The M

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The Médecins Sans Frontières interventionin the
Marburg epidemic Uige/Angola, 2005 Lessons
learnt in the hospital and communityPaul
RoddyMSF-Spain
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Objective

• To share future outbreak recommendations

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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 (n31)
• local key informants (n11)
• Semi-structured group interviews (n10)
• families of MHF patients and local staff of
  outbreak control teams.

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• The hospital response included
• Case diagnosis
• Nursing care
• Psychological care
• Design of the Marburg ward
• Case detection in the hospital
• Medical management
• Infection control in the hospital

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• The community response included
• Peripheral health facility support
• Burial and disinfection
• Home-based risk reduction (HBRR)
• Epidemiological surveillance
• Psychosocial support
• Information and education campaign (IEC)

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The initial outbreak response

• What happened?

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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

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Information and education campaigns

• Message 1
• There is no cure for this disease

• Message 2
• Come to hospital and receive treatment

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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

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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

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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

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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

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