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Marburg: Don’t be caught off guard

By Flavia Nassaka

Ugandan experts speak out on what World can do in West Africa

Just as the world was grappling with the worst ever outbreak of the hemorrhagic fever, Ebola, in West Africa with over 4000 dead, tragedy struck thousands of kilometres away in Uganda.

A male radiographer at Mengo Hospital in the capital city, Kampala, died. When nurses attending to him in his last moments noted severe bleeding an alert was raised. Hemorrhagic fever was suspected.

Unlike West Africa where procrastination, denial, and lack of personnel and equipment are being blamed for the runaway epidemic, Uganda has an elaborate reporting, investigation, and response protocol for health threats.


When Ebola first broke out in Uganda in 2000, a national Task Force was initiated to control all the interventions against the epidemic.

So, immediately the Mengo Hospital case suspected, samples were collected and taken to the Centres for Disease Control (CDC) laboratory at Entebbe, about one hour drive from the capital. Five days later, the results were out; it was not Ebola but another equally deadly hemorrhagic fever, Marburg.

Marburg hemorrhagic fever, like Ebola, is an acute infectious viral disease because it belongs to the same family.

The disease which is believed to be spread by monkeys and bats is transmitted through direct contact with blood, secretions, and other body fluids of infected persons or animals. Armed with the results, the National Taskforce kicked up its public awareness campaign urging the public to report any suspected cases. Isolation units at major hospitals across the country were readied for the worst.

Public awareness

When a few days later the country celebrated its Independence Day anniversary on Oct.9, President Yoweri Museveni said he would not be shaking hands with any of the visiting dignitaries because of Marburg. That weekend, clerics in mosques, churches, and temples across the country cancelled the handshaking rituals and cautioned their followers to be on the lookout for Marburg.

When on Oct.13 the Minister of Health in Charge of Primary Health Care,  Sarah Opendi briefed the media about Marburg, she remained cautious. Although no other case had been confirmed, she did not declare an all clear state. Instead she said “commendable efforts to contain the Marburg predicament” had been made.

She revealed that there had been no other confirmed case but 149 `contacts’ remained under follow up for possible signs of Marburg. Up to 80 were from Kampala district, 11 from neighbouring Mpigi district, and 58 from far away Kasese district where the victim was buried.

Five other suspects who had tested negative but had presented similar symptoms, nonetheless remained under isolation at the various Isolation facilities around the country.

The latest Marburg scare revealed Uganda’s typical response to disease outbreaks. The response offers a window into what possibly needed to have been done in West Africa to avert the spread of the epidemic.

“Uganda is always alert,” says Dr Alex Opio, the Commissioner National Disease Control, “We have made a comprehensive preparedness plan.  When Ebola broke out in West Africa, we heightened surveillance.”

Whenever an outbreak is feared, the system is re-activated. As we spoke on October 12, the Isolation Unit at the Mulago National Referral Hospital already had two suspected cases, Entebbe Hospital one, and Rubaga Hospital two.

“We don’t want to be caught off guard,” Dr Opio said.

The doctor says the Ugandan public is also very alert when it comes to such outbreaks and helps in updating the ministry on what takes place in their communities. This is in stark contrast to some West African countries where families were seen hiding patients.

Dr Opio says in addition to many alerts received daily, that the ministry on Oct.11 had received an alert from Bukwo district where people were suspecting a 30-year old man to have contracted Marburg when he presented with similar symptoms. He was later found to have had liver failure due to excessive consumption of alcohol.

Being extra-careful

As part of preparedness, Rose Achieng, Health Ministry Director General says screening centers have been established at every entry point to the country and more health workers have been trained in infection control and response to the disease.

Both Opio and Achieng say the persistence of Ebola in West Africa could be blamed on the public not taking government messages seriously.

“This disease is all about being extra careful. Even wearing the gear cannot give you 100% protection. There’s protocol in removing the gear; one needs to be thoroughly sprayed. Dealing with Ebola and Marburg, one needs to take serious precautions” Achieng said.

But there is a trick. Dr Opio warns the diseases may be difficult to diagnose early since many of the initial symptoms are mimicked by other tropical infectious diseases including malaria, infections of the gut or typhoid.

“Therefore high level of suspicion is required, especially if the presenting patient has a history of travel or close contact with an ill individual who has travelled or lived in regions where the outbreak has occurred,” he says.

For Marburg, Opio explains fever usually appears on the first day of illness, followed by progressive and rapid deterioration in health. A severe watery diarrhea, abdominal pain and cramping, nausea, and vomiting begin about the third day. During the incubation period which ranges between 2 to 21 days, infected people are not contagious.

“As with Ebola, there’s no vaccine and no treatment other than supportive care such as keeping one’s blood pressure in check, rehydrating the patient and reducing the fever by administering pain-killers and other soothers”.

The last Marburg epidemic in Uganda was in 2012. It lasted two months claiming at least 10 lives. In the same year, the country was hit by two outbreaks of Ebola but these were contained quickly.

What you need to know about Marburg
Marburg is a rare though severe and highly fatal disease. It is called haemorrhagic fever because unlike many other fever causing diseases, it is often associated with significant bleeding from multiple sites in the body during days 5 to 7 of the onset of the illness.  The first reported outbreaks of this disease occurred in Marburg, Germany and in the 1960s where scientists were conducting a study that involved monkeys from Uganda. Severe outbreak of the disease first occurred in Democratic Republic of Congo from late 1998 to 2000. It involved 154 cases, of which 128 were fatal, representing a case fatality of 83%. According to Dr. Julius Lutwama, a researcher at Uganda Virus Research Institute, the appearance of patients at the early period of the disease has been described as being pale, deep-set eyes and extreme weakness coupled with lack of appetite though at times a patient may develop an itch less rash on the second day of infection.

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