It will be difficult to control the epidemic unless cases of infection can be identified and quarantined much sooner than currently is the case. Some people still are trying to take care of their sick family members at home.

WHO says the outbreak is unprecedented in both its size and its urban nature, and warns that its dimensions are still unfolding.

Health workers are gaining in their efforts to track down cases, but surveillance is not comprehensive. Every day, mobile teams collect bodies in Uige, under the constant threat of violent outbreaks by panicked individuals who do not fully understand how the infection progresses and are angry over what they view as disrespect in burying the dead.

More vehicles are urgently needed, according to WHO, which is making the necessary arrangements to send them to the areas hardest hit.

Community Acceptance of Health Workers Vital

It will be difficult to control the epidemic unless cases of infection can be identified and quarantined much sooner than currently is the case. Some people still are trying to take care of their sick family members at home.

Health care facilities also need better infection control, as well as additional supplies of special protective equipment for their staff. WHO continues to provide those resources.

On the positive side, WHO has welcomed the decision by the International Federation of Red Cross and Red Crescent Societies to strengthen their presence in Uige. These groups have extensive experience in responding to emergencies in Africa and have been instrumental in bringing large outbreaks of Ebola under control, WHO notes, and their workers usually find acceptance in the communities that need help.

Volunteers from these organizations, as well as community and church leaders and traditional healers, have been going door-to-door to educate the populace about the virus and the steps they need to take to protect themselves.

On Wednesday, workers received specialized training from experts in social mobilization and medical anthropology drawn from the Global Outbreak Alert and Response Network, WHO reported. These workers have been delivering talks at markets and schools.

Advice for Travelers

Casual contact plays no role in the spread of Marburg hemorrhagic fever, WHO points out. Transmission requires extremely close contact involving exposure to blood or other bodily fluids from a patient who most likely will be showing visible signs of illness. The disease also can be transmitted following exposure to items, including bedding and clothing, recently contaminated by a patient.

Transmission can occur in hospitals lacking adequate equipment and supplies for infection control or training in their proper use. The hospital system in Angola has suffered from almost three decades of civil unrest, and several cases of Marburg hemorrhagic fever have occurred in health care staff exposed during the treatment of patients in Uige.

WHO is not aware of any cases of Marburg that have affected foreign nationals other than those involved in the care of cases in Uige.

WHO does not recommend restrictions on travel to any destination within Angola, but does advise some precautions. Travellers to Angola should be aware of the outbreak of Marburg hemorrhagic fever and of the need to avoid close contact with ill persons. Persons with existing medical conditions who might require hospitalization should consider deferring non-essential travel to Angola, particularly to Uige Province.

Safeguards for Health Care Workers

Those travelling to Angola for the purpose of working in health care settings should be fully informed regarding the outbreak of Marburg hemorrhagic fever, as well as equipped with effective personal protective equipment and trained in the procedures to prevent transmission in such settings, WHO cautions.

Travellers leaving Angola should be advised to seek medical attention should any illness with fever develop within 10 days of their departure. Information about recent travel to Angola should be included when symptoms are reported.

Health care workers and health authorities in countries neighbouring Angola should be aware of the symptoms of Marburg hemorrhagic fever and maintain vigilance for cases, WHO advises. Countries having close ties with Angola, necessitating frequent travel there by their citizens, may want to consider the introduction of measures to increase vigilance for potential symptoms in persons returning from Angola.

In some cases, the introduction of screening procedures to identify potentially infected persons may be considered.

WHO recommends that travellers with a clear exposure history be treated as contacts and placed under surveillance for 21 days, during which time their temperature should be monitored daily.