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Reported Marburg Cases Eliminated from Malange

Recombinomics Commentary

April 19, 2005

>>  The Provincial Director of Health in Malanje, Francisco Chagas, said that the results of nine test samples of suspected cases of haemorrhagic fever sent to Luanda were negative, but technicians still in alert on the illness.  <<

The nine negative results above suggest false negatives are creating a serious undercount of Marburg cases.  Since patients are avoiding the isolation wards, many patients are dying at home, limiting contact tracing.  Moreover, private burials may keep these patients from being identified at all.

The above comment on the negative cases, however, suggest that false negatives are adding to the undercount.  Since samples were collected, it would seem that the nine had symptoms.  Since there has been significant damage to the health care system in northern Angola, collection and transport of samples for testing may be less than ideal.

The Angola Ministry of Health puts out a daily update on Marburg cases, and there have been at least 5 prior cases reported in the province of Malange (2 in Calandula and 3 in Malange).  At least two of these five died.  However, all five have now been removed and there are no reported cases in the entire province.  Although it is not clear if the nine mentioned above are in addition to the five that had been tallied as reported cases, or if the total is nine.  However Malange now has no cases that have been confirmed, so there is no evidence that any samples collected in the field in Malange are properly collected, transported, or tested.

Prior descriptions of sample collection indicated collection was arbitrary, delayed because of safe transport concerns, and collected at least 24 hours after death, possibly via a single saliva sample.  All of the above can generate false negatives, and without the identification of an etiological agent causing the Marburg symptoms and/or death, there is little reason to believe the official tally. 

The "official" tally now indicates there are not now, nor have there been, any Marburg cases in the province of Malange.

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