Uganda: Marburg hemorrhagic fever

[Gert van der Hoek]

News | August 2, 2007

Marburg virus: Kamwenge mine closed, isolation units established

KITAKA gold mine in Kamwenge District has been closed and isolation units set up in the area, a day after a mine worker was confirmed to have died of the Marburg viral disease.

Speaking in Parliament yesterday, Dr Richard Nduhuura, the minister of state for health, said his ministry has sent rapid response teams to the affected areas to contain the situation.
All mine workers have been located and are being monitored, he said.

?We have one confirmed case of Marburg virus disease who died on 14th July 2007,? Dr Nduhuura said. ?The second suspected case has fully recovered. Both cases are gold miners from Kitaka Mine located in Kakasi Forest Reserve in Kamwenge District.?

He said all the other people whom the afflicted miners had come into contact with have been found and are also being screened and contained.
Marburg hemorrhagic fever, the minister said, is a rare but severe type of disease that causes generalised bleeding in humans.

?The incubation period is between 5 to 10 days after contact with an infected person or vector,? he said. ?The actual vector is unknown although there?s a strong association with monkeys and rats.?

The symptoms include sudden onset of high fever, headache, muscle pain, followed by a body rash and bleeding tendencies.
Since 1967, the ministry says, a total of 377 cases have been reported worldwide.
In Uganda, 19 cases were reported in Nakibembe Village in Busesa, Bugiri District in 1977.

The transmission, Dr Nduhuura said, is limited to very close contact with blood and body fluids of affected persons and is low compared to Ebola.
The minister said that the Marburg disease is less brutal compared to Ebola which is a severe, often fatal illness in humans and nonhuman primates such as monkeys, gorillas, and chimpanzees.

The action on the gold mine in Kamwenge District came a day after the Director General of Health Services, Dr Sam Zaramba, announced that two suspected cases of Marburg viral disease had been reported in the area.

"The blood samples from the suspects are being collected," Dr Nduhuura said, "And their contacts are being screened locally and at international collaborating centres including the Centres for Disease Control, Atlanta, Georgia, USA.?

Dr Nduhuura told Parliament that the government had established a multi-disciplinary task force made up of national and international experts similar to the one that contained the Ebola outbreak in northern Uganda in 2000.

A health ministry official, speaking on condition of anonymity, told IRIN News that one team of experts is going to Kamwenge, another will go to Mityana and a third to Kayunga where the contacts with the Marbufg sufferers are reported to have gone.

?I wish to appeal to the general public and health workers not to panic but to be vigilant and report any suspected cases to the nearest health units,? the minister said. ?So far there have been no more new cases for the last 15 days.? He said that the continuation of the trend would signify the containment of the deadly virus.

Kamwenge District Chairman Edward Musingye said: ?The situation is not severe but as a district we are on full alert to see that the situation doesn?t get out of hand.?

http://www.monitor.co.ug/news/news08022.php

 

[Gert van der Hoek]

Re: Uganda: Marburg hemorrhagic fever

Definition of Marburg disease

Marburg disease: A severe form of hemorrhagic fever which affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, its recognition led to the creation of this virus family. The four species of Ebola virus are the only other known members of the filovirus family.

Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). A total of 37 people became ill; they included laboratory workers as well as several medical personnel and family members who had cared for them. The first people infected had been exposed to African green monkeys or their tissues. In Marburg, the monkeys had been imported for research and to prepare polio vaccine.

Recorded cases of the disease have appeared in only a few locations. While the 1967 outbreak occurred in Europe, the disease agent had arrived with imported monkeys from Uganda. No other case was recorded until 1975, when a traveler most likely exposed in Zimbabwe became ill in Johannesburg, South Africa - and passed the virus to his travelling companion and a nurse. 1980 saw two other cases, one in Western Kenya not far from the Ugandan source of the monkeys implicated in the 1967 outbreak. This patient's attending physician in Nairobi became the second case. Another human Marburg infection was recognized in 1987 when a young man who had traveled extensively in Kenya, including western Kenya, became ill and later died.

Marburg virus is indigenous to Africa. While the geographic area to which it is native is unknown, this area appears to include at least parts of Uganda and Western Kenya, and perhaps Zimbabwe. As with Ebola virus, the actual animal host for Marburg virus also remains a mystery. Both of the men infected in 1980 in western Kenya had traveled extensively, including making a visit to a cave, in that region. The cave was investigated by placing sentinels animals inside to see if they would become infected, and by taking samples from numerous animals and arthropods trapped during the investigation. The investigation yielded no virus: The sentinel animals remained healthy and no virus isolations from the samples obtained have been reported.

