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Marburg Virus Spreads to Zaire

Recombinomics Commentary

April 8, 2005

>> The Health Ministry said they control 230 people who had contact with infected people.

Luanda province registered eight cases, being two confirmed, two suspects and six deaths. Twenty people are also being monitored after having contacted affected people.

Uige received 11 alerts from different municipalities and two deaths and 200 contacts being monitored.

Kwanza-sul province is investigating six deaths that occurred from March 20 to April 02 who presented suggestive symptoms, in the municipalities of Amboim and Kilemba.

Zaire registered six deaths including one that happened today. <<

The above detail demonstrates why the Marburg outbreak will not be quickly contained.  The outbreak originated in Uige, where there are the most cases and the largest number being monitored.  However, the virus has radiated out from Uige, and there is little monitoring in the outlying regions.  Thus, the monitoring is chasing the virus, which continues to transmit ahead of the monitoring.

Warnings last week indicated Uige was the Marburg epicenter, and all cases originated in Uige.  This week warnings have gone out to countries adjacent to Angola (Congo, Democratic Republic of Congo, Namibia, and Zambia), warning that Angola is the epicenter.  There are already reports of suspect cases in South Africa, including one death.

The above update indicates Marbug has now spread to Zaire.  WHO just announced Kwanza-sul yesterday, although the above report indicates there have been deaths there since March 20, and the spread to Kwanza-sul was reported earlier.  Provinces previously reported, but not listed above include Cabinda, Kwanza-Norte, and Malange.

The update on Luanda is most alarming because there is a population of 4 million and an international airport. 

There have been two widely reported cases in Cacuaco, a slum on the outskirts of Luanda.  The first case was a 12 year-old, who began to hemorrhage badly two days after admission.  She was then transferred to Americo Boa Verde in Luanda.  There would have been many contacts at the clinic alone, because she did not initially present as a Marburg case, and when she was admitted March 25, the staff was poorly equipped with gloves, masks, and gowns.  At that time there were already 6 other cases in Luanda, and since only 20 people are being monitored, many contacts of these initial cases are not being found.

A 22 year-old patient was admitted April 6, and she too was hemorrhaging badly.  Her transfer to Luanda was delayed because only one ambulance was available and risk of contamination of the vehicle was too high. 

These two cases highlight the difficulties in treating these patients and monitoring contacts.  Controlling the spread of the virus in the slums near Luanda will be particularly challenging because of a high population density, and an increase in the number of people who want to leave the area.

Thus, as the virus radiates out from Uige, controlling spread via contact tracing and quarantine will be increasingly difficult.

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