Re: Dutch woman infected with Marburg in Uganda
MARBURG HEMORRHAGIC FEVER - THE NETHERLANDS ex UGANDA
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International Society for Infectious Diseases
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Date: Thu 10 Jul 2008
Source: European Centre for Disease Prevention and Control (ECDC) [edited]
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On Thu 10 Jul 2008, the authorities in The Netherlands notified their
European Union partners and the World Health Organisation of one
confirmed case of Marburg fever diagnosed in the Leiden University
Medical Centre. The case involves a 40-year-old woman who had
recently returned from a holiday in Uganda. The travel included a
visit to 2 caves in the Maramagambo forest (between Queen Elizabeth
Park and Kebale), where she was exposed to fruit bats.
ECDC's initial assessment is that the threat to public health is
limited and mainly focused on the people who have been in close
contact with the patient after the onset of her symptoms. People
intending to travel to Uganda should be aware that there may be a
risk related to visiting caves in the Maramagambo forest.
ECDC is in contact with the authorities in The Netherlands and is
monitoring the situation closely.
--
Communicated by:
Erik Huisman, M.D. <ERIK.HUISMAN@XS4ALL.NL>.
[The following information has been abstracted from the ECDC Fact
sheet on Ebola and Marburg haemorrhagic fever.
Ebola and Marburg viruses are members of the family _Filoviridae_.
Ebola virus includes 4 distinct subtypes: Zaire, Sudan, Cote d'Ivoire
and Reston. Three subtypes, Zaire, Sudan and Cote d'Ivoire cause
serious illness in humans. Ebola Reston subtype, found in the Western
Pacific, only causes asymptomatic illness.
The natural reservoir for both diseases is unknown, although it is
presumed there is an animal reservoir. Ebola virus has been isolated
from cynomolgus monkeys and Marburg from green monkeys and bats.
Ebola and Marburg viruses are highly transmissible by direct contact
with blood, secretions, organs or other body fluids of dead or living
infected persons. Sexual contact transmission can occur up to 7 weeks
after clinical recovery. Transmission can also occur by contact with
dead or living infected animals (e.g., monkeys, chimpanzees, forest
antelopes, and bats). Nosocomial transmission can occur. Health care
workers can be infected through close contact with infected patients.
The risk for infection can be significantly reduced through the
appropriate use of infection control precautions and adequate barrier
procedures. This is especially important when performing invasive procedures.
In 1967, isolated cases of hemorrhagic fever occurred among
laboratory workers handling tissues from African green monkeys
(_Cercopithecus aethiops_) from Uganda and in medical personnel who
attended the laboratory workers. This was a new virus named Marburg
virus after the city in Germany where it was 1st characterized. In
1976, epidemics of severe haemorrhagic fever occurred simultaneously
in Zaire and Sudan, and a new filovirus was identified, serologically
different from the Marburg virus. This new virus, Ebola, was named
after a small river in Democratic Republic of Congo. Later studies
clarified the specific nature of these viruses and defined a separate
family, the Filoviridae.
Multiple outbreaks of both Ebola and Marburg have been identified
since their initial discovery. The most recent outbreaks of Ebola
virus were in 2007 in the Democratic Republic of Congo, with 372
cases, of which 166 (45 percent) were fatal, and in 2008 in Uganda,
where there were 3 cases detected among mine workers from Kakasi
Forest Reserve in Kamwenge District. The most recent outbreaks of
Marburg virus were in 2004-2005 in Angola, when there were 252 cases,
of which 227 (90 percent) were fatal and in Uganda in 2007, when 2
mine co-workers were infected; one died.
The typical incubation period for these viruses is from 2 to 21 days.
In most cases, an infected patient experiences sudden onset of fever,
malaise (weakness), muscle and joint pains and headache followed by
progressive weakness, anorexia (lack of appetite), diarrhea (watery
stools sometimes containing blood and mucus), nausea and vomiting.
Some patients progress to develop impaired kidney and liver function
and haemorrhagic symptoms. These manifest by bleeding from the nose,
gums and skin (like bruising), bloody vomiting and stools, and
prolonged bleeding from needle puncture sites. Other symptoms include
skin rash, conjunctival injection, inflamed throat and difficulty
swallowing. Depending on the filovirus and subtypes, risk of death
ranges from 30 to 90 percent.
Laboratory tests on blood specimens detect viral material (including
genetic material) or the patient's antibodies to the virus. These
tests are not commercially available. Samples from infected patients
and viral material present an extreme biohazard and have to be
handled (including for testing) under maximum biological containment
conditions in level 4 biosafety laboratories.
No curative treatment is available for Ebola or Marburg infections.
Treatment is supportive, and severe cases require intensive care. - Mod.CP]
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