To the Editor: We believe that Ndayimirije and Kindhauser'scharacterization of Watsa and Durba, the Democratic Republicof Congo, the locations of the first Marburg outbreak in Africa,as "two sparsely populated villages in a remote corner of thecountry" (May 26 issue)1 is misleading. Watsa is a town. InDurba, there was a gold rush, with thousands of young men, oftenfrom an urban background, living in crowded conditions; therewas a lot of traffic toward Uganda. Watsa and Durba are notcities, like Uige, but are different from the truly rural, remote,and sparsely populated border areas of Gabon and Republic ofCongo that have been plagued by regular Ebola virus outbreaks.
The main differences in the Marburg virus outbreak in Watsaas compared with that in Uige are that in Watsa the outbreakwas maintained by repeated introduction of the virus into thehuman population2; iatrogenic transmission (e.g., in pediatricservices) had a minor role, so that the proportion of affectedchildren was 10 percent,3 as compared with an initial 75 percentrate in Uige4; the Watsa population was familiar with outbreaksof hemorrhagic fevers; and isolation of probable cases was achievedby persuasion; nobody attempted to enforce isolation. As a result,panic levels were low and hostile reactions against medicalteams an exception. Lessons can be learned from the Watsa outbreakthat are relevant for urban settings such as Uige.
Matthias Borchert, M.D. London School of Hygiene and Tropical Medicine London WC1E 7HT, United Kingdom matthias.borchert{at}lshtm.ac.uk
Sabue Mulangu, M.D. Institut de Recherche Bio-Médicale Kinshasa, Democratic Republic of Congo
Patrick Van der Stuyft, M.D., Ph.D. Antwerp Institute of Tropical Medicine B-2000 Antwerp, Belgium
References
Ndayimirije N, Kindhauser MK. Marburg hemorrhagic fever in Angola -- fighting fear and a lethal pathogen. N Engl J Med 2005;352:2155-2157. [Free Full Text]
Bausch DG, Borchert M, Grein T, et al. Risk factors for Marburg hemorrhagic fever, Democratic Republic of the Congo. Emerg Infect Dis 2003;9:1531-1537. [Web of Science][Medline]
Borchert M, Muyembe-Tamfum JJ, Colebunders R, Libande M, Sabue M, Van Der Stuyft P. A cluster of Marburg virus disease involving an infant. Trop Med Int Health 2002;7:902-906. [CrossRef][Web of Science][Medline]
Marburg haemorrhagic fever in Angola — update 7. Geneva: World Health Organization, April 2005. (Accessed August 26, 2005, at http://www.who.int/csr/don/2005_04_06/en/.)
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