Marburg in Angola

I'm catching up on the news, and trying to sort out what to make of the Marburg virus outbreak in Angola.

The 11 April, 2005 New York Times story reports;

The race to contain the outbreak of Marburg, a deadly relative of the better-known Ebola virus, is centered here in the town of Uíge (pronounced weezh), where health officials fear the makings of a public health disaster that could spread elsewhere in Angola and beyond.

The number of victims is already the largest ever recorded from a Marburg outbreak, and there is no effective treatment. Nine out of 10 people who get the virus die, usually within a week.

...The virus is named for the town in Germany where it was first identified in 1967 after laboratory workers were infected by monkeys from Uganda.

Scientists do not know the source of the virus or how this outbreak began. But the Centers for Disease Control and Prevention in Atlanta confirmed the first Marburg case in Uíge on March 8. That suggests that two months more of illness and deaths lie ahead.

It's a nasty bug, no question about it.

The 10 April, 2005 New York Times story by Sharon Lafraniere, "To Contain Virus in Angola, Group Wants Hospital Closed", contains other interesting tidbits.  The article begins;

UIGE, Angola, April 9 - An international medical charity battling a hemorrhagic fever that so far has killed 181 Angolans has urged the government to close the regional hospital here, at the center of the outbreak, saying the medical center itself is a source of the deadly infection.

Doctors Without Borders, the global relief organization that runs an isolation ward at the hospital for victims of the deadly fever, Marburg virus, told Angolan officials on Friday that the hospital should be closed if the rapidly spreading epidemic was to be contained.

Two other hospitals within 60 miles of Uige may also have to be shut down, said Monica de Castellarnau, the organization's emergency coordinator in Uige, the provincial capital, where the outbreak was first reported.

That possibility raises the prospect of a second health care crisis, one in which hundreds of thousands of people already facing a disease that is almost always fatal may suddenly have no access to hospital care. But in an interview in the streets of Uige, where an intensive effort is under way to find and isolate new cases of the virus, Ms. Castellarnau said there might be no alternative.

"The hospital has been the main source of infection," she said. "We have to break that chain somehow. It is a massive public health decision, and it must be taken by the government."

No doubt this ought to make people think hard about contingencies in an Avian Flu pandemic.  If we have to start implementing quarantines on hospitals and clinics because they are concentrated sources of virus, what happens to ongoing medical and emergency care?  Hopefully, the folks at Effect Measure are pondering this.

I also have, sitting on my desk, a preprint describing how both Ebola and Marburg employ mechanisms that suppress the human anti-viral response.  Since the article is not published, I can't describe the details here.  Essentially, both viruses specifically down-regulate key genes known to play a role in anti-viral reactions, down-regulate coagulation related gene expression, and also appear to suppress the ability of liver cells to regenerate clotting factors.

Reuters and the AP are both carrying stories about how local customs have led to the spread of the disease from corpses to family members, and about how hard it is to change those cultural practices.  The Marburg Wiki has similar information.

The AP story ends with the following tidbit, which is both interesting and troubling;

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.

Once again, this reminds us how carefully we have to watch the Avian Flu outbreak in SE Asia, particularly in the areas hit by the tsunami (see my post, A Confluence of Concerns).