- Concerns are growing internationally as the outbreak of the Ebola-like Marburg virus is spreading in Angola. With 126 confirmed deaths, this is already the largest Marburg outbreak ever recorded. Infections are now also reported outside Angola's Uige province and among health workers.
While the Marburg outbreak is still mainly concentrated in the northern province of Uige, 4 deaths have already been reported in Angola's capital, Luanda, and several more are infected. Also in Angola's northern exclave Cabinda, one death has been confirmed and 14 contacts have been placed under hospital quarantine.
There are also concerns that the epidemic may spread outside the country. A recent passenger from Angola to Portugal died on Saturday. His death, which is still under investigation, may have been caused by the Marburg virus and Portuguese authorities are on high alert. Finally, authorities in Congo Kinshasa (DRC) are on alert, as that country neighbours both Uige and Cabinda in an area where borders are porous.
The Angolan Ministry of Health has formally declared an epidemic in the province of Uige and is now closely monitoring the few cases reported outside Uige. National authorities further are receiving technical support from the World Health Organisation (WHO) and other UN agencies to control the spread of the deadly virus.
The work to control the outbreak is however not without risks. At least two policemen, two physicians and six nurses have died due to their work with Marburg patients. The two physicians - from Italy and Vietnam - died in Luanda last week after treating patients in Uige. Another Angolan physician is also infected.
The Marburg virus disease has no vaccine or curative treatment and is mostly rapidly fatal. In the present outbreak, most deaths have occurred between 3 to 7 days following the onset of symptoms. The Ebola-like disease is a viral haemorrhagic fever causing an acute febrile illness. A severe watery diarrhoea, abdominal pain, nausea and vomiting are early symptoms, as are severe chest and lung pains, sore throat, and cough.
As is the case with Ebola, scientists hold that the natural reservoir of the Marburg virus is in the region's ape population. It probably spreads to human as a result of ape hunting and preparation of bushmeat, under which there are close contacts with bodily fluids of the infected ape. During an outbreak, the disease is believed to spread by "close contact with bodily fluids of infected people," according to WHO.
The current Marburg outbreak in Angola is already the largest and deadliest ever recorded. Until now, the largest outbreak on record occurred from late 1998 to late 2000 in the Congo Kinshasa and involved 149 cases, of which 123 were fatal. With 126 confirmed deaths by now, the Marburg outbreak in Angola thus has surpassed the Congolese record.
The outbreak in Angola also has a very high case fatality rate, which might reach 100 percent. Numbers released by WHO so far indicate a case fatality rate of around 95 percent. This however includes patients that have not been sick long enough to die. There have been no recent reports of any Marburg infected patients in Angola who have recovered. During the 1998-2000 outbreak in Congo, the case fatality rate was 82 percent.
The disease was first identified in 1967 during simultaneous outbreaks affecting laboratory workers in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia. The outbreaks, which involved 31 cases and seven deaths, were subsequently linked to contact with infected monkeys imported from Uganda.
The virus then disappeared until February 1975, when an acutely ill man with a recent travel history to Zimbabwe was admitted to a hospital in South Africa. Infection spread from the man to his travelling companion and a nurse at the hospital. The man died, but the other two cases recovered.
In 1980, two cases, one of which was fatal, occurred in Kenya. In 1987, an additional single case, which was fatal, occurred in Kenya. The next outbreak was the 1998-2000 epidemic in Congo Kinshasa, which was initially concentrated in workers at a gold mine in Durba in the country's north-eastern corner.
According to WHO, Marburg virus disease occurs very rarely and appears to be geographically confined to a small number of countries in the southern part of the African continent. "When cases do occur, the disease has epidemic potential, as it can spread from person to person, most often during the care of patients," the UN agency however warns.
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