SOUTHERN AFRICA: Marburg toll rises as neighbours go on high alert

LUANDA, 11 Apr 2005 (IRIN) - Neighbouring countries placed their health services on high alert as the death toll in Angola's deadly Marburg epidemic climbed to 192.

With the number of cases of the Ebola-like bug rising to 213, efforts in Angola's northern province of Uige, the epicentre of the outbreak, focused on tracking down what potentially amounts to scores of people who have been in close contact with victims.

Media in the area reported that terrified townspeople threw stones at field workers trying to trace carriers of the disease, accusing them of killing people who had been taken away sick.

The attacks forced the World Health Organisation (WHO) to temporarily suspend some of its case-finding and contact follow-up work on Friday, but all operations resumed on Saturday, a UN official said.

"There was one incident in one region - this was not a generalised revolt of the population," the official told IRIN. "There was a meeting between the sobas [traditional leaders], the governor and the representatives in the field, and the sobas accompanied the health workers on their visits and explained what was happening."

Residents of Uige were reportedly frightened by medical workers decked out in spacesuit-style protective clothing as they ventured into local communities to conduct surveillance work.

"Locals saw teams of 'astronauts' in the neighbourhoods - there was a lack of transparency and the local population was worried. That is normal. But the sobas are involved and a second wave of the social mobilisation programme is about to start, so this situation should improve," the UN official commented.

In the US, the New York Times newspaper said the international medical charity, Medicins Sans Frontieres (MSF), had urged the government to close the regional hospital at the centre of the outbreak, saying the medical centre itself was a source of the deadly infection.

"The hospital has been the main source of infection," Monica de Castellarnau, the organisation's emergency coordinator in Uige, told the newspaper. "We have to break that chain somehow. It is a massive public health decision, and it must be taken by the government."

A WHO official confirmed that a complete survey of the hospital was underway, but noted that closing the facility would send the wrong message to an already alarmed population.

"There is an assessment being done as we speak; that will be finalised today and there will be a report ready this evening [Monday]. Based on that, WHO will make a recommendation to the government, but it is only the government that can take the final decision," the WHO official told IRIN.

Meanwhile, South Africa, Namibia and Zambia have activated their health emergency response to a possible outbreak of the deadly fever.

The South African government has begun screening visitors at various ports of entry, health department spokesman Solly Mabotha told IRIN. "The screening process involves intensive interviews with people returning from Angola about their travel patterns, keeping the incubation period in mind," he explained.

According to the US-based Centers for Disease Control, after an incubation period of 5-10 days, the symptoms of Marburg begin abruptly, with fever and chills, followed by nausea and vomiting. Because many of the signs are similar to other infectious diseases, such as malaria or typhoid fever, diagnosis can be difficult.

South Africa has significant business links with Angola and medical centres with isolation facilities in the country's nine provinces have been identified, Mabotha added.

Namibia, which borders Angola, has also prepared for the possible spread of the Marburg virus.

"We have medical workers, trained to deal with outbreaks such as Ebola in all our hospitals across the country, who have now been placed on high alert," said Dr Kalumbi Shangula, head of Namibia's department of health.

Shangula told IRIN the immediate concern was to make Namibians aware of the symptoms of the disease. "We held a press conference to spread the message and the alert out through the media."

Zambia shares a 1,110 km border with Angola, where health officials at points of entry have been placed on high alert, said Dr Ben Chirwa, head of the health department. The Zambian department of health was "fully prepared to deal with any possible outbreak," he stressed.

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