Marburg Surveillance Project

Various ^ | May 4, 2005 | Vanity

[Judith Anne]

Welcome to the Marburg Surveillance Project.

This thread will be used for all of the latest Marburg Outbreak News and comments. This is the place to post all comments about the Marburg outbreak, all articles and links to articles about the Marburg outbreak.

We're going to use just one thread instead of having to go from article to article as we have in the past. We'll use this thread as long as we can.

[Judith Anne]

I belive the 12/9 [Uige Case/Death] and 1/1 [Songo Case/Death] numbers are to be added to the 313/280 totals giving us 326/290. Otherwise the embassy update from yesterday makes no sense (310/279 + 13/10 does not equal 313/280).

I agree. And those are just the ones that are confirmed...how many deaths aren't investigated, how many patients aren't tested? How many have fled--and where did they go?

[Judith Anne]

Excellent question.

[EternalHope]

From: May 5th press release from MSF

Marburg fever epidemic still not under control in Angola

MSF believes that to control the epidemic it is vital to inform the population about the disease and its prevention. Families and patients must receive the support from the authorities, the community and all present actors in this crisis. Violence and threats to affected families that have been reported to MSF staff will only worsen the situation and lead to stigmatisation.

Six weeks after the confirmation of the Marburg fever outbreak in Angola through biological tests on March 22, the epidemic is still not under control. The official toll, as of April 30, is of 271 deaths and 301 cases. The disease has taken a heavy toll among the medical staff - at least 19 have died.

The situation has increased to levels that MSF is now increasing its role in infection control. MSF was previously restricted to infection control only in the isolation unit but is now taking on similar responsibilities throughout the hospital.

The situation is still alarming. In the city of Uige, the main focus of the epidemic, bodies are collected every day. Since the first alert was, a new focus has sprouted in Songo hospital, about 50 kilometres northwest from Uige.

Many problems remain unsolved and new difficulties arise every day. Last week, three Marburg cases died in different wards of Uige hospital. The infection control system put in place has been inefficient.

The World Health Organization (WHO), that was supporting the Angolan Ministry of Health in the implementation of this system, recognized last Friday that "under such conditions, amplification of transmission is highly likely to occur".

In order to protect both the patients and the medical staff - and in response to a request from the authorities - MSF will increase its responsibility for infection control. All wards will be disinfected, and a stringent triage of patients needs to be put in place in order to temporarily restrict admissions to life-saving emergencies.

For these measures to succeed it is imperative that they be strictly respected.

As a consequence of this new situation, the peripheral health centres need to be reinforced in order to deal with the additional flow of patients and treat diseases other than Marburg fever. The local health authorities and the WHO also need to improve the system of identification of suspect cases and the follow up of people who have been in contact with infected patients.

MSF believes that to control the epidemic it is vital to inform the population about the disease and its prevention. Families and patients must receive the support from the authorities, the community and all actors present in this crisis. Violence and threats to affected families, as reported to MSF staff, will only worsen the situation and lead to stigmatisation.

MSF has treatment wards for Marburg patients in Uige, Songo, Negage and Luanda. These centres allow MSF to isolate the cases and take care of the patients. MSF is also collecting patients and bodies in the community and carries out burials respecting the strictest bio-protection measures. Awareness-raising activities have also been intensified so that these public health measures can be understood by the population.

MSF has 55 expatriates working in this emergency.

[Judith Anne]

This last comment concerns me. If you are monitoring someone, i.e. temperature twice a day because they have the non specific symptoms, aren't they likely to be transmitting the disease, if they have Marburg. It appears that they aren't isolated at that point.

Me too. In a previous Marburg outbreak, only 7 of 23 patients had the hemorrhaging (from CIDRAP--link above). If there are people dying from Marburg who are not hemorrhaging--potentially, from the history of outbreaks, 2 out of 3 could just be at home, spreading it around with no official notice or concern...

[Judith Anne]

MSF has treatment wards for Marburg patients in Uige, Songo, Negage and Luanda. These centres allow MSF to isolate the cases and take care of the patients.

And Luanda has an international airport. I wonder if any friends or relatives of anyone working at the airport has visited any place that has a case...

[EternalHope]

A few tidbits from the MSF press release:

In the city of Uige, the main focus of the epidemic, bodies are collected every day.

Not according to the government of Angola.

MSF has treatment wards for Marburg patients in Uige, Songo, Negage and Luanda.

Treatment wards in LUANDA? Are they empty?

[blam]

" People coming into your village with a space suit in a rush, stealing away dead bodies is culturally completely unacceptable and creates a lot of tension and a lot of mistrust."

I'll say.

[null and void]

Yeah. There needs to be a way for the men in white to clean the body and environs, and provide a local sterile burial.

Nothing that couldn't be accomplished with a water buffallo or two of bleach, and a couple kilos of quicklime.

Let the families watch and mourn while the hut is sprayed down, the body gently and respectfully moved, wrapped in a clean shroud, placed in a bleach sprayed hole, covered in quicklime and buried.

Really. How hard is that?

[null and void]

Also, move the bodies where????

I'm sure no accidents ever happen on Angolan roads, so I guess we don't have to worry about the body spreading contamination from beyond the veil...

