6 September 2005

Marburg viral haemorrhagic fever in Angola - update

As of 23 August 2005, 374 cases of Marburg viral haemorrhagic fever (VHF) had been reported by the Ministry of Health of Angola, of which 329 have died (CFR 88%) [1]. 368 of the reported cases, including 329 deaths, were reported in Uige Province in the north of the country, bordering Democratic Republic of Congo. This is where the outbreak originated in October 2004.

52 contacts are currently being monitored in Uige Province and clinical specimens continue to be sent to the Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada for diagnostic testing.

The last confirmed case of Marburg VHF died on 21 July 2005 in Sogo municipality in Uige Province; there have been no laboratory confirmed cases since then. Approximately 75% of cases have occurred in children under the age of 5 years. Cases in adults include a small number of health care workers.

Marburg VHF is a severe and highly fatal disease caused by a virus from the Filoviridae family, which also includes Ebola virus. It occurs very rarely and appears to be geographically confined to a small number of countries in central and eastern Africa. No animal reservoir or other environmental source of virus has been identified. The virus has the potential to spread from person to person, especially among health care staff and family members who care for patients with Marburg VHF, when appropriate infection control practices are not followed. After an incubation period of 5-10 days, the disease usually presents with sudden fever, chills, and muscle aches. Around the fifth day after onset of symptoms, a skin rash can occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhoea may follow. Symptoms become increasingly severe and may include jaundice (yellow skin and eyes), severe weight loss, mental confusion, shock, and multi-organ failure.

The Foreign and Commonwealth Office are currently advising against all but essential travel to Uige Province of Angola, due to this outbreak. [2] The likelihood of contracting VHF, including Marburg, is considered low unless there has been travel to the affected area and direct contact with the blood or body fluids (e.g., saliva, urine) of symptomatic infected persons or animals, or objects that have been contaminated with body fluids. Health professionals in the UK are reminded of the importance of taking a travel history from anyone with a severe infection who may have visited the area.

Guidance for the UK on the management and control of haemorrhagic fevers has been produced by the Advisory Committee on Dangerous Pathogens:  http://www.hpa.org.uk/webw/HPAweb&Page&HPAweb

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Guidance for healthcare workers who will be working with VHF patients in African healthcare settings, has been produced by the US Centres for Disease Control and Prevention (CDC) in conjunction with the World Health Organization: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm

References

1. World Health Organization. Marburg haemorrhagic fever in Angola - update 25. 24 August 2005. Available at: http://www.who.int/csr/don/2005_08_24/en/index.html

2. Foreign and Commonwealth Office. Travel Advice by country - Angola. Cited 5 September 2005. Available at: http://www.fco.gov.uk/en/travelling-and-living-overseas/travel-advice-by-country/sub-saharan-africa/angola/