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The Médecins Sans Frontières intervention
in the Marburg epidemic Uige/Angola, 2005:
Lessons learnt in the hospital and community
Paul Roddy
MSF-Spain
Objective
To share future outbreak recommendations…
Methods
• Individual semi-structured face-to-face interviews
– available MSF expatriate and local staff directly involved
with disease control activities and arriving in Uige before
June 3rd, 2005 (n=31)
– local key informants (n=11)
• Semi-structured group interviews (n=10)
– families of MHF patients and local staff of outbreak control
teams.
The hospital response included:
1. Case diagnosis
2. Nursing care
3. Psychological care
4. Design of the Marburg ward
5. Case detection in the hospital
6. Medical management
7. Infection control in the hospital
The community response included:
1. Peripheral health facility support
2. Burial and disinfection
3. Home-based risk reduction (HBRR)
4. Epidemiological surveillance
5. Psychosocial support
6. Information and education campaign (IEC)
The initial outbreak response
What happened?
Burial and disinfection
MSF protocol
• Technically sound
• Failure:
– incorporating local
traditions
– addressing the
psychological and
spiritual needs of
families
– explaining procedures
WHO protocol
• Time consuming - execution
• Contained the culturally
sensitive aspects missing from
the MSF protocol
Information and education campaigns
Message 1
‘There is no cure for this
disease’
Message 2
‘Come to hospital and receive
treatment’
Future outbreak recommendations - hospital
1.
Give IV fluids
2.
Continue symptomatic care
3.
Collect quality clinical data
4. Possibly accept the use of injections
5.
Use a combination of fencing (mesh and solid) for isolation
area
6.
Others…
Future outbreak recommendations - community
1. Dress/undress in presence of household
2. Enter household with family member dressed in PPE
3. Outside household – explain procedures
4. Family views corpse before burial
5. Family members know the location of the grave
6. Burial rites reflect traditional ones
7. After disinfection, replaced damaged household items
Future outbreak recommendations - community
1.
Implement psychosocial intervention and IEC programmes
from the beginning of intervention
2.
Use local staff in psychosocial programme
3.
Treatment – albeit limited in its effectiveness – and care by
medical professionals is available at the FHF ward
4.
Others…
Authors & Affiliations
Paul Roddy1, David Weatherill1, Benjamin Jeffs1, Zohra Abaakouk1, Claire Dorion1,
Josefa Rodriguez-Martinez1, Pedro Pablo Palma1, Olimpia de la Rosa1, Luis Villa1,
Isabel Grovas1, Matthias Borchert1,2
1 Médecins Sans Frontières - Spain
2 Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical
Medicine
The Journal of Infectious Diseases
Supplement entitled: Filoviruses: Recent Advances and Future Challenges
Roddy et al. The Médecins Sans Frontières intervention in the Marburg epidemic
Uige/Angola, 2005 – II: Lessons learned in the community