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Marburg Fatalities Spread to Negage in Angola

Recombinomics Commentary
March 30, 2005

>."The hospital is closed," he said speaking of the sole health facility there. "Even the emergency services are shut down. Here everything is politicised. Only international experts from the World Health Organisation and the Medecins sans Frontieres (Doctors without Borders) are here."
Godi said there were four more deaths on Tuesday - two in Uige and two at the nearby town of Negage about 30km away - which take the unofficial toll to 130.

Provincial health official Godi meanwhile heaped scorn on government criticism.

"These are people who simply talk. The entire team sent by the health ministry has left leaving only international experts on the spot." <<

The latest update on Marburg fatalities suggest the virus may be spreading to areas that are not actively monitored.  This reduces the effectiveness of contact tracing, and suggests that control of the virus will be hampered by this lack on monitoring.

Yesterday WHO issued an update indicating that all known cases originated in Uige and the number of diagnosed patients that were still alive numbered 7, and that 117 of the 124 cases had died.  Since 6 newly admitted cases were covered in recent media reports, contact tracing appeared to be relatively straightforward.

However, the 8 deaths on Monday and Tuesday, most of whom were not among the new admissions, indicates the number of missing infections in the WHO tally may be significant. Media reports have detailed 17 deaths in the past six days, including 1 in Cabinda, 4 in Luanda, 10 in Uige, and 2 in Nagage.  The two deaths in Negage are cause for concern.

Reports of the closure of the main hospital in Uige, the province capital and epicenter of the outbreak, create significant instability.  The large number of health care workers and first responders who have died in recent days (6 nurses, 2 physicians, 2 policemen), suggests infection control was lacking.  Closing of the main hospital, and forcing patients to areas that would have more poorly equipped facilities with less trained staff, will almost certainly facilitate the spread of the Marburg virus among patients and health care workers.

Since there is no treatment for the Marburg hemorrhagic fever virus, its control relies on contact tracing and quarantine.  This is being done for the higher profile cases.  In Cabinda 14 contacts of the fatality there have been placed on 21 day hospital quarantine, and 21 day quarantines are being applied to contacts associated with the flight of the Italian pediatrician from Uige to Luanda.  The physician died in Luanda last Thursday.

Eight fatalities in the past two days is cause for concern, suggesting a significant increase in fatalities in the short term.  These new cases present serious obstacles for effective contact tracing and control.

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