Stronger measures needed in Marburg Fever outbreak in Angola

Despite these alarming statistics, measures announced to contain the epidemic have been slow to act and have so far failed to stop the epidemic spreading. While the epicentre of the outbreak is in Uige, last week saw the emergence of new areas of infection. In Songo, an hour west of Uige, four cases have been reported. While in Negage, 30 minutes south-west of Uige, the figure stands at three. The health infrastructure in these two localities has been affected.

Fighting a deadly and contagious disease and a complex epidemic

Marburg Fever - from the same family as the Ebola virus - is a deadly and contagious disease. Stamping it out requires a rigorous, multi-level strategy.

Because Marburg Fever can be transmitted through direct contact with bodily fluids, it is imperative that isolation units be put in place to treat those affected. No specific treatment exists but measures must be taken to treat those affected (rehydration, administering of antalgics and drugs to prevent vomiting, etc.)

Since the beginning of the crisis our teams have set up two isolation and treatment units: one in Uige Hospital, and one in Amerigo Boavida Hospital in the capital, Luanda. 23 patients have already been admitted to the centre in Uige. Isolation units are also being set up in Negage and in Songo, while the unit in Camabatela is already in place.

© MSF
MSF visits local areas with staff and display the protective gear to the local population used in the treatment of family and friends who contract the disease. Until recently little had been done to raise awareness, and in a climate of fear, MSF teams and WHO personnel have been met by hostile reactions during their visits to the areas of Cadongo and KimaKongo in Uige.

Click to see large view

 

Human and logistical action: Informing the population

To limit the risk of infection, efforts must be made to identify and assess suspected cases, and to locate and check on any people who may have come into contact with those affected by the virus. Nearly 500 'contacts' have so far been counted in Angola - 360 of these in Uige alone. In addition, strict sanitary procedures must be adhered to when burying victims of the Marburg virus - whether they have died at hospital or at home.

Such priorities require important logistic and human efforts. Protective clothing (gloves, gowns, masks, glasses, boots, etc.) is essential, while proper vehicles must be provided to locate suspected cases in different areas of the country, and to transport patients and bodies. All medical and non-medical personnel must be notified immediately.

Our volunteers are in charge of training Angolan medical and military personnel, alerting them to the strictest sanitary precautions to be taken in order to guarantee their own safety in the event of contact with victims and bodies. This effort must however be intensified.

If these measures are to succeed, they must be supported by specific policy aimed at informing the local population. So far little has been done to raise awareness, and in a climate of fear, MSF teams and WHO personnel have been met by hostile reactions during their visits to the areas of Cadongo and KimaKongo in Uige. Because fighting the outbreak means isolating patients and burying the victims in body bags, the local population often see the medical personnel as 'confiscating' the sick and the dead.

What is more, the high mortality rate of patients admitted to the isolation units (only two have survived more than 24 hours) has led to a culture of suspicion among the local population. Consequently, locals sometimes refuse to hand over the sick and the dead to medical teams, preferring instead to keep them at home, which creates a potential for future contamination.

By informing the population and alleviating the panic, those showing early signs of the virus may be hospitalised sooner - a move that will lead to a drop in mortality rates.

Reorganising the hospitals affected

Elsewhere, hospitals affected by the virus must completely reorganised to avoid any risk of the virus 'nosocomiale' infection (this occurs when the virus is spread in the confines of the hospital itself). All services must be disinfected and an isolation ward must be put in place.

Triage of patients must be stepped up in order to isolate suspected cases, and to prevent those infected by the virus coming into contact with patients of other illnesses.

These precautionary measures must be applied throughout the hospital. This involves not only the wearing of safety equipment but also the suspension of all invasive procedures (surgical operations, lab inspections, intravenous and intramuscular injections, etc.) with the exception live-saving operations (emergency surgery, caesarian sections, etc.) which should be carried out in accordance with strict sanitary procedures.

Inadequate reaction

For the time being, our efforts and those at both the national and international level remain largely inadequate given the gravity of the situation. It is imperative that Angolan authorities take into account the extent of the epidemic.

Without proper treatment of patients and protection of the population, Marburg Fever will continue to spread throughout Angola.