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Quarantine of Contacts of Fatal Marburg Cases in Angola

Recombinomics Commentary
March 29, 2005

>> In another incident that raised concern about spread of the disease, an Italian citizen who died of Marburg in Angola's Luanda province, last week had flown on an airplane from Uige province to Luanda. Vita Vemba, the provincial director of Luanda Health Department, said in a statement, also on Monday, an undisclosed number of people who were on the flight had been placed under quarantine for 21 days  <<

The above comment suggests that the number of contacts placed under 21 day quarantine may be large, suggesting the number of contacts of unreported cases, who are not under quarantine may also be large.  The latest update from WHO showed that the number of known Marburg patients who have not died is only 7.  Moreover, 6 of those 7 are described in recent media reports as recent hospital admissions. Therefore the case fatality rate is nearly 100% and there have been no reports of patients surviving the Marburg hemorrhagic fever infections.

The recent reports also indicate the number of cases grew significantly over a short time frame, and this increased patient load was associated with infections of healthcare workers and first responders.  Consequently, there have been 6 nurses, 2 physicians, and 2 policemen who have died in the past 1-2 weeks.  In some of these cases the deaths were preceded by travel from Uige to Luanda, and as noted above, some, if not most, of this travel was by air.

The travel from Uige to Luanda may have been precipitated by deteriorating conditions in Uige.  The deaths of all of the patients in Uige would have been discouraging.  The appearance of the same symptoms in the caregivers would have been cause for concern.  The under-appreciation of the transmissibility of the Marburg virus may have resulted in a fairly large number of exposures of contacts.

There were 14 hospital quarantines associated with the fatal case in Carbinda, and an undisclosed number of quarantines associated with the Italian doctor's flight.  Since there are at least six other patients treated in Luanda, and all originated in Uige, there were six additional transportation events between Uige and Luanda.

As noted in the WHO update, the number of known diagnosed patients is quite small.  The next several days should provide indications of the extent, if any, of additional transmissions during the movement of patients and residents from Uige.

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