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Sunday, May 29, 2005

WHO's Watching Marburg?

The WHO has been implying that the epidemic is slowing, things are getting under control, etc. Recombinomics (a private company) has been pointing out consistently that all is not well, that something is wrong, etc. Most of the problem may stem from the Angolan Ministry of Health, which keeps issuing premature declarations of victory. On the 16th an Angolan official claimed new cases were occurring only in the slums of the town of Uige.

Well, the "official" count of Marburg cases was up to 399 as of May 26th. Deaths were listed at 335. This has got to be an undercount. More new cases must be occurring outside of Uige town, and this seems to indicate a widening vector. As Recombinomics notes:
In the May 25 report these was one new case and one new fatality in the city of Uige on May 24 bringing the total number of cases to 350 with 316 deaths. The data as of May 26 is 399 cases and 335 deaths. Both of these numbers are 11 higher than the Uige totals, which has been the case for many weeks.

The differential between cases and deaths has exploded to 64. Since there a very few discharges, this big jump in reported cases that are still alive suggests a large jump in newly reported cases.. The May 25 report showed that the number of people being monitored had fallen to 153. Five were in Buengas, the remainder in Uige township.
See this prior post on Marburg, in which a person on the spot reported a dramatically different understanding than the Angolan Ministry of Health. On the 16th the local person had said in part:
"The outbreak is not over. We've seen new cases in new municipalities that don't have obvious links to earlier cases of Marburg. We are very concerned about the situation," she said, speaking by phone from the northern Angolan province where all cases have so far originated.
I would say she was right. On the 18th (using the figures from the 17th of May) WHO was reporting 337 cases and 311 deaths. There has been to date one confirmed survivor of this epidemic, so that meant 25 cases were new. It looks like there might be two now, because of the 335 deaths in the last report. (But CIDRAP reports 337 deaths. I think this is a mistake.)

Two survivors out of 337 cases? Sixty-two new cases in nine days? That's nearly 7 new cases a day. As near as I can figure, on April 19th there were 243 cases. That's 156 new cases in one month and one week, with the rate of new cases escalating rapidly. WHO reports that an effort to educate traditional healers is underway but they still seem to be blaming a lot of contagion on the practice of giving injections.

On April 27th WHO was reporting 275 cases in total. That is 124 cases in the last month. If nothing changes, we may well see 200 new cases in June.

Further WHO Marburg updates should be posted to this page.
Other links:
Canada. com
Angola Ministry of Health says epidemic ebbing (May 12th)

MOM, this is something everyone should really be concerned about.

I lived in Angola almost a year. I traveled in various parts of the country and participated in such things as monitoring aid food distribution and administering polio vaccine to children in the countryside. I met and dealt with a number of government officials and came to know the society fairly well. Angola is among the most corrupt countries in Africa with one of the least capable governments. That's saying a lot. To the extent we're relying on the Angolan government to manage the Marburg crisis, or even to collect and report data accurately, we're in trouble.

Marburg is a horrendous bug, and Angola is only a plane trip away from European and American cities.
Tom - I'm glad I'm not fighting ghosts here. This last set of stats looks to me like there must be cases outside of the town of Uige. I bet they don't have the manpower to even properly collect samples for testing. Surely WHO needs to move some major resources in there.

Thanks for contributing your hands-on knowledge. Not only is Marburg bad, but the fatality rate in this particular outbreak still appears to be over 99%. Furthermore, there are reports of people testing positive (women with babies dying) but not acutely ill. If this is true, at some point someone's going to leave the country who is ill.

I think it is time to move into pre-panic mode here.
I've said it before, I'll say it again- the clock is ticking.

Tom hights a three pointer when he clearly states an evident truth- "Angola is among the most corrupt countries in Africa with one of the least capable governments. That's saying a lot. To the extent we're relying on the Angolan government to manage the Marburg crisis, or even to collect and report data accurately, we're in trouble."

To be clear- there are no capable governments in Africa, save perhaps South Africa. The UN has, over time, been less effective than the WHO would have you believe.

This year- or next year or the year after- Marburg is going to make Avian flu look like a walk in the park. Toronto was a peek into the future.
SC&A - I sure hope not. This strain of Marburg has produced the highest death rate of which I've ever heard. I feel so sorry for these people; by helping them we would also help ourselves.

Both altruism and selfishness should agree on this one.
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