UN health agency confronts Angolan families’ refusal to isolate Marburg patients

Faced with reluctance by Angolan families to isolate victims of deadly Marburg fever in hospitals, the United Nations health agency may introduce a temporary emergency “harm reduction strategy,” providing protective supplies to homes to stop the worst outbreak on record of the haemorrhagic disease from turning into a full-blown epidemic.

Isolation, reducing opportunities for further transmission, is among the main tools for controlling Marburg, which is spread by close contact such as exposure to the blood and other bodily fluids of patients, and for which there is no vaccine or treatment. The current outbreak, the deadliest ever, has a mortality rate of about 90 per cent.

“It is apparent that, for the time being, the community does not accept the concept of isolation,” the World Health Organization (WHO) said in its latest update on the disease, which has so far claimed 215 lives out of 235 cases in just a few weeks, far faster than in previous outbreaks.

“Given the urgency of the situation, WHO may temporarily introduce, as an emergency measure, a harm reduction strategy aimed at making a dangerous situation somewhat better.

“Family members and other caregivers who refuse to allow patients to be cared for in the isolation facility are being informed of ways to protect themselves from infection and given appropriate supplies. WHO has placed urgent orders for disinfectants, which are currently in short supply in Angola,” it added.

Health care workers in hospitals and surveillances teams have been provided with protective clothing covering them from head to foot, including face masks and goggles.

WHO has repeatedly stressed that early diagnosis, isolation and tracing of all contacts are the only way to break the transmission chain of the disease, a relative of the equally deadly but better-known Ebola, which begins with severe diarrhoea, abdominal pain, nausea, vomiting and chest and lung pains, and progresses to severe haemorrhage in the gastrointestinal tract and lungs.

Uige province in northwestern Angola, epicentre of the outbreak, remains the most severely affected area, with 208 cases and 194 deaths, yet the isolation ward at the large 400-bed hospital, specially equipped and staffed for the care of Marburg patients, is empty despite the fact that cases and deaths are known to be occurring.

The previous worst outbreak was in the Democratic Republic of the Congo (DRC) and took two years to claim 149 cases, 123 of them fatal, from 1998 to 2000. By contrast the present outbreak is believed to have started in October and has killed scores of people in the just the past few weeks.