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Marburg Virus Spread Raising International Concerns

Recombinomics Commentary
March 29, 2005

>> A potential access route for importation of Marburg hemorrhagic fever into Europe via travelers between Angola and Portugal, mentioned in the final paragraph, is an alarming development. Information on the cause of the death of the returning Portuguese national would be appreciated (at present there in no further information available in newswires).

In addition the possibility of introduction of Marburg virus into Europe,
the proximity of Uige Province to the Democratic Republic of the Congo
(DRC) leads to concerns across the border as well. Of note, there was an
outbreak of Marburg virus in the DRC during the period 1998 - 2000 in the northeastern part of the country,  approximately 2000 kilometers from where Uige borders with the DRC in the southwest of the country. - Mods.CP/MPP] <<

The above commentary by ProMed expresses some of the international concern over the Marburg situation in Angola and potential transmission worldwide.  The virus has taken a toll on the population in Uige, the epicenter of the infections.  There have been reported deaths of 6 nurses, 2 physicians, and 2 policemen who appear to have been infected in Uige.  However, the infections of first responders and health care workers have produced a significant strain on the heath care system there.  Many employees have avoided hospitals, and all of the reported deaths in Luanda, including two physicians, are patients that came to Luanda from Uige.

The movement of the virus out of Uige is cause for concern.  Uige borders the Democratic Republic of the Congo.  There has already been a death in Cabinda of a resident who went to Uige for a funeral of a Marburg victim.  14 contacts in Cabinda have been placed in hospital quarantine.  However, the transfer of a 12-year old Luanda resident from a Luanda suburb health care center to a larger hospital in Luanda, raises concerns about transmission of the virus in Luanda.  Luanda has an international airport and is the capital of Angola.

Concerns about Marburg transmission via air travel were heightened by the death of a passenger returning to Portugal from Angola.  Although the investigation was disclosed on Saturday, there have been no updates on the passenger's age, gender, flight, contacts, relatives, or clinical symptoms.  Another passenger was quickly cleared, but the lack of information on the fatal case is causing concern.

The passenger's death shortly after arriving in Portugal would suggest significant risk to contacts if the passenger died from Marburg.  The virus could be passed to airport personal handling baggage or providing on board service.  Similarly, transmission at airport food courts would be a concern.  Infections at international airports could quickly move the virus around the world.  In the current outbreak in Angola, the case fatality rate is near 100% and there is no known treatment.

Updated information on the status of the Portugal investigation would be useful.

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