DRC and Congo: Marburg haemorrahagic fever Information Bulletin No. 1 (4 suspect cases in DRC)

This Information Bulletin (no. 1/2005) is being issued for information only. The Federation is not seeking funding or other assistance from donors for this operation at this time.

This Buletin is issued in conjunction with the Minor Emergency for Angola: Marburg haemorrhagic fever outbreak, no. 05ME021, and it intended to highlight the response in countries neighbouring Angola.

The recent surge in cases of Marburg haemorrhagic fever in Angola has alerted many neighbouring countries to the risk it poses. Many have responded by means of task forces or focus committees. Cross-border travel and high mobility of people can easily lead to a spread of Marburg fever to countries like the Democratic Republic of the Congo (DRC) and the Republic of Congo (Congo). This potential risk has panicked many in these two countries, particularly in the border provinces of Bas Congo, Bandundu, Kasai Occidental and Katanga in DRC, and the provinces of Kouilou and Niari in Congo-Brazzaville.

Some cases that are suspected to be Marburg have been reported in Matadi (2), Kisantu (1) and Kinshasa (1), DRC; however, these are unconfirmed. There are currently no reported cases in Congo.

Analysis follows:

Both Knishas and Matadi are adjacent to Cabinda and North-West Angola.

The working thesis on this board is thatCabinda/Cabinda City is currently in the midst of an outbreak of Marburg that is being un- or undereported by WHO/Angolan Ministry of Health. [See http://www.freerepublic.com/focus/f-news/1392130/posts for more]

Our main evidence for this is the 26 April 2005 WHO field maps of Cabinda City up on http://unosat.web.cern.ch/unosat/ along with an earlier WHO field map of Uige town, the previous center of the outbreak.

To date Angolan offcials report only one (1) death from Marburg in Cabinda City. http://allafrica.com/stories/200504040492.html

However a ministry press release on 28 April 2005 http://www.angolapress-angop.ao/noticia.asp?ID=337223 (no English translation] References the barrio of "Povo Grande" which to the best of my searching ability seems to be associated with Cabinda City and Cabinda Province, not with Uige.

If the Povo Grande in this report is the barrio associated with Cabinda City, this would be further evidence of an outbreak in Cabinda. If there is an outbreak in Cabinda it is probably the source of the Marburg virus in the DRC (if the cases turn out to be Marburg).

The two other barrios mentioned in the release "Quixicongo and Quinguangua" appear to be towns to Uige Province.

Additionally, today (28 April 2005), the ministry of health has released new guidelines for its citizens. http://www.angolapress-angop.ao/noticia.asp?ID=337238 (not available in English)

Any further information on this subject is appreciated.

I would normally take the following article at face value--but given the lack of reporting from WHO in the Angola outbreak, I require more definitive proof (i.e. something from DWB/MSF or IFRC) before I will accept the statement below.

http://www.promedmail.org/pls/askus/f?p=2400:1001:14536390177800776959::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,28788

Training Exercise Responsible for Ebola Hemorrhagic Fever Alert

This report is apparently a miscommunication. There is no outbreak of Ebola
haemorrhagic fever in Equatorial Guinea. I have received this information
from a colleague in Equatorial Guinea.

"Maybe you heard about an Ebola Case in Bata (Equatorial Guinea); they
talked about it during the week-end on Radio France Internationale.
According to a WHO representative, what really happened was that a training
exercise was held to update medical workers on haemorrhagic fevers.
Evidently some people thought that there really was an outbreak of Ebola!"

Nevertheless, the point that Marburg hasn't seemed to spread geographically within Angola is an important one. I think most of the people who have been following these threads for the past couple of months expected to see some horrific numbers coming out of Luanda as the disease spread.

It hasn't happened, and there would be no way to cover up an outbreak there.

So, the virus is still in a very select area within Angola, almost exclusively within Uige, and now possibly in Cabinda City. But Cabinda City is where the virus was first identified, so it may not represent much of a spread, especially since it's very close to Uige, anyway.

Hopefully, the suspicious cases in the Congo turn out to be something else other than Marburg, but even if they are, this virus while extremely deadly, isn't appearing to be transmitted as easily as the flu.

These numbers indicate that the growth is increasing, not decreasing as previously advertised.

The basic dynamics of this epidemic can be modeled somewhat simply because the fatality rate is 100%. See Derive for a derivation.

The fundamental parameter (which you can infer from common sense) is the ratio of the cumulative deaths to cumulative cases (D_c/I_c). The lower this ratio, the faster the growth. This is common sense because it indicates that the number of active cases, which are the ones putatively that spread the disease, is increasing.

