Outbreak of Marburg in Uganda has authorities on high alert

Aug 7 2007

Health officials in western Uganda believe the latest outbreak of the Marburg virus may have originated from a monkey.

Health officials suspect the outbreak which was confirmed on the 30th of July was contracted from a Colobus monkey, which was caught and skinned by two people who both became sick.

A 29-year-old man became sick on 4 July 2007, was admitted to hospital on 7 July and died on 14 July; the disease was confirmed by laboratory diagnosis on 30 July.

A 21-year-old co-worker with a similar illness to whom he had been providing care then developed the symptoms for Marburg on the 27th of June and was hospitalized with a haemorrhagic illness; he has since recovered and was discharged on 9 July.

Both men were working in a mine in western Uganda.

Senior health officials say tests on the skin of the animal are being conducted by the Centers for Disease Control (CDC) and as many as 150 people thought to have had contact with the victims were being monitored.

Isolation centres have been set up by Uganda's health ministry in both the main referral hospital of Mulago and at the clinic in Kamwenge where the victims were reportedly working in a gold mine.

A hundred or so contacts have been isolated in Kamwenge, fifty in the mining camp and fifty in the local neighbourhood where six people who helped skin the animal are said to be in a serious condition, while more people are being monitored in the capital, Kampala.

National rapid response teams have been mobilized in the the area with the support of the World Health Organization (WHO) and other partners in the field, to investigate the outbreak.

According to the WHO the Marburg virus is a rare but highly fatal haemorrhagic illness with epidemic potential and is caused by a virus from the same family as the one that causes Ebola haemorrhagic fever.

The virus is transmitted from person to person by close contact via blood or other body fluids (faeces, vomitus, urine, saliva, and respiratory secretions).

Transmission via infected semen can occur up to seven weeks after recovery.

The illness caused by the Marburg virus begins suddenly with a high fever, a severe headache and severe malaise; muscle aches and pains are also common.

Rapid, progressive debilitation follows accompanied by severe watery diarrhoea, abdominal pain and cramping, nausea, and vomiting on about the third day; the diarrhoea can persist for a week leaving patients drawn and extremely lethargic.

Severe haemorrhagic manifestations appear between days 5 and 7, and fatal cases usually have some form of bleeding, often in vomit and faeces and from the nose, gums, and vagina.

The severe phase of illness is accompanied by sustained high fevers, confusion, irritability, and aggression.

Death occurs most often between 8 and 9 days after symptom begin and are usually preceded by severe blood loss and shock.

The WHO says the worst outbreak of the disease killed nearly 250 people in Angola in 2005.

Although the disease may be contracted from monkeys, according to the WHO, animals and plants are generally not viable hosts and despite years of intensive investigation no animal reservoir or other environmental source of the virus has been identified.

The WHO says there is no indication of the need for any restrictions on travel or trade with Uganda.