Angola är ju en före detta portugisisk koloni, och kontakterna mellan de två länderna är täta. Man har i Portugal de senaste veckorna vårdat fyra mer eller mindre starkt misstänkta fall av Marburg-feber, varav tre är friförklarade och en inväntar provsvar.

Situationen i Portugal skiljer sig alltså rätt mycket från den svenska, men det kan möjligen vara intressant för EPI-aktuellts läsare att ta del av hur man nu tänker i Portugal. Följande information från det portugisiska hälsoministeriet mailades runt till de andra EU-länderna igår, 12 april:

1. Information på flygplatser

Följande information med råd till hemvändande resenärer från Angola sitter uppe på internationella flygplatser i Portugal, och ligger även på hälsoministeriets hemsida:

Ministry of Health Directorate-General of Health FHM1i/P 04-04-05

MARBURG HEMORRHAGIC FEVER

Information to Travellers coming from Angola
Since October 2004 cases of hemorrhagic fever have been detected in the Angolan province of Uíge. On the 21st of March 2005 Marburg virus was identified as the agent responsible for this epidemic.

Marburg Hemorrhagic Fever is a rare deadly disease, in 25% to 80% of cases; it has an average incubation period of 2 to 9 days, which can go up to 21 days.

The initial symptoms of this disease are: high fever of sudden onset; malaise; muscular pain; headache; followed by sore throat; rash; diarrhoea; abdominal pain; nausea; vomiting and chest pain. Five to seven days after the onset of these symptoms a high proportion of patients can present bleeding through the nose or gums, skin, digestive tube (vomiting and diarrhoea with blood), lungs kidneys and genitals.

If you were recently in the province of Uíge or had direct contact without protection with:

  • sick person,
  • organs or biological products (blood, urine, faeces, semen, etc) from a person or an animal infected by the virus,
  • any material or objects used in the treatment of patients
    bodies during their preparation and funeral ceremonies.

you should monitor your health during 21 days after the stay or the last contact. If during this period you feel the above identified symptoms you should contact the Public Health Line (808 211 311) identifying the symptoms and the voyage.

2. Falldefinition

Följande definition för misstänkta eller konfirmerade fall av Marburg-feber används av de portugisiska hälsomyndigheterna:

MARBURG HEMORRHAGIC FEVER

Case definition

Suspect case:

An individual who presents:

  • high fever of sudden onset

and one or more of the following signs/symptoms:

  • malaise; chills; myalgia; headache; pharyngitis; maculopapular rash (prominent on the trunk); diarrhoea; abdominal pain; nausea; vomiting; chest pain; hemorrhagic manifestations; jaundice; delirium; inflammation of the pancreas; weight loss; shock; liver failure; multi-organ dysfunction.

and one or more of the following conditions:

  • recent history (2 to 21 days before the onset of symptoms) of travel, stop over or residence in the province of Uige (Angola)
  • close contact with cases of Hemorrhagic Fever, in the 2 to 21 days preceding the onset of symptoms

Confirmed case:

A suspect case with laboratory confirmation.

3. Vidtagna åtgärder

Följande åtgärder har redan vidtagits av Portugals Generaldirektorat för Hälsa:
- The Public Health Line started to work 24 hour/day and the line agents were trained to give information to the public and to identify suspicions of MHF;
- 4 Reference hospitals (3 for adults and 1 for children) were defined and activated to receive MHF suspect cases;
- The Emergency transportation of MHF suspect cases was also defined and activated;
- The laboratory procedures for collection, transportation and testing of samples for Marburg virus were defined and activated, in collaboration with the Bernhard-Nocht-Institut fur Tropenmedizin, in Hamburg.
- Regional Health Authorities are doing contact tracing
- General information about the disease to the public and recommendations to travellers coming from Angola (both as leaflets in the international airports and in our internet site .
Guidelines to health professionals (also available at the internet site) namely about:
Protective Barriers
Laboratory Procedures
Procedures for the Health services if a MHF case is detected
Suspect cases clinical notification form
Procedures when a case is detected during a flight
Procedures when a case is detected during a sea voyage

/Johan Giesecke