Angola: Marburg 'worst is over', say health officials

[This report does not necessarily reflect the views of the United Nations]

LUANDA, 9 Jun 2005 (IRIN) - The world's deadliest outbreak of the Marburg virus seems to have peaked and the worst is over, according to international medical NGOs, the United Nations and the Angolan health department.

"There are still a few cases, but nothing compared to the peak of the emergency," said Pierre-Francois Pirlot, the UN Resident Representative in Angola.

"We are making good progress; we are optimistic but we cannot say that the epidemic is over," agreed Pierre Rollin, a representative of the US Centers for Disease Control (CDC), who is working with the Ministry of Health and World Health Organisation (WHO) on the Marburg outbreak.

Rollin explained that for the epidemic to be officially declared over, there should be no new cases of the Ebola-like haemorrhagic fever for 42 days - twice its maximum incubation period.

"Marburg is under control, in as much as things are organised, but before we declare victory we have to have this period of grace," Pirlot said.

As of 5 June, the Angolan Ministry of Health reported that 357 people had died, out of a total of 423 cases of the Marburg infection in Angola's northern province of Uige.

"The number of new cases being reported in Uige municipality has declined considerably, with only one new confirmed case detected in the past week," the WHO said in its 7 June bulletin.

"For comparison, during the peak of the outbreak, which occurred in late March and April, 30 to 40 new cases were being reported weekly," it commented.

"There's light at the end of the tunnel - I'm confident, which doesn't mean you have to lower your guard, obviously," said Pirlot.

The international medical NGO, Medicins sans Frontieres (MSF), agreed that the situation was certainly changing for the better, but noted a few suspected cases on the periphery of Uige town, where the outbreak originally started and access can be difficult.

The Marburg taskforce, led by the Ministry of Health and WHO, were working on the situation, but experts said a few lingering cases towards the end of the outbreak was not considered unusual.

"Epidemics don't just stop like that; it (Marburg) is following a regular pattern," Rollin noted.

The international community has responded well to the Marburg crisis, in terms of both funding and expertise, but Marta Canas, the Head of Mission at MSF Spain, stressed that there was still a need for some assistance.

"The hospital is running out of bio-security supplies, which are essential to avoid transmission and keep the epidemic under control. The government needs continued support from the donors in that sense," she said.

Officials have praised the way the Angolan authorities handled the crisis, which came just three years after the end of a devastating 27-year civil war.

"There is a lot of progress in the fight against the outbreak, and the way people are following up cases. They did a good job in the field and we can see that in the dramatically reduced number of cases," Rollin said.

Pirlot also praised the "commitment and a tremendous effort" made by the health ministry in organising the response to the outbreak, but said it had highlighted the fact that there were still weaknesses in the health structure, particularly in the provinces.

The outbreak appeared to be petering out, but the consequences of the gruesome bug would continue to be felt for some time. The UN Children's Fund (UNICEF) said it was particularly concerned about hundreds of children who had lost one or both their parents to the disease.

Akhil Iyer, a senior programme officer at UNICEF, said at least 320 children under the age of 16 faced an insecure future and would have to be monitored closely.

"Some of those children are really in destitute and dire circumstances - we're very concerned indeed - children in such situations are normally at a much higher risk of exploitation and abuse," he said.

Many of those who lost parents and other family members have been left deeply traumatised and without a family support structure. UNICEF was carrying out ongoing assessments on children in the area to identify their needs.

"They lost their parents very suddenly and ... very unexpectedly, and it's absolutely devastating," Iyer added.

Some children, particularly in the early stages of the outbreak, had been denied access to their locked homes, or had seen them burned or destroyed after their parents had succumbed to the disease.

"A problem earlier on in the epidemic was the brisk removal of infected or suspected parents - this can have a devastating impact on children; it can be extremely frightening," he said.

The main challenges likely to face these children - poor nutrition, particularly among very young children; access to health, education and documentation services - were no different to those facing the majority of Angola's youth, but Iyer said it was vital to keep a close eye on this particularly vulnerable group, to make sure they were not left behind or abandoned.


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