Marburg outbreak - experts struggling to get message across

Apr 12 2005

Disease experts in Angola say it will be weeks before it is determined whether the on-going Marburg crisis can be averted in Angola where the disease has already killed at least 194 people.

This is the largest recorded outbreak of the virus and 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. The World Health Organization (WHO) has put the toll at 194.

Monica de Castellarnau from Doctors Without Borders/Médecins Sans Frontière, says fear of the disease is rife with panicked locals hiding infected family members, fearing they might never see them again if they are taken to isolation units. She says this is understandable as they do not understand the illness or the role of health workers in providing care. Workers from Doctors Without Borders were attacked by locals who feared the teams had brought the virus with them and were responsible for spreading it.

Tribal elders, Roman Catholic Church officials and musicians are now being recruited to help educate villagers who are hiding infected family members and have attacked aid groups sent to check the virus' spread. A Uige music group, is writing a song 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.

Last week some locals threw stones at a WHO team who wanted to place a body in a plastic bag and take it away for immediate burial says Jose Caetano, a Luanda-based spokesman for the WHO, he says there is a lot of cultural resistance.

The World Health Organization has 50 experts already in the field helping local authorities, but is flying in more specialists to deal with the potential epidemic. Also helping are the medical aid group Doctors Without Borders which has a heavy presence on the ground. The U.S. Centres for Disease Control and Prevention has sent experts to Uige province in northern Angola.

Marburg hemorrhagic fever is a rare but 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 about a week after the first symptoms.

WHO spokeswoman Maria Cheng says their health workers are focusing on detecting infections early, isolating those infected, training local hospitals on infection control and removing dead bodies, which can spread the disease.

So far 214 known cases have been detected in Angola and WHO has advised neighbouring countries to step up surveillance efforts because of close proximity to Angolan borders.

Dr. Mike Ryan, WHO's top outbreak specialist says the next couple of weeks are crucial.

Meanwhile, scientists at the U.S. Army Medical Research Institute of Infectious Diseases are investigating whether a drug that has shown promise against Ebola might work against Marburg. In a 2003 study, the drug cured Ebola in one-third of the monkeys it was tested on, but, even if the drug looks promising on monkeys, it may take months before it can be tried on people infected with Marburg, says Ryan.

As this is an unlicensed drug the ethics will have to be looked at extremely carefully and even though there may be a case for compassionate use, he says it can't be given it to people just like that.