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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: Volume 15, No.14 (PDF file, 828 KB)
An outbreak of Marburg haemorrhagic fever that has been occurring in Angola, south west Africa since October 2004 (1), is continuing. As of 6 April 2005, there were 181 cases including 156 deaths (case fatality rate, 86%) reported by the Ministry of Health (2). This is the largest recorded outbreak of the disease to date and the first to occur in an urban setting. Cases and deaths have been reported from five northern provinces in Angola: Uige, Luanda, Cabinda, Malange, and Kuanza Norte, although all cases have so far originated from Uige province only. While children under the age of 5 years initially accounted for around 75% of cases, recent cases have included an increasing number of adults.
The World Health Organization (WHO) and the Global Outbreak and Response Network (GOARN) (3) are continuing to provide assistance with five mobile teams investigating rumours and searching for additional cases. Over 100 contacts are being followed up. The Angolan Ministry of Health is also working with WHO to finalise a national plan of action for control of the outbreak.
Although there have been rumours of suspect cases reported to have been imported from Angola, (including the neighbouring Democratic Republic of the Congo, South Africa, Portugal, and Italy) no such cases have so far been confirmed (4, 5).
The United Kingdom Foreign and Commonwealth Office has for some time not recommend leisure travel to Angola due to civil conflicts, and advises against all but essential travel to northern provinces of North and South Lunda, and the interior of Cabinda (6). There is not currently any advise against travel to Angola due to the threat of Marburg virus. Imported European cases of Marburg virus are extremely rare. International travellers, who may go to Angola however, need to be aware of the possible risk of infection if they come into close contact with a case. In this unlikely event, travellers should seek medical advice immediately if they experience any symptoms such as fever, diarrhoea, abdominal pains, and vomiting on return to the United Kingdom (UK) (1). Marburg virus disease may be easily confused with other febrile illnesses such as malaria, yellow fever, and typhoid. Healthcare professionals are reminded to take a full travel history from anyone with suspicious symptoms; official guidance on the management of viral haemorrhagic fevers is available on the Health Protection Agency website at <http://www.hpa.org.uk/infections/topics_az/VHF/ACDP_VHF_guidance.pdf>.
Marburg virus is in the same family, Filoviridae, as the Ebola virus, and produces a similar clinical illness with a rapidly progressing and severe haemorrhagic fever; mortality rates can reach 90% or more as in this current outbreak. There is no vaccine or specific treatment for Marburg as yet, although research into possible vaccine candidates is being undertaken (7). The main route of transmission is thought to be by direct contact with bodily fluids of an infected person or animal. Previous outbreaks have usually begun in rural areas, but the natural reservoir for both Marburg and Ebola viruses is unknown. Experiments to find the natural reservoir of filoviruses have been conducted on over 3000 vertebrates and 30,000 arthropods, but have so far proved negative (8). Further information on Marburg virus can be obtained from the WHO website at <http://www.who.int/csr/disease/marburg/factsheet/en/>.
1.Health Protection Agency. Marburg virus disease in Angola. Commun Dis Rep CDR Wkly [serial online] 24 March 2005 [cited 6 April 2005] 15(12): News. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr1205.pdf>.
2.Angola: Marburg Haemorrhagic fever – Angola (17): South African case suspected. Archive no 20050405.0984. In Promed Mail [online]. Boston US: International Society for Infectious Diseases, 5 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>.
3.Angola: Marburg Haemorrhagic fever – Angola (15). In promed mail [online]. Boston US: International Society for Infectious Diseases, 4 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>.
4.World Health Organization [online]. Global outbreak alert and response network. Geneva: WHO, 2005 [cited 5 April 2005]. Available at: <http://www.who.int/csr/outbreaknetwork/en/>.
5.Angola: Marburg hemorrhagic fever – Angola (13). In promed mail [online]. Archive no 20050402.0951. Boston US: International Society for Infectious Diseases, 1 April 2005 [cited 6 April 2005]. Available at <http://www.Promedmail.org>.
6.Foreign and Commonwealth Office [online]. Travel Advice by Country: Angola. [cited 5 April 2005]. Available at <http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket%2FXcelerate%2FShowPage&
7.Warfield KL, Swenson DL, Negley DL, Schmaljohn AL, Javad Aman M, Bavari S. Marburg virus-like particles protect guinea pigs from lethal Marburg virus infection. Vaccine 2004; 22: 3495-502.
8.Leirs H, Mills JN, Krebs JW, Childs JE, Akaibe D, Woollen N, et al. Search for the Ebola virus reservoir in Kikwit, Democratic Republic of the Congo: reflections on a vertebrate collection. J Inf Dis 1999; 179(Suppl 1):S155-63.
The Chief Medical Officer for England has announced that everybody aged 65 years and over who have not previously been immunised against pneumococcal infection should be offered pneumococcal polysaccharide vaccine (1). This is the third phase of the immunisation programme originally announced in August 2003. People aged 80 years and over were offered the vaccine in 2003/04 (2) and people aged 75 years and over were offered the vaccine in 2004/05.
For individuals aged five years and over in at-risk groups, such as such as those with heart conditions, chronic lung disease and chronic liver disease., and for all those aged 65 years and over, a single dose of 23-valence pneumoccocal polysaccharide vaccine is recommended.
1.Older people to be offered jab against pneumococcal infection Press release 2005/0165. London: Department of Health, 5 April 2004. Available at <http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?
2.Chief Medical Officer. Update on the influenza and pneumococcal immunisation programmes. PL CMO (2004)4. London: Department of Health, 2004. Available at <http://www.dh.gov.uk/assetRoot/04/08/73/40/04087340.pdf>.
Med-Vet-Net, the European network of excellence for zoonoses research has recently launched a public website at <www.medvetnet.org>. The website aims to provide a gateway for public information on zoonoses (infectious diseases transmitted by animals). As work within the Network progresses, it will also provide research results and publications.
Med-Vet-Net, which officially commenced on 1 September 2004, is a European Union funded network of excellence comprising 16 partners across Europe, including the Health Protection Agency, Veterinary Laboratory Agency, and the Society for Applied Microbiology in the United Kingdom (1). It integrates veterinary, medical, and food science research on infectious diseases transmitted from animals to man. It is funded for five years at a cost of €14.4 million (£10 million) by the European Union (EU) 6th Framework Programme, within the ‘Quality and Safety of Food’ Priority Area.
Around 61% of the disease agents known to be pathogenic to man are zoonotic – such diseases include salmonellosis, rabies, and cryptosporidiosis. In addition to the human pain and misery caused by these diseases, the cost to the EU is thought to be well in excess of €6bn/yr.
The legend in figure 1from Late diagnosis and mortality in HIV-infected men who have sex with men (MSM), published in CDR Weekly, Vol 15, no.12, 24 March 2005 had an error, which has now been corrected.
The orange coloured line (solid line) was originally published as representing the percentage of ‘Estimated short-term mortality of MSM not diagnosed late’. This line actually represents ‘Estimated short-term mortality of MSM diagnosed late’, and has now been amended accordingly. Correspondingly, the dashed line now represents ‘Estimated short-term mortality of MSM not diagnosed late’. The amended graph is shown below (figure 1).
The Original article (now including explanatory note) is available at:
Figure 1 HIV trends in new diagnoses, late diagnoses, and short-term mortality of MSM: 1993 to 2001