Just how the animal host first transmits Marburg virus to humans is unknown. However, as with some other viruses which cause viral hemorrhagic fever, humans who become ill with Marburg hemorrhagic fever may spread the virus to other people. This may happen in several ways. Persons handling infected monkeys who come into direct contact with them or their fluids or cell cultures, have become infected. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease.

After an incubation period of 5-10 days, the onset of the disease is sudden and is marked by fever, chills, headache, and myalgia. Around the fifth day after the onset of symptoms, a maculopapular rash, most prominent on the trunk (chest, back, stomach), may occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea then may appear. Symptoms become increasingly severe and may include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.

Because many of the signs and symptoms of Marburg hemorrhagic fever are similar to those of other infectious diseases, such as malaria or typhoid fever, diagnosis of the disease can be difficult, especially if only a single case is involved. Laboratory tests including antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM-capture ELISA, polymerase chain reaction (PCR), and virus isolation, can be used to confirm a case of Marburg hemorrhagic fever within a few days of the onset of symptoms. The disease is also readily diagnosed by immunohistochemistry, virus isolation, or PCR of blood or tissue specimens from deceased patients.

Recovery from Marburg hemorrhagic fever may be prolonged and accompanied by prolonged hepatitis and transverse myelitis. Other possible complications include inflammation of the testis, spinal cord, eye, and parotid gland. The case-fatality rate for Marburg hemorrhagic fever is between 23-25%.

Specific treatment for this disease is unknown. However, supportive hospital therapy includes balancing the patient's fluids and electrolytes, maintaining their oxygen status and blood pressure, replacing lost blood and clotting factors and treating them for any complicating infections. Sometimes treatment also has used transfusion of fresh-frozen plasma and other preparations to replace the blood proteins important in clotting.

http://www.medterms.com/script/main/art.asp?articlekey=6367

 

[Niko]

Marburg fever outbreak kills miner in Uganda-WHO

Marburg fever outbreak kills miner in Uganda-WHO

Marburg fever outbreak kills miner in Uganda-WHO


Thu 2 Aug 2007, 10:37 GMT
<input value="13" name="CurrentSize" id="CurrentSize" type="hidden">

GENEVA, Aug 2 (Reuters) - The deadly Marburg haemorrhagic fever has broken out in a mining community in western Uganda, killing one person and possibly infecting four others, the World Health Organisation (WHO) said on Thursday.

The Kitaka mine, located in Kamwenge district some 250 km (155 miles) west of the capital Kampala, has been shut down temporarily, WHO spokesman Gregory Hartl said.

The rare but highly fatal disease, caused by a virus from the same family as the one that causes Ebola haemorrhagic fever, is transmitted by close contact with blood or other body fluids and can cause bleeding from multiple orifices.

"We have one confirmed case of death from Marburg haemorrhagic fever plus up to four rumoured or suspected cases," Hartl said.

The confirmed case was a 29-year-old miner who died on July 14 after accompanying another sick miner in an ambulance to hospital from a local clinic, he said. His laboratory results were only received this week.

The sick miner, 21, was discharged from hospital after recovering. Tests have not yet confirmed if he had been infected with Marburg fever, but it was strongly suspected, Hartl said.

Dr Sam Okware, head of Uganda's national task force for haemorrhagic viruses, played down the risk. "There was just one confirmed case of Marburg, the one who died, and one suspected case -- he recovered from a fever, but we have no confirmation it was the virus," Okware told Reuters.

Local residents would be told to stay where they were for 21 days, he said, which was enough time to complete two cycles of the virus, which takes up to 10 days to kill.

"No one in the area is supposed to leave their villages," he said. "By the end of next week, if there are no further cases, I would be quite comfortable that the virus has been contained."

A WHO official in Uganda was helping the health ministry, which has deployed a rapid response team. Officials have been tracing contacts of the sick men and carrying out public awareness campaigns in the area.

There is no vaccine or specific treatment for Marburg disease, which begins abruptly with severe headache and fever followed by rapid debilitation.

Severe diarrhoea, abdominal pain and vomiting begin about the third day, and in fatal cases, death occurs eight to nine days after the onset of symptoms. (Additional reporting by Tim Cocks in Kampala)

Map can be found here: (click on Google map at this link) http://visz.rsoe.hu/alertmap/woalert_read.php?cid=12649&cat=dis&lang=eng

 

[sharon sanders]

Marburg Virus Makes an Unwelcome Comeback

Marburg Virus Makes an Unwelcome Comeback

Marburg virus makes unwelcome comeback
03 Aug 2007 11:49:00 GMT

<!-- 03 Aug 2007 11:49:00 GMT
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A health worker in protective clothing in the northern Angolan town of Uige during the 2005 Marburg outbreak. REUTERS/Mike Hutchings

<!-- AN5.0: inline article box end --><script language="JavaScript" src="http://www.alertnet.org/bin/js/article.js"></script><input value="13" name="CurrentSize" id="CurrentSize" type="hidden"> After a couple of quiet years, the Marburg virus is back. Like its cousin the Ebola virus, Marburg is a contagious haemorrhagic fever that produces sudden massive internal bleeding and can kill within days. Death is painful but slightly less spectacular than Ebola - one journalist once described the sound of someone dying of Ebola as like a sheet being ripped.

