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Marburg Toll in Angola Increases to 264

Recombinomics Commentary

April 20, 2005

>>  "This trend towards a reduction in cases and deaths is due to the strong mobilisation of the population in the province of Uige," said health ministry spokesman Carlos Alberto.

Much of the trend toward a reduction of cases and death has been due to the removed of reported cases outside of the province of Uige.  For municipalities within Uige, the current numbers are equal or greater than the number at the beginning of the month.  In contrast, almost all municipalities outside of Uige have had previously reported cases discarded.

The basis for this removal has been unclear.  In the latest report, most reported cases have not been confirmed.  There are 264 cases, but only 68 have been lab confirmed.  However, 66 of the 68 confirmations have been in Uige.  The only 2 confirmations outside of Uige have been 2 in Luanda, presumably the first two reported cases, a 15 year-old male and the Italian physician.  Both died on March 23 in Luanda.

A recent media report indicated that 9 samples from Malange were sent for testing and all were negative.  Since the number of cases in Malange has been reduced to zero, it seems that the negative lab test was used to exclude the suspect cases.  However, there was no diagnosis reported for these suspect cases, so false negatives could not be ruled out.  Since only two lab positive results have been reported outside of Uige, there is little data showing that these locations outside of Uige are capable of collecting and delivering a positive sample from a Marburg patient.

The Marburg test clearly has utility in identifying infected patients.  Several patients who had not yet shown signs of hemorrhage were positive, raising the possibility of a large number of Marburg infected patients who have not shown signs of advanced disease.  Therefore identifying these cases via a Marburg test helps with contact tracing.  However, exclusion of patients solely based on a negative test, especially from areas that have never produced a positive Marburg result, would be inappropriate.  Exclusion of these patients should be based on a positive diagnosis of another illness, preferably supported by positive lab results.

In spite of removal of cases outside of Uige, the total number of reported Marburg cases to date continues to rise.  The number of reported cases remaining on the official tally has risen to 264, which is 16 shy of the record death toll for Ebola in Republic of Congo in 1976.  Since the beginning of the outbreak last fall, the number of monthly cases has doubled each month.  Last month there were approximately 70 cases that have remained on the official list.  Since there have been approximately 130 new cases this month that have not been discarded, it seems likely that the number of cases in April will be more than double the number of cases in March.

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