1. The Médecins Sans Frontières intervention in the Marburg epidemic Uige/Angola, 2005: Lessons learnt in the hospital and community Paul Roddy MSF-Spain

2. Objective To share future outbreak recommendations…

3. 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 3 rd, 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.

4. 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

5. 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)

6. The initial outbreak response What happened?

17. 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

22. Information and education campaigns Message 1 ‘There is no cure for this disease’ Message 2 ‘Come to hospital and receive treatment’

23. 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…

24. 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

25. 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…

26. Authors & Affiliations Paul Roddy 1, David Weatherill 1, Benjamin Jeffs 1, Zohra Abaakouk 1, Claire Dorion 1, Josefa Rodriguez-Martinez 1, Pedro Pablo Palma 1, Olimpia de la Rosa 1, Luis Villa 1, Isabel Grovas 1, Matthias Borchert 1,2 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