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Marburg Transmission in Angola Capital Luanda

Recombinomics Commentary
March 28, 2005

>> It kills around one in four who contract it,....

Of the seven people who contracted Marburg in Luanda, two have died an Italian doctor and a 15-year-old boy who both came from Uige. <<

The case fatality rate and transmission of Marburg outside of the epicenter in Uige need to be clarified.  Marburg and Ebola are two closely related single stranded, negative sense RNA viruses.  They are the two Filoviridae. The associated fatality rate can vary markedly.  In the largest prior outbreak of Marburg, the case fatality rate was 83%. That outbreak was in the Democratic Republic of the Congo between 1998 and 2000. 123 out of 149 patients died.

There have been similar large outbreaks for Ebola, but the case fatality rate can vary.  In 1976 in Zaire, 280 out of 318 patients died giving a case fatality rate of 88%.  However, in southern Sudan in the same year, the case fatality rate was only 42%, with 117 out of 284 patients dying.

The case fatality rate for the current Marburg outbreak in Angola is above 90%, and may actually be close to 100%, because several of the diagnosed cases are alive, but are still in the hospital.  There have been no reports of recent discharges of recovered patients.

The number of reported patients who have contracted Marburg in Luanda appears to be limited to a 12 year-old girl.  The first two fatalities in Luanda were a 15 year-old boy and an Italian physician.  However, both had come from Uige.  Similarly, the third fatality was a Vietnamese physician who had also treated patients in Uige.  Two other patients hospitalized in Luanda had also been from Uige.  A sixth person hospitalized was a Portuguese citizen who was hospitalized at a military hospital, but who had also been in Uige.

The 12 year-old girl was initially admitted to a suburban Cacuaco Health Centre.  When she started to hemorrhage, she was transferred to Americo Boa Vida hospital in Luanda.  Thus, she appears to be the only reported transmission in Luanda and the only transmission outside of Uige.  The fatality in Cabinda had been to a funeral in Uige and the fatality in Portugal is still under investigation.

However, since Marburg has an incubation period of 3-7 days, more transmissions may have happened which have not been reported.  Moreover, the source of the infection in the 12 year-old also has not been reported.  Thus, the attention outside of Uige has been on the one case in Luanda, although there are concerns that additional cases will develop and the number of deaths will exceed the 122 reported thus far.

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