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Marburg Toll in Angola Rises to 277

Recombinomics Commentary

May 1, 2005

[The Angolan Ministry of Health reported totals of 275 cases of Marburg hemorrhagic fever and 255 fatalities on Wed 27 Apr 2005.  Therefore there have been only 2 additional deaths during the past 72-hour period, suggesting that the situation has been stabilized despite the lapse in disease security at the Provincial Hospital in Uige. - Mod.CP]

The above commentary at ProMed is incorrect because it is relying on the daily totals in the Ministry of Health report.  This report's totals included the number of new cases, minus the number of discarded cases, giving a net total.  Thus, the report on April 27 indicated the total number of new cases was 270 (259 in Uige) and the deaths were 248 (237 in Uige) on April 25.  However on April 26 there were 3 new cases and 5 new deaths, which raised the totals to 273 cases (262 in Uige), and 253 deaths (242 in Uige).  The latest media report increases the number of cases to 277 (266 in Uige) and deaths to 257 indicating 4 more deaths in the following 2 or 3 days.

Thus, the number of cases and deaths has been averaging 2-3 per day, which is lower than the daily average of about 5 for April, but about the same as March, when Marburg was identified and international support began to arrive.  The "stabilization" in cases has really been a stabilization in the net totals, which include discarded reported deaths. The discarding had been at about the same rate as newly reported patients.  Since the number of patients outside of Uige is now down to 11, there are not many more cases available for discarding.  Now the increase in cases should be more reflective of the increase in reported new cases and deaths.

However, since a large number of cases outside of Uige were discarded, it is unclear what criteria were used.  Similarly, this new criteria has kept the new cases limited to Uige.  The cases outside of Uige have been reduced to 11, four of which were in Luanda.  Since the 3 confirmed cases in Luanda are the only confirmed cases outside of Uige, there is no evidence that any of these outlying provinces can collect a Marburg sample that tests positive in the confirmatory lab test. So the possibility of false negatives from these areas is a concern.  Moreover, there has been no explanation as to what caused the Marburg symptoms in these patients, most of whom had died.  There is no explanation for the symptoms of the large number of negatives in patients outside of Uige.

Similarly, there are persistent reports of suspect cases in neighboring Democratic Republic of the Congo, but since there has been no confirmation or reported diagnosis on these patients, there true status has remained unclear.  The potential hazard caused by these suspected Marburg patients is increased by the fact that the daily report from Angola indicates that there is no monitoring of contacts outside of Uige.

The numbers within Uige are also suspect because patients have again stopped coming to the hospital.  The only survivor was just announced, so 257 deaths out of 258 cases does not make a hospital admission attractive.  Moreover, more health care workers have died or have a fever, and more breaches of infection control procedures in the hospital have been reported.

The possibility of a serious undercount in and around Uige remains a very real possibility.

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