Posted on 04/29/2005 9:33:35 AM PDT by tdewey10
Marburg haemorrhagic fever in Angola - update 16
29 April 2005
As of 27 April, the Ministry of Health in Angola has reported 275 cases of Marburg haemorrhagic fever. Of these cases, 255 were fatal. In Uige Province, which remains the epicentre of the outbreak, 266 cases, of which 246 have been fatal, were reported as of 28 April.
With all control measures – teams, equipment, and protocols – needed to contain the outbreak now in place, extreme care must be taken to guard against any practices that could again amplify transmission. At this point in the outbreak, an amplification event would be a setback capable of extending the presently intense containment efforts for several weeks. During past outbreaks of viral haemorrhagic fevers, such events have historically resulted in an additional two transmission cycles and a second wave of cases.
Control operations in Uige have experienced some recent setbacks. On two occasions earlier this week, doctors at Uige’s large provincial hospital were directly exposed to blood from Marburg patients being treated on general wards, without adequate infection control. The doctors are under observation. These high-risk exposures should not have occurred.
Such incidents indicate that infection control procedures at the hospital have been seriously compromised. They occurred despite a system put in place, and supported by equipment and training, to safely screen new admissions for exposure history and fever and ensure the separation of possible cases from patients on the general wards.
In another recent incident, the body of a deceased patient was left, uncleaned and uncollected, on an open ward for more than eight hours, placing hospital staff and other patients at risk. In another incident, a severely ill baby admitted to the paediatric ward was placed in a cot, without disinfection, immediately after the body of another baby, who died from the disease, had been removed. In line with cultural practices, mothers are present on the paediatric ward and share the care of severely ill children, thus also sharing the exposure risk.
Under such conditions, amplification of transmission is highly likely to occur. Had safety protocols, set in place by the international team, been followed, none of these incidents would have occurred. Closing of the hospital has been considered but is not a viable option. Such a step would deprive many patients of potentially life-saving care while re-directing others to private clinics, where conditions and practices are even more unsafe and even more likely to result in additional cases.
Yesterday, the Minister of Health, accompanied by both vice-ministers and the head of the WHO office in Angola, flew to Uige to investigate the situation, find solutions, and oversee their implementation. The officials have recognized that strong measures will be needed to ensure that patients admitted to the hospital for other conditions are not placed at risk of Marburg infection. The first steps to correct the situation were put in place today, and involve the collaboration of ministry officials, WHO, and Médecins Sans Frontières.
WHO has decided to strengthen the presence in Uige of international staff specialized in infection control. WHO welcomes the direct intervention of ministry officials. This high-level support should help ensure that containment measures, previously set in place and of proven efficacy, are restored and fully adhered to.
Investigation of several recent fatalities in Uige indicates a clear link between home-based treatments using unsafe syringes and spread of the virus. This problem is being addressed urgently. A massive door-to-door campaign, supported by banners and posters throughout Uige municipality, was launched yesterday to inform residents of the associated dangers and collect and safely destroy syringes. The campaign has continued today.
The new official numbers are in.
I could have sworn LAST week there were only 200 some deaths. Hasn't increased all that much. Could they have stopped the spread (or could the disease itself have run its course by killing its victims so swiftly)?
God help them
Amen.
I can'd do the analysis, wait for 2ndreconmarine. But these are bad numbers. The increase means it is not being contained and continuing to spread.
Something is still wrong with the numbers, either the spread has stoped or they are"reclasifing" cases as fast as new ones are coming in.
yeah ,...I'll be looking and listening for Botswana , Gabon , Zambia , Namibia , South Africa , Dem. Rep. of the Congo
These are Angola Health Ministry's numbers. As I think we've (Judith Anne, 2ndreconmarine, etc) figured out, WHO uses their numbers and does not provide its own. So, I agree with you.
As for the spread stopping--the Angolans seem to think it could go anywhere.