Marburg is quieter, but just as lethal. There is no vaccine, no cure and little effective treatment.

The last outbreak of the virus, which is transmitted through bodily fluids, was centred around the town of Uige in northern Angola in 2005, close to the border with the Democratic Republic of Congo. Out of 374 cases identified by the Angolan Ministry of Health, 329 died, according to the final International Federation of Red Cross report. But by mid to late 2005, the outbreak had died out. Now, the World Health Organisation says Marburg has been confirmed in the case of a 29-year-old man who died in a mining community in Uganda, again near the Congolese border. There have been several other suspected cases, and the Ministry of Health and WHO are closely monitoring the area. By the time I arrived in Angola in 2005 with a Reuters multimedia team, travel to the infected area had become almost impossible. Drivers, car hire firms and just about anyone else refused to risk the trip. Eventually, we found a South African charter flight company who were willing to fly us in. A few weeks earlier, the same company had flown a foreign doctor back to the capital after he had become infected. He died soon after. Uige itself was functioning surprisingly normally, with shops and markets still open, but with a strange apocalyptic feel in the air. Government teams in protective gear could be seen moving around, while the nights were punctuated by spectacular thunderstorms. A few days before we arrived, three Red Cross and one other local health worker working on educating the population about Marburg were killed by lightning while sheltering under a tree. Much of the local hospital staff had died in the early stages of the outbreak but new staff had been flown in both from Angola and from elsewhere in the world courtesy of the World Health Organisation. But with so many people dying at the hospital, relatives were apparently reluctant to bring their sick people there. Too often, the WHO teams going out into the community were finding cases after the victims had died - and therefore after they had infected family members through their sweat and blood. Others contracted it as they washed and kissed their dead relatives prior to burial in accordance with local custom. Some called local traditional healers who themselves became infected and spread the disease. Dressed in protective "spacesuits", WHO teams were even being attacked as they went out into the cramped slums around Uige - a town that still bore the scars of decades of neglect and occasional fighting during Angola's recently finished civil war. Local residents somehow came to believe it was the medical teams who were spreading the disease. But by the time we got there, the tactics had changed and the message was beginning to get through. The key aim was to make people less afraid of the health teams and more terrified of the virus. So the WHO contact teams kept their "spacesuits" off until they reached the doors of infected houses, while leaflet distributions and loudspeaker vans - some broadcasting a specially composed "Marburg song" by local band - spread the message. Success meant making people avoid contact with the sick. While those in town were sometimes able to get relatives to the new isolation ward at the hospital, out in the countryside the options were more brutal. One of the signs of "success" was when we heard of a man whose pregnant wife began vomiting blood. Instead of caring for her and infecting himself and the rest of the family, he took himself and the other children out of the house and locked the door. Local residents said she was screaming for several days but by the time WHO arrived she was dead. But the family survived, and the virus did not spread. The Uganda outbreak is not nearly at that stage, and hopefully never will be. The one identified fatality died on July 14, and no new cases have been reported for a couple of weeks. But on an emerging infectious diseases website run by the International Society for Infectious Diseases, the moderator sounds a note of caution. "In prior outbreaks of viral haemorrhagic fevers in Africa, the occurrence of cases leads to panic and contacts frequently leave the area...returning to their distant villages while incubating the infection," they write. "This moderator doesn't wish to appear as a gloomy predictor, but rather is exerting caution in giving an 'all is clear' message."

http://www.alertnet.org/db/blogs/36072/2007/07/3-114948-1.htm

 

[Sally Furniss]

Re: Marburg Virus Makes an Unwelcome Comeback

Re: Marburg Virus Makes an Unwelcome Comeback

http://english.people.com.cn/90001/90777/6231652.html

Health experts in Uganda have linked the outbreak of the deadly Marburg Hemorrhagic Fever (MHF) in the western part of the country to a monkey similar to those that were responsible for the first outbreak in 1967.

Sam Okware, the head of the national task force to fight the spread of the epidemic told, a news conference here on Friday that preliminary investigations showed that the virus may be passed to one of the two victims by a Colobus monkey which was slaughtered.

