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Marburg Airborne Transmission in Angola?

Recombinomics Commentary

April 10, 2005

<< Medical workers warn visitors not to shake hands with anyone and not to stand directly in front of residents when talking to them, for fear that a cough could release an infectious spray of spittle. …..

Silo Margarita is one of the few nurses still working at the 500-bed regional hospital here, a sprawling collection of well-kept, one-story concrete buildings that appeared almost deserted on Saturday afternoon. Wearing a surgical mask and plastic wrapped on her boots, she continued to care for 12 patients despite the fact, she said, that as many as 15 of the hospital's nurses and two doctors have died from the Marburg virus. Two nurses died only last Thursday, she said. <<

The deteriorating situation in Uige is raising the obvious question.  Is Marburg transmitting through the air in Angola?  Although there have always been warnings about transmission via contact with bodily fluids, the concern about coughing raises questions about ease of airborne transmission.

Initially most of the Marburg cases were children under the age of one, suggesting transmission via contaminated needles during childhood vaccinations.  However, about 1 month ago the first health care worker died, and as noted above, that number has grown to 17. Although protective gear was in short supply initially, the deaths of health care workers are still being recorded. 

The total number of Marburg cases alive is relatively small.  When the WHO first announced the sequence results on March 23, there were only 7 Marburg patients alive.  95 out of 102 had died.  The number diagnosed has risen to 213 and the number still alive has grown to 30.  The increase in patients alive simply reflects the fact that newly diagnosed patients are being tallied quicker than older existing cases are dying.  As noted above, there are only 12 patients in the main hospital at the epicenter of the outbreak.

The ability of such a small number of patients to infect so many health care workers, especially after infection control efforts have been increased, raises the possibility that airborne transmission is fairly efficient.  The current outbreak in Angola has a case fatality rate at or near 100%, higher than any prior large outbreak of Marburg or Ebola.  It has now begun transmitting in Luanda, and will easily eclipse the old record of 280 deaths set for Ebola in 1976.

Marburg has now been reported in 7 provinces in Angola.  All of these cases outside of Uige have happened in the past several weeks.  The widespread transmission, coupled with the near 100% fatality rate, suggests the Marburg virus is a recombinant, and the new virus may have increased its ability to transmit and kill.

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