Flash Appeal for the Angola Marburg Hemorrhagic Fever Outbreak Response
As of 6 April 2005, 181 confirmed and suspected cases of Marburg viral hemorrhagic fever (VHF) have been reported in five provinces, with the majority (168) in Uige. Of the 181 cases, 159 have been fatal. While children under the age of five years initially accounted for 75% of cases, recent cases are including an increasing number of adults.
The epicentre of this outbreak is Uige Province, which remains the primary focus of outbreak response activities. Two cases have been confirmed in Luanda. In addition, alert cases have been reported in four other provinces (Cabinda, Malanje, Kwanza Norte, and Zaire). Three further provinces (Bengo, Kwanza Sul, and Lunda Norte) – sharing internal borders with Uige province – are considered at increased risk.
As surveillance and reporting mechanisms improve, the number of alert, suspect and confirmed cases, as well as the number of municipalities affected, is likely to increase.
The Angolan Ministry of Health (MINSA) is responsible for coordinating the national response to the Marburg VHF epidemic. The World Health Organization (WHO) Country Office, Regional Office for Africa /AFRO), and Headquarters, in collaboration with the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP), Médecins Sans Frontières (MSF), and the International Federation of Red Cross and Red Crescent Societies (IFRC), are supporting MINSA and coordinating the mobilisation of international technical support.
The capacity of the Ministry of Health to implement outbreak control, to enhance surveillance and data collection, is hampered by lack of trained human resources, lack of personal protective equipment and supplies, limited information systems to deal with case finding and contact tracing, and limited technical and operational coordination and logistics.
On-going operations on the ground are prioritised as:
Addressing immediate needs in Uige Province, to control the outbreak through establishment of an effective isolation facility (taken on board by MSF), intensive case/contact tracing, social mobilisation for community awareness, and support to epidemic control and co-ordination of response activities;
Ensuring that Luanda, other provinces in Angola and border areas are on a heightened state of alert and are adequately prepared to deal rapidly with any case(s) that may occur;
Investigating events/rumours rapidly in other areas;
Raising awareness among the heath personnel for early detection (in particular hospitals and other frontline health facilities) and precautions when taking care of suspected cases;
Sustaining multidisciplinary technical support from WHO and the Global Outbreak Alert and Response Network (GOARN) in the field (including clinical management, infection control, epidemiology, laboratory, social mobilisation, medical anthropology, logistics and communications).
To effectively support the national surveillance and epidemic preparedness and response, and to ensure coordination of international technical support, WHO has mobilised regional networks of experts and GOARN and has strengthened collaboration and coordination with partners such as UNICEF, MSF and the IFRC in Angola.
WHO is coordinating intensive investigation of rumours and alert in other countries, particularly those countries bordering Angola. National health authorities in the Democratic Republic of Congo (DRC) and Republic of Congo have enhanced surveillance in bordering areas. In DRC – in response to an alert case in Matadi – a national team supported by the WHO Country Office is alerting the local population, augmenting surveillance and performing active case finding. MSF teams in Bas-Congo are also on the alert and implementing readiness measures. WHO/AFRO is providing regular situation reports to all WHO Country Offices in the Region to avoid panic and inappropriate restrictions on travel and trade.
This epidemic is the latest VHF outbreak in central Africa (previous ones having occurred in Gabon, Congo Brazzaville, the Democratic Republic of Congo, southern Sudan and Uganda) and underlines the need to rapidly strengthen a sub-regional alert and response network focused on VHFs, and to capitalise on the limited capabilities developed during outbreak response over the past 5 years. This will be the subject of a further appeal for financial support.
Cumulative totals since cases of VHF were first reported in Uige in October 2004 (source MINSA/WHO).