As epidemiologist Sylvia Briand boots up to take samples from a prospective victim of the deadly Marburg virus in a cramped Angolan slum, wailing family and neighbors stand by in fear, grief and fascination.
Identifying cases of the Ebola-like hemorrhagic fever is seen as key to controlling an outbreak that has killed more than 230 people in this southern African country and which the U.N. World Health Organization says is not yet contained.”We have seen some cases where it has killed 11 people in one family,” Briand said. “At the moment they are so afraid of the disease they do not see us as partners.”The government has said the epidemic is under control, with cases limited largely to the northern province of Uige or occurring among travelers returning from the region.But Angola and its southern African neighbors remain on alert, fearing the scenes in Uige could be repeated elsewhere.South African officials on Wednesday tested a sick passenger who arrived in Johannesburg on a plane from Angola’s capital Luanda, although there was no immediate indication that the illness was Marburg.In Uige, a tower of black smoke rises into the air above the town — where lack of power and water and heavily-potholed streets show the legacy of Angola’s 27-year civil war — as health workers in protective gear burn contaminated waste.Most Marburg cases are reported only after death, by which time family and other carers have often also contracted the virus through body fluids including saliva, blood and sweat.Marburg infection begins with severe headaches, muscle pain and fever followed by vomiting, diarrhea, and internal bleeding. Death occurs most often between 8 and 9 days after symptoms start, usually preceded by severe blood loss and shock.If Briand’s tests on the swabs taken from the 20-year-old woman, who died suddenly and whose body lies visible inside the one-room corrugated iron roofed hut, come back positive, her family and others in the crowd of more than 50 gathered around the home may already have the disease.”Look how poor we are,” said a retired pharmacist living near the suspected case, which was visited by the WHO team on Tuesday. “How can we put in hygiene measures which they are telling us to?” TRACKING THE SPREADThe joint WHO-government database of people who have been in contact with the disease is growing. Some 90 percent of infected cases have died, although in a province of half a million people most families remain untouched by the disease.At one stage, the WHO suspended operations after its vehicles were stoned by scared residents. Sporadic attacks continue, and health workers say they are very aware of how fast crowds around victims’ homes can turn ugly.”There were rumors the white people had brought the disease,” said Briand. “I always put my suit on in front of them to show I am a real person.”After talking to local leaders and the family while wearing no protective gear except white rubber boots, Briand and her Angolan colleagues disinfect the ground they stand on with bleach before pulling on full-body protective clothing and masks to move in and inspect the corpse.Doctors say if the virus was airborne like some other diseases such as flu, the death toll would be much higher.As the crowd presses close and relatives cry and wail, the suited figures spray the door frame and door with bleach as they move slowly into the house before taking a swab from the dead woman’s mouth.”There was not much blood so it might not be Marburg,” Briand said. “But she was very young and died quickly and we have had cases turn up positive that we thought were negative.” (Source: Reuters Health, April 2005)