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Marburg Case Fatality Rate Remains Above 99.6%

Recombinomics Commentary

May 3, 2005

>> LUANDA, Angola (AP)--The rare Marburg virus has killed 280 people in Angola over the past six months, at a fatality rate of 89%, authorities said.

The Health Ministry and the World Health Organization said in a joint statement late Monday that officials have recorded 313 cases since the outbreak began in October.

All but 11 of the deaths have occurred in the northern province of Uige <<

The fatality rate quoted by authorities is incorrect. Fatality rates are based on known outcomes of cases.  There are 281 reported outcomes for Marburg in Angola and 280 are deaths.  Thus, the case fatality rate remains in excess of 99.6%.  The fatality rate cited by authorities would be correct if all of the 32 reported cases with unknown outcomes would survive.  Since there has only been one survivor in the first 281 outcomes, it is unlikely that there will be 32 survivors in the next 32 outcomes.

The case fatality rate cited by the authorities is misleading.  It is going down because more patients are being diagnosed.  The difference between those reported and those who have died is 33, which is an all time high for the outbreak.  Since only 1 of the 33 Marburg cases alive has been discharged, the 32 reported cases with no outcome are also at an all time high.  This indicates the numbers are increasing at a record rate, even though most reported cases outside of Uige have been removed, and no new cases outside of Uige are being added.

If residents of Uige are allowed to leave Uige, it seems unlikely that there are no cases outside of Uige.  The hospital remains a source of infection.  The number of confirmed health care worker deaths has risen to 19 and new cases have been identified in the hospital.  Consequently, the number of Marburg patients seeking hospital treatment in Uige has fallen once again.  The continued infection of health care workers inside Uige would increase the chances of more transmission outside of Uige, where there is less awareness or training. 

The last two daily reports showed increases in deaths of 14 and 9, while increases in reported cases were 14 and 13.  These increases support the fact that the number of cases is on the rise within Uige, and announcements of containment are suspect.

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