The Médecins Sans Frontières interventionThe Médecins Sans Frontières interventionin the Marburg epidemic Uige/Angola, 2005: in the Marburg epidemic Uige/Angola, 2005: Lessons learnt in the hospital and communityLessons learnt in the hospital and community

Paul RoddyPaul RoddyMSF-SpainMSF-Spain

ObjectiveObjective

To share future outbreak recommendations…

MethodsMethods

• 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:

1.1. Case diagnosisCase diagnosis

2.2. Nursing careNursing care

3.3. Psychological carePsychological care

4.4. Design of the Marburg wardDesign of the Marburg ward

5.5. Case detection in the hospitalCase detection in the hospital

6.6. Medical managementMedical management

7.7. Infection control in the hospitalInfection control in the hospital

The community response included:

1.1. Peripheral health facility supportPeripheral health facility support

2.2. Burial and disinfectionBurial and disinfection

3.3. Home-based risk reduction (HBRR)Home-based risk reduction (HBRR)

4.4. Epidemiological surveillanceEpidemiological surveillance

5.5. Psychosocial supportPsychosocial support

6.6. Information and education campaign (IEC)Information and education campaign (IEC)

The initial outbreak responseThe initial outbreak response

What happened?

Burial and disinfectionBurial 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 campaignsInformation and education campaigns

Message 1

‘There is no cure for this disease’

Message 2

‘Come to hospital and receive treatment’

Future outbreak recommendations - hospitalFuture 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 - communityFuture 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 - communityFuture 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 & AffiliationsAuthors & 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