/ 21 April 2005

Angola’s neighbours watch for Marburg

Fewer cases of Marburg fever were reported in Angola this week, but medical experts said on Thursday it is too soon to say this indicates the hemorrhagic virus is waning.

And countries of the region, under the 13-member Southern African Development Community, are certainly not dropping their guard.

This week saw two scares in South Africa as travellers, both from Angola, suffered high fevers. In each case, they were found to be suffering from malaria.

But the swift reaction is seen by authorities as an indication that there is healthy vigilance against the disease that has killed 235 in Angola.

No official travel restrictions have been put in place by the South African authorities, although the private Johannesburg-based travel clinic that advises travellers on potential health risks has warned South Africans against visiting Angola unless absolutely necessary.

”We did not feel the need to impose specific travel restrictions because one would need to come into rather close contact with an infected person to contract the virus,” said Barry Schoub, director of South Africa’s National Institute of Communicable Diseases.

”It cannot be contracted by casual contact. It is transmitted by bodily fluids,” he said.

”We have preferred to conduct an information campaign aimed at people possibly incubating the disease who are entering South Africa.”

”We have notified all the port authorities of the signs and symptoms and they in turn are advising people to be aware of these,” Schoub said.

”So anyone displaying any signs of the disease is advised to be in contact with the authorities — particularly those who have come from the Angolan provinces where there have been outbreaks.”

There have been cases of Marburg fever in seven of Angola’s 18 provinces but all of these have been found to have originated in Uige, a municipality in the north of the country, with a population of 200 000.

”There have been fewer cases reported in recent days so it appears the epidemic might be tailing off, but it is early days yet,” Schoub said.

”So far there have been no cases reported in South Africa, despite a number of scares.”

Tom Ksiazek of the Atlanta-based Centre for Disease Control said this outbreak is distinguished from previous cases in that it has taken place in a confined, urban environment.

Journalists who have visited Uige say the lack of fresh, running water and a limited health infrastructure is compounding the difficulty in treating the epidemic.

World Health Organisation (WHO) officials say efforts have been intensified to teach these communities about the disease and to report cases.

Last week the WHO said it provided training for 82 nurses in high-risk departments, including maternity wards and the laboratories. Similar training is planned for doctors and police officers.

The disease has a mortality rate in excess of 90% and is not treatable with any known drug. It can kill a healthy person within a week from diarrhoea, vomiting and severe internal bleeding. It is spread through contact with bodily fluid blood, urine, saliva, excrement, sweat, tears and vomit.

The disease was first discovered in 1967 when laboratory workers in the German town of Marburg came into contact with infected monkeys.

The Democratic Republic of Congo (DRC) had an outbreak five years ago that killed 123 people. The DRC is on the alert for infected persons crossing the border.

Similarly the authorities in the Republic of Congo, Kenya, Gabon and Namibia have all alerted their citizens to the danger of travelling in Angola.

Kenya’s health ministry says it had set up a system at the country’s two main airports — Jomo Kenyatta International airport in Nairobi and Moi International airport in Mombasa — to screen passengers arriving from Angola.

It has alerted all hospitals and clinics to the potential for the virus to appear in Kenya, which recorded three cases of the disease in the 1980s, two involving travellers in the west of the country and the Nairobi physician of the first patient.

”The ministry has issued an alert to all health facilities about the Marburg outbreak and directed that all health workers strictly adhere to the standard guidelines for infection prevention and control for all infectious condition including virus hemorrhagic fevers in health care settings,” it said.

The ministerial council in Gabon, where Ebola bleeding fever killed 116 people in 1994 and 2002, has also placed the epidemiological surveillance services on maximum alert following news of the outbreak in Angola. – Sapa-IPS