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Marburg Toll in Luanda Continues to Grow

Recombinomics Commentary

April 12, 2005

>> The few patients who have turned up in Luanda contracted the disease about 180 miles away in Uíge, the province at the center of the outbreak, and are not thought to have passed it one to anyone else.

It is not known whether Mr. Soloca had the Marburg virus - one blood test was negative, but a second must still be done. He was admitted because he had some Marburg-like symptoms - fever, and blood in his urine and vomit - and he might have been exposed to the virus while being treated for malaria at another Luanda hospital where a Marburg patient had died. Because of that, his doctors said, they had to treat him as if he did have the virus.

 Earlier in the day, he said, he had considered starting an intravenous line but did not, because it would increase the nurses' risk of being exposed to Mr. Soloca's blood or stuck by a contaminated needle.

"I don't know whether it would have made a difference," he said. "It's a fine line to balance care for the patient and risk to yourself." <<

The above comments on the first Marburg patient in the Americo Boavida hospital in Luanda raise additional issues regarding the true state of Marburg transmission in Luanda.  Moreover, the descriptions clearly demonstrate why such isolation wards are to be avoided at all costs.

From the patient's point of view, Mr. Soloca was clearly in the wrong place at the wrong time.  Exactly where that place and time were would be of interest, but it seems that at a minimum he was not in contact with bodily fluids from any Marburg patient who died in a different location in Luanda.

If Mr. Soloca was infected by another patient, he would be the "official" first transmission of Marburg in Luanda, and his infection would raise some serious questions about ease of transmission and infection control in the hospital.

If Mr. Soloca is not infected with Marburg, then being somewhere in the vicinity of the patient caused him to be transferred to an isolation ward with minimal care.  As noted, he then would have needlessly been isolated from his family, and die a death that did not even include painkillers to ease his passing.

The failure to start an IV raises serious questions about the level of care as well as sample collection for testing.  The situation sounds remarkably like SARS in Toronto in 2003.  Virus was readily isolated from initial cases, but as nurses became ill and infection control procedures became more rigorous, the recovery of virus from clinical samples fell to zero.

If samples were collected from Mr. Soloca, the integrity of the clinical samples may have been compromised by the long delays linked to changing into and out of the heavy protective gear.

Thus, the isolation units may create conditions that limit the care given the patient, and also reduce the quality of samples collected, which could lead to false negatives.

The status as the first Marburg transmission would also be questioned, because it seems quite clear that transmission of Marburg in Luanda has already happened.  This was noted last week by MSF (Medicins Sans Frontieres) and two of the transfers to Americo Boavida were from Cacuaco, a slum on the outskirts of Luanda.

The number of patients described in media reports would seem to be more than a few.  5 have already died - the 15 year-old and Italian pediatrician on March 24, the Vietnamese physician on March 25, a 1 year old on March 27 and another patient on March 31.  In addition, there was a Portuguese national who entered a military hospital, and two other patients from Cacuaco, that were transferred to Americo Boavida.
It is unclear if any of the above eight was the patient who died near Mr. Soloca.  However, it seems unlikely that there was contact with bodily fluids, but rather some efficient method of transmission, that has killed 17 nurses, and now has possibly killed a malaria patient who was in the wrong place at the wrong time.

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