Marburg virus makes unwelcome comeback
Written by: Peter Apps

A health worker in protective clothing in the northern Angolan town of Uige during the 2005 Marburg outbreak. REUTERS/Mike Hutchings
After a couple of quiet years, the Marburg virus is back. Like its cousin the Ebola virus, Marburg is a contagious haemorrhagic fever that produces sudden massive internal bleeding and can kill within days. Death is painful but slightly less spectacular than Ebola - one journalist once described the sound of someone dying of Ebola as like a sheet being ripped. Marburg is quieter, but just as lethal. There is no vaccine, no cure and little effective treatment. The last outbreak of the virus, which is transmitted through bodily fluids, was centred around the town of Uige in northern Angola in 2005, close to the border with the Democratic Republic of Congo. Out of 374 cases identified by the Angolan Ministry of Health, 329 died, according to the final International Federation of Red Cross report. But by mid to late 2005, the outbreak had died out. Now, the World Health Organisation says Marburg has been confirmed in the case of a 29-year-old man who died in a mining community in Uganda, again near the Congolese border. There have been several other suspected cases, and the Ministry of Health and WHO are closely monitoring the area. By the time I arrived in Angola in 2005 with a Reuters multimedia team, travel to the infected area had become almost impossible. Drivers, car hire firms and just about anyone else refused to risk the trip. Eventually, we found a South African charter flight company who were willing to fly us in. A few weeks earlier, the same company had flown a foreign doctor back to the capital after he had become infected. He died soon after. Uige itself was functioning surprisingly normally, with shops and markets still open, but with a strange apocalyptic feel in the air. Government teams in protective gear could be seen moving around, while the nights were punctuated by spectacular thunderstorms. A few days before we arrived, three Red Cross and one other local health worker working on educating the population about Marburg were killed by lightning while sheltering under a tree. Much of the local hospital staff had died in the early stages of the outbreak but new staff had been flown in both from Angola and from elsewhere in the world courtesy of the World Health Organisation. But with so many people dying at the hospital, relatives were apparently reluctant to bring their sick people there. Too often, the WHO teams going out into the community were finding cases after the victims had died - and therefore after they had infected family members through their sweat and blood. Others contracted it as they washed and kissed their dead relatives prior to burial in accordance with local custom. Some called local traditional healers who themselves became infected and spread the disease. Dressed in protective "spacesuits", WHO teams were even being attacked as they went out into the cramped slums around Uige - a town that still bore the scars of decades of neglect and occasional fighting during Angola's recently finished civil war. Local residents somehow came to believe it was the medical teams who were spreading the disease. But by the time we got there, the tactics had changed and the message was beginning to get through. The key aim was to make people less afraid of the health teams and more terrified of the virus. So the WHO contact teams kept their "spacesuits" off until they reached the doors of infected houses, while leaflet distributions and loudspeaker vans - some broadcasting a specially composed "Marburg song" by local band - spread the message. Success meant making people avoid contact with the sick. While those in town were sometimes able to get relatives to the new isolation ward at the hospital, out in the countryside the options were more brutal. One of the signs of "success" was when we heard of a man whose pregnant wife began vomiting blood. Instead of caring for her and infecting himself and the rest of the family, he took himself and the other children out of the house and locked the door. Local residents said she was screaming for several days but by the time WHO arrived she was dead. But the family survived, and the virus did not spread. The Uganda outbreak is not nearly at that stage, and hopefully never will be. The one identified fatality died on July 14, and no new cases have been reported for a couple of weeks. But on an emerging infectious diseases website run by the International Society for Infectious Diseases, the moderator sounds a note of caution. "In prior outbreaks of viral haemorrhagic fevers in Africa, the occurrence of cases leads to panic and contacts frequently leave the area...returning to their distant villages while incubating the infection," they write. "This moderator doesn't wish to appear as a gloomy predictor, but rather is exerting caution in giving an 'all is clear' message."
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Peter Apps covered business, politics, disaster, disease, agriculture and occasional crime stories for Reuters in southern Africa before being reposted to Sri Lanka just in time for a new outbreak of civil war. A minibus crash on assignment in September 2006 broke his neck and left him quadriplegic. Nine months to the day after the crash, he was released from hospital in a wheelchair and returned to work for AlertNet in London, scheming his return to field reporting.
06 Mar 2008 18:34:27 GMT
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