Indeed, including these 4 cases, the total number of reported actives is 24, which is the highest it has been in 4 weeks. Therefore, the growth is nominally faster now than 4 weeks ago. (Ignoring the "administrative re-classification" of data).

The present value is: D_c/I_c = 253/277 = 91% (including these 4 cases). This number has remained the same for the past 4 weeks, and arguably longer.

This thing is not contained.

My best guess (given that the data are all over the place and have been "administratively reclassified" to death), is that the e-folding time constant is about 40 days.

I think most of the people who have been following these threads for the past couple of months expected to see some horrific numbers coming out of Luanda as the disease spread.

It hasn't happened, and there would be no way to cover up an outbreak there.

That is an excellent point.

The epidemic is certainly not spreading anywhere near as fast as the original data indicated.

However, it is also not quite contained, as seemed to have been advertised.

Given the numbers reported today out of Angola, the disease continues to spread at a very slow, but steady rate. If these four cases are also Marburg, then the growth rate is increasing slightly.

Actually there is some question as to whether it is Kuando Kubango province (southern Angola)

http://allafrica.com/stories/200504080756.html

It is an open question whether there is still Marburg in Luanda.

The following article indicates that some measures are being taken in Cacuaco, a barrio of Luanda. About six miles from Luanda on the Luanda-Uige road.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/VBOL-6BVEQL?OpenDocument&rc=1&cc=ago

I would like this minor diaster to end--ASAP--and I am concerned that the lack of information from Angolan authorities and WHO are turning this minor diaster to a major disaster.

So far it has only affected the Angolan poor (who can not travel that far) and Angolan and International health officials (who apparently remain isolated after exposure). Unless it is stopped soon it will hit the Angolan middle/upper classes who can travel and who interact with international travellers.

There is some serious disinformation going on. Every recent article trumpets the fact that the WHO & CDC thinks the virus is contained and that uige is the problem spot and that infections were going from 35 a week to 15 a week.

What was actually said at the 25 April 2005 conference is as follows:

excerpt from: http://www.reliefweb.int/rw/RWB.NSF/db900SID/KHII-6BS2SF?OpenDocument&rc=1&cc=ago

Reporter: I just wanted to understand again where we are in the epidemic. Is it fair, does everyone agree that it's peaking now, or is it still too soon to say that? And the numbers--you've gone from about 35 cases per week to about 15 cases per week--is that correct? Is that a sign that it's peaking or do you still feel people are hiding cases from you?

Formenty: Okay. Quite simply, I would reply, it's an average since week 10 now that we have between 25 to 30 cases per week. Now we cannot really give you solid data, statistically speaking, because week 10 with week 11 and 12, we may have missed some transmission chains, because we were focused in Uige. This last week, week 15, we have had, I'm checking again, 15 cases, but still, there is in some barrios, suspect cases that are dying and there are still, for example today, four deaths reported by the community. Some of them were sick last week, so when we are talking about 15 cases last week, we are talking by dates of onset, and some people who were beginning their disease last week are dying just two days after, or will die today on Saturday or Sunday, so this number will go back. So week 15 is not over. And our tendency is that it seems that if we're talking about trends, I would say that it's just a gut feeling that maybe things are going to be better in the sense that people are reporting more and more systematically their deaths. For example, we are even organizing funerals not only for Marburg cases, but for other kinds of diseases. So we are much better in terms of our surveillance in the community. It seems that things are going better in terms of, people now, we see when we go for the corpses that are reported to us, when we go to these places, to see the family, we see in fact that they understand that the disease is transmissible by contact within the family, so they have just one or two people who are taking care of the sick patient at home, because they don't want for example to come to the hospital. And for example, the family knows that they don't have to touch the body, and this is why they are calling the medical teams. So the transmission, I would say, linked to the funeral and transmission linked to the patient is really decreasing. But still, for us, I would say a bit bizarre that we have these high numbers per week. 15 cases per week is high for a city like Uige. And we have the feeling, because we have heard several stories, that maybe the use of injection at home may be the cause, and sharing syringes or used needles, may be the cause of additional cases. And this is why we have these days developed a massive campaign against injection at home, and asking people to use other kinds of medicines or to come to the hospital or the health centre to have a safe injection with new devices.

The key line: We may have missed some links because we were concentrating on Uige.

I want this to be over, but I think we need to commit a lot more resources to ending it.

Just my .02.

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