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Marburg Toll in Angola Explodes to 399

Recombinomics Commentary
May 27, 2005

>> As of 26 May, the Ministry of Health in Angola has reported 399 cases of Marburg haemorrhagic fever. Of these cases, 335 were fatal. The vast majority of cases have occurred in Uige Province, where 388 cases and 324 deaths have been reported.

Yesterday, four new suspected cases, of which three were fatal, were reported in Bungo municipality, in Uige Province. Two of these cases have been laboratory confirmed. These are the first cases in this municipality detected since early April. An urgent investigation has been launched to determine whether the Bungo cases can be linked to Uige municipality, where transmission is known to be ongoing. Another focus of transmission would be a disturbing development for outbreak control. >>

The WHO report above raises serious questions about the validity of the daily numbers released by the Angola Ministry of Health.  The numbers can fluctuate dramatically and many previously reported fatality are discarded.  Media reports suggest many patients are excluded based on a negative Marburg test.  However, media reports raise questions about the frequency of false negatives.  There are only three confirmed cases outside of Uige Province.  All three are in Luanda, raising questions above the ability of sites outside of Uige and Luanda to collect a sample that would register as a positive.

In the May 25 report these was one new case and one new fatality in the city of Uige on May 24 bringing the total number of cases to 350 with 316 deaths.  The data as of May 26 is 399 cases and 335 deaths.  Both of these numbers are 11 higher than the Uige totals, which has been the case for many weeks.

The differential between cases and deaths has exploded to 64.  Since there a very few discharges, this big jump in reported cases that are still alive suggests a large jump in newly reported cases.. The May 25 report showed that the number of people being monitored had fallen to 153.  Five were in Buengas, the remainder in Uige township.

Exclusion of cases based upon a single cheek collection is inappropriate.  Media reports suggest collection of these samples from deceased patients is far from ideal.  False negatives erase links to contacts, which can give rise to new cases without clear cut links back to known cases.

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