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Another Marburg Infected Health Care Worker?

Recombinomics Commentary

April 19, 2005

>>  Claudia turned 1 on Friday. Inside the house where she died Saturday, family and neighbors sang and wailed over her body, as they had done for much of the night. She had been sick with a fever for only a few days. She never hemorrhaged, so the family did not suspect Marburg, said Dr. Enzo Pisani, who has worked here for seven years for an Italian aid group, Doctors With Africa. But tests after her death found the virus.

"I think the mother infected her," Dr. Pisani said, explaining that Claudia's mother, a nurse, 37, was still alive but had been ill with a fever for about 10 days. Few Marburg victims live that long. She had not been tested, but the doctors said they felt sure she had the virus, and might be among the minority who survive.

The doctors said they hoped to persuade her to enter the isolation unit for Marburg victims at the hospital here. She and her husband have another child, who is 4. It was too soon to tell whether anyone else in the family was infected............

Claudia's mother is not the only possibly infected person still living in the community. On Saturday night, a pregnant woman close to her delivery date and terribly ill, sought help at the maternity ward in Uíge. Staff members there, suspecting Marburg, sent her straight to the isolation ward for Marburg patients. Doctors drew blood to test for the virus.

"She escaped," Dr. Pisani said. "After she was there for about an hour, a car drove up with four people in it, and they took her away. We tried to find her but we could not."

The test for Marburg was positive.

"I hope she dies before she has the baby," he said, shaking his head sadly. Otherwise, he said, while giving birth, "she could infect 20 people."  <<

The above descriptions of patients in Uige raise several points that indicate control of  Marburg will be difficult.  Since the baby has died and is positive for Marburg, it is likely that the mother, who is a nurse with fever, is also infected.  If true, it would indicate that health care workers are still becoming infected, even after new supplies have been received, and infection control procedures implemented.  Surviving for 10 days after symptoms is also unusual.  Doctors Without Borders had indicated only 2 patients had survived more than 24 hours in the isolation ward.

However, being ill with fever for 10 days also increases the likelihood of transmission, which appears to have happened with the baby.  However, the baby died prior to developing symptoms, suggesting other cases could be missed because of the high infant mortality rate.  In this case, testing was almost certainly related to the mother's condition and occupation.

The patient described above also raises issues regarding transmission.  When the pregnant mother was placed in the isolation ward, she left.  Since she was near full term and positive for Marburg, further transmission may be linked to her giving birth or some type of rescue effort for the baby if she becomes even more ill.

The above two families include two confirmed cases, and 1 or 2 likely cases if the baby is born.  However, recent reports indicate only a few people per day are dying in Uige, raising the possibility of a large number of unreported or unconfirmed cases, both in Uige, and surrounding communities, including Luanda.

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