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Commentary

Marburg Spread to Democratic Republic of the Congo?

Recombinomics Commentary
April 30, 2005

>>  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. <<

The continued reports of Marburg in Democratic Republic of the Congo are cause for concern.  Although these reports remain unconfirmed, a confirmation of the agent causing the Marburg symptoms would be useful.  The discarding of most of the cases outside of Uige in Marburg raises the same concerns.  Since the number of confirmed cases outside of Uige is limited to 3 cases, all in Luanda, the ability of these other regions inside and outside Angola to collected a positive samples and deliver it to Uige or Luanda for testing remains unproven.

Negative data from sources that have never collected a positive sample is not very conclusive.  Statements on non-confirmation would be more convincing if a positive diagnosis was available for these patients.  The situation in Luanda is a good example.  Last month there were 5 Marburg deaths reported as well as two patients in Cacuaco who were hemorrhaging and sounding like Marburg victims.  The reported cases in Luanda grew to 12 and 6 of the patients had died.  However, the cases in Luanda were removed over a period of several days as were cases in other province in Angola.  In Luanda the number of cases was reduced to 4.  The number of other cases outside of Uige was reduced to 7 (5 in Zaire, and 1 each in Kwanza del Norte and Cabinda).  All 11 of the cases have died.  However, there has been do reports on what caused the deaths of the other discarded cases, which raises questions about the accuracy of the official lest as well as comments on unconfirmed cases outside of Angola

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Marburg Case Fatality Rate at 99.6%

Recombinomics Commentary

April 30, 2005

>> But while the number of fatalities had risen, Espirito-Santo said that for the first time an infected patient had recovered and was discharged from an isolation ward at the Uige provincial hospital.

"This patient's case may mean that not all infected will die and that people are developing antibodies to the disease,'' she said.

The patient's age and sex were not known. Espirito-Santo said more people were going to hospitals for treatment after an intensive publicity campaign to alert people of the dangers of Marburg. <<

The official announcement of the first Marburg discharge allows an accurate case fatality rate to be calculated. Various media reports indicated the rate was greater than 90%, but a true rate is based on outcomes. Assuming that the large number of discarded cases was not Marburg, the official count is 1 discharge and 257 deaths. Thus, the case fatality rate is 257/258 or 99.6%, indicating that prior reports of a case fatality rate of 100% were accurate.

The prior high case fatality rate for Marburg or Ebola was 88% and the record death toll is 280. Since the number of official cases is now almost 280 and the case fatality rate is close to 100%, it seems very likely that the current outbreak will cause more deaths than the highest recorded outbreak for Ebola. The prior Marburg record of 126 deaths was broken earlier this month