraldo]

Seems like any short-term survivors are left with problems that could get them in the medium turn.

[EBH]

Swedish government grants 421 US dollars to fight Marburg fever {Just about fell out of my chair at this title}

http://www.reliefweb.int/rw/RWB.NSF/db900SID/VBOL-6BEHQV?OpenDocument&rc=1&emid=ACOS-635NGV

Luanda, 13/04 - The Swedish Government has granted about 421,000 American dollars to aid the fight against Marburg haemorrhagic fever in Angola, a press note says.

According to the document, the amount will be used by the United Nations agencies to intensify their efforts in the fight against the sickness that has already killed 203 people.

Northern Uije Province has already recorded 184 obits, out of the 196 cases, said the document, adding that there are others 362 suspected cases.

Marburg haemorrhagic fever appeared in Uije on October 2004, being that the two first cases were identified in March 2005.

[Covenantor]

Yeah, right.

Total US dollars 421,000...[of which] 421 American dollars....will be used by the United Nations agencies to intensify their efforts in the fight against the sickness. The remaining amount will be in Coffee Anon's Swiss account

[Covenantor]

On one of the other threads Judith Anne had posted the horrific effects even on survivors, most of whom don't live beyoind a few more years at best IIRC.

But still, a government wanting to calm its citizenry would paint a picture with at least some hope. That silence as to survivors among the infected speaks to the virulence of this infection. This is a whole new beast that is rewriting the medical dictionary as we watch it unfold.

[Covenantor]

ping list...I believe Mother Abigail has one. I just do a keyword search using Marburg to do a quick catch if I haven't been pinged.

[EBH]

Uige, Angola

[EBH]

Luanda, Angola

[Covenantor]

And Luanda is about the size of the Miami metro area. But that picture of Uige is not unlike some suburban areas of Wash. DC

[MarkL]

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

We've already had a loss of containment of a strain of ebola. It's "Ebola Reston," after Reston, VA, a suburb of Washington DC. It was a strain that did spread via airborn transmission, but we got very lucky in that the strain is only fatal in monkeys: In humans, it only causes cold-like symptoms.

It's documented in the book, "The Hot Zone."

Mark

[EBH]

I am a visual type person and the graphs you all have been posting really help me. I hope the pictures of the cities we're discussing give everyone a better idea of the challanges that are being faced. Luanda isn't some small town in the jungle it's a bustling urban place on the port. The big economics are oil and diamonds.

[Covenantor]

I've tried to do the same with the maps.

[kanawa]

I've tried to do the same with the maps.

I noticed your map over here

I've been playing with this one...trying to keep it small with losing too much detail.

[kanawa]

with=without

[EBH]

Ping

[Judith Anne]

I thought I remembered reading that it COULD be spread during the incubation period...

Here on this thread I see that someone says it cannot...I'm not sure what to think. I guess it's time to do some re-checking of my facts.

[barkeep]

We have known for a while that some people, perhaps a majority, will not contract the disease even if the virus gets in system. Precisely why and how often is yet unknown, but research on sporadically recurring Level IV pathogens is damned difficult. During the outbreak, typically at some spot inconveniently distant from a world class virology research center, the priority tends to be treatment and suppression.

Usually, the horrific lethality of Marburg and Ebola actually help contain its spread. It is actually inefficient for a pathogen to kill this effectively and this quickly. The indigenous population of potential hosts has a tendency to, in medical terms, run like hell! Deprived of further vectors, the virus usually subsides into whatever long-term resevoir sustains it between human outbreaks. Unfortunately from the research perspective, this has so far left us with more questions than solid answers.

[EBH]

You are correct based on the old knowledge, prior to this outbreak. The WHO and the DWB both concur this is a more virulent strain than has been dealt with in the past, adding onto that this is not some remote villages but is hitting urban areas. Another week or two will tell us if the efforts to control are working or we have a true crisis on our hands. The Angolan government has already issued a National Crisis statement...

[EBH]

http://www.freerepublic.com/focus/f-news/1382773/posts

[I'll be your Huckleberry]

This is just a note to those of you who are new to the viroogy/infectious disease threads.

A little Free Republic history:

In the spring of 2003 Mother Abigail posted one of the strangest treads ever posted on this site. It was called Precogntion

http://www.freerepublic.com/focus/f-chat/865868/posts

within a few days the SARS story began to break and MA became the resident FR expert.

FR became the central clearing house for all SARS information, and for those of us who followed her posts it was an awakening.

I have my own opinion about who she is and what her specialty is, but let's just say that IMHO she is the FR virologist of record and one of the kindest and most giving of people.

As the SARS epidemic grew and fear and anxiety built everywhere, some posters on FR turned on MA and began to call her a fear monger and worse. It was some of the most unpleasant reading I have ever done.

She went away and finally came back (I am not sure when) to post once again.

My wife and I are among her bigest fans and read everything she writes. I urge you to read the entire SARS episode, it is both enlightning and freightning.

When you speak of Viri (sp) you should always include MA, she is our treasure and the founder of using Free Republic as a conduit for Virology issues.

[dc-zoo]

Amen to everything you said.