Marburg Toll In Angola Grows to 181
Recombinomics Commentary
April 7, 2005
>> As of 5 April, the Angolan Ministry of Health has reported 181 cases of Marburg haemorrhagic fever. Of these, 156 have died. Cases have now been reported from five provinces. Uige remains the epicentre of the outbreak. While children under the age of 5 years initially accounted for around 75% of cases, recent cases are including an increasing number of adults.
One person is currently under investigation for Marburg haemorrhagic fever in the Democratic Republic of Congo.
Based on experiences with Ebola, control measures can have an immediate impact by interrupting chains of transmission. The eventual success of such measures depends on their sustained application, supported by efficient surveillance, and requires very good communication and transportation systems. Such systems are not presently available in Angola and cannot be established quickly. As another consequence of the country's recent history, hundreds of thousands of landmines are thought to remain in the country, making transportation by rail and road precarious and necessitating air transport of staff and equipment.
Intensified surveillance in Uige over the past few days has determined that some patients are not being hospitalized and are dying within the community, creating an urgent need to organize services for the safe collection and burial of deceased persons. <<
The WHO update describes some of the problems associated with control of the Marburg outbreak. The number infected has grown to 181 and the growing differential between the number diagnosed and number dead merely reflects more cases diagnosed. There still are no reports of discharges, so the larger spread, now at 22, will translate into a larger daily death toll in the upcoming days, since the fatality rate remains at or near 100%.
Recent reports of cases in Luanda slums complicate control even more, as do cases that are not hospitalized. The patients are infectious, and many of the early symptoms match more common and less deadly illnesses in Angola, so additional transmission is likely.
The 156 deaths reflect a growing daily death toll, which seems certain to surpass the record for Ebola, which is 280 in Democratic Republic of Congo in 1976.
As noted above, a case in Democratic Republic of Congo is being investigated, as is the death of a South African who recently returned from Angola. His contacts in South Africa are also being tested for transmission of Marburg.
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