Marburg fever epidemic still not under control in Angola

Six weeks after the confirmation of the Marburg fever outbreak in Angola through biological tests on March 22, the epidemic is still not under control. The official toll, as of April 30, is of 271 deaths and 301 cases. The disease has taken a heavy toll among the medical staff - at least 19 have died. The situation has increased to levels that MSF is now increasing its role in infection control. MSF was previously restricted to infection control only in the isolation unit but is now taking on similar responsibilities throughout the hospital. The situation is still alarming. In the city of Uige, the main focus of the epidemic, bodies are collected every day. Since the first alert was, a new focus has sprouted in Songo hospital, about 50 kilometres northwest from Uige. Many problems remain unsolved and new difficulties arise every day. Last week, three Marburg cases died in different wards of Uige hospital. The infection control system put in place has been inefficient. The World Health Organization (WHO), that was supporting the Angolan Ministry of Health in the implementation of this system, recognized last Friday that "under such conditions, amplification of transmission is highly likely to occur". In order to protect both the patients and the medical staff - and in response to a request from the authorities - MSF will increase its responsibility for infection control. All wards will be disinfected, and a stringent triage of patients needs to be put in place in order to temporarily restrict admissions to life-saving emergencies. For these measures to succeed it is imperative that they be strictly respected. As a consequence of this new situation, the peripheral health centres need to be reinforced in order to deal with the additional flow of patients and treat diseases other than Marburg fever. The local health authorities and the WHO also need to improve the system of identification of suspect cases and the follow up of people who have been in contact with infected patients. MSF believes that to control the epidemic it is vital to inform the population about the disease and its prevention. Families and patients must receive the support from the authorities, the community and all actors present in this crisis. Violence and threats to affected families, as reported to MSF staff, will only worsen the situation and lead to stigmatisation. MSF has treatment wards for Marburg patients in Uige, Songo, Negage and Luanda. These centres allow MSF to isolate the cases and take care of the patients. MSF is also collecting patients and bodies in the community and carries out burials respecting the strictest bio-protection measures. Awareness-raising activities have also been intensified so that these public health measures can be understood by the population. MSF has 55 expatriates working in this emergency.