Information update from RC Angola on Marburg outbreak

Latest Developments
As of 12 April, 231 cases of the Marburg virus have been notified with
210 resulting in deaths. Only 44 cases have been confirmed on the basis
of laboratory analysis of blood specimens.

Blood specimens from the deceased Cuban doctor of Meditex clinic in
Luanda tested negative for Marburg virus. The test was also negative for
the second alert from the same facility, a nurse, whose condition is now
improving.

WHO's activities in Uige have not been suspended, only case-finding and
contact follow-up operations were halted on Friday 8 April. All
operations resumed on 9 April.

Findings from a WHO-CDC-MSF joint assessment argued against the temporary
closure of Uige Provincial Hospital and recommended a series of measures
to be immediately implemented to reduce the risk of infection in the
hospital.

Flash appeal
In response to the 3.5 million USD flash appeal launched on 7 April by
the UN, pledges announced by donors in Luanda amount so far to over
1,700,000 US Dollars. Additionally, bilateral supply of equipment was
made by USAID and the Italian, Portuguese and Spanish embassies.

Surveillance and epidemiology
On 7 April a surveillance mobile team encountered resistance from the
community in one neighbourhood in Uige city, with stones reportedly being
thrown at the specialists. WHO suspended on 8 April its case-finding and
contact follow up operations in order to investigate. A meeting between
traditional community leaders, Sobas, the Governor of the Province and
partners was organised in order to improve understanding of the teams'
activities. On 9 April, Sobas led the mobile teams back into the
communities and work has been carried out normally since then.

Individuals that were in contact with suspected or confirmed cases are
defined as "Contacts" (they must have been in physical contact with a
case, with clothing and bed clothing or have slept in the same house for
a month). They don't necessarily become infected but require monitoring.
The complete identification and follow up of all contacts will allow
stopping the spread of the virus. So far 484 contacts are being closely
monitored, 361 in Uige province alone, 93 in Kwanza Sul, 20 in Luanda and
10 in Zaire. Surveillance mobile teams of the Ministry of Health, WHO and
MSF are actively searching remaining contacts to complete the
epidemiological tree, a picture of the virus spread.

Case management
An infection control assessment carried out in the Uige Provincial
Hospital on 10 April made a series of recommendations aimed at preventing
transmission of the virus in the hospital. Critically, cleaning and
disinfection should be thoroughly performed and personal protection
equipment should be supplied in adequate quantities. Other measures
relating to patient care were also made. Provided that the recommended
set of measures is implemented promptly, the hospital should be kept
functioning.

WHO will be supporting the management of the hospital with a new team of
specialist who should travel to Angola next week.

Social mobilisation
Social mobilisation and interpersonal communication teams are now active
and have access to the communities. The TV and radio spots are being
broadcast nationwide. In Uige, 18,000 leaflets are being distributed by
trained teams. An additional one million brochures will be printed and
then distributed in Luanda, and all provinces at risk. The highly
effective scouts have been mobilised to the province and in Luanda.

WHO and UNICEF will both dispatch 5 international social mobilisation
specialists to Uige to support ongoing activities throughout the
province. 2 of them are fluent in local languages and will adapt messages
to specific communities.

Symptoms and Transmission
Main symptoms observed are fever (100% of cases) and haemorrhage
-presence of blood in vomit, stools, urine, from gums, eyes or skin-
(98%), as well as vomiting (64%), diarrhoea (42%) and cough (38%).

The virus is transmitted by direct contact with the blood, urine,
excrement, semen and organs of infected persons who are in an advance
stage, at the onset of symptoms. Transmission does not take place during
the incubation period (2 to 21 days).

Groups particularly at risk are health workers not wearing personal
protective equipment and in-patients in hospitals, persons caring for ill
and preparing bodies for funerals and persons manipulating bush meat of
primate origin.

Early reporting of suspected cases can contribute to prevent further
spread.

Background
Deaths due to the Marburg virus first occurred in Uige city in October
last year. Since then, the number of reported cases has steadily grown.
Children under fourteen years of age represent 49% of the total though
the incident is falling. There is currently no cure against the virus.
Owing to the rarity of Marburg, MINSA, following international norms,
formally declared an epidemic situation. The coordination is orchestrated
by the National Technical Commission composed by the Ministry of Health
(MINSA), WHO, MSF, UNICEF and CDC. The Commission and Sub-commissions of
Epidemiological surveillance, Logistics and Social Mobilisation meet
daily.

Measures Taken by the UN
In light of the above information, previously announced measures are
maintained:

- UN staff presently in the province of Uige are urged to reinforce
preventive measures related to water and food consumption and basic
hygiene. Most important, they should avoid physical contact with people
in general, and in particular those in health facilities.

All nonessential travel to the province of Uige by UN personnel is
deferred until further notice.

- WFP Air passenger service is operating a twice-weekly flight to Uige.
As well, the air service is being used to transport much needed equipment
and materials to the province.

- WHO is solely responsible for establishing procedures for, and
organising, any medivac from Uige province.

Within the UN system WHO will continue to closely monitor the situation
to identify any changes. This, as well as any other related information,
will be communicated as soon as it comes to light. The focal points for
confirming any information are:

-WHO Information Officer, Mr. José Caetano - 912-220543
caetanoj@ao.afro.who.int

-UNICEF Information Officer, Ms. Macarena Aguilar ? 912-219524
maaguilar@unicef.org

-OCHA/TCU Information Officer, Mr. Christophe illemassene ? 912-500370
illemassene@un.org

You will be informed of any new developments as they occur. This Note,
as well as subsequent updates, can be shared with agency partners as you
believe appropriate.


Pierre-François Pirlot