[tdewey10]

Latest[google]:
http://www.angolapress-angop.ao/noticia.asp?ID=339140

registados three more deaths for Marburg in the province of Uige

Luanda, 05/05 - Three deaths and six new cases of hemorrhagic fever of Marburg had occurred in last the 24 hours, in the province of the Uige, after a relative calm, today announced the vice-minister of the Health, Jose Van-Dúnem. In this way, the number of deaths caused for the virus of Marburg goes up for 203[sic], in 319 cases, since 13 of October of the year transacto. The governor needed that of deceased, two had occurred in community and one in the hospital, but it is not about the patient interned there has already some days. How much to this, the source guaranteed that it continues to recoup. Jose Van-Dúnem gave to know that the new cases had had place in the quarters of the "Quarry", with two, "Banza-Luanda", one and "Quinguangua People", with three. In these areas, the inhabitants oppose sistematicamente in accepting the orientações of prevention of the technician of the Health, primando for the cultural aspects. In the provinces of Cabinda, Luanda, Huambo, Malange, Zaire and Kwanzas-North and South, the situation is calm, second still the vice-minister of the Health.

Note that I am positive the "203" is a typo by angpo in this case--not undercounting. Should read 283.

[Judith Anne]

Thanks for posting. 2ndreconmarine made the point some time ago that increases in cases over deaths means one thing: the epidemic is spreading. It doesn't mean that the virus has evolved into something less deadly--it represents what will be apparent: an exponential increase.

So far, after having had this outbreak since LAST FALL, there have been NO credible reports of survivors. And of the two reported survivors, there are absolutely no details, ie age, sex, location, date of illness, treatment, nothing.

[Judith Anne]

Here's some information I found on the web about what happens if you LIVE, after Ebola or Marburg. Frankly, your troubles are not over.

Here it is:

The overall incubation period for hemorrhagic fever viruses is 2 to 21 days. There is no documentation of transmission of disease during the incubation period. Patients usually exhibit nonspecific prodrome, which usually lasts less than a week. The primary prodrome features associated with VHF are often flu-like illnesses consisting of fever, muscle aches, malaise, joint and muscle pain, headache, nausea, abdominal pain and weakness initially but then progress into prominent symptoms of fever, hypotension, relative slow heart rate, increased respiration rate, conjunctivitis, pharyngitis, and rash. Then there may be progression to both internal and external bleeding and multiple system involvement. Often VHF results in severe life threatening conditions, including shock and severe hemorrhage. A convalescent period may be prolonged and complicated by weakness, fatigue, anorexia, malnutrition, balding, and joint pain. Sequelae may be present with hearing or vision loss, impaired motor coordination, inflammation of the testes, uvea, spinal cord, bone marrow, lining of the heart, and pancreas. While the majority of VHF cases have these common features, each hemorrhagic fever has its own set of specific characteristics. Case fatality rate ranges from .5% (Omsk hemorrhagic fever) to 90% (ebola). Death is usually preceded by hemorrhagic diathesis, shock, and multi-organ system failure 1 – 2 weeks following onset of signs and symptoms.

Here's the link:

http://www.state.in.us/isdh/bioterrorism/manual/section_10.htm

[Judith Anne]

Just to reiterate, survivors of Ebola or Marburg have serious difficulties:

A convalescent period may be prolonged and complicated by weakness, fatigue, anorexia, malnutrition, balding, and joint pain. Sequelae may be present with hearing or vision loss, impaired motor coordination, inflammation of the testes, uvea, spinal cord, bone marrow, lining of the heart, and pancreas. While the majority of VHF cases have these common features, each hemorrhagic fever has its own set of specific characteristics.

[tdewey10]

I like the second half of the statement about the regions opposing the health providers.

[tdewey10]

I like the second half of the statement about the regions opposing the health providers.

[Domestic Church]

"So what we do when we meet people who have had contact is we check their temperature twice a day and monitor them closely and if then if they become a probable case, i.e. start having some of the more violent symptoms, then we isolate them."

And at what point during the 10 day incubation does an individual become infectious with this new variant? It makes no sense to isolate them *after* they have become a "probable case". Those who have had contact should be isolated for at least 10 days until they have cleared the incubation period.

[null and void]

Tonight on Coast to Coast AM:

First Half-Hour: Dr. Henry Niman of Recombinomics will speak about emerging pandemic signals.

[Domestic Church]

"3. The doctor who raised the alarm, last fall, died from
it this year. Did she get tired, or careless? How was
she infected?"

Surely she used the highest precautions she could as other health care workers had already died before her, IIRC. Perhaps in changing out of her protective gear some virus was aerosolized in microscopic droplets and she inhaled it or it made contact with her eyes after she removed her face shield. The other possibility is that this nasty bug can penetrate latex or vinyl gloves (is there any weaponized or natural biologic than can do this?)

[Amalie]

Thanks for the ping

[Judith Anne]

Ebola and Marburg both have early symptoms that could be any number of diseases--malaria, flu, typhoid, etc.

Rash doesn't appear until a few days after symptoms begin. So people could be shedding virus, sick, and be treated for something else (what if they already have malaria?)

I think that they don't even CHECK for Marburg, unless the patient has the hemorrhagic symptoms--and people with Ebola or Marburg don't always have the hemorrhagic symptoms--they can die without hemorrhaging.

So, I think that means there's a whole lot of Marburg going on...

Incidently, I've read in a number of places that it is not thought that Marburg can be infectious before symptoms begin. Although I wonder about that (seriously), that's the best information available, and we have to go by that.