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Fear and violence accompany deadly angola virus { April 9 2005 } Original Source Link: (May no longer be active)
http://www.nytimes.com/2005/04/09/health/09angola.htmlhttp://www.nytimes.com/2005/04/09/health/09angola.html
April 9, 2005
Fear and Violence Accompany a Deadly Virus Across Angola
By SHARON LaFRANIERE and DENISE GRADY
LUANDA, Angola, April 8 - The death toll in Angola from an epidemic caused by an Ebola-like virus rose to 174 Friday as aid workers in one northern provincial town reported that terrified people had attacked them and that a number of health workers had fled out of fear of catching the disease.
International health officials said the epidemic, already the largest outbreak of Marburg virus ever recorded, showed no signs of abating. Seven of Angola's 18 provinces have now reported suspected cases and several neighboring countries have announced health alerts.
"It's becoming a huge problem," said Dick Thompson, a spokesman for the World Health Organization, which has dispatched surveillance teams to the country's northern provinces. "We clearly don't know the dimensions of the outbreak."
Health officials said some Angolans are hiding sick relatives out of fear that they will die if taken to the hospitals, thereby increasing the chance the disease will spread. There is no cure or vaccine for the highly contagious virus. Victims suffer a high fever, diarrhea, vomiting and severe bleeding from bodily orifices and usually die within a week.
The initial outbreak appears to have spread through a pediatric ward in Uige, a town in a farming district about 180 miles north of the capital of Luanda. More than 60 percent of the victims so far have been children.
One health official in Uige said that more than a dozen health care workers have perished from the disease, including two doctors, and that many workers are deserting the town's hospital in fear. Some townspeople are refusing to allow their sick relatives to be taken to an isolation unit set up at the hospital there by Doctors Without Borders, fearing it leads only to a graveyard.
As field workers tried to trace suspected cases in two Uige neighborhoods Thursday, townspeople threw stones at them, accusing them of killing people who had been taken away sick and who were returned to them dead. The violence forced the health workers to suspend their checks, according to officials from the World Health Organization and Doctors Without Borders. The government has dispatched soldiers to the province but so far made only a limited effort to educate an increasingly terrified public.
"We want people to understand that in a public health emergency you sometimes have to take unpopular measures," said Monica Castellarnau, the emergency coordinator for Doctors Without Borders in Uige. "At the moment all they understand is that we take someone to a locked-up place in a hospital, and then they die."
The World Health Organization officials said the disease so far appears confined to Angola but have recommended that four bordering countries be on the lookout for cases of the virus. The disease is spread through bodily fluids, including blood, excrement, saliva and vomit.
The United Nations appealed Friday for $3.5 million to fight the disease, saying Angola needs field laboratories, field workers to spot cases early, isolation units for the sick and a huge information campaign. Officials said the epidemic was spreading much faster than it did in the Democratic Republic of Congo, which until now had recorded the highest number of Marburg deaths. That two-year outbreak killed 123 people and ended in 2000.
Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said.
The intensity of Angola's outbreak is apparently partly due to the horrific state of the nation's hospitals after a 27-year civil war that ended in 2002, the failure to identify the disease for months after the first case and some traditional burial customs, including kissing corpses. Only when health care workers began dying in early March, six months after what health officials now believe was probably the first case, was the alarm fully raised.
The number of suspected cases, now at 200, shot up dramatically in the past two weeks, as epidemiologists have fanned out to try to identify the sick. The government is broadcasting daily radio warnings, asking people to transport any people with Marburg-like symptoms to the hospital and not to touch the corpses.
A cousin to the Ebola virus, Marburg is named for the town in Germany where it was first identified in 1967 after laboratory workers were infected by monkeys from Uganda.
Scientists do not know the source of the virus or how the current outbreak began, but they suspect that the virus was transmitted from an animal, possibly a bat. Health experts say that to control the epidemic, medical workers must check everyone who had contact with a victim after the first display of symptoms. That can mean 10 or 20 people to follow for each suspected case, each of whom should be checked once a day.
"As soon as someone is suspected and hospitalized, then you start to follow all the contacts, all the people with him in the last few days when he was still O.K.," said Dr. Pierre Rollin, a physician in the Special Pathogens Branch of the Centers for Disease Control and Prevention. In one Ebola outbreak, he said, epidemiologists had to track 3,000 people a day.
"It is quite impossible sometimes," he said.
The task may be especially daunting in Angola, with its rutted dirt roads, teeming townships, remote villages and countryside still littered with land mines from decades of conflict. Epidemiologists say teams of specialists may be needed for months to come.
Sharon LaFraniere reported from Luanda for this article, and Denise Gradyfrom London.
Copyright 2005 The New York Times Company
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