Factors associated with Marburg hemorrhagic fever: analysis of patient data from Uige, Angola.

BACKGROUND: Reliable on-site polymerase chain reaction (PCR) testing for Marburg hemorrhagic fever (MHF) is not always available. Therefore, clinicians triage patients on the basis of presenting symptoms and contact history. Using patient data collected in Uige, Angola, in 2005, we assessed the sensitivity and specificity of these factors to evaluate the validity of World Health Organization (WHO)-recommended case definitions for MHF. METHODS: Multivariable logistic regression was used to identify independent predictors of PCR confirmation of MHF. A data-derived algorithm was developed to obtain new MHF case definitions with improved sensitivity and specificity. RESULTS: A MHF case definition comprising (1) an epidemiological link or (2) the combination of myalgia or arthralgia and any hemorrhage could potentially serve as an alternative to current case definitions. Our data-derived case definitions maintained the sensitivity and improved the specificity of current WHO-recommended case definitions. CONCLUSIONS: Continued efforts to improve clinical documentation during filovirus outbreaks would aid in the refinement of case definitions and facilitate outbreak control.

The control of an epidemic outbreak of Marburg hemorrhagic fever in Angola, 2004-2005 / No disponible

Entre Octubre del 2004 y Septiembre del 2005 Angola vivió un brote epidémico de fiebre hemorrágica debida al virus Marburg. La epidemia se dio por oficialmente por concluida el 7 de Noviembre del 2005, y se consideró la más grave de las ocurridas en todo el mundo, con 252 casos y 227 muertes, lo que suponía una tasa de mortalidad del 90%. Considerando que es un agente patógeno de gran virulencia para el cual no hay vacunas o tratamiento específico, estas epidemias precisan de una enorme cantidad de recursos humanos, financieros y técnicos tanto nacionales como internacionales Es importante poner de manifiesto que el laboratorio del Center for Diseases Control de Atlanta fue el responsable del primer aislamiento del virus y de su identificación como causante de la epidemia. Posteriormente fue el encargado de monitorizar la epidemia y estudiar todas las muestras biológicas recogidas de los casos sospechosos. Hasta este momento ha sido imposible identificar el foco primario de la enfermedad, aunque existen sugerencias a nivel local sobre la posibilidad de que el hospital provincial de UIge haya sido el sitio inicial y responsable de la diseminación de la epidemia a través de la infección nosocomial. En una segunda fase la ausencia de una adecuada educación para la salud, el pánico y las tradiciones culturales locales fueron los elementos cruciales para la diseminación de la enfermedad a otras provincias del país. En este contexto, la participación de sociólogos y antropólogos fue un factor clave para el control de las epidemias, en paralelo a las medidas de bioseguridad y detección activa emprendidas (AU)

Angola has lived an epidemic outbreak of hemorrhagic fever caused by Marburg virus between October 2004 and September 2005. The epidemic was officially terminated in November 7th 2005, and considered the most severe ever occurred in the world, with 252 cases and 227 deaths, with a lethality rate of 90%. Considering that it is a pathogenic agent of great virulence for which there are no vaccines or specific treatment, these epidemics caused a huge recruitment of national and international human, financial and technical resources despite some local constraints. It must be outlined that CDC-Atlanta laboratory was the responsible for the first isolation of the virus as the cause of the epidemics, and later on, for monitoring the epidemics and manipulating all biological samples collected from suspected patients. Until now it was impossible to identify the primary focus of the disease, though there are suggestions from local oral comments that Uige provincial hospital may have been the initial site and responsible for the dissemination of the epidemics through nosocomial infection. In a second phase, lack of proper health education, panic and local cultural traditions were the crucial elements for disease spread to other provinces of the country. In this context, the participation of sociologist and anthropologists was a key factor for the epidemics control, in parallel with the biosafety and active survey measures undertaken (AU)