Posted on 04/17/2005 12:10:40 PM PDT by Lessismore
The Angolan Ministry of Health has announced that the death toll from the epidemic of Marburg hemorrhagic fever has jumped to 233 from a total of 255 cases recorded in Angola until Saturday.
According to a press release issued here by the ministry on Sunday, all the reported cases of the Ebola-like disease had originated in the northwestern province of Uige, though patients have died elsewhere, including Luanda, Zaire, Malange, Kuangza Norte, Kuanza South and Cabinda provinces.
The rising death toll in the absence of patients in the isolation wards in Uige and Luanda supports the observation that patients are dying in neighborhoods and avoiding hospitals. These numbers would also suggest that infected individuals are moving out of the area. However, it is difficult to see why such movement would not result in transmission in the new areas, because the families would not be trained in infection control. The large number of fatal Marburg cases in health care workers indicates that transmission associated with close contact with dead or dying patients is quite efficient.
The increase in patients follows a period of reclassification of Marburg cases. Health reports from last week suggested the requirements for inclusion in the case tally were being tightened. All of the new reported cases in Uige for April 13 were laboratory confirmed, suggesting lab confirmation may be a new requirement for inclusion as a reported case. That requirement may be more easily met in Uige, since there is now a new lab set up with rapid turnaround of testing data. However, a lab confirmation requirement may produce a significant undercount, especially in more distant provinces. Sample collection may be absent in some cases, and in others transport of collected samples to testing facilities may produce sample degradation and false negatives.
The reclassification did eliminate cases from Kwanza Sul, where there were cases clustered in 3 adjacent municipalities. The reported cases in Zaire were also eliminated administratively by reclassifying them.
Efforts to manage an outbreak by simply administratively eliminating cases because of unrealistic requirements can lead to gross undercounts and undetected spread of virus. The analogies with the bird flu management in southeast Asia have some striking parallels. The bird flu undercounts were driven by several factors, including unreported data, untested patients, and using tests with poor sensitivity. False negatives due to poor testing procedure or sample degradation also contributed to the gross undercount.
The data management practices have been particularly disastrous in Vietnam, which is likely to be the epicenter of the next flu pandemic, which may have already begun. In spite of almost daily press releases citing provinces that were bird flu free because of no detectable virus, a recent report indicated that 71% of the ducks in all 11 provinces in the Mekong Delta were positive for H5N1, as were about 25% of the chickens. These numbers were so high, that management via culling was considered to be a poor option.
Similarly, the size of human clusters continues to grow. Confirmatory data from the largest clusters is being withheld while 1000 samples are sent to the CDC for analysis. Since these samples were collected over 3 weeks ago, it would seem that most of the samples are positive, and CDC is analyzing sequences to identify which molecular changes are correlating with which clinical diseases. However, it seems quite clear that while Vietnam was administratively eliminating the virus, the H5N1 virus itself became so entrenched that the number of options has diminished.
Unfortunately, the administrative management of Marburg via press release and reclassification appears to be on the same misdirected path. The approach eliminates reports of virus that don't match models or wishful thinking, while the virus continues to spread beyond control.
New statistics ping
Tens of millions dead from AIDS.
THAT is a "balloon" number.
This is still "chump change."
"Balloon" doesn't refer to the size of the death toll, but rather to the rate of change: exponential.
Not chump change for a disease as easily transmissable as this one is.
Very scary stuff!
No signs of slowing yet.
Question-
Is it airborne or not?
I don't think that it is airborne in the sense of being able to dry out. However, droplets from sneezes or coughs and contact with sweat are methods of transmission. You do not want to be within several feet of someone with Marburg.
I can't disagree. With a population of 10 million+ 255 deaths is miniscule. We kill more than that on the highways each week.
AIDS is avoidable. Even if you contract HIV that proceeds to AIDS, the progression of the disease is a matter of years. This variant of Marburg incubates in 7 to 10 days. The infected individual is infectious but asymptomatic during that time. Once symptoms appear, death ensues in 92% of cases in around 3 days. The ease of transmission, extended period of asymptomatic infectious state and high mortality rate makes this Marburg variant much more dangerous than AIDS.
At it's current rate of growth, Marburg deaths would total six million by the end of May. It must be stopped.
And that's just the cases that tested positive at the CDC two weeks ago.
Ugh.
It should be "its."
This has the potential to be very very bad. There doesn't seem to be a very serious effort to stop it, yet.
re" "balloon"
See graphs from last week in thread:
Marburg Toll in Angola Rises to 237 - 11 in Luanda
http://www.freerepublic.com/focus/f-news/1382511/posts?page=32#32
Adjust today's case number, adding back some of the
"administratively removed" cases, and estimating the
case counts nobody knows about yet, and see if we're
still on the curve of runaway spread.
And the CDC is still saying:
"No U.S. travel restrictions are recommended at this time."
(circa 14 April)
The CDC pages do seem to be quietly dropping the claim
that this disease is only 23-25% fatal.
Is there any effective treatment for Marburg?
No. They just try to make the patients as comfortable as possible. Beyond that, they can't do anything for them.
Do you know of any patients who have recovered from this outbreak, who could donate blood?
There was some mention on another thread that the US has a potential Ebola treatment, but that it is experimental, so it wouldn't be ethical to use on these terminally ill patients.
A fascinating article.
The most troubling aspect is the mention of "undercount" several times.
If we ignore the undercount, then the data are quite consistent and are showing that the epidemic is slowing, dramatically. Consider:
The number of deaths / cumulative cases is 233/255 ~ 92%, which has been the number throughout the epidemic.
However, these numbers are reported for today 4/17/2005. If the virus were spreading at the exponential level, the number of cumulative cases should be 413 as of today. Under the data we discussed before, that would lead to a total number of cumulative cases of 1 million by the end of June, 50,000 by the end of May, and 1,800 by the end of April. If these data are correct, the exponential growth is slowing dramatically.
We are at 158 cases below the exponential growth curve predictions. If the data are accurate, this is great news, the epidemic is becoming contained. By contrast, if there are 150 or so uncounted cases out there, then we are still following the growth curve.
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