"The probable case who is alive has been identified to have skinned a Colobus monkey a week prior to falling ill," Okware said flanked by the World Health Organization representative in Uganda, George Melville.

"The skin of the monkey has been recovered and is in safe custody at the Uganda Virus Institute. Samples of the skin have been sent for further analysis," he added.

The Ugandan government on Wednesday announced that two cases of MHF were identified at a gold mine located in Kakasi Forest Reserve, Kamwenge district, 250km west of Kampala.

One of the two miners confirmed to have contracted the virus died on July 14 and another miner was recovering after being treated.

"The number of cases still remain two - one confirmed who died and one probable who is still alive. Please note that the situation has not changed since notification of the outbreak," Okware noted.

He also revealed that the task force is monitoring over 140 people who are believed to have come into contact with the two miners both in the capital city Kampala and Kamwege district.

"In Kampala, 46 contacts have been identified. Among these eight are close contacts being relatives of the probable case and the deceased. In Kamwenge, 100 contacts who are all miners have been identified.

Of the 100, 50 are local miners living in the village, while another 50 are in a camp 200 meters from the mine. Of these six are very close contact to the probable case, as they participated in skinning the monkey," Okware said.

The government has set up isolation units at Mulago hospital in Kampala and Kicheche health center III in Kamwenge.

The health official again urged the public to remain calm and report any suspected cases to the nearest health unit.

MHF, like Ebola, is a highly deadly and contagious disease characterized by sudden onset of high fever and bleeding, resulting into death within a week if untreated.

The virus can be transmitted through close contact with blood and other body fluids from carriers who have developed clinical symptoms. It can also be transmitted following exposure to contaminated items, such as bedding and clothing of the patients.

The virus is named after Marburg, a city in Germany, where the first outbreak occurred in 1967 among laboratory workers doing research on monkeys imported from Uganda in order to prepare a polio vaccine.

According to the WHO, the last two recent outbreaks of MHF in the Democratic Republic of Congo during 1998-2000 and in Angola during 2004-2005 have claimed 128 and 323 lives respectively.

 

[Gert van der Hoek]

Re: Uganda: Marburg hemorrhagic fever

Archive Number 20070803.2514

Published Date 03-AUG-2007

Subject PRO/AH/EDR> Marburg hemorrhagic fever - Uganda

http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,38651

 

[Treyfish]

Re: Uganda: Marburg hemorrhagic fever

MARBURG HEMORRHAGIC FEVER - UGANDA (02)

<TABLE summary=""><TBODY><TR><TD noWrap align=right>Archive Number</TD><TD noWrap align=left>20070804.2533</TD></TR><TR><TD noWrap align=right>Published Date</TD><TD noWrap align=left>04-AUG-2007</TD></TR><TR><TD noWrap align=right>Subject</TD><TD noWrap align=left>PRO/AH/EDR> Marburg hemorrhagic fever - Uganda (02)</TD></TR></TBODY></TABLE>


Date: Sat 4 Aug 2007
Source: People's Daily (English) online, Xinhua report [edited]
<http://english.people.com.cn/90001/90777/6231652.html>


Monkey might be source of Marburg disease outbreak

Health experts in Uganda have linked the outbreak of the deadly
Marburg hemorrhagic fever (MHF) in the western part of the country to
a monkey similar to those that were responsible for the 1st outbreak in 1967.

Sam Okware, the head of the national task force to fight the spread
of the epidemic told a news conference here on Friday [3 Aug 2007]
that preliminary investigations showed that the virus may [have been]
passed to one of the 2 victims [only one of whom has been confirmed
as a case of Marburg hemorrhagic fever - Mod.CP] by a Colobus monkey
which had been slaughtered.

"The probable case who is alive has been identified to have skinned a
Colobus monkey a week prior to falling ill," Okware said flanked by
the World Health Organization (WHO) representative in Uganda, George
Melville. "The skin of the monkey has been recovered and is in safe
custody at the Uganda Virus Institute. Samples of the skin have been
sent for further analysis," he added.

The Ugandan government on Wednesday [1 Aug 2007] announced that 2
cases of Marburg hemorrhagic fever had been identified at a gold mine
located in Kakasi Forest Reserve, Kamwenge district, 250km [155.34
miles] west of Kampala. One of the 2 miners confirmed to have
contracted the virus died on 14 Jul 2007 and another miner was
recovering after being treated. "The number of cases still remains 2
-- one confirmed who died and one probable who is still alive. Please
note that the situation has not changed since notification of the
outbreak," Okware stated.

