Posted on 04/14/2005 2:39:24 PM PDT by Covenantor
No it won't help the victims, but it might help ease the fears of surrounding locals. And who knows, they just might ask some hard questions.
Done
I'm still not sure about that. I'm considering a patient who has replicating virus throughout the body, a couple of days before symptoms, coughing or sweating or spitting, whatever. I could be wrong, but common sense says it can be spread before symptoms. Please, anyone with definitive information to the contrary please tell me.
That was asserted in the article I posted yesterday afternoon, although it was a bald assertion without any supporting evidence offered.
I have to believe that it's true, however, because if people were shedding viruses for up to a week before feeling sick, the numbers would be much higher than they are.
Unless you're a Howard Hughes germ fanatic, you come into contact with a lot of people during the course of the week simply by touching the same things they touch.
Angola should quarantine any family where they recover a Marburg victim for two weeks.
How ambulatory is a victim after becoming symptomatic?
Beats me. It sounds like it starts with flu-like symptoms, so I think you could get around for a day or two. By the time it progresses to bleeding out of every hole in your body, you're probably not moving much at all.
Judging by the initiual symptoms, quite ambulatory. Just some abdominal cramps and the runs - how often do you get that travelling somewhere?
Since toilet paper isn't used on that continent to any large degree, touching someone with the left hand could be the kiss of death, so to speak.
| Year | Location | Cases | Status | Dead |
Mortality |
Description |
| 1967 | Germany and Yogoslavia |
25 |
primary secondary |
7 |
28% |
25 people contracted Marburg hemorrhagic fever after handing material from infected monkeys which were imported from Uganda. An additional 6 people contracted the disease from the infected humans. |
| 1975 | South Africa |
1 |
primary secondary |
1 |
100% |
An Australian contracted the disease while traveling through Zimbabwe and subsequently died after 12 days of illness. Two people who cared for him, his traveling companion and a nurse, contracted severe cases of the disease. His companion contracted Marburg 7 days after the onset of his symptoms; the nurse contracted the disease 7 days after contact with the second patient. Both companion and nurse survived. |
| 1980 | Kenya |
1 |
primary secondary |
1 |
100% |
A French engineer contracted Marburg (and died); the physcian who attempted to resuscitate the engineer contracted the disease, but survived |
| 1982 | South Africa |
1 |
primary |
1 |
100% |
A single occurrence; no secondary cases occurred. |
| 1987 | Kenya |
1 |
primary |
1 |
100% |
A young Danish man who, while traveling in western Kenya, had visited the same park as the French engineer. No secondary cases occurred. |
See http://tarakharper.com/v_marbrg.htm
http://www.phac-aspc.gc.ca/tmp-pmv/2005/marburg050324_e.html
Thank you. I was working with what I had found. Indeed, this changes things quite a bit. This outbreak then is overwhelming the previous data and rewriting many of the assumptions about the Marburg virus.
This is what I have been worried about all along ... if this is true, thank goodness for "small" favors.
here's a graphic for you.
I really appreciate the graphics, thank you.
Well done. It would be interesting to refine it as new data comes in.
Instead, they tap right legs – avoiding all skin contact – a new custom devised to help check the spread of the Marburg virus, which is passed by contact with bodily fluids and has no known cure.
An elderly woman visiting Uige's main market Thursday, where there was plenty of produce but few shoppers, said she had little hope of surviving the outbreak.
"We don't know if (the virus) was sent by God or the devil, but we're helpless either way," she told The Associated Press, conveying the deep sense of dread here.
The woman, like others in this impoverished city of about 200,000 people, refused to give her name. She and others said they feared outsiders were spying on them or would force them to go to the local hospital where dozens have died of the disease.
The last outbreak of Marburg, a hemorrhagic fever named after the German city where it was discovered in 1967, occurred in the African nation of Congo. It lasted from 1998 to 2000 and killed 128 people.
To check the disease's spread, foreign experts have streamed into this Angolan city 180 miles north of Luanda, the capital of the former Portugese colony on the southwest coast of Africa.
