Angola has not seen a new case of Marburg haemorrhagic fever for almost two weeks, officials said on Tuesday, suggesting the outbreak that killed more than 300 people is petering out - but they still urge caution.
With the last confirmed case on July 9, emergency teams have been leaving Uige, the northern province which bore the brunt of the disease. But they say the outbreak in the Southern African country will not be officially over until 42 days after the last case, twice the maximum incubation period.
“We really are moving towards the end,” said Fatoumata Binta Dialla, Angola representative for the United Nations World Health Organisation. “But we cannot say the outbreak is over until we have finished tracking down all the people who came into contact with the victims.”
The Ebola-like virus spread through saliva, sweat and other bodily fluids, with victims at their most contagious in the final stages of the disease as they suffered high fever and then usually die after massive internal haemorrhaging.
In the early stages of the outbreak, many residents refused to take sick relatives to the hospital, treating them at home and often contracting the disease themselves.
Health officials launched a vast effort to spread awareness and track down cases, but often arrived too late to do more than recover the bodies. There is no cure or vaccine.
The disease devastated the local hospital, killing most of the paediatric nurses and an Italian doctor. Prices in the region soared as drivers refused to deliver supplies there from the capital Luanda.
After a careful review of cases in Uige province, Angolan officials said they had revised the total death toll down to 312 dead out of 351 total cases.
IS IT OVER?
Another six died outside Uige, although all cases stemmed from the area, where the international medical effort is winding down. Medical charity Medicins Sans Frontieres (MSF) said it had withdrawn its 250-strong emergency medical team.
“The epidemic is coming to an end, without a doubt,” said Javier Fernandez, Head of Mission at MSF Spain. “We are still in Uige, continuing work on our regular projects, but our emergency intervention has finished.”
WHO Emergency Health Action official Nsala Domingos said everyone in the remote region - where roads, hospitals and other infrastructure were devastated by battle and neglect during decades of civil war - was asking the same question. “Is it over?”
“I have been telling people that it is not over yet, and the danger, while not as it was before, is still there,” said Domingos, who recently returned from the area.
“We have to continue to push the message to make sure people don’t relax ... If they don’t participate, if cases remain hidden, then we will never break this disease.”
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD