Deadly virus outbreak may date to October
By Sharon Lafraniere and Denise Grady
The New York Times
UIGE, Angola - The staff in the pediatric ward of Uige's regional hospital suspected something terribly wrong as early as October, when children who had been admitted with seemingly treatable illnesses began, suddenly and wrenchingly, to die.
But did the Marburg virus cause those early deaths in Angola? If it did, and had it been diagnosed at the time, might the current epidemic have been averted?
"Nobody really has a sense of where or when it started," said Dr. Thomas Grein, a medical officer in the World Health Organization. "The widespread belief that it began in October is speculation."
But local officials in Uige, the center of the outbreak, believe it began around that time, and spread from the pediatric ward of the regional hospital, which has now been declared off limits, except for its isolation ward.
Experts say at least 214 people have caught the virus and 194 have died, including eight pediatric nurses and the doctor in charge of the pediatric ward, six other nurses and one other doctor. It is the largest Marburg epidemic ever reported.
Marburg is spread by contact with bodily fluids, from blood to sweat, and kills with gruesome efficiency. Victims suffer from vomiting, diarrhea, high fever and bleeding from body orifices. Nine in 10 are dead within a week. There is no effective treatment.
When strange deaths first began to appear in October, mystified local health officials shipped samples of tissue and blood from four children to the United States. In November the Centers for Disease Control and Prevention tested them for at least three types of hemorrhagic fever, including Marburg. The results, which nearly all agree to have been accurate, came back negative.
By the end of December, at least 95 children were dead, local health workers say. How many deaths were Marburg-related is unknown, but the numbers were alarming.
"In October, November, December, we were seeing so many children dying -- just children," said Dr. Gakoula Kissantou, 31, the hospital's acting administrator. "It was becoming scarier."
He recalled the doctor in charge of the pediatric ward at the time, Dr. Maria Bonino of Italy, calling a meeting with the staff and asking, "What is going wrong here in the hospital?" She herself died in March, a victim of the virus.
It was not until February that Angolan authorities shipped more samples to the CDC in Atlanta. This time, 9 of 12 came back positive for Marburg, which by then was claiming more victims by the day.
In early March, the provincial health officials alerted a WHO representative that they had found 39 suspected cases of Marburg. When a larger international team arrived, the members identified more than 60 suspected cases.
Since new lab tests positively confirmed the virus on March 18, a growing number of epidemiologists, anthropologists, public health experts and emergency medical workers have descended on Uige in a race to cut off the disease.
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