Amount of decision: EUR 500,000
Decision reference number: ECHO/-AF/BUD/2005/01000
1 - Rationale, needs and target population:
1.1. - Rationale:
Recurring reports of a mysterious illness killing small children in Uige province in northern Angola came to a head when two members of the health staff treating patients in Uige hospital also died of similar symptoms. Blood specimens tested at the Institut Pasteur in Dakar tested negative for viral haemorrhagic fevers, including yellow fever, West Nile, Rift Valley, lassa, dengue, Chikungunya, Crimean-Congo. However, blood specimens sent to the laboratories of the Centre for Disease Control (CDC) in Atlanta, USA, tested positive for the Marburg virus, a rare cause of viral haemorrhagic fever belonging to the same family as Ebola. The results were issued on the afternoon of 22 March, and the Government of Angola declared an outbreak on 23 March. Because many of the signs and symptoms of Marburg fever are similar to those of other infectious diseases, such as malaria which is endemic in Angola, diagnosis is extremely difficult and all suspect cases must be treated as Marburg.
By the time the diagnosis was confirmed, the overall number of cases registered in the Provincial Hospital of Uige stood at 101, with 93 deaths. These figures are primarily a result of ongoing retrospective case investigation at the hospital. While some cases involving adults have been identified, children under 5 years of age represent 75% of total cases.
According to information published by the Centre for Disease Control Special Pathogens Branch, the Marburg virus was first recognized in 1967 in laboratories in Marburg, Germany, and recorded cases are extremely rare. It is an extremely contagious and virulent disease, with a reported case fatality rate of about 25%. According to data currently available, though, the case fatality rate of the Angolan outbreak is more than 90%. For example, from 18th March, when the samples were sent for analysis, to 21st March, five new patients were admitted to the hospital, of whom three have died. Though Marburg fever is a very rare human disease, when it does occur, it has the potential to spread quickly to other people, especially health care staff and family members who care for the patient.
After almost thirty years of conflict, peace came to Angola in April 2002. The conflict left the country devastated, with the provision of social services such as basic health care absent in many cases. Though the situation is improving somewhat, the weak capacity of the health staff, coupled with extremely poor hygiene practices among the general population, contribute to both causing and compounding the spread of disease.
1.2. - Identified needs:
Though there is no specific treatment for Marburg fever, supportive hospital therapy and barrier nursing techniques to prevent direct contact with the patient must be envisaged. Supportive hospital therapy includes the provision of strong antibiotics and IV treatments to counter dehydration, delivered in an environment where the patient is kept in strict isolation. In order to avoid cross-contamination, each patient must be provided with individual containers for clean (chlorinated) water, and blankets which must be burned after use. Barrier nursing techniques include the wearing of total protective equipment by carers, such as suits and gloves which must be burned after each patient contact, rubber boots and goggles, constant disinfection, provision of clean water (such as bladder tanks), chlorine, bleach, etc. Epidemiological investigation will be required in order to identify and eliminate the source of the outbreak, which will need to be carried out by specialists in the disease, of which there are only a handful in the world. (1)
1.3. - Target population and regions concerned:
For the moment, the outbreak appears to be limited to Uige town, Uige Province in northern Angola, and the surrounding area. The population of Uige town and its immediate surroundings is approximately 400.000. As the nature of outbreaks is unpredictable, and as data collection is notoriously difficult due to the long conflict and the isolation of much of the province, interventions funded from this decision may extend to other areas, even outside Angola.
1.4. - Risk assessment and possible constraints:
The rainy season, which is very heavy and long in this area of Angola, may constrain the logistics aspects of this intervention. The main risk is the possible spread of the outbreak, possibly even to the bordering areas of the Democratic Republic of Congo, which are home to the same Bakongo ethnic group. In order to avoid additional constraints to the rapid control of the outbreak, the Government of Angola is urged to waive visa formalities for epidemiologists specialised in Marburg fever entering the country.
(1) Information published by Centre for Disease Control, Atlanta. Additional elements kindly provided by Dr. Simon Mardell, epidemiologist at the Liverpool Institute for Tropical Medicine.