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Africa: Subsaharan

Marburg still peaking - WHO

2005-04-14

The headline and the quote below should say 'Marburg Still Not Peaking'. WHO's performance on this really has been dismal even by UN agency standards. They appear to have been the cause of the outbreak by using tainted needles in a childhood vaccination program and now sink to new lows here by blaming the Angolan people. They should be bringing in epidemiologists to find out how people are being infected and not continually repeating that infection results from contact with body fluids. Outside of a hospital setting, evidence from previous outbreaks is that contact with body fluids is not the primary cause of infection, it's contact with an unknown animal vector or tainted injections. There was a report yesterday that a family of 5 died within days of each other in Uige. This is strongly indicative of infection from a single external source not transmission within the family.

Uige - There is no end in sight to the outbreak of the Marburg virus in Angola, a top expert from the World Health Organisation said on Wednesday, citing "massive problems" in mobilising Angolans to fight the Ebola-like bug in this northern city.

"After four weeks, this epidemic is still peaking," said Pierre Formenty, the WHO's top specialist on new and dangerous diseases. "It has not been stopped, because we have massive problems in mobilising the community against it," he told AFP as the death toll from the deadly haemorrhagic fever hit 210. The length of the epidemic "really depends on the degree of the mobilisation by the Angolans, of the people itself, not only on the authorities... They don't realise that it could take months", Formenty said in an interview.

A team of top scientists arrived last month in the northern city of Uige, the epicentre of the epidemic that was first detected in October. Their efforts have been met with fierce resistance and denial by many residents in Uige, who are shunning the hospitals and the specially-suited medical teams that roam the city in search of Marburg cases. "Uige is not a classic urban environment. It's a village with 200 000 inhabitants," said Formenty, a French doctor who has been on various WHO teams to combat a dozen similar deadly outbreaks, including Ebola which hit mainly rural areas in central Africa.

"The difference between this outbreak of Marburg and previous outbreaks, including Ebola, is that this one is in an urban, confined area, while the others were in rural areas," said Tom Ksiazek, who heads the Atlanta-based centres for disease control's (CDC) special pathogens branch. "(That is what's making) this one more difficult to control," he told AFP.
I think what he means is we don't know how tranmission occurs in an urban context.

Apart from a lack of information to the public, despite the best efforts of the WHO, health experts are trying to battle the outbreak with the very little infrastructure left over from the country's civil war that ended in 2002. There is almost no running water and no electricity, except for a few homes running on generators in Uige.
So bring in generators and water purification equipment. It aint rocket science.
More experts are on their way to join the battle being fought by the WHO and Medecins sans Frontieres (MSF, Doctors without Borders).

Posted by:phil_b

#9 Bodily fluids, anyone?

no thanks - I'm sticking to the Cabernet

Posted by: Frank G 2005-04-14 10:53:16 PM

#8 One thing that helps spread the disease is the local custom of washing the dead before burial. Modern medicine has a hard time going up against traditions. Bodily fluids, anyone?

Posted by: SteveS 2005-04-14 10:37:02 PM

#7 Phil, my graduating class in high school had 43 people. I find it difficult to believe that rural folks come in to contact with more people than urban folks, regardless of culture. Why would this disease, alone amongst the communicable diseases, thrive better in rural areas than urban areas?

Much of the vector depends on the life expectancy of the virus in air. Ebola is fragile. Every minute that Marburg is infectious after leaving its host is another minute someone else can catch it. If I nurse my sick mother, then go vegetable shopping, might I be spreading the disease? How contaigous might I be with the early stages of this illness and still walk through the crowded markets, etc.? All questions we don't know the full answer to as yet.

And, you don't have hospitals in rural settings in most of Africa. Hospitals are an urban locus. Hence, more easily spread in urban settings.

Posted by: Chuck Simmins 2005-04-14 8:29:28 PM

#6 Transmission is occurring in the normal manner. It's easier t have it spread in an urban setting because more people can come in contact with the bodily fluids that spread the disease. Chuck, is there evidence for this? What little data that exists on previous outbreaks indicates that outside of hospitals contact with the unknown animal vector or contaminated needles were the main causes of infection. In addition, in developing countries large groups of people live in close proximity in both rural and urban environments. In rural areas, people live in villages of hundreds of people or an extended family lives in a single house. Its not like in the West. In fact I would expect the reverse - a person in a rural environment would come into close contact with more people than someone in an urban environment.

Posted by: phil_b 2005-04-14 7:06:18 PM

#5 Moose, can you source that?

Posted by: Chuck Simmins 2005-04-14 11:34:24 AM

#4 When you are dealing with what is essentially an "invisible monster", it is very easy to lapse into superstition and the blame game. In this case, however, consider that a high percentage, relatively speaking of the casualties have been foreign medical personnel from developed countries. I would not *first* suspect these people of practicing bad medical hygiene or incompetance in an otherwise highly septic environment with poor hygiene practices and general ignorance about disease.

Posted by: Anonymoose 2005-04-14 11:23:17 AM

#3 Transmission is occurring in the normal manner. It's easier t have it spread in an urban setting because more people can come in contact with the bodily fluids that spread the disease.

So far, with little data, the growth of the disease is not exponential. See my Marburg data.

The WHO has only been tracking this epidemic for 22 days. Almost half the cases are believed to have happened between October 2004 and March 21 2005 when the virus was identified.

The major problem with the data is that the WHO is reporting it on an irregular basis, so that their reports tend to show a spike in cases where there is none. In other words, a report three days after the last report will show many more cases than a report the following day would have.

Much of WHO's efforts are centered at their HQ, in Geneva I think.

Posted by: Chuck Simmins 2005-04-14 11:04:03 AM

#2 Dr Steve, your thoughts?

Posted by: thibaud (aka lex) 2005-04-14 10:30:39 AM

#1 I read an article some time back that argued that a major factor in the early rapid spread of HIV in Africa was the practice of conducting mass immunizations using only a few needles, possibly compounded by vaccines tainted with a/several monkey HIV viruses. If so, it sounds like WHO is criminally negligent at best in remaining committed to a known dangerous innoculation protocol.

Posted by: trailing wife 2005-04-14 10:29:17 AM

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