Bozur
Amicus
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Post by Bozur on Mar 28, 2005 3:54:40 GMT -5
NYTimes.com > International > Africa
Virus New to Angola Kills 95; Travelers Told to Avoid North
By MICHAEL WINES
Published: March 24, 2005
JOHANNESBURG, March 23 - Health officials urged travelers on Wednesday to avoid UÃge Province, in northern Angola, after the World Health Organization identified the Marburg virus as the source of an epidemic that has killed at least 95 Angolans since October.
The Marburg virus, a close relative of Ebola, has been identified in Uganda, Kenya and Congo, where the last major outbreak was recorded from 1998 to 2000. But it had not been found before in Angola.
In recent months, tens of thousands of refugees from Angola's 21-year civil war have passed through UÃge, returning from neighboring Congo under a repatriation program sponsored by the United Nations. United Nations officials suspended the program last week as evidence of the disease spread.
Three in four Angolan victims were 5 or younger, officials said, and some of the adults were health care workers who had come in direct contact with the bodily fluids of infected persons. At least seven more Angolans are infected with the virus, officials said.
The virus causes a high fever, diarrhea, vomiting and extensive hemorrhaging in the lungs and digestive tract. There is no cure or effective treatment. Victims in the Angola outbreak have generally died within a week of the onset of symptoms, the World Health Organization said Wednesday. The incubation, from infection to onset of the illness, is 5 to 10 days.
The virus was first discovered in 1967, when monkeys imported from Uganda infected laboratory workers in Marburg and Frankfurt, Germany, and Belgrade, Yugoslavia. It is spread largely by direct contact with infected people, and human outbreaks are exceedingly rare.
The latest instance is rivaled only by the 1998 epidemic in Congo, which infected 149 people and killed 123, mostly miners at Durba.
At a news conference on Tuesday, Angolan and United Nations health officials said the virus was first detected in the central hospital in UÃge, but had since spread to villages as far as 31 miles away. The government has begun a public awareness campaign stressing the need for cleanliness to combat the spread.
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Bozur
Amicus
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Post by Bozur on Apr 9, 2005 20:19:31 GMT -5
NYTimes.com > International
World Briefings
Published: April 5, 2005
Michael Wines (NYT)
ANGOLA: MARBURG VIRUS CLAIMS MORE LIVES An outbreak of Marburg virus, a rare and highly contagious form of hemorrhagic fever closely related to the Ebola virus, has intensified in Angola, claiming more than 29 lives over the last four days and taking the nationwide toll to 155, the World Health Organization and the Angolan government said in a statement. The cases, mostly involving children, continue to be confined to northern Uíge Province. (Agence France-Presse)
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NYTimes.com > Health
Fear and Violence Accompany a Deadly Virus Across Angola
By SHARON LaFRANIERE and DENISE GRADY
Published: April 9, 2005
LUANDA, Angola, April 8 - The death toll in Angola from an epidemic caused by an Ebola-like virus rose to 174 Friday as aid workers in one northern provincial town reported that terrified people had attacked them and that a number of health workers had fled out of fear of catching the disease.
International health officials said the epidemic, already the largest outbreak of Marburg virus ever recorded, showed no signs of abating. Seven of Angola's 18 provinces have now reported suspected cases and several neighboring countries have announced health alerts.
"It's becoming a huge problem," said thingy Thompson, a spokesman for the World Health Organization, which has dispatched surveillance teams to the country's northern provinces. "We clearly don't know the dimensions of the outbreak."
Health officials said some Angolans are hiding sick relatives out of fear that they will die if taken to the hospitals, thereby increasing the chance the disease will spread. There is no cure or vaccine for the highly contagious virus. Victims suffer a high fever, diarrhea, vomiting and severe bleeding from bodily orifices and usually die within a week.
The initial outbreak appears to have spread through a pediatric ward in Uige, a town in a farming district about 180 miles north of the capital of Luanda. More than 60 percent of the victims so far have been children.
One health official in Uige said that more than a dozen health care workers have perished from the disease, including two doctors, and that many workers are deserting the town's hospital in fear. Some townspeople are refusing to allow their sick relatives to be taken to an isolation unit set up at the hospital there by Doctors Without Borders, fearing it leads only to a graveyard.