He also revealed that the task force is monitoring more than 140
people who are believed to have come into contact with the 2 miners
both in the capital city Kampala and in Kamwege district. "In
Kampala, 46 contacts have been identified. Among these, 8 are close
contacts being relatives of the probable case and the deceased. In
Kamwenge, 100 contacts who are all miners have been identified. Of
the 100, 50 are local miners living in the village, while another 50
are in a camp 200 metres [218.7 yards]from the mine. Of these, 6 are
in very close contact with the probable case, as they participated in
skinning the monkey," Okware said.

The government has set up isolation units at Mulago hospital in
Kampala and Kicheche health center III in Kamwenge. The health
official again urged the public to remain calm and report any
suspected cases to the nearest health unit.

Marburg hemorrhagic fever, like Ebola hemorrhagic fever, is a highly
deadly and contagious disease characterized by sudden onset of high
fever and bleeding, resulting into death within a week if untreated.
The virus can be transmitted through close contact with blood and
other body fluids from carriers who have developed clinical symptoms.
It can also be transmitted following exposure to contaminated items,
such as bedding and clothing of the patients.

The virus is named after Marburg, a city in Germany, where the 1st
outbreak occurred in 1967 among laboratory workers doing research on
monkeys imported from Uganda in order to prepare a polio vaccine.
According to the WHO, the last 2 recent outbreaks of Marburg
hemorrhagic fever in the Democratic Republic of Congo during
1998-2000 and in Angola during 2004-2005 have claimed 128 and 323
lives, respectively.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[It is well established that Marburgvirus can infect various
species of monkeys and primates, and indeed the virus was originally
transmitted from imported monkeys to humans in laboratories in
Marburg, Germany, and in the former Yugoslavia. It may be that the
virus responsible for the current outbreak in Uganda was transmitted
from the Colobus monkey that was skinned by the miner who became
subsequently a suspected case of Marburg hemorrhagic fever. However,
this is uncertain since it has not been confirmed that the monkey was
infected with Marburg virus. Likewise it has not been confirmed that
the person who skinned the monkey (and who is no longer ill) was
actually suffering from a Marburgvirus infection.

Even if it is confirmed that the monkey and the miner were infected
by Marburgvirus, the ultimate source of the virus remains unknown.

A description and a photograph of the Colobus monkey can be viewed at
<http://www.awf.org/content/wildlife/detail/colobusmonkey>. - Mod.CP]

http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,38675</PRE>

 

[Niko]

No new cases / Uganda: Marburg hemorrhagic fever

No new cases / Uganda: Marburg hemorrhagic fever

Good news!!!



No fresh Marburg fever cases reported, virus cycle nears end

Publication date: Monday, 6th August, 2007
<table align="right" width="30%"> <tbody><tr> <td>

</td> </tr> <tr> <td> Dr. Sam Okware
</td> </tr> </tbody></table> By Fred Ouma

NO more cases of the deadly Marburg fever have been reported since the Ebola-like virus killed one person in Kamwenge 20 days ago. The virus has an active life cycle of 21 days.

?It is now 20 days since the outbreak and no more cases have been reported. Theoretically, we?re seeing a ray of hope as the virus cycle comes to an end,? the head of the national task force for haemorrhagic viruses, Dr. Sam Okware, said yesterday.

He reassured the public to stay calm, saying none of the people being monitored, including those who shared accommodation with patients, had developed fever or any other sign of Marburg.

An emergency response team, he added, had intensified surveillance on all places where the ?contacts? live.

?We?re on the ground, even in Kawumu village in Luweero district, where the victim was buried,? he said.

Meanwhile, the number of people being monitored for the deadly haemorrhagic fever in Kampala has increased to 55, up from 46 last week, the Ministry of Health, has said.

Nine more persons are being monitored in Bweyogerere, about 9km from Kampala city after they came in contact with the patients.

Other people being monitored are in Erisa Zone in Kawempe division, Ntinda I village in Nakawa and Kayonjo village in Kayunga district.
In Kamwenge district, the source of the outbreak, 100 persons are being monitored, the highest number so far.

The viral disease related to Ebola attacked two workers at the now closed Kitaka mine, some 420km from the capital city, Kampala.

Meanwhile, blood samples, including those of the skin of the monkey suspected to have caused the outbreak, are yet to be analysed at the US Centre for Disease Control in Atlanta.

Okware noted that an ecology study has began in Kamwenge to establish the link between the Marburg disease and vectors such as bats, monkeys, rats, ticks flies and fleas, thought to be reservoirs.

Prof. Apuda Asibo, a professor of epidemiology from Makerere University, is leading the team of over eight experts from the Ministry of Health, the Uganda Virus Research Institute, the US Centre For Disease Control and the World Health Organisation.

