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Marburg Spread Accelerating in Uige and Adjacent Provinces

Recombinomics Commentary

April 4, 2005

>>  An outbreak of the deadly Ebola-like Marburg virus has intensified in Angola, claiming more than 29 lives over the past four days and taking the nationwide toll to 155, heightening fear of the disease in the capital Luanda, authorities said on Monday.

Angolan health minister Sebastiao Veloso said the toll climbed to "175 cases, among them 155 dead, all from the province of Uige", the epicentre of the outbreak in the country's north on the border with the Democratic Republic of Congo.

The official toll had stood at 126 on Thursday.<<

The Marburg cases in Angola are exploding as the virus geographically extends its reach.  Today's WHO announcement indicates deaths have now occurred in four provinces outside of Uige, including Cabinda, Luanda, Kuanza Norte, and Malange.  Although the cases may trace back to Uige, the large number of new cases and deaths in new provinces seems likely to lead to new transmissions.  The 20 case differential between the number of infections and number of deaths does not represent discharges.  The case fatality rate remains at 100%, but now new patients are being identified at a higher rate than patients dying.  The increased number of new admissions indicates the outbreak is accelerating.

The demographics began to change several weeks ago when the first health care workers were infected.  The number of workers who have died is at least 12.  In the past 1-2 weeks deaths have been reported for the first time in the four provinces surrounding Uige.

The latest reports do not have as much detail on the age of patients or the breakdown of locations.  They also do not update the status of the passenger in Portugal being tested (a report on the third passenger was scheduled for release last Thursday), or the suspect cases in the Democratic Republic of Congo.  There have also been media rumors of additional cases in Cabinda.

The number dead has surpassed the record of 126 for Marburg and now appears likely to surpass the record number of 280 Ebola deaths.  Although contact tracing efforts are increasing, the 20 newly diagnosed patients who have not died indicate that the number of contacts should be at least 2-4X the 100 being monitored or traced by WHO.  Media reports indicate that 16 are under hospital quarantine in Cabinda and 9 are under quarantine in Italy.  These 25 under quarantine are linked to just two of the 155 deaths.

The case fatality rate of 100% and rapid spread of the virus in five provinces is markedly different than prior Marburg outbreaks.

This behavior suggests the Marburg virus in Angola is a recombinant.

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