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Marburg Toll in Angola Increases to 221
April 11, 2005
>> A total of 203 people have died in Angola from the Marburg virus, the worst outbreak recorded of the Ebola-like bug, the Angolan health ministry and the World Health Organisation said on Monday.
The greatest number of deaths - 184 - was recorded in the northern Uige province, the epicentre of the epidemic that was first detected in October, according to the figures from health authorities released in a statement in Luanda.
A total of 221 cases of the Marburg virus have been discovered, out of which 203 resulted in death, the statement said, putting the mortality rate countrywide from the outbreak at 92%. <<
The 221 discovered Marburg cases give a lower limit on cases with Marburg symptoms. These numbers clearly lag the number of people in Angola infected with Marburg. The total infected patients is markedly higher than 221, but that number is largely unknown. WHO uses the term confirmed cases to generate an even lower number, which appears to lag the numbers identified for several weeks. Media stories tonight still maintain that there has been no transmission of Marburg in Luanda, and the number of confirmed Marburg deaths in Luanda remains at two. However, the first two deaths in Luanda, a 15 year old male and the Italian pediatrician, died on March 24, over two weeks ago.
Last week MSF (Medicins Sans Frontieres) conceded that urban transmission of Marburg in Luanda had begun because there were cases that had no connections to Uige. Moreover, media reports described patients in Cacuaco, a Luanda slum, that also had no clear ties to Uige. The number of deaths in Luanda last month was at least 5, so the comments on Marburg Luanda transmission attributed to WHO are clearly quite dated.
These comments on last month's situation are transmitted almost daily to Luanda residents and foreign workers. It is not clear if these dated comments are believed by the residents, but clearly they have had little effect on the spread of the virus. Daily repeating of the same dated material offers little confidence in WHO's ability to control the spread of Marburg. WHO is either citing dated material, or is significantly lagging on the confirmation of patients.
Since these patients are already dead and buried and clear Marburg victims, the delay may simply offer some validation for the cited numbers which are several weeks old. The rapid spread of the virus has produced a much more serious situation, that WHO has chosen to either misrepresent or allow media to misrepresent for them.
WHO's track record in Angola is less than ideal. The WHO has consistently underplayed the seriousness of the outbreak, which began in October, 2004. They did not view the situation seriously until health care workers were infected about a month ago. They then stated that the number of infected patients was too high because cases had been misdiagnosed.
When Marburg was identified as the etiological agent, WHO failed to correct two major media misconceptions. WHO knew that the case fatality rate was at or near 100% when they initially announced that 95 of 102 patients had died. WHO certainly knew that all or most of the 7 diagnosed patients who were still alive were newly admitted patients who would also soon probably die. However, initial reports indicated that Marburg was milder than Ebola and had a case fatality rate around 25%. When the number of cases was only a few more than the number of deaths, media reported the total number of cases diagnosed plus dead, when in fact the total number of patients was just those diagnosed, most of whom were dead (the reporting doubled the number of patients and halved the fatality rate). Media reports continue to misrepresent the case fatality rate, although now it is generally cited as being in the 80-90% range. WHO knows that there are few if any survivors and the fatality rate is close to 100%.
Now WHO is continuing to ignore the fact that Marburg is transmitting in densely populated slums of Luanda. If the only two cases WHO has been able to confirm in Luanda are the two victims who died on March 24, then WHO should explicitly state that as of March 24 there was no evidence of transmission in Luanda.
To repeatedly state that there are only two confirmed cases in Luanda is at best misleading and clearly scandalous, either because the confirmation process lags the cases on the ground by over two weeks, or because the media is allowed to publish misleading information on a daily basis without comment from WHO.