This article can be found on-line at: http://www.newvision.co.ug/D/8/12/579931


<!-- end story layout piece here -->

 

[Sally Furniss]

Re: Uganda: Marburg hemorrhagic fever

Source of Marburg outbreak sought

http://www.miamiherald.com/news/world/AP/story/196805.html

By MARIA CHENG
AP Medical Writer

LONDON --
Virus hunters swathed in protective gear plan to enter a lead and gold mine in a remote part of western Uganda this week to search for bats they believe may be the source of the latest outbreak of a deadly Ebola-like disease.

Wearing gowns, boots, masks, goggles and leather gloves, the medical investigators will attempt to catch 1,000 bats to be transported to a nearby mobile laboratory, where they will take blood samples to look for antibodies of the Marburg virus, before killing the animals and removing their livers and spleens.

"It's quite dangerous work, but we hope it will help us answer some important questions about Marburg," Dr. Pierre Formenty, a hemorrhagic fever expert at the World Health Organization, said in a telephone interview Tuesday from Kampala, Uganda. "It will be a very delicate operation."

Last week, WHO confirmed one case of Marburg in a 29-year-old man who worked at the mine and who died on July 14.

Marburg is a rare and virulent disease for which there are no cures or effective treatments. It causes headaches, nausea, diarrhea and vomiting. In severe cases, the central nervous system is attacked, and patients may bleed from the eyes, ears and elsewhere.

Scientists are not sure how it is transmitted to humans, but believe people may become infected by being bitten by bats or by insects or other animals that have been infected by bats. Another possibility is that people catch it by breathing in air carrying virus particles from bat feces. Since Marburg was first identified in 1967, large outbreaks have been reported in Congo, Angola and other countries.

"If we knew what the animal reservoir was, we would have a better chance of stopping the infection," Formenty said, adding that experts could then more precisely warn people about which behaviors - and animals - were particularly risky. That "would open up new avenues for future treatments and developing vaccines."

Formenty and about two dozen other experts from WHO, the Centers for Disease Control and Prevention in Atlanta, Medecins Sans Frontieres, the Ugandan Ministry of Health and other agencies will be involved in the effort to collect bats from the mine.

The team may also take blood samples from miners and villagers in the area, to check for antibodies that would indicate they might have been exposed to Marburg. Experts think that sporadic cases of hemorrhagic fever in the region are not uncommon, and that cases of Marburg have probably gone undetected for years.

"We are learning new tricks from each outbreak," said Dr. Pierre Rollin, a Marburg expert from the CDC, who was on his way to Uganda on Tuesday. "If we cannot go to the outbreak site immediately after it happens, we are losing a chance."

Unlike previous Marburg outbreaks, when doctors have been preoccupied with trying to save peoples' lives, the number of patients in the current outbreak appears to be limited. In addition to the confirmed Marburg death, one other "highly probable" case is still alive, and health authorities are monitoring about 100 contacts of the two men, who both worked in the mine.

"In the past, the early teams that have gone out have been busy establishing isolation wards to prevent further infections and following up case contacts," said Dr. Stuart Nichol, a CDC Marburg expert.

By the time doctors were able to shift from treating patients to investigating the outbreak, many months had passed. "In this outbreak, we have a chance to focus on the ecological side soon after the outbreak to see where the disease may actually come from," Nichol said.

Some 5 million bats, as well other animals and insects, live in and around the mine at the center of the outbreak.

Bats have long been suspected of playing a role in transmitting Ebola and Marburg to humans. "There have been anecdotal reports in each outbreak that bats have been around," Rollin said.

After past Marburg outbreaks, scientists have trapped bats in surrounding caves and mines, but they have never found the smoking gun necessary to prove the bats' role in transmission: antibodies against the virus.

"Diseases like Marburg are very complex and take time to understand," Formenty said. "Every outbreak is an opportunity for us to prevent future infections."

 

[Sally Furniss]

Re: Uganda: Marburg hemorrhagic fever

http://www.miamiherald.com/news/world/AP/story/198332.html

By KATY POWNALL
Associated Press Writer

KAMPALA, Uganda --
An outbreak of a deadly Ebola-like disease at a mine in western Uganda has been contained, health officials said Thursday.

The Marburg virus, a rare hemorrhagic illness, killed a 29-year-old last month. The country had not seen a Marburg outbreak for 30 years.

Health Minister Dr. Stephen Mallinga said the 21-day maximum incubation period has passed with no new cases reported.

"Theoretically the transmission chain has been broken, the transmission has been stopped and the outbreak contained," he said.

The disease has a death rate that can be higher than 90 percent and no treatment or vaccine. Marburg can cause headaches, nausea, diarrhea and vomiting. In severe cases, the central nervous system is attacked, and patients may bleed from the eyes, ears and elsewhere.