Authorities have banned the sale of monkey meat, which is common fare. Although scientists are not sure how humans get the virus, it is known that monkeys can get infected and handling carcasses is considered risky.
Teams from the World Health Organization, Doctors Without Borders, the International Red Cross and the U.S. Centers for Disease Control and Prevention are in Uige.
Local people don't understand why the disease appeared and often resent the measures taken to contain it, officials say. For now, at least, schools remain open.
WHO said in its latest update that the death toll climbed to 210 on Monday, with 190 of the deaths reported in Uige, where the outbreak is believed to have started six months ago.
The agency said medical teams are focusing their efforts on detecting cases and quickly isolating them, as well as collecting bodies for swift burial.
But panicked residents are hiding family members who fall ill for fear they will be taken away and never be seen again, officials say. That is increasing fears of contagion, and whole families in Uige have died from the virus. The disease can also be transmitted by items like clothing and bedding contaminated by fluids from an infected person.
Also, according to Angolan tradition, the bodies of the dead are bathed before burial – another high-risk practice.
Hostile villagers have pelted medical teams with rocks when they arrive, dressed in white protective suits and face masks, to collect the dead and remove anyone suspected of being infected.
The medics pour bleach on the bodies and place them in transparent body bags. A blood sample is taken and they are buried within hours, without ceremony.
Residents resent the intrusion.
"None of this is easy for people who are used to caring for their dead," Uige's Roman Catholic Bishop Francisco Mourisca said.
WHO disease expert Nestor Dayimirije of Uganda blamed the hostility on lack of information. "We're running late on educating the people," he said.
At WHO headquarters in Geneva, outbreak specialists are closely monitoring the security of their field staff.
At least one aid worker, Italian pediatrician Dr. Maria Bonino of the Italian aid agency Cuamm Medici con L'Africa – Doctors with Africa – has died of the disease.
"We have serious security concerns," WHO spokeswoman Maria Cheng said from the U.N. health agency's headquarters. "We are assessing the situation constantly and if it deteriorates, we certainly would have to consider all our options."
Foreign experts have recruited traditional healers and Roman Catholic Church leaders to help educate residents about the disease.
Angola's protracted civil war, which ended in 2002, wrecked the country's public infrastructure, including hospitals and roads.
Uige still bears the scars of that war: some houses are still partial ruins with bullet holes and smashed walls. When the outbreak began, the hospital didn't have a single pair of medical gloves, officials said.
Turnaround on sample reads is about two weeks. Thus, this information, while it is the latest available, is two weeks old and unreliable.
This does not take into account the likely cases--some already dead, that are not classified as Marburg due to not having the labs read yet. This also does not take into account the likely cases that refuse what passes for medical attention and actively attempt to evade the WHO and UN.
This is an excellent point and it bears considering.
I had previously argued (I believe now in error) that these effects did not matter because the process was constant throughout. Therefore, the numbers we had, even if delayed, were still valid and the growth and spread could still be calculated. (The technical term is that the system was parametrically invariant).
However, I think you are right. When the epidemic was in its incipient stages, they medical workers had time to send samples off for evaluation, and the number of samples was modest. When the epidemic becomes larger, they will not have time, nor support, for the larger number of samples.
My speculation about what will happen with the data is that there will be longer delays for the updated values at first, then a period when the quoted values remain constant. Then the medical workers may just report Marburg based on symptoms and give up on the testing. At this point the quoted numbers might increase substantially. Of course, all of this is predicated on the worst case, 9 day efolding time, growth scenario. If the outbreak is contained, we would also see the numbers leveling out.
I'm still not sure about that. I'm considering a patient who has replicating virus throughout the body, a couple of days before symptoms, coughing or sweating or spitting, whatever. I could be wrong, but common sense says it can be spread before symptoms. Please, anyone with definitive information to the contrary please tell me.
I did not mean to imply that we know that it cannot be spread until symptoms appear. Indeed, this is clearly uncertain. It was just a hope. However, your arguments to the contrary certainly make sense.
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