Toll in Angola's Marburg outbreak reaches 244

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Apr 22, 2005 (CIDRAP News) – The death toll in Angola's outbreak of Marburg hemorrhagic fever has climbed to 244 of 266 people infected, but Angolan officials say the epidemic has been confined to the province where it began, according to news reports today.

The World Health Organization (WHO), in a statement late yesterday, said 239 of 266 people had died of the disease as of Apr 19. But reports from Reuters and Agence France-Presse (AFP) today put the death toll in the world's worst Marburg epidemic at 244. An AFP report on Apr 17 had listed the death toll as 235.

Angola's deputy health minister, Jose Van Dunem, said no new cases have occurred outside the northern province of Uige, according to the AFP report. "We have circumscribed the epidemic to the province of Uige," he said, adding that the disease "is on a decline."

The age distribution of patients has shifted upward, according to health ministry figures reported by AFP. Forty-two percent of patients have been children and 35% have been adults, with no age information available for the other 23%. Earlier in the epidemic, about 75% of patients were said to be children, for reasons that remain unclear.

AFP reported that 518 people are under observation nationwide because of exposure to Marburg patients. The number includes 406 in the city of Uige.

The WHO's latest statement didn't offer a judgment on the overall success of containment efforts, but it said, "Significant progress has been made in increasing the engagement of affected communities. Some cases and deaths have, however, continued to occur within the community. Efforts to rapidly isolate cases, shortly after symptom onset, and follow up contacts need to be further intensified."

Further, the WHO said healthcare teams have learned that some families caring for patients at home have been giving them injections, which can help spread the disease. Officials have prepared materials explaining the dangers of the practice and will add them to the educational messages already being used.

A Canadian disease expert who just returned from Angola said self-treatment with vitamin and herbal injections, often with shared needles, is among factors that appear to be spreading the disease, according to a report in the Toronto Globe and Mail today.

The comment came from Dr. Heinz Feldmann, acting director of zoonotic diseases and special pathogens at the Public Health Agency of Canada in Winnipeg, Man. Feldmann spent 3 weeks in Angola helping to operate a portable laboratory that tested blood samples for the Marburg virus, the report said.

A US scientist said the Marburg outbreak is not yet under control but does not constitute a serious global threat, according to a Reuters report published today.

Tom Ksiazek of the special pathogens branch of the Centers for Disease Control and Prevention, who has been in Angola since the early stages of the outbreak, told Reuters, "I don't think it's under control, but I don't think it's out of control either. I don't think it's that dangerous in global terms. It doesn’t have the ability to go through the general community. The common cold is a lot more transmittable."

The disease spreads through contact with patients' bodily fluids. Reports say most of the victims have been medical workers and family members who cared for other patients. Ksiazek said that if the disease reached a major Western city, it could easily be controlled with measures that prevent contact with bodily fluids.

The Reuters report said markets in Uige remain open and most of the province's half a million people have felt little direct impact from the outbreak.

The WHO said a team of 28 Angolan healthcare workers arrived in Uige yesterday to help with the containment effort. They were to work on infection control, surveillance for new cases, tracing and managing contacts of patients, and public education efforts.

In the Globe and Mail report, Feldmann downplayed reports of violence against WHO teams trying to combat the outbreak. He said he was "never physically threatened" and added that anger can be expected among people dealing with the devastating outbreak.

See also:

Apr 21 WHO update
http://www.who.int/csr/don/2005_04_21/en/index.html

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