Posted on 07/10/2008 1:49:33 PM PDT by InfraRed
WHO has been notified by the Government of the Netherlands of a case of Marburg haemorrhagic fever (MHF) in a Dutch tourist who visited Uganda. Marburg virus infection has been demonstrated by laboratory tests performed by the Bernhard Nocht Institute in Hamburg, Germany.
The 40-year-old woman travelled in Uganda from 5-28 June, 2008, and entered caves on two occasions. The first cave was visited on 16 June at Fort Portal. No bats were seen in this cave. She was reportedly exposed to fruit bats during a visit to the “python cave” in the Maramagambo Forest between Queen Elisabeth Park and Kabale on 19 June. This cave is thought to harbour bat species that have been found to carry filoviruses in other locations in sub-Saharan Africa. Filoviruses cause two types of viral haemorrhagic fever: Marburg and Ebola. A large bat population was seen in the cave and the woman is reported to have had direct contact with one bat.
The woman returned to the Netherlands on 28 June in good health. The first symptoms (fever, chills) occurred on 2 July and she was admitted to hospital on 5 July. Rapid clinical deterioration with liver failure and severe haemorrhaging occurred on 7 July. The patient remains in a critical clinical condition.
Contact tracing and temperature monitoring have been initiated for unprotected contacts with a history of possible exposure to the case after 2 July. Although further epidemiological investigation is needed to exclude other possible sites of exposure to MHF virus, as a precaution Dutch authorities have alerted the tour operator to avoid visits to the caves until further information is available.
No citizens of other countries were involved in this trip except for a local tour guide, but the cave in the Maramagambo Forrest is known to be a tourist attraction. No measures were taken with respect to the passengers on the flight from Uganda as the flight occurred four days before the onset of symptoms in the patient.
WHO has informed the Ministry of Health Uganda which will take appropriate steps nationally to investigate these events, and WHO has recommended that the MoH advise all residents and travellers to avoid entering caves with bat populations.
Of all the crummy bat caves in Uganda, she has to come into the one with infested bats!
P.S. - Somebody napalm those bat caves, it will be worth the expense.
Sharing needles in that free drug culture has become even more dangerous.
Is Marburg pneumonic?
Is Marburg pneumonic?
Don’t know, but it sounds nasty.
WHO's on 1st.
Sorry, I couldn't resist.
There was a large (400+ patients) outbreak of Marburg in Angola a couple of years ago that had me VERY concerned, as there is a daily flight from Angola to Houston, iirc.
It started with some few pediatric patients, and the lady doctor who alerted authorities died from it. WHO and MSF had several clashes with each other, as well as local autthorities and victims. The moon suits (the only way to prevent infection) upset the rural victims, and people’s usual burial rituals were made impossible. A few dogs and pigs also got it, iirc.
Marburg is NOTHING to fool with. Case fatality rate is very high.
This would be good to keep track of.
Marburg is bad ... just glad it’s not the Reston strain. (that one was airborne but only went after monkeys)
Though caused by different viruses, the two diseases are clinically almost indistinguishable. Both diseases are rare, but have a capacity to cause dramatic outbreaks with high fatality. Historically, outbreaks have tended to reach the attention of health authorities only after transmission has been amplified by inadequate infection control in health care settings.
Neither disease has a vaccine or specific treatment. Despite years of intensive investigation involving the testing of hundreds of animals, insects, and plants, no animal reservoir or other environmental source of either virus has been identified. Monkeys are susceptible to infection but are not considered viable reservoir hosts as virtually all infected animals die too rapidly to sustain survival of the virus. Humans are not considered part of the natural transmission cycle; their infection is accidental.
Causative agent. Marburgvirus of the Filoviridae family.
Geographical occurrence. Outbreaks and sporadic cases have been reported in Angola, Democratic Republic of Congo, Kenya, and South Africa (in a person with a recent travel history to Zimbabwe). The initial outbreaks, in Germany and the former Yugoslavia in 1967, have been linked to laboratory work using African green monkeys (Cercopithecus aethiops) imported from Uganda.
Transmission. Transmission of the virus from person to person requires extremely close contact with a patient. Infection results from contact with blood or other body fluids (faeces, vomitus, urine, saliva, and respiratory secretions) with high virus concentration, especially when these fluids contain blood. Transmission via infected semen can occur up to seven weeks after clinical recovery.
Infection through casual contact is thought to be exceedingly rare. The low rate of transmission to persons with casual contact suggests that aerosol transmission via the respiratory tract is not efficient, if it occurs at all. Transmission does not occur during the incubation period.
Patients appear to be most infectious during the phase of severe illness accompanied by haemorrhagic manifestations. Close contact with a severely ill patient, during care at home or in hospital, and certain burial practices are common routes of infection. Transmission via contaminated injection equipment or through needle-stick injuries is associated with more severe disease, rapid deterioration, and possibly higher fatality.
Incubation period. 3 to 9 days.
Susceptibility. All age groups are susceptible to infection, but most cases have occurred in adults. Prior to the present outbreak in Angola, paediatric cases were considered extremely rare. In the largest outbreak previously recorded, which occurred in the Democratic Republic of Congo from late 1998 to 2000, only 12 (8%) of the cases were under the age of 5 years.
