The New York Times reports on the effort to stop the Marburg outbreak in Angola:
For nearly four weeks, teams of health experts have been trying to set up a rescue operation in this town of windowless, crumbling buildings with no running water, intermittent electricity, poor sanitation and a perennially jammed telephone network.
[. . .]
Their efforts to curtail the outbreak turn on whether distrustful local people in this poor and isolated town of 50,000 people alert health workers to suspicious cases. So far, persuading them has not been easy. Victims who are taken to the isolation ward are never seen again; their bodies, rapidly buried for safety, cannot be honored in the traditional funerals so important in this country.
[. . .]
For the people of Uíge, rampant death is now joined by the near equivalent of a space invasion: health workers encased in masks, goggles, zip-up jump suits, rubberized aprons and rubber boots as they collect corpses in the stifling heat. The garb is all white, a symbol of witchcraft here.
Teams of epidemiologists and provincial health workers have fanned out, checking reports of potential new cases and tracking down people who had contact with the dead or dying.
So far, most reports from the community deal with the dead, not the sick.
The Angolan's are hiding sick relatives and attacking medical teams that go out into neighborhoods to check out reports of possible Marburg cases. The Angolan government still has not done nearly enough to try and halt the Marburg outbreak:
Dr. Alexandre [the Uíge hospital director] said many deaths might have been prevented had the authorities acted more rapidly.
"The emergency public health service should have begun investigating right in October, or at least in November," he said. "What happened was we lost a lot of time."
Even now, health experts say, Angola's government has failed to mount a full-scale response to the epidemic, leaving the bulk of the burden to the outside groups that have come to Uíge. The government has sent only four or five medical specialists to the province, and 30 to 35 soldiers, who are mainly helping to collect and bury bodies.
Unless the government does a better job of explaining the epidemic to its people, the health workers fear, they face a long, uphill battle.
"What we are doing now is having almost no impact," said Monica de Castellarnau, who headed the Doctors Without Borders team here until Friday. "We cannot replace the government."
The Times' article contains this reporting on the beginning of the outbreak:
Dr. Bonino, from the charity Doctors With Africa, began suspecting that there was something dreadful in the children's ward of the sprawling regional hospital in March of last year, months before anyone else became alarmed. The ward of 97 cots was crammed with youngsters suffering every ailment that Angola's oppressive climate and primitive sanitation could muster. She noted that one child stood out, suffering from vomiting, fever and bleeding, symptoms she recognized as classic indicators of hemorrhagic fever, her colleagues say. The child died within days.
[. . .]
In July, a new hospital director, Dr. Matondo Alexandre, was installed. He said Dr. Bonino quickly told him of the possible case of hemorrhagic fever. She pointed out another case in October, he said, and four blood and tissue samples were sent to the capital, Luanda, and then to the Centers for Disease Control and Prevention. The tests, generally considered reliable, turned up negative; recent retests came up negative again.
Between November and January, Dr. Alexandre said, he sent two more samples to Luanda, taken from people apparently killed by hemorrhagic fever. He said he got no response.
Dr. Alexandre said the initial negative test results might have blinded the government. This is, after all, a country where one in four children dies before the age of 5; the causes for a slew of deaths on the pediatric ward could be legion.
"I think the results maybe influenced people to think that there is something normal going on, and this was just one disease out of so many diseases we have going on," he said.
On the pediatric ward, though, the situation seemed anything but normal after October.
More than 200 patients filled the ward, according to Luiza Maria Costa Pedro, the chief pediatric nurse, and two other doctors who worked at the hospital. Children slept two to a bed. Mattresses were spread upon the floor for those who could not fit in the bunks.
Dr. Bonino was increasingly worried. "She sat across from me in that chair and said we are having too many strange deaths," said Dr. Enzo Pisani, who works at the hospital, also for the Italian charity.
Mrs. Costa Pedro said the children were admitted with vomiting, diarrhea and fever. Those symptoms are typical of malaria and many other tropical diseases. But after October, the death rate went up from three to five children a week to three to five a day, she said, and many died bleeding from the mouth or other orifices.
"We were very, very upset," she said. "We didn't have any way to help the patients, and we couldn't discover who brought here this sickness."
When national authorities failed to respond to requests for more tests, Dr. Alexandre took to the radio. In February, he announced that he suspected an outbreak of hemorrhagic fever in Uíge.
Now, he said, he has been cast as a scapegoat. Traditional leaders, he said, circulated rumors that he had used witchcraft to create the virus in hopes of winning a job promotion, a charge that can carry substantial weight in a region where deep superstitions blend seamlessly with modern beliefs. He was dismissed as hospital director.
His aunt was beaten by angry residents, he said. Last week, national authorities sent a helicopter to carry him and his family to Luanda.
The radio broadcast did, however, provoke the national Health Ministry to send a team to Uíge in early March. The World Health Organization quickly followed.
Dr. Bonino gave the arriving teams a list of 39 suspected cases of hemorrhagic fever. The investigators found two dozen more. New samples were flown to Atlanta.
On March 21, 9 of 12 came back positive.
Less than a week later, Dr. Bonino died of Marburg virus. Fourteen nurses and a Vietnamese surgeon who worked at the hospital have also died. The surgeon was probably infected while performing an autopsy on a Marburg victim, Dr. Pisani said.
This Marburg outbreak is very frightening and needs to be dealt with more effectively. California Yankee has been posting about the Angolan Marburg outbreak since March 16th. the posts are indexed here. I don't understand why the outbreak isn't getting more coverage why there hasn't been a more effective international response. Until there is a more effective response the death toll will keep rising.
South Africa's News24.com reports that the death toll is now over 200:
The death toll from the Marburg virus epidemic in Angola rose to 235 on Sunday with about 500 people under surveillance after coming in contact with the Ebola-like virus, the health ministry and the World Health Organisation said.
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