As field workers tried to trace suspected cases in two Uige neighborhoods Thursday, townspeople threw stones at them, accusing them of killing people who had been taken away sick and who were returned to them dead. The violence forced the health workers to suspend their checks, according to officials from the World Health Organization and Doctors Without Borders. The government has dispatched soldiers to the province but so far made only a limited effort to educate an increasingly terrified public.
"We want people to understand that in a public health emergency you sometimes have to take unpopular measures," said Monica Castellarnau, the emergency coordinator for Doctors Without Borders in Uige. "At the moment all they understand is that we take someone to a locked-up place in a hospital, and then they die."
The World Health Organization officials said the disease so far appears confined to Angola but have recommended that four bordering countries be on the lookout for cases of the virus. The disease is spread through bodily fluids, including blood, excrement, saliva and vomit.
The United Nations appealed Friday for $3.5 million to fight the disease, saying Angola needs field laboratories, field workers to spot cases early, isolation units for the sick and a huge information campaign. Officials said the epidemic was spreading much faster than it did in the Democratic Republic of Congo, which until now had recorded the highest number of Marburg deaths. That two-year outbreak killed 123 people and ended in 2000.
Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said.
The intensity of Angola's outbreak is apparently partly due to the horrific state of the nation's hospitals after a 27-year civil war that ended in 2002, the failure to identify the disease for months after the first case and some traditional burial customs, including kissing corpses. Only when health care workers began dying in early March, six months after what health officials now believe was probably the first case, was the alarm fully raised.
The number of suspected cases, now at 200, shot up dramatically in the past two weeks, as epidemiologists have fanned out to try to identify the sick. The government is broadcasting daily radio warnings, asking people to transport any people with Marburg-like symptoms to the hospital and not to touch the corpses.
A cousin to the Ebola virus, Marburg is named for the town in Germany where it was first identified in 1967 after laboratory workers were infected by monkeys from Uganda.
Scientists do not know the source of the virus or how the current outbreak began, but they suspect that the virus was transmitted from an animal, possibly a bat. Health experts say that to control the epidemic, medical workers must check everyone who had contact with a victim after the first display of symptoms. That can mean 10 or 20 people to follow for each suspected case, each of whom should be checked once a day.
"As soon as someone is suspected and hospitalized, then you start to follow all the contacts, all the people with him in the last few days when he was still O.K.," said Dr. Pierre Rollin, a physician in the Special Pathogens Branch of the Centers for Disease Control and Prevention. In one Ebola outbreak, he said, epidemiologists had to track 3,000 people a day.
"It is quite impossible sometimes," he said.
The task may be especially daunting in Angola, with its rutted dirt roads, teeming townships, remote villages and countryside still littered with land mines from decades of conflict. Epidemiologists say teams of specialists may be needed for months to come.
Sharon LaFraniere reported from Luanda for this article, and Denise Gradyfrom London.
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Bozur
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Post by Bozur on Apr 12, 2005 17:51:57 GMT -5
A Daunting Search: Tracking a Deadly Virus in Angola By SHARON LAFRANIERE and DENISE GRADY
Published: April 12, 2005
UÍGE, Angola, April 11 - The staff in the pediatric ward of Uíge's regional hospital suspected something was terribly wrong as early as October, when children who had been admitted with seemingly treatable illnesses began, suddenly and wrenchingly, to die.
But were those early deaths caused by the Marburg virus? If they were, and had they been diagnosed at the time, might the current epidemic have been averted?
The international health experts who have descended on Angola say they cannot pinpoint exactly when the largest outbreak of the deadly virus began.
"Nobody really has a sense of where or when it started," said Dr. Thomas Grein, a medical officer in the World Health Organization. "The widespread belief that it began in October is speculation."
But local officials in Uíge, the center of the outbreak, believe it began around that time, and then spread from the pediatric ward of the regional hospital, which has now been effectively closed except for emergency operations.
If they are correct and there was a delay in explaining the deaths, the reason may be that in Africa, sometimes the extraordinary is buried in the ordinary.
Children die at such an astonishing pace here and for any range of horrible reasons unknown to other parts of the world that it takes much more time for health workers to piece together if something as deadly as Marburg is at work.
