Health Workers Race to Block Deadly Virus in Angolan Town

http://www.nytimes.com/2005/04/11/in...html?th&emc=th

Health Workers Race to Block Deadly Virus in Angolan Town
By SHARON LaFRANIERE

Published: April 11, 2005

UÍGE, Angola, April 10 - Larrinda Pinto died Thursday, probably
unaware of the frantic effort that would follow by emergency medical
workers hoping to block the spread of the Marburg virus that claimed
her life.

Someone alerted one of the mobile teams of health workers that scour
neighborhoods here daily that Mrs. Pinto, a 42-year-old pediatric
nurse, appeared to have become another victim of the Marburg epidemic,
which is centered in this northern province, also called Uíge.

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Her death was quickly noted in white chalk on a blackboard hung on the
second-story landing of the run-down, salmon-colored building where
World Health Organization workers with two-way radios try to track the
deadly virus's spread.

By Friday, workers clad in white protective suits located Mrs. Pinto's
small mud-brick home, festooned with clotheslines, and persuaded her
family to let them wrap her body in plastic and bury it immediately in
the town cemetery.

On Sunday morning, two World Health Organization workers were back,
copying the names and ages of 14 relatives and 7 neighbors who had
been in close contact with Mrs. Pinto. For the next three weeks, they
promised, they would check on them daily. By Monday, they would
disinfect the house.

The workers' effort is organized, determined, swift. But not as swift
as the epidemic, which as of Sunday had claimed at least 193 lives,
almost all in the past month. And possibly not effective enough - at
least for now - to save families like Mrs. Pinto's.

The race to contain the outbreak of Marburg, a deadly relative of the
better-known Ebola virus, is centered here in the town of Uíge
(pronounced weezh), where health officials fear the makings of a
public health disaster that could spread elsewhere in Angola and
beyond.

The number of victims is already the largest ever recorded from a
Marburg outbreak, and there is no effective treatment. Nine out of 10
people who get the virus die, usually within a week.

The first cases of the virus were identified in the pediatric ward
where Mrs. Pinto had worked. Despite incessant warnings on local radio
that families of the sick should neither treat them at home nor touch
them if they die, Mrs. Pinto's family cared for her in their house and
prepared her for burial. The virus is spread by bodily fluids, and
even stray drops of spittle or beads of sweat can lead to death.

"We heard on the radio that we were not supposed to do it, but out of
emotion, we touched the body," said her husband, Antonio, 53. "We
washed her when she was alive and after she died."

He also knew about the isolation unit set up at Uíge's regional
hospital, where Mrs. Pinto had worked for 20 years. But he refused to
take her there, he said, because "people believe the isolation unit is
making people die."

Cases like this, epidemiologists here say, show how much remains to be
done before the Marburg virus is contained here. But Dr. Nestor
Ndayimirije, an epidemiologist and leader of the World Health
Organization's efforts in Uíge, said he that believed headway was
being made.

"If we compare with previous weeks, when we had 10 to 15 cases a day,
now we have 4 to 5 cases a day," he said. "I am certain we will
control this epidemic if we work more with the communities."

Antonio Pinto has now taped two photos of his wife, the mother of his
six children, on his home's wall. In one, she wears a long
rose-colored dress. In the other, she stands proudly before a medical
cabinet, wearing her white nurse's uniform.

Yolanda, her 20-year-old daughter, described her as a devoted,
sympathetic nurse who kept working in the pediatric ward long after
the virus began claiming hospital workers as well as patients.

The two say they are not afraid. "Even though we held her, did
everything for her, I don't fear," said Mr. Pinto, dressed in black as
he sat Sunday morning in his dirt yard. "I trust in God."

But he is also filled with questions. Why is there no vaccine? What
precautions can his family take now? How long will the epidemic last?

Dr. Ndayimirije's answer to the last query is not comforting. "Usually
three months," he said.

The virus is named for the town in Germany where it was first
identified in 1967 after laboratory workers were infected by monkeys
from Uganda.

Scientists do not know the source of the virus or how this outbreak
began. But the Centers for Disease Control and Prevention in Atlanta
confirmed the first Marburg case in Uíge on March 8. That suggests
that two months more of illness and deaths like Mrs. Pinto's lie
ahead.


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