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Marburg Toll in Angola Explodes to 313

Recombinomics Commentary

May 3, 2005

>> There have been 313 cases detected of the Marburg virus since monitoring of the outbreak, the worst recorded to date, began on October 13, it added…….

Deputy Health Minister Jose van Dunem told journalists that a health team travelled to the village of Ngombe, 150km north of the city of Uige, on Sunday and was told that a woman who had attended the funeral of a relative in Uige had spread the virus to the village.

"When she returned to Ngombe, she contaminated 12 other members of her family and they all died," said Van Dunem.

A traditional healer who treated many patients sick with Marburg in a town outside of Uige has also died from the haemorrhagic fever, he added.

No new cases of the Marburg virus have been detected outside the province.

Results from a blood test on a suspected case of Marburg in nearby Malange province were negative, he said.  <<

The dramatic jump of Marburg cases to 313 is cause for concern.  The official death toll of 280 matches the total death toll in the worst recorded Ebola outbreak.  The prior record Marburg death toll of 126  was eclipsed last month.

However, the sudden jump in cases raises serious questions about the accuracy of the official tally put out daily by the Angola Ministry of Health.  That list has discarded most of the previously reported cases outside of Uige.  The basis for the discarded cases remains unclear.

As noted above, suspect cases outside of Uige continue to test negative, but the only province that has submitted a sample that was positive on the Marburg blood test was Luanda.  Without a diagnosis on the suspect cases, the negative blood test remains suspect, especially for the many deaths that have been discarded. 

Since there has been only one Marburg discharge, the jump in the differential between reported cases and deaths indicates there are many newly diagnosed Marburg patients who have not died.  This differential of 33 is the highest reported to date.  This indicates the spread of Marburg is accelerating, not diminishing, as stated in Marburg media reports based on comments by Angolan officials.

Last week the WHO warned of a second wave of cases due to infection control breaches at the hospital in Uige.  However, the cluster of cases in Ngombe, 150 km north of the city of Uige would appear to be unrelated.  The index case had attended a funeral of a Marburg patient.  The index case has already died, as have 12 other family members, suggesting the transmission chain began some time ago.  Moreover, the death of 13 family members raises questions about transmission in Uige and the Democratic Republic of the Congo, since its border with Angola is also about 150 km north of the city of Uige.

The detection of a large familial cluster in Uige province raises significant detection issues similar to those seen in the bird flu outbreak in Vietnam.  Frequently, there was no sample collected from the index case of the cluster or initial tests were negative or inconclusive.  The cases were discovered and added to the official toll because they occurred in large clusters that could not be ignored.  Since there has only been one reported recovery in Uige, the number of patients being admitted to the hospital has again fallen, increasing the chance of undetected cases and transmissions.  This leads to more transmissions, in part, because of no contact tracing.

The use of the Marburg blood test to exclude patients with no alternate diagnosis for their Marburg symptoms or death is cause for concern.

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