Since Marburg was first identified in 1967, large outbreaks have been reported in Congo, Angola and elsewhere.

Virus hunters swathed in protective gear plan to enter the lead and gold mine in Uganda to search for bats they believe may be the source of the latest outbreak. The medical investigators will take blood samples to look for antibodies of the Marburg virus, before killing the animals and removing their livers and spleens.

Scientists are not sure how the virus is transmitted to humans, but believe people may become infected by being bitten by bats or by insects or other animals that have been infected by bats. Another possibility is that people catch it by breathing in air carrying virus particles from bat feces.

 

[Gert van der Hoek]

Re: Uganda: Marburg hemorrhagic fever

Third Marburg case in Uganda after man breaches infected mine

Tue, 02 Oct 2007

Kampala, Uganda - A Ugandan man tasked with guarding a Marburg virus-infected mine crept into the underground cove only to be infected with the Ebola-like disease, health officials said Tuesday.

The mine was closed when the epidemic struck the western area situated in a forest reserve, killing one person, but the 58 miners were monitored by the health ministry, as were the people they had come in contact with.

The epidemic was declared over in early August but health ministry officials said that a man who was guarding the closed mine "sneaked" in, contracting the disease and that he is currently under treatment.

"The mine was closed but one person, purportedly guarding the mine, sneaked in quietly and got the problem. We have taken his contacts and tracking down all the other people who may have come to him," said Paul Kaggwa, the ministry?'s spokesman.

Authorities believe the virus might have been transmitted from the hundreds of thousands of bats dwelling in the scores of tunnels of the mines or from monkeys in a government forest reserve where the mines are situated.

The Marburg virus which is similar to but less virulent than Ebola, was isolated in 1967 in Germany's Marburg Virus Institute from monkeys which were imported from Uganda.

An Ebola outbreak in the Congo has killed six people since April.

http://www.earthtimes.org/articles/show/117556.html

 

[Sally Furniss]

Re: Uganda: Marburg hemorrhagic fever

Uganda: Deadly Fever Hits Kamwenge Again

http://allafrica.com/stories/200710021151.html

New Vision (Kampala)

Fred Ouma
Kampala

A NEW case of the deadly Marburg haemorrhagic fever has been reported in Kamwenge district in western Uganda.

The Ministry of Health, in a statement yesterday, confirmed that a mine worker at Kitaka gold mines in Kamwenge had contracted the disease, the same place where the deadly virus hit two months ago.

In late July, a 29-year-old man was killed by the Ebola-like virus and another one infected. Both had been working in the Kitaka mines, located 420km west of the capital Kampala.

The mines had been closed temporarily to allow for an ecological study. The results are to be released at the end of this month.

"Our preliminary investigations suggest that a mine worker re-entered the mine which had earlier been closed. The case has been identified, isolated and confined in one of the health facilities in the country," said Dr. Sam Zaramba, the Director General of health services.

He added that experts from the ministry were following up on anybody who could have been in contact with the victim.

The Commissioner for Community health, Dr. Sam Okware, advised the public to avoid the mines.

"We collected over 1,000 bats from the mines to establish the suspected transmission from bats to humans. The new victim, who was the guide of our research team, must have returned to the mine unprotected," said Okware, who is also the head of the national task force for haemorrhagic viruses.

The health ministry has issued a directive, urging all district medical officers to cooperate with security officials and ensure that the mines are a no-go area for the general public. "The public should not panic as appropriate measures are being taken to avert any further spread of the disease," the statement said.

The rare but highly fatal disease, caused by a virus related to the one that causes Ebola, is transmitted through contact with blood or other body fluids of infected people.

It is characterised by sudden bleeding from several orifices and high fever, resulting into death within a few days. The disease is also spread by rats.

The virus is named after Marburg, a city in Germany, where the first outbreak occurred in 1967 among laboratory workers. The workers had been doing research on monkeys, imported from Uganda, in order to prepare a polio vaccine.

The new case comes after the World Health Organisation praised Uganda for its prompt reaction to the first outbreak.

