Health experts battle unknown disease outbreaks in north and south

Health organisations in Angola are scrambling to identify a disease that has surfaced in Uige Province, in the north, and in Huila Province, in the south, to prevent further transmission and treat fatally ill patients - half of whom have already died.

"We have seen more than 35 cases since November and 50 percent of the patients were dying," Karen Godley, head of mission in Angola for Medecins Sans Frontieres (MSF)-Switzerland, told IRIN.

Although located at opposite ends of Angola, Uige and Huila both have a growing number of patients with symptoms like "bloody diarrhoea", Godly said. "We have no idea what we are dealing with - there is an urgency to identify the pathogen to protect communities and health workers, and to provide the best treatment for patients." Pathogens are disease-causing agents, such as bacteria or viruses.

Of the 16 cases in Uige, six have been fatal, according to Monica Camacho, head of mission in Angola for MSF-Spain. "There are few patients, but the fatality rate is high."

Health organisations are still in the dark as to how the disease is spread. "We are trying to find out, together with the government and the World Health organisation [WHO], if there is a common link to determine how the illness is transmitted - experts are trying to find out if it is water, food or mosquitoes," Camacho said.

According to Dr Satounata Diallo, WHO country representative in Angola, "this is not Ebola or Marburg". In 2005 Angola saw the largest-ever recorded outbreak of Marburg haemorrhagic fever, a rare but fatal disease caused by a virus from the same family as the Ebola virus.

Patients have shown bleeding of the gastro-intestinal tract and perforations in the stomach. Diallo said, "judging by the symptoms, doctors suspect yellow fever, typhoid or leptospirosis, with yellow fever as the main suspect." Leptospirosis is a bacterial disease, with symptoms that include high fever, muscle aches, vomiting, and sometimes jaundice, with abdominal pain, diarrhoea, or a rash. Left untreated, it can lead to kidney damage, meningitis, liver failure and respiratory distress.

Large outbreaks of yellow fever, a viral disease spread by mosquitoes, have occurred in Africa. According to the WHO, infection can cause a wide spectrum of symptoms, from mild discomfort to severe illness and death, but 15 percent of patients enter a "toxic phase" within 24 hours and complain of abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes and/or stomach and, once that happens, blood appears in the vomit and faeces.

Godley said there was no indication to suggest that the outbreaks in Huila and Uige were related. "We are probably looking at two different things, but it is urgent that the pathogens are identified. We do not believe that we are dealing with a viral hemorrhagic fever [like Marburg] in Huila, but we cannot completely rule out the possibility without proper and highly sophisticated laboratory testing."

Angola lacks the capacity to conduct adequate testing and epidemiological surveillance. Disease samples were sent to the US National Health Services Centers for Disease Control and Prevention laboratories in Dakar, in Senegal, and Atlanta, in the United States, earlier this week. "We are waiting for results and remain on high alert," Camacho said.

tdm/he