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Marburg Outbreak Now Devastating All Age Groups

By Shaoni Bhattacharya
NewScientist.com
May 11, 2005

http://www.newscientist.com/article.ns?id=dn7363

The outbreak of the deadly Marburg haemorrhagic fever sweeping across northern Angola is now devastating all age groups - and no longer predominantly young children - say epidemiologists on the ground.

The rare but deadly virus has been rampaging through the Angolan province of Uige since March 2005, leading to the worst outbreak yet known. In the early weeks of the outbreak, the virus mysteriously appeared to be striking down mainly children under five. Before this happened, cases in children were considered extremely rare.

But now the disease appears to be attacking all ages, says Evelyn Depoortere, an epidemiologist and physician with Paris-based Epicentre. "It's not focused on children anymore," she told New Scientist from Luanda , Angola , where she is working with a Medecins Sans Frontieres team to help track and contain the virus.

 According to the latest figures the MSF team has received, the number of cases had snowballed to 311 in Uige on 7 May, including 271 deaths. Most cases have occurred in the province but there have been cases elsewhere. Some reports suggest there may be 327 people affected in Angola .

 "But we can't say if the outbreak is slowing down or not," says Depoortere. "At this point it's really difficult to have all the information."

 In another new development, Zambia announced a Marburg alert on Wednesday, according to the Zambian Red Cross in Lusaka . This was after a man living in Mongu - a western province on the Angolan border - visited Angola and then died from what is suspected to be Marburg disease.

 Chain of transmission

 In Uige, the MSF team has been working with the authorities to provide a Marburg treatment ward at the region's main hospital, where probable and confirmed patients can be treated in isolation. It is also working with the World Health Organization to trace contacts of infected people to help break the chain of transmission.

 "I have been visiting families of patients to try and find the epidemiological link," says Depoortere. Early in the outbreak, the virus's rapid and unusual spread among children prompted scientists to speculate that unsafe medical practices - such as unsterile injections - might be fuelling its spread.

 Depoortere believes that human-to-human transmission may now be the most important factor. Contact with sick people or with those who have died - at a traditional burial, for example - is an important mode of transmission. But she thinks unsafe practices such as using dirty needles remain a problem.

 Raising awareness

 Various agencies, along with the Angolan ministry of health, are also working to train health care staff, including traditional healers, on how to safely deal with possible cases. And they are also working with communities to ensure that burials are carried out safely. The WHO has even been broadcasting a new song about the deadly virus from vans driving through Uige.

 "We feel it's very important to be very present in the community raising awareness so people have confidence in medical teams and the system so they continue to be alert for cases and are not afraid to come to the hospital," says Depoortere.

 This outbreak of Marburg - which is related to the Ebola virus - is the worst ever seen, though only a handful of outbreaks have been documented since the virus's discovery in 1967. The Marburg virus also appears even deadlier than its fearsome relative in this outbreak, killing over 90% of its victims, according to the WHO.

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