Expert Warning — The Outbreak of the Deadly Marburg Virus is Worse Than Ebola

 

LUANDA (AFP) – The outbreak of the deadly Marburg virus in Angola is worse than Ebola, a UN disease expert said, as the world body launched an urgent appeal for funds to fight the fever which has claimed 180 lives.

"Marburg is a very bad haemorrhagic fever, even worse than Ebola," said Allarangar Yokouib from the UN World Health Organisation (WHO). 

"We have had several Ebola epidemics in the region but none with such a high mortality rate," he told reporters at a press conference in Luanda. 

In Geneva, the WHO said the world's worst-ever outbreak of the virus was not yet under control. 

Mike Ryan, head of the WHO's emergency response unit, said international agencies and local health authorities must remain firmly engaged in Angola for the next four to six weeks, adding that the situation "now in Angola is not under control yet." 

The world body on Friday launched an emergency appeal for 3.5 million dollars (2.7 million euros) to "intensify the fight" against the outbreak which "was the largest ever recorded and still growing." 

"The appeal for 3.5 million dollars will enable UN agencies, including the WHO, UNICEF and the WFP to support the Angolan government intensifying outbreak control efforts," said the UN's resident co-ordinator in Angola, Pierre-Francois Pirlot. 

"It is clear that this epidemic is unprecedented not only in Angola, but everywhere. It is the biggest epidemic of haemorrhagic fever so far," he said. 

Most of the victims come from the northern town of Uige, the epicentre of the outbreak some 300 kilometres (180 miles) north of the seaboard capital Luanda. Some 200 cases had been reported since it first surfaced in October. 

"The victims included nine health workers, seven nurses and two doctors," said Angolan vice health minister Jose Van Dunem. 

Fear has gripped the capital and the country of 14 million people, which emerged three years ago from a brutal 27-year civil war. 

The Ebola-like Marburg virus, whose exact origin is unknown, spreads through contact with bodily fluids such as blood, excrement, vomit and saliva, but can be contained with relatively simple health precautions, according to experts. 

Yokouibd told reporters that the disease "was transmitted through contact with all bodily fluids which also included sweat and tears if you touch a sick person," but he stressed that it was "not an airborne disease". 

He said the worst-ever outbreak of Ebola, in the same family as Marburg, was in Uganda where some 404 cases were reported at the end of the outbreak. 

"We had several epidemics of Ebola in the region but none of which had such a high mortality rate," said Yakouibd. "It's worse than for example in Uganda." 

There was another Ebola outbreak in the Democratic Republic of Congo, with "only 144 cases" and another in Gabon, with 100 cases. 

The WHO has recommended that four neighbouring countries: Congo, the Democratic Republic of Congo, Namibia and Zambia go on a Marburg alert. 

The DRC has been on "rapid general alert" since March 30, while the Congo and Gabon have alerted its network of epidemiology watchers. 

Sao Tome and Principe, the tiny island country off the west coast of Africa, was screening all travellers from Angola, and Kenya has taken preventative measures. 

The death toll from the virus has jumped from 174 to 180 and has more than doubled in the last three weeks, now reaching into seven of the poor southern African country's 18 provinces.

Marburg hemorrhagic fever is a rare, severe type 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.

Biological weapon

The Soviet Union had an extensive offensive and defensive biological weapons program that included MARV. At least three Soviet research institutes had MARV research programs during the Cold War: the Virology Center of the Scientific-Research Institute for Microbiology in Zagorsk (today Sergiev Posad), the Scientific-Production Association "Vektor" (today the State Research Center of Virology and Biotechnology "Vektor") in Koltsovo, and the Irkutsk Scientific-Research Anti-Plague Institute of Siberia and the Far East in Irkutsk. As most performed research was highly classified, it remains unclear how successful the MARV program was. However, Soviet defector Ken Alibek claimed that a weapon filled with MARV was tested at the Stepnogorsk Scientific Experimental and Production Base in Stepnogorsk, Kazakh Soviet Socialist Republic (today Kazakhstan),suggesting that the development of a MARV biological weapon had reached advanced stages. Independent confirmation for this claim is lacking. At least one laboratory accident with MARV, resulting in the death of Koltsovo researcher Nikolai Ustinov, occurred during the Cold War in the Soviet Union and was first described in detail by Alibek.

Outbreaks and sporadic cases have been reported in Angola, Democratic Republic of Congo, Kenya, and South Africa (in a person who had recently travelled to Zimbabwe). The largest outbreak on record to date occurred in 2005 in Angola, and involved 374 cases, including 329 deaths. Two unrelated sporadic cases occurred during 2008 following visits to the “python cave” in the Maramagambo Forest in western Uganda; this cave is home to a large colony of Egyptian fruit bats. Both people became ill after return to their home country; one in the Netherlands and one in the USA. The most recent outbreak was in 2012 in southwestern Uganda. In Brazil, from 1993 to November 2005, there were 610 cases of HCPS, with an approximate lethality of 40 %, mostly in Minas Gerais, Paraná, São Paulo and Santa Catarina. In the Southeast, the HCPS occurs more in the months from April to July, dry season, harvest time and burning of sugar cane and production braqueária grass seeds, enjoyed food by the rodents. In the South, most cases occur in the second half, linked to working with Pinus, corn or ratada (large proliferation of rodents) , occasional event linked to the flowering of taquara8. Among the four hemorrhagic fevers that occur in Brazil are from diseases with thousands of reported cases, such as DHF / DSS, the rare diseases such as hemorrhagic fever arenaviruses. There may be subnotificção cases of hemorrhagic fever in Brazil due to the limited dissemination and knowledge of doctors about some of these diseases. All induce capillary leak and evidenciáveis bleeding disorders by raising the hematocrit and platelet count. Early clinical suspicion followed by hospitalization accelerates the installation of support measures, which is critical to the survival of patients. The four viral hemorrhagic fevers question has extensive differential diagnosis includes, usually, bacterial sepsis and leptospirosis. Specific antiviral treatment with ribavirin, is effective only in the hemorrhagic fever arenaviruses. The parenteral fluid infusion, recommended in profusion in DHF / DSS, should be cautious in HCPS. Vaccines are available for yellow fever and possibly for hemorrhagic fever arenaviruses.

Marburg Virus    
There is currently no effective marburgvirus-specific therapy for MVD. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control hemorrhaging, maintaining oxygen levels, pain management, and administration of antibiotics or antimycotics to treat secondary infections. Experimentally, recombinant vesicular stomatitis Indiana virus (VSIV) expressing the glycoprotein of MARV has been used successfully in nonhuman primate models as post-exposure prophylaxis. Experimental therapeutic regimens rely on antisense technology: phosphorodiamidate morpholino oligomers (PMOs) targeting the MARV genome could prevent disease in nonhuman primates.

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