title: The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola.
abstract: BACKGROUND
  Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date.
  
  
  RESULTS
  A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention.
  
  
  CONCLUSIONS
  The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.
authors.affiliation: Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
authors.forename: Allen
authors.initials: A
authors.lastname: Grolla
authors.forename: Steven M
authors.initials: SM
authors.lastname: Jones
authors.forename: Lisa
authors.initials: L
authors.lastname: Fernando
authors.forename: James E
authors.initials: JE
authors.lastname: Strong
authors.forename: Ute
authors.initials: U
authors.lastname: Ströher
authors.forename: Peggy
authors.initials: P
authors.lastname: Möller
authors.forename: Janusz T
authors.initials: JT
authors.lastname: Paweska
authors.forename: Felicity
authors.initials: F
authors.lastname: Burt
authors.forename: Pedro
authors.initials: P
authors.lastname: Pablo Palma
authors.forename: Armand
authors.initials: A
authors.lastname: Sprecher
authors.forename: Pierre
authors.initials: P
authors.lastname: Formenty
authors.forename: Cathy
authors.initials: C
authors.lastname: Roth
authors.forename: Heinz
authors.initials: H
authors.lastname: Feldmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000810:Angola / Q000453:epidemiology; D000818:Animals; D001769:Blood / Q000821:virology; D001942:Breast Feeding / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008379:Marburg Virus Disease / Q000453:epidemiology* / Q000635:transmission; D029024:Marburgvirus / Q000302:isolation & purification*; D008828:Microbiological Techniques / Q000379:methods; D008875:Middle Aged; D008952:Mobile Health Units / Q000706:statistics & numerical data*; D009061:Mouth Mucosa / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D018571:Sentinel Surveillance; D014944:World Health Organization; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000635:transmission