• Marburg hemorrhagic fever in Durba and Watsa, Democratic Republic of the Congo: clinical documentation, features of illness, and treatment

      Colebunders, Robert; Tshomba, Antoine; Van Kerkhove, Maria D; Bausch, Daniel G; Campbell, Pat; Libande, Modeste; Pirard, Patricia; Tshioko, Florimond; Mardel, Simon; Mulangu, Sabue; et al. (2007-11-15)
      The objective of the present study was to describe day of onset and duration of symptoms of Marburg hemorrhagic fever (MHF), to summarize the treatments applied, and to assess the quality of clinical documentation. Surveillance and clinical records of 77 patients with MHF cases were reviewed. Initial symptoms included fever, headache, general pain, nausea, vomiting, and anorexia (median day of onset, day 1-2), followed by hemorrhagic manifestations (day 5-8+), and terminal symptoms included confusion, agitation, coma, anuria, and shock. Treatment in isolation wards was acceptable, but the quality of clinical documentation was unsatisfactory. Improved clinical documentation is necessary for a basic evaluation of supportive treatment.
    • The Medecins Sans Frontieres Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. I. Lessons Learned in the Hospital.

      Jeffs, B; Roddy, P; Weatherill, D; de la Rosa, O; Dorion, C; Iscla, M; Grovas, I; Palma, P; Villa, L; Bernal, O; et al. (Published by Infectious Diseases Society of America, 2007-11-15)
      When the epidemic of Marburg hemorrhagic fever occurred in Uige, Angola, during 2005, the international response included systems of case detection and isolation, community education, the burial of the dead, and disinfection. However, despite large investments of staff and money by the organizations involved, only a fraction of the reported number of cases were isolated, and many cases were detected only after death. This article describes the response of Medecins Sans Frontieres Spain within the provincial hospital in Uige, as well as the lessons they learned during the epidemic. Diagnosis, management of patients, and infection control activities in the hospital are discussed. To improve the acceptability of the response to the host community, psychological and cultural factors need to be considered at all stages of planning and implementation in the isolation ward. More interventional medical care may not only improve survival but also improve acceptability.
    • The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. II. lessons learned in the community.

      Roddy, P; Weatherill, D; Jeffs, B; Abaakouk, Z; Dorion, C; Rodriguez-Martinez, J; Palma, P P; de la Rosa, O; Villa, L; Grovas, I; et al. (2007-11-15)
      From 27 March 2005 onwards, the independent humanitarian medical aid agency Medecins Sans Frontieres, together with the World Health Organization, the Angolan Ministry of Health, and others, responded to the Marburg hemorrhagic fever (MHF) outbreak in Uige, Angola, to contain the epidemic and care for those infected. This response included community epidemiological surveillance, clinical assessment and isolation of patients with MHF, safe burials and disinfection, home-based risk reduction, peripheral health facility support, psychosocial support, and information and education campaigns. Lessons were learned during the implementation of each outbreak control component, and the subsequent modifications of protocols and strategies are discussed. Similar to what was seen in previous filovirus hemorrhagic fever outbreaks, the containment of the MHF epidemic depended on the collaboration of the affected community. Actively involving all stakeholders from the start of the outbreak response is crucial.
    • Organisation of Health Care During an Outbreak of Marburg Haemorrhagic Fever in the Democratic Republic of Congo, 1999.

      Colebunders, R; Sleurs, H; Pirard, P; Borchert, M; Libande, M; Mustin, J P; Tshomba, A; Kinuani, L; Olinda, L A; Tshioko, F; et al. (2004-05)
      Organising health care was one of the tasks of the International Scientific and Technical Committee during the 1998-1999 outbreak in Durba/Watsa, in the north-eastern province (Province Orientale), Democratic Republic of Congo. With the logistical support of Médecins sans Frontières (MSF), two isolation units were created: one at the Durba Reference Health Centre and the other at the Okimo Hospital in Watsa. Between May 6th, the day the isolation unit was installed and May 19th, 15 patients were admitted to the Durba Health Centre. In only four of them were the diagnosis of Marburg haemorrhagic fever (MHF) confirmed by laboratory examination. Protective equipment was distributed to health care workers and family members caring for patients. Information about MHF, modes of transmission and the use of barrier nursing techniques was provided to health care workers and sterilisation procedures were reviewed. In contrast to Ebola outbreaks, there was little panic among health care workers and the general public in Durba and all health services remained operational.
    • Outbreak of Marburg hemorrhagic fever among miners in Kamwenge and Ibanda Districts, Uganda, 2007

      Adjemian, Jennifer; Farnon, Eileen C; Tschioko, Florimond; Wamala, Joseph F; Byaruhanga, Emmanuel; Bwire, Godfrey S; Kansiime, Edgar; Kagirita, Atek; Ahimbisibwe, Sam; Katunguka, F; et al. (Oxford University Press, 2011-11)
      Marburg hemorrhagic fever was detected among 4 miners in Ibanda District, Uganda, from June through September, 2007. Infection was likely acquired through exposure to bats or bat secretions in a mine in Kamwenge District, Uganda, and possibly human-to-human transmission between some patients. We describe the epidemiologic investigation and the health education response.
    • The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg outbreak in Angola

      Grolla, Allen; Jones, Steven M.; Fernando, Lisa; Strong, James E.; Ströher, Ute; Möller, Peggy; Paweska, Janusz T.; Burt, Felicity; Pablo Palma, Pedro; Sprecher, Armand; et al. (Public Library of Science, 2011-05-24)
      Background: Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date. Methodology/Principal Findings: A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in ,4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. Conclusions/Significance: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.
    • Viewpoint: filovirus haemorrhagic fever outbreaks: much ado about nothing?

      Borchert, M; Boelaert, M; Sleurs, H; Muyembe-Tamfum, J J; Pirard, P; Colebunders, R; Van der Stuyft, P; van der Groen, G; Institute of Tropical Medicine, Antwerp, Belgium. mborchert@itg.be (2000-05)
      The recent outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo has put the filovirus threat back on the international health agenda. This paper gives an overview of Marburg and Ebola outbreaks so far observed and puts them in a public health perspective. Damage on the local level has been devastating at times, but was marginal on the international level despite the considerable media attention these outbreaks received. The potential hazard of outbreaks, however, after export of filovirus from its natural environment into metropolitan areas, is argued to be considerable. Some avenues for future research and intervention are explored. Beyond the obvious need to find the reservoir and study the natural history, public health strategies for a more timely and efficient response are urgently needed.