Two More Reported Marburg Deaths Discarded from Luanda Total
Recombinomics Commentary
April 21, 2005
>> Almost all the deaths from the rare Ebola-like virus have occurred in Uige, a city 180 miles north of Luanda. Several victims who died in other areas of the country had previously been in Uige.
``It's clear (the virus) is contained in Uige,'' Veloso told reporters, adding that authorities hoped to stamp out the virus by the end of next month. <<
Although it is clear that the daily report put out by the Ministry of Health in Angola has eliminated enough cases outside of Uige to give the appearance that the Marburg virus is contained in Uige, the basis for the elimination of the additional cases is far from clear.
Yesterday's report removed two more deaths from Luanda, lowering the total to four cases and two deaths. Media reports described five deaths in Luanda last month, and additional detail on three more cases, including two in the Luanda slum of Cacuaco. Since the first reported death, a 15 year-old male who died on March 24, has been described by WHO comments as the first confirmed case, and the Italian pediatrician died in Luanda on the same day, these two would appear to be the two deaths that remain on the "official" list. Last week the list had 12 reported Luanda cases, including 6 deaths, so the removal of 8 previously tallied cases, including four deaths, has helped "lower" the number of dead and reported cases outside of Uige. Yesterday there were 4 deaths reported in Uige, but since two previously reported deaths in Luanda were discarded, the number of dead in Angola rose by two.
Thus far all of the discarded cases are outside of the province of Uige and media reports suggest the removal is because the reported cases test negative for Marburg. However, descriptions of sample collection indicate the collections are arbitrary, poorly supported, and collected more than 24 hours after death, even for cases that die in the hospital. Moreover, since there are no confirmed cases outside of Uige, other than 3 cases in Luanda, none of the other provinces have proven that they can collect a Marburg sample from a patient that produces a positive lab test.
The steady reduction of reported cases outside of Uige has been without explanation. Without an alternate explanation for the patient's Marburg symptoms, discarding patients based solely on a negative Marburg test is not justified.
Indeed, the initial tests last November by the CDC in Atlanta failed to identify any Marburg positive samples, and 3 of the 12 cases tested by the CDC last month were negative in the Marburg test. The procedures tied to collection, storage, and shipment of clinical samples in Angola fail to instill confidence in negative lab data and press conferences reporting lack of transmission outside of Uige.
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