The latest from Angola News Agency (google translate):
http://www.angolapress-angop.ao/noticia.asp?ID=337736
Huambo: Director of the health congregated itself with traditional therapists Huambo, 29/04 - the provincial director of the Huambo of the health, Elias Finde, congregated itself today, in this city, with the traditional therapists for he informs them on the causes and forms of prevention to have with the virus of Marburg. Elias Finde used to advantage the meeting to transmit to the gifts the symptoms and cares of prevention to have with the illness, despite the province of the Huambo not having registado until the o moment none case of this illness. The provincial director of the health requested to the therapists the installment of information foresaw to the sanitary authorities, in case that they appear sick suspicious of Marburg in the locality where they exert its activities. "they do not keep the sick people in your residences to count that they are witchcraft cases, best he is to inform the competent authorities to give the due treatment", alerted Elias Finde. For beyond the combat to the hemorrhagic fever, that responsible one also asked for the contribution of the therapists related with the HIV/Sida, measles, cough convulsa and polio. "It has illnesses that the medical assistance and others are dealt traditionally with, but this in does not give the right to them to continue to make businesses with you happened them and conjuncts", it advanced the responsible one. This was the first meeting that the provincial direcção of the health carried through with the traditional healers and spirituals, gone of some points of the province. Formative and informative documents on the hemorrhagic fever had also been distributed the traditional therapists so that they sensetize the population of its communities on the forms of manifestation of the illness. The direcção of the health benefited recently of ONG World Vision (WV) of a thousand headresses, two a thousand dismissable gloves, one hundred dressing gowns and equal number of you mask for the protecção of the nurses.
DRC already has 4 suspected cases--see Freeper thread.
I can't imagine what sort of treatment family members are giving ill patients using syringes.
I'm going to use my ping list, here. My apologies to everyone who's already here and didn't need the extra ping.
What is you analysis of the update?
If we don't see a secondary spread in the next week or two,
they may have a handle on it.
Judging by the report, I think we will see it.
With all that talk about exposure errors and conatminated needles WHO is virtually warning to expect the worse. It does not sound like they are confident at all that Marburg is anywhere near under control.
However, it's good that they recognize these as a setback and intend to aggressively prevent them again in the future.
As long as this virus remains in the relatively isolated area of Uige it is containable. Had the initial outbreak occurred in Luanda, it would be a much more formidable task.
Well, just as the article says, infection protocols have been seriously compromised in more than one location.
One of the most horrifying is the ward, where mothers and children stay, sharing the care of the sick children...that looks like a lot of dead people walking, to me...
I suspect most of the compromised protocols have occurred because of lack of supplies. It doesn't sound like they have much, to me. I've worked on isolation cases where the group of us--dietary, physical therapy, family, and nursing staff have gone through over 100 disposable gowns in a 24 hour day for ONE person.
And if a family wants to invite the traditional healer to send in a syringe of something "helpful," and that syringe gets shared, then sent back to the healer...
Sounds like there should have been a huge explosion of case numbers. Why isn't there? Massaging the data, most likely. There are those 175 possible cases (people already sick with symptoms that could be Marburg) and 84 confirmed in addition of Marburg--why aren't they included in these numbers?
This bullbleep keeping the total case numbers in the 200s is total fantasy on the part of Angola, in coordination with WHO. It's twice that high right now, if you ask me.
I saw that and the comment about Marburg patients in non-isolation wards.
On the bright side, the news can only get better:
http://www.angolapress-angop.ao/noticia.asp?ID=337765
http://www.angonoticias.com/full_headlines.php?id=5076[basically same story, Google translation]
Minister of the Health says that hemorrhagic fever is controlled the minister of the Health, Sebastião Veloso, defended today, in this city, that after being controlled the hemorrhagic fever for virus of Marburg, the start to follow is to work in its eradication. Speaking during the meeting with the technician of health of the province of the Uíge, he admitted that for the success of the battle the persistence of all is necessary the health technician, having in the recognized occasion its effort and sacrifice in the treatment of the sick people. He advanced that the government is pledged in the eradication of the illness, pointing out that the devotion of each health technician is determinative so that, short-term, if reach this objectivo. After the meeting, the governor congregated itself with the members of the emergency commission where she thanked the cooperation of the international community, that engloba the technician of the OMS and the Medical ONG without Borders and others. The minister finishes sunday its stay in the province, after visiting some cities of that region. Sebastião Veloso is since thursday in the province of the Uíge, in visit of work, for constatação of the evolution of the sanitary situation provoked by the hemorrhagic fever for virus of Marburg, that already vitimou two hundreds of people more than, including personal physician.
The Angolan President is, of course, leaving the country.
http://www.angolapress-angop.ao/noticia-e.asp?ID=337787
President To Visit Brazil, Argentina From Sunday
Luanda, 04/29 - The President of the Republic, Jose Eduardo dos Santos, will Sunday start a official visit to the Federative Republic of Brazil and, and after to the Republic of Argentina, according to a official note made available to Angop [Angolan News Agency].
I don't know, WHO seems frustrated from the report. If this continues a Luanda outbreak is only a matter of time.
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