Marburg Hemorrhagic Fever in Angola — Fighting Fear and a Lethal Pathogen

On March 21, 2005, the Centers for Disease Control and Prevention (CDC) in Atlanta confirmed the presence of Marburg virus in 9 of 12 patient samples of tissue and blood sent for analysis by health authorities in Angola.The samples came from a growing number of patients, almost all of them linked to a single pediatric ward in the main hospital in Uige Province, who were rapidly dying from an unknown disease with hemorrhagic manifestations.The identity of the causative agent came as a surprise: Marburg hemorrhagic fever is an exceedingly rare disease, and there had never been a case before in Angola.Diagnostic confirmation set in motion a large-scale international response that began the day after the CDC's finding.Both the features of Marburg hemorrhagic fever and the conditions in Angola have made this response an extreme test of the national and international capacity to hold a dangerous emerging disease at bay.Like the closely related Ebola hemorrhagic fever, Marburg is a rare but severe and highly fatal disease caused by a virus in the Filoviridae family (see diagram).The viruses that cause these two diseases are among the most lethal pathogens known to infect humans.Both hide in some still-elusive place in nature, surfacing from time to time to cause a few sporadic cases and then disappearing again.Both diseases can flare into dramatic outbreaks, usually associated with unsafe practices that amplify transmission in a health care setting.The sudden onset, rapid deterioration of patients' condition, dramatic hemorrhagic symptoms, and high mortality rate invariably cause great anxiety in the affected populations.In the current Marburg outbreak in Angola, fear, albeit understandable, has been one of the greatest impediments to the control of the spread of disease.Dr. Ndayimirije is an epidemiologist at the World Health Organization (WHO) in Brazzaville, Congo, and Ms. Kindhauser is a science writer at WHO in Geneva.Obtaining Specimens from a Patient Who Has Died.