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.

[Oorang]

Out of curiosity I searched to see what airlines have flights to Luanda. All have stops in other major cities with connecting flights into Angola. Here is a short list of some of the airlines:
British Airways, Lufthansa, KLM, Northwest, Continental, United, TAP Air Portugal and New Zealand.

TAAG Angola Airlines has flights to various African locations as well as London, Rio de Janeiro and Paris, which originate in Luanda.

[Rushmore Rocks]

The first six airlines on your list are ones that we use frequently..........uunnghh! So far we have avoided travel to Africa, no forests there producing any of the lumber products we need for our business. Sometimes I really hate this "global economy".

Another scary "bump".

[Judith Anne]

Here's another article, at

http://www.cmaj.ca/cgi/content/full/172/11/1430

I'll post the text immediately below.

[Judith Anne]

Angola, Africa
In the field, Canadians diagnose Marburg
Laura Eggertson
CMAJ

Using a portable lab they had packed into suitcases and hauled halfway around the world, a Winnipeg virologist and a lab technician rendered life-or-death verdicts during the recent outbreak of Marburg in Angola.



Figure. Dr. Heinz Feldmann of the Public Health Agency of Canada suits up, with the help of Dr. Jim Strong, to enter the infectious area of the hospital in Uige, Angola, where he was testing for Marburg virus. Photo by: Public Health Agency of Canada



Over a 3-week period in March and April, Dr. Heinz Feldmann and Allen Grolla tested blood samples for Marburg virus, a hemorrhagic fever that has been raging in Uige, Angola, since February.

A positive result meant virtual certainty of death. Marburg has a mortality rate of 90%.

"The most frustrating thing is that, after 20 years, I still can't treat anyone. I still can't do very much," Feldmann, a specialist in rare pathogens, said after returning from Uige on Apr. 21.

"I would love to provide help," said Feldmann, acting director of zoonotic diseases at the National Microbiology Laboratory in Winnipeg.

The Canadians were part of a team of international experts who began battling Marburg, a close cousin to Ebola, soon after the world's worst outbreak was detected in March.

Toting the specially designed lab — a collection of equipment worth a modest $100 000, packed into 8–10 suitcases — the Feldmann and Grolla created a field facility that saved physicians and families days, if not weeks, of uncertainty.

Normally, samples are sent to labs elsewhere in Africa or to the US. Instead, Feldmann and Grolla processed between 2 and 30 blood samples daily, providing results within 4 hours.

Testing is essential to the outbreak control efforts of the World Health Organization and Médecins Sans Frontières, since the isolation of confirmed cases is the only defence against the spread of the disease.

Feldmann has studied the Marburg virus for 20 years. The disease first came to the attention of the scientific community in 1967, after monkeys infected lab workers in Marburg, Germany. The virus is spread by close contact with bodily fluids.

They confirmed about one-third of the 266 people diagnosed as of Apr. 20; 244 of those patients have died. "We could have done more, but we didn't get the samples," says Feldmann.

Fearful that the outsiders had brought the virus, many Angolans resisted their approach — there were even reports of some vehicles being stoned. Families often hid sick members and avoided the hospital because with no cure or treatment for the virus, it "had the reputation for being a death trap," Feldmann said.

Some people turned to witch doctors and traditional healers. Often, they received injections of what Feldmann believes were vitamins or herbs in a vain attempt to ward off the virus. Instead, they risked contamination by sharing needles.

By the time patients did arrive at the hospital, most were already in the end stages of the disease. All physicians could do was isolate them.

If the blood samples came from a corpse, family members either conducted their traditional burial rites or faced the distressing prospect of seeing the body removed to be burned. Then they had to face the reality that they, too, might be infected and needed to be tested.

To stay focused on their work, Feldmann says they tried not to ask existential questions. "You start thinking, why is this always happening to the poor people of the world — why are they being affected much more by these diseases?"

"Sorry is not enough to say for these people. It's a terrible situation. But that doesn't help you very much in the field."

Still, the helplessness marked them.

"The feeling of not knowing what to do — I could see it in the faces of the people," Feldmann said. "Hoping to the very end that if someone comes down with the fever, that it might be malaria or something else."

One family lost 12 of its 16 members.

As they pulled dead bodies from the makeshift morgue for testing, it was hard not to identify with the families left behind. "Particularly if it's kids. You never forget these faces," Feldmann said.

Colleagues Dr. Jim Strong and biologist Lisa Fernando from Winnipeg took over from Feldmann and Grolla in Uige, and were expected back in May.

Feldmann hopes the worst is over, as more test results werecoming back negative before he left. But uncertainty persisted about the situation in the outlying villages, where WHO officials were trying to gain a better picture of how many are affected.

[Judith Anne]

Thank you for the airline information.

[Gritty]

You are doing terrific work in analysis as well as patient and coherent explanations to those of us more mathematically challenged but still seriously interested in this ongoing, real life horror show which may yet jump borders and quickly show up on our own doorsteps.

My only wish was your work was leading to a different conclusion. However, every passing day seems to confirm just the opposite.

As usual, the MSM is missing in action. But maybe that's a good thing at this stage. There will be plenty of time at international breakout - if it occurs. In the meantime, the poor souls in Angola just die at home. But if this thing is as unrelenting as it appears, many will no doubt soon run (if they haven't already) and the news will then boil over as military force gets involved.

Probably the CDC and others in the early warning food chain are also aware of what is going on and their silence is speaking volumes. If they thought this thing was licked, they wouldn't be able to control their glee. Instead, we get almost dead silence.

Ominous.

[unseen]

The silence is definitely speaking very loudly but unfortunate we can not hear exactly what it is saying. It this thing out of control? Is is moving into different cities? Are people starting to panic in Angola? What about the "ebola-like" illness in the Congo? There has been no news on that for awhile now. The silence is indeed speaking loudly I just wish we could understand what it is saying better.

[Judith Anne]

I just did something that I recommend as a useful exercise.

I went back and re-read the first 500 posts to this thread, and over the next couple of days I'm going to try to re-read them all again.

Thanks to everyone who is participating, whether lurking, reading, posting--to all of you, thanks.

This thread is information-rich and very dense. Some common themes are emerging that weren't there when we started. It might be useful to identify most or all of those themes.

Here are some I have come up with:

Marburg Angola is a new variant with >99% mortality, origin unknown.

The CDC, WHO, and likely Angolan authorities know the genetic sequencing of this virus.

The Angolan military is assisting in the attempt to contain the spread of the virus, and is failing.

No one knows the actual case numbers, but they are certainly above reported case numbers.

The outbreak is still increasing.

Is there any disagreement on any of the above?

[Judith Anne]

Note: This thread has gotten nearly 25,000 hits. Amazing.

[Gabz]

,i>Is there any disagreement on any of the above?

Not from me!!!!

[xVIer]

Here is a link ...same info, but a little more detail....
http://www.medicalnewstoday.com/medicalnews.php?newsid=25354
Quotes someone in Uige saying alot of people have fled to Luanda and other villages...also more hospital desciptions...

[dc-zoo]

No disagreement here. It would help if more people would recognize the danger here and that Marburg will not burn out.

[Judith Anne]

From your link:

"In Angola we have known war," said Ligia María Costa Pedro, head of the pediatric ward in the Uige hospital, "and we have come out of it and moved on. Even though Marburg is killing a lot of people, there will always be a few survivors."

She lost seven of her colleagues to Marburg

So the people are stoic...and there is no improvement.

[infominer]

Good recent article. It seems according to the article, Horacio survived.

Earlier articles relate that there have been previously reported instances of Marburg being passed by survivors up to three months after the onset via sexual intercourse. Without a cure, how does this apparent fact of subsequent transmission contribute to the perpetuation of the outbreak and evolution of the virus?

[Judith Anne]

Something else just occurred to me--if the disease can be transmitted by sexual intercourse for up to at least 3 months after a victim recovers, then the statement by WHO that only 42 days after the last case, the outbreak can be declared over?

That's just completely wrong, if it can still be transmitted for up to three months (or more--I thought I read six months).

[null and void]

Dammit! I'm giving up on sex...

[Judith Anne]

Oh, suuuuuuuure...I know your type. 89 days into the 3 months, you'll have one beer, and then another, and then...the gal in the corner booth will start to look good, she'll give you a little wink, and DAMMIT! It'll all start all over again...;-D

[null and void]

Nope. I've avoided sex for years.

All I need to dois think of my ex...

[unseen]

I hear you...kind of drives the lust right out of you doesn't it.

[null and void]

yeah. If I ever thought the little guy would get me in that much trouble again, I'd seriously consider amputation...