Clinical features. Illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Muscle aches and pains are a common feature.
A high fever usually appears on the first day of illness, followed by progressive and rapid debilitation. A severe watery diarrhoea, abdominal pain and cramping, nausea, and vomiting begin about the third day. Diarrhoea can persist for a week. The appearance of patients at this phase has been described as showing ?ghost-like? drawn features, deep-set eyes, expressionless faces, and extreme lethargy. In the 1967 European outbreak, a non-itchy rash was a feature noted in most patients between days 2 and 7 after symptom onset.
Many patients develop severe haemorrhagic manifestations between days 5 and 7, and fatal cases usually have some form of bleeding, often from multiple sites. Findings of fresh blood in vomitus and faeces are often accompanied by bleeding from the nose, gums, and vagina. Spontaneous bleeding at venipuncture sites can be particularly troublesome. During the severe phase of illness, patients have sustained high fevers. Involvement of the central nervous system can result in confusion, irritability, and aggression. Orchitis has been reported occasionally in the late phase of disease (day 15).
In fatal cases, death occurs most often between 8 and 9 days after symptom onset, usually preceded by severe blood loss and shock.
Natural reservoir of the virus. Unknown.
1967: Germany and Yugoslavia. Marburg haemorrhagic fever was initially detected following simultaneous outbreaks in Marburg and Frankfurt, Germany and Belgrade, former Yugoslavia. The initial cases occurred in laboratory workers handling African green monkeys imported from Uganda. The outbreaks involved 25 primary infections, with 7 deaths, and 6 secondary cases, with no deaths. The primary infections were in laboratory staff exposed to Marburg virus while working with monkeys or their tissues. The secondary cases involved two doctors, a nurse, a post-mortem attendant, and the wife of a veterinarian. All secondary cases had direct contact, usually involving blood, with a primary case. Both doctors became infected through accidental skin pricks when drawing blood from patients.
1975: South Africa, possibly via Zimbabwe. In mid-February 1975, an acutely ill Australian man, aged 20 years, was admitted to a hospital in Johannesburg, South Africa. During early February, he and his 19-year-old female companion had travelled extensively through Zimbabwe, often sleeping outdoors. He died four days after hospital admission. All primary contacts of the case were placed in isolation and strict infection control was introduced. Infection nonetheless spread to his travelling companion and a 20-year-old female nurse, who attended both patients. Both women were given vigorous supportive treatment and eventually recovered.
1980: Kenya. On 8 January 1980, a 56-year-old Frenchman, employed in Western Province, developed a sudden febrile illness, followed by headache, diarrhoea and vomiting. His recent travel history included a visit to Kitum Cave in Kenya?s Mount Elgon National Park. Despite specialized care in Nairobi and aggressive resuscitation attempts, he died on 15 January. The doctor who attempted resuscitation developed symptoms 9 days later. He recovered.
1987: Kenya. On 13 August 1987, a 15-year old Danish male, who had been in Kenya for one month, was admitted to hospital with a three-day history of headache, malaise, fever, and vomiting. Nine days prior to symptom onset, he had visited Kitum Cave in Mount Elgon National Park. Despite aggressive supportive therapy, the patient died on the 11th day of illness. No further cases were detected.
1998?2000: Democratic Republic of Congo. The outbreak in DRC marked the first large outbreak of this disease under natural conditions. The outbreak, which occurred from late 1998 to 2000, involved 154 cases, of which 128 were fatal, representing a case fatality of 83%. The majority of cases occurred in young male workers at a gold mine in Durba, in the north-eastern part of the country, which proved to be the epicentre of the outbreak. Cases were subsequently detected in the neighbouring village of Watsa. Family members involved in the close care of patients accounted for some cases, but secondary transmission appeared to be rare. Subsequent virological investigation indicated that virus of several different strains was introduced to human populations, from some yet unknown environmental source, on more than seven separate occasions.
2004?2005 (ongoing): Angola. The outbreak is believed to have begun in Uige Province in October 2004. As of 2 April 2005, the Ministry of Health reported a cumulative total of 163 cases, of which 150 were fatal. Most cases detected in other provinces have been linked directly to the outbreak in Uige. At the request of the government, international assistance, coordinated by WHO, has been organized to help contain the outbreak.
ick. bad stuff.
that’s like a hiker i met above tucson in the mountains.
she complained that she went into a cave and there were
guess what?
rattlesnakes in there.
surprise, surprise.
Marburg and Ebola were engineered by the CIA to kill blacks.
The Soviets did a lot of research with Marburg with respect to biological warfare. It's too hot for that even. Ugh.
There is one strain of Ebola that is almost 100 percent fatal, if I recall. I believe it’s the Zaire strain, and it is wicked, nasty stuff. Basically kills by liquefying your internal organs, including blood vessels.
Don’t know, but it sounds nasty.
Read "The Hot Zone." It reads like fiction: It's not... It's all about the different strains of these diseases, most commonly known generically as "Ebola."
Mark
Yes. It is pneumonic, just as Ebola is pneumonic.
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