 

[Treyfish]

Re: Uganda: Marburg hemorrhagic fever

<TABLE summary=""><TBODY><TR><TD noWrap align=right>Published Date</TD><TD noWrap align=left>02-OCT-2007</TD></TR><TR><TD noWrap align=right>Subject</TD><TD noWrap align=left>PRO/AH/EDR> Marburg hemorrhagic fever - Uganda (06): new case</TD></TR></TBODY></TABLE>

MARBURG HEMORRHAGIC FEVER - UGANDA (06): NEW CASEDate: Tue 2 Oct 2007Source: Earth Times.org [edited]<http://www.earthtimes.org/articles/show/117556.html>Another Marburg case in Uganda after man breaches infected mine-----------------------------------------------------------------------------------A Ugandan man tasked with guarding a Marburg virus-infected mine crept into the underground [mine] only to be infected with the Ebola-like disease, health officials said Tuesday [2 Oct 2007]. The mine was closed when the epidemic struck the western area situated in a forest reserve, killing one person, but the 58 miners were monitored by the health ministry, as were the people they had come in contact with.The epidemic was declared over in early August [2007] but health ministry officials said that a man who was guarding the closed mine "sneaked" in, contracting the disease and that he is currently under treatment.Uganda has contained an outbreak of Marburg disease among gold miners, but contacts of the 2 known cases must now make sure they don't spread the deadly virus through sexual activity, the World Health Organisation (WHO) said on Fri 17 Aug 2007.WHO expert Pierre Formenty said investigators had collected hundreds of bats from the mine, which they suspect may be a possible reservoir of the disease."The mine was closed but one person, purportedly guarding the mine, sneaked in quietly and got the problem. We have taken his contacts and are tracking down all the other people who may have come to him," said Paul Kaggwa, the ministry's spokesman.Authorities believe the virus might have been transmitted from the hundreds of thousands of bats dwelling in the scores of tunnels of the mines or from monkeys in a government forest reserve where the mines are situated.The Marburg virus which is similar to but less virulent than Ebola, was isolated in 1967 in Germany's Marburg Virus Institute from monkeys which were imported from Uganda.An Ebola outbreak in the Congo has killed 6 people since April [2007].--Communicated byroMED-mail<promed@promedmail.org>[A major outbreak of Marburg hemorrhagic fever occurred among gold miners in the Democratic Republic of Congo between 1998 and 2000, causing 128 deaths among 154 cases. An outbreak in Angola in 2004-2005 killed 150 people among 163 cases, The Uganda outbreak of 2007 is also associated with a mining community, but has affected only a few minersA miner died on 14 Jul 2007 and another was confirmed 13 Aug 2007 as having survived this rare viral hemorrhagic disease. The WHO Weekly Epidemiological Record of Fri 17 Aug 2007 (<http://www.who.int/wer/ 2007/wer8233/en/index.html>) stated that the mine authorities have identified one additional suspected case and 2 individuals who were taken ill in mid-June 2007 and have since recovered. Other miners under surveillance for Marburg hemorrhagic fever had been at the mine for approximately 8 months with no movements outside the mining area during that time, but no other cases were detected among miners or health care workers at the mine.This new case (only the 3rd confirmed case) reveals that the virus is still lurking in the environment of the mine, but an association with bats or monkeys is still conjecture. - Mod.CP]:tiphat: http://tinyurl.com/ynohxw</PRE>

 

[Sally Furniss]

Re: Uganda: Marburg hemorrhagic fever

Uganda: Marburg Fever - Six Persons Isolated in Ibanda District

http://allafrica.com/stories/200710031233.html

THE Ministry of Health has confined six residents to its Ibanda isolation unit for observation and screening for the virus that causes Marburg haemorrhagic fever.

This was after a new case was reported in Kamwenge District a few days ago. According to an assistant commissioner in the ministry who declined to be named because he is not authorised to speak to the press, five of the isolated persons had been in close contact with the suspect.

"We have followed up the case and identified the people he came into close contact with. None of them travelled to Kampala. They are currently in Ibanda," the doctor said yesterday in a phone interview. The six are to spend 42 days in the isolation centre as they are monitored for two incubation periods.

The incubation period of the virus, whose transmission is limited to very close contact with blood and body fluids of an infected person, is between five to 10 days. Failure to register a case within two incubation periods normally signifies containment of the epidemic, which was first reported in Uganda in 1977.

At that time, 377 cases were reported worldwide. According to a statement the Director General of Health Services, Dr Sam Zaramba, issued on Tuesday, the confirmed case was of a mine worker at Kitaka gold mines in Kamwenge.

"Our preliminary investigations suggest that a mine worker re-entered the mine which had earlier been closed," reads part of the statement. It was from the same mines that the last Marburg case, still of a gold miner, originated. The Ministry of Health thereafter closed the mines as experts from the World Health Organisation and the US-based Centres for Disease Control and Prevention and Medicines San Frontiers were dispatched to carry out tests on the thousands of bats that lived in the mines.

The spleens and livers of the bats, suspected to be the hosts of the virus, were flown to the US for examination, the results of which are expected at the end of this month.

At the time, it was suspected that 29-year-old Hannington Ssengendo could have contracted the virus from his brother who skinned a colobus monkey. The July outbreak claimed one life - Ssengendo because medical personnel contained the situation. The ministry has assured the public not to panic.