Monday, April 18, 2005

Marburg: Update 4...


A recent ABC News Online update claims that Doctors [fear] Marburg virus outbreak will worsen. It is a curiously provocative assessment for a very short update that provides no new information on Angolas outbreak of Ebola-like virus.

A previous story from ChinaView provides more information, reflecting a growing sense of fear extending to neighboring countries,

A number of African countries are taking measures to ward off the Ebola-like Marburg disease after an outbreak of the illness in Angola, local media reported Sunday.

The reports said Zimbabwe's Health Ministry has asked public hospitals and entry ports to increase vigilance against the hemorrhagic fever. Returningvisitors from Angola will have to go through necessary checks and those with suspected symptoms will beput in quarantine.

The Democratic Republic of the Congo (DRC) also requires people traveling in and out of the 57 entry ports bordering Angola to have body temperature measured and go though strict medical checks.

The Zambian authorities have sent medical and protective equipment to the three states bordering Angola and boost people's understanding of the Marburg disease in the areas. Kenya, Cameroon, South Africa and the Republic of the Congo arealso adopting measures to keep out the disease.

According to the Angolan Health Ministry, the epidemic has killed 233 people in the country since it first struck in October last year.

A story from Reuters South Africa has a more optimistic tone than the later ABC story reporting that Angola says Marburg outbreak coming under control:

Deputy Health Minister Jose Van Dunem said government and international health workers were turning to traditional healers and leaders to talk to the population.

"We already have it under control," he told Reuters in an interview in the capital Luanda late on Sunday. "There have been no new cases in other provinces. We know exactly how to cut the epidemiological chain of transmission."

But then there's this curious bit of contradiction in the same story...

International health workers in Uige have not yet confirmed the outbreak is under control. Marburg, which is transmitted through bodily fluids such as sweat, blood and saliva, has killed 235 people and infected 22 more,the health ministry said late on Sunday.

Almost all the cases have occurred in Uige province, northeast of Luanda.A handful of cases have been reported elsewhere in the country, but all among people who had recently visited Uige, the health ministry said.

Nearly three decades of civil war has wrecked the oil producing country's transport and health systems.

Van Dumen said 70 percent of hospitals and clinics were destroyed before the conflict ended in 2002. This has made it harder to tackle the disease.

But Van Dumen said poor roads between Uige and the rest of the country had also slowed the spread of the outbreak.

Residents say the main road out of the city is often all but impassable with flooding, potholes, and landmines still common along the route.

The Australian confirms that the death toll continues its steady daily climb, however, and seems to echo the sentiments of ABC's subsequent story...

The death toll from the Marburg epidemic has risen to 235 in Angola, with some 500 people under surveillance after coming into contact with the Ebola-like virus.Health officials are treating a total of 257 cases of the killer bug that has claimed 219 lives in the northern province of Uige, the epicentre of the outbreak, which was first detected in October. Angola's health ministry and the World Health Organisation said another 513 people were under surveillance. WHO experts said last week that there was no end in sight for the epidemic...
The information that is emerging from the region is curious at best. One is left to wonder if the full nature of this current outbreak is known, and if so, if it is been accurately reported. The sentiments reflected in the latest ABC story, seems to confirm their parallel suspicions.

One thing is for certain, the death toll continues a steady and perhaps slightly accelerated climb.

UPDATE: 04.19.05:12:32
Another story yesterday from Doctors Without Borders, both confirms some previous assessments and concerns, and shows evidence that the outbreak has reached beyond the Uige province... (HT. Freeper Judith Anne)

Despite these alarming statistics, measures announced to contain the epidemic have been slow to act and have so far failed to stop the epidemic spreading. While the epicentre of the outbreak is in Uige, last week saw the emergence of new areas of infection. In Songo, an hour west of Uige, four cases have been reported. While in Negage, 30 minutes south-west of Uige, the figure stands at three. The health infrastructure in these two localities has been affected...

Since the beginning of the crisis our teams have set up two isolation and treatment units: one in Uige Hospital, and one in Amerigo Boavida Hospital in the capital, Luanda. 23 patients have already been admitted to the centre in Uige. Isolation units are also being set up in Negage and in Songo, while the unit in Camabatela is already in place.

If the Uige containment has been breached, more personnel and supplies will be required to expand the efforts now in place. Each new case must be identified and assessed. All contacts must be identified, tracked and assessed as well. As the cases grow arithmetically, the task grows logarithmically. And strict sanitary procedures must be practiced throughout the process. Treatment hospitals must be reorganized as well, as the story further notes...

... hospitals affected by the virus must completely reorganised to avoid any risk of the virus 'nosocomiale' infection (this occurs when the virus is spread in the confines of the hospital itself).

All services must be disinfected and an isolation ward must be put inplace. Triage of patients must be stepped up in order to isolate suspected cases, and to prevent those infected by the virus coming into contact with patients of other illnesses.

These precautionary measures must be applied throughout the hospital. This involves not only the wearing of safety equipment but also the suspension of all invasive procedures (surgical operations, lab inspections, intravenous and intramuscular injections, etc.) with the exception live saving operations (emergency surgery, caesarian sections, etc.) which should be carried out in accordance with strict sanitary procedures.

Both the task at hand and the danger grows with each passing day. But, do let's remember those good people that are putting their lives on the line to both save the sick, and protect the well... and thank them silently, if not vocally.

Thank you.

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