Handshakes Out as Marburg Virus Stalks Angola

Bowing and curtsying have replaced handshakes and hugs in northern Angola as health workers battle a deadly viral outbreak that has killed 237 people and left victims too scared to go to hospital.

In Uige, the center of Angola’s Marburg epidemic, soldiers in white protective gear decontaminated the homes of victims on Tuesday and aid agencies said they feared each case may have infected others in their household.Initially, children died but their mothers now make up an increasing proportion of the dead.”Our Angolan province of Uige is hit by a terrible illness called the Marburg fever,” government officials said through loudspeakers on streets still bearing the scars of 27 years of civil war. “It is fatal and kills in an extremely small time and is extremely contagious. The only solution is prevention.”The disease — transmitted through bodily fluids including blood, sweat and saliva — has killed over 90 percent of the 261 people known to be infected, the health ministry said late on Monday.Most of the victims have been in Uige, about 190 miles north of the capital Luanda, but some cases were reported among travelers who had recently returned from the region.”It’s a horrible disease. You bleed through every orifice,” UNICEF communications officer Patricia Cervantes said. “Families have died inside with their doors locked.”The WHO says Marburg’s symptoms often begin 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.The government said the outbreak was under control but the World Health Organization said it was not yet contained in Uige. Agencies said it was too soon to say if messages about how to prevent the virus’s spread were getting through to local people. PATIENTS STAY AWAY”It is still hard to really make some conclusion on the reaction of the community,” said Medecins Sans Frontieres spokesman Alois Hug in their field headquarters, where — as elsewhere in Uige — staff avoid shaking hands.Aid workers say residents greet them with bows and curtsies.”At least that message is getting through,” UNICEF’s Cervantes said after returning from the suburbs. “But we suspect people are keeping patients away from the hospital.”Convincing families to bring the sick to a recently opened isolation ward, where staff wear sweltering protection suits, is seen as key to breaking the chain of infection, with patients at their most infectious in the final stages of the illness.But most victims stay away, fearing both the hospital’s reputation as a center of the Marburg outbreak and the unusual precautions that medical workers are forced to take.”If someone says they’re not going into the isolation ward there’s nothing we can do to make them,” WHO spokesman Dave Daigle said. “We have to tell relatives how to care for them in the safest way possible.”Prices of fuel, phonecards and other goods have risen as traders avoid the area. But the panic that followed the first cases was subsiding, residents said.”We were terrified when the epidemic started because so many people were dying,” 27-year-old Simao Filipe said. “But now fewer people are dying and things are getting back to normal.” (Source: Reuters Health, April 2005)