In a country like Angola, where one in four children dies before the age of five, mostly from infectious diseases, crises like the one in the pediatric ward can easily be overlooked.
An outbreak of Marburg can look like a host of other illnesses to doctors and nurses who have never before encountered the disease.
"This is Africa," said Dave Daigle, the spokesman here for the World Health Organization. To be a health official here, he said, "is like being a fireman in a village with the whole village on fire."
Experts say at least 214 people have caught the virus and 194 have died. Marburg is spread by contact with bodily fluids, from blood to sweat, and kills with gruesome efficiency. Victims suffer from vomiting, diarrhea, high fever and bleeding from body orifices. Nine in 10 are dead within a week. There is no effective treatment.
When strange deaths first began to appear in October, mystified local health officials shipped samples of tissue and blood from four children to the United States.
In November, the Centers for Disease Control and Prevention tested them for at least three different types of hemorrhagic fever, including Marburg.
The results, which nearly all agree were accurate, came back negative. But in the tumult of deadly diseases and other health issues that plague this continent, it remains possible that Marburg was present in Uíge even then.
By the end of December, at least 95 children were dead, local health workers say.
How many deaths were Marburg-related is unknown, but even by the grim standards of the continent, it was an alarming number of deaths.
"In October, November, December, we were seeing so many children dying - just children," said Dr. Gakoula Kissantou, 31, the hospital's acting administrator. "It was becoming scarier."
He recalled the doctor in charge of the pediatric ward at the time, Dr. Maria Bonino of Italy, called a meeting with the staff and asked, "What is going wrong here in the hospital?" She herself died in March, a victim of the virus.
It was not until early March that the provincial health officials alerted a W.H.O. representative that they had found 39 suspected cases of Marburg. W.H.O. officials identified 60 possible cases. Angolan authorities then shipped more samples to the C.D.C. in Atlanta. On March 18, 9 of 12 came back positive for Marburg, which by then was claiming more victims by the day.
Since those new lab tests positively confirmed the virus, a growing number of epidemiologists, anthropologists, public health experts and emergency medical workers have descended on Uíge in a race to cut off the disease.
One thing is certain, scientists say: the epidemic began with just one infected person, and was then transmitted from one person to another.
That conclusion, based on finding only one strain of virus in all the samples tested, means the outbreak can be stopped if infected people are isolated.
Given the degree to which it has been contaminated, the regional hospital, which serves 500,000 people, has now been limited to emergency operations and an isolation ward where Doctors Without Borders, the international health charity, treats Marburg victims.
Eight pediatric nurses and the doctor in charge of the ward are dead, along with six other nurses and one other doctor, all Marburg victims. Every mattress, bed sheet and hospital uniform must be thrown out. Everything left must be disinfected.
On Monday, teams of soldiers and hospital personnel clad in bright yellow prowled the grounds, spraying grass, benches and dirt paths with a solution of diluted bleach. Afterward, they burned their uniforms.
At some point, said Dr. Kissantou, the hospital's acting administrator, normal operations will resume. He refused to hazard a guess as to when.
"I am upset that we are not serving patients," he said, plopping down on a wooden chair outside his office as two aides stood by. Barred from the hospital, he said, some of the sick are diagnosing their own illnesses and trying to treat themselves with medicine they buy at the local market, with disastrous results.
"Some people are dying because the medicine doesn't fit the illness," he said. "That's why we are asking for help, so people can come here to get treatment."
But to treat patients safely again, hospital officials need to address a range of problems. They must find ways to systematically isolate high-risk patients before they mix with other patients; to equip the medical staff with masks, gloves and other protective equipment; and to enforce sanitation measures, like proper hand-washing, even when there is no running water.
Dr. Kissantou, one of only two Angolan doctors at the hospital, says all that could be done, with enough money. The provincial governor has promised $1 million, he said, but more support is needed.
Yet the biggest challenge of all may be regaining the trust of the community after so many deaths. It is one reason why Dr. Kissantou, who took over the hospital after his predecessor was fired, still comes to work every day.
"I am a doctor," he said. "I will not flee, because I prefer to give my life to another."
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