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Stronger Measures Needed to Contain Marburg Fever in Angola
April 17, 2005
Marburg Fever continues to spread in the Angolan province of Uige. As of April 17, the official death toll stood at 235 among 257 reported cases. The virus was confirmed by the World Health Organization (WHO) on March 22 after extensive biological testing, and since then, 136 new cases have been identified, with 129 proving fatal.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams have set forth emergency measures in order to contain the epidemic, but so far these measures have failed to stop the epidemic from spreading. While the epicenter of the outbreak is in Uige, new areas of contamination emerged last week: In Songo, one hour west of Uige, four cases were reported, while in Negage and Camabatela, thirty minutes southwest of Uige, the three cases were reported.
Fighting a Deadly Disease and a Complex Epidemic
Marburg Fever – from the same family as the Ebola virus – is a deadly and contagious disease. Eradicating it will require a rigorous, multi-level strategy. Because Marburg Fever can be transmitted through direct contact with bodily fluids, it is imperative that isolation units be set up to treat those who are affected. No specific treatment exists, but measures like re-hydration, medicine to prevent vomiting, and the administration of pain medication are essential to the patient's comfort and possible survival.
Since the beginning of the crisis, MSF teams have set up two isolation and treatment units: one in Uige Hospital and one in Amerigo Boavida Hospital in the capital, Luanda. Already, 23 patients have been admitted to the center in Uige. Isolation units are also being set up in Negage and in Songo, while a unit in Camabatela is already in place.
Informing the Population
To limit the spread of infection, efforts must be made to identify and assess suspected cases, as well as to locate any people who may have come into contact with those affected by the virus. Nearly 500 contacts have already been counted in Angola – 360 of those in Uige alone. Strict sanitary procedures must also be adhered to when burying victims of the Marburg virus – whether they have died at the hospital or at home.
Protective clothing such as gloves, gowns, masks, goggles, and boots are essential. Special vehicles must also be provided to locate suspected cases, to transport patients, and to transport the deceased. MSF volunteers are training Angolan medical and military personnel on the strictest sanitary precautions in order to guarantee their own safety in the event of contact with victims. This effort, however, must be intensified.
If these measures are to succeed, they must be supported by policies aimed at informing people in the most affected areas. So far, too little has been done to raise awareness, and in a climate of fear, MSF teams and WHO personnel have been met by hostile reactions during their visits to the areas of Cadongo and KimaKongo in Uige. Because combating the outbreak means isolating patients and burying the victims in body bags, people often see medical personnel as "confiscating" the sick and the dead. The high mortality rate of patients admitted to the isolation units (only two have survived more than 24 hours) has also generated a culture of suspicion among the local populace. As a result, many people are reluctant or simply refuse to hand over the sick and the dead to medical teams, preferring instead to keep them at home which creates a potential for future contamination. By informing the population and alleviating the panic, those showing early signs of the virus may be hospitalized sooner – a move that could help better serve patients' needs.
Reorganizing the Hospitals
In areas affected by the virus, hospitals must be completely reorganized to avoid any risk of infection. This can occur when the virus is spread within the hospital itself. The entire hospital must be disinfected and an isolation ward must be created. Triage of patients must be stepped up in order to isolate suspected cases and to also prevent those infected by the virus from coming into contact with patients suffering from 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.) except for lifesaving operations like emergency surgery or caesarian sections.
An Inadequate Reaction
Up until now, MSF efforts as well as those at both the national and international level remain largely inadequate given the gravity of the situation. It is crucial that the Angolan authorities recognize the magnitude of the epidemic. Without proper treatment of patients and protection of the population, Marburg Fever will continue to spread throughout Angola.