Marburg Toll In Angola Explodes to 200

[pandemic_1918]

Marburg Toll In Angola Explodes to 200
http://www.recombinomics.com/News/04070504/Marburg_Explodes_200.html
Recombinomics Commentary
April 7, 2005

>> As of 6 April, 200 cases of Marburg haemorrhagic fever have been reported in Angola. Of these cases, 173 have died. Kuanza Sul has reported its first case, bringing the number of affected provinces to six, all concentrated in the north-western part of the country. <<

The latest update from the WHO clearly shows exponential growth a Marburg cases, created increasing difficult conditions for contact tracing, which virtually assures continuation of the record breaking increase in cases.

The differential between diagnosed cases and those who have died has grown to 27. Last week the differential was 5-8. The increase in patients who are still alive does not indicate that patients are recovering. It indicates that new cases are being discovered faster than the older cases can die, because the number of older cases is small. The growing differential also indicates that a number of additional patients have been identified and the exponential growth virtually guarantees a new death record this month. The prior record of 280 deaths was set in the Ebola outbreak of 1967.

The dramatic growth in cases can be seen in the monthly figures. January there were 20, 31 in February, and 75 in March. In the first 6 days of April there are already 74 newly diagnosed cases. The case fatality rate remains at or near 100% and new cases in neighborhoods or slums near Luanda indicates many more infections will be reported in the coming weeks.

[etherealtruth]

1. I have heard that children are making up a large % ...

Which is unusual (compared to other outbreaks).
These hemorrhagic diseases scare the hell out of me.

[Warpy]

2. This one is particularly bad because the Angolese government

has lacked both the will and the means to quarantine areas where the virus has shown up, allowing people who think they can outrun a virus to take it with them wherever they go.

[etherealtruth]

4. We're all only one (relatively) short plane ride away from any disease

[pandemic_1918]

25. Marburg Has Spread to Zaire

Marburg has spread to Zaire, causing at least 6 deaths

http://news.google.com/news?hl=en&lr=&tab=wn&ie=UTF-8&scoring=d&q=marburg+zaire&btnG=Search+News

[sharonking21]

84. Just so we are clear here

I believe the reference to spread to Zaire is talking about the province of Zaire in far NW Angola (next to the province of Uige)--not the country we used to know as Zaire which is now (more or less anyway) the Democratic Republic of the Congo.

[Media_Lies_Daily]

87. It could just as easily be the country of Zaire.

[pandemic_1918]

93. Marburg in Zaire

The have been 6 deaths in the province of Zaire. It is the 7th province in Angola with reported Marburg.

Cases of Marburg in Democratic Republic of Congo (formerly Zaire) are still under investigation and have not been officially confirmed.

[pandemic_1918]

110. Marburg Death Toll Tops Ebola

Looks like Marburg has already broken the Ebola record for deaths (280), but since official numbers are trailing real numbers by 1-2 weeks official toll of infected at 218

http://news.google.com/news?q=marburg%20218&hl=en&lr=&sa=N&tab=wn

[pandemic_1918]

54. Marburg Transmitting in Luanda (have plane, will travel)

NPR interview today indicated Marburg was transmitting in Luanda

http://news.google.com/news?hl=en&lr=&tab=nn&ie=UTF-8&q=marburg+luanda+angola+sans

[pandemic_1918]

94. Airborne Transmission of Marburg

The large number of health care worker deaths from a relative small number of Marburg cases has raised serious questions about airborne transmission

http://news.google.com/news?q=marburg%20airborne&hl=en&lr=&sa=N&tab=wn

[sharonking21]

100. Airborne Transmission

First of all, lets clear up the difference between what is commonly referred to as airborne transmission and airborne droplet transmission.

Airborne droplet transmission consists of a situation where a large droplet of body fluids containing the virus is excreted (cough, sneeze, bleed, etc) and is directly and immediately transmitted into the body of a bystander--usually no more than 1 meter away--via some open portal into the body of the second person. This method of transmission has always been considered to be a potential way that both Ebola and Marburg could be spread. Further, usually it does not enter through the respiratory system, but instead the membranes of the eyes, open wounds, scratches,etc. It is properly classified under the label of Direct Contact Transmission. In this case the offending virus can be either one that has adapted to living outside the body for some time or it can be a virus that does not maintain well at all outside the body for any length of time--Ebola and Marburg are thought to fall in this class. Many things that are transmitted this way have a preference for attaching to certain cells of the body--if it is flu, which can be transmitted either way, its preference is for respiratory system cells. If it is HIV, for example, its preference is for certain immune system cells.

Airborne transmission is totally different. In that case the infected person does the same thing re: coughing or sneezing, but the virus is one that has adapted to living outside the body of the original host. In that case, it remains alive as the droplet condenses into what is called an airborne droplet nuclei or is encased in a dust particle and it hangs around suspended in the air or floats down and hangs around on the surfaces of things. In this case you do not have to be close to the person doing the coughing and sneezing. Either way, usually, the offending virus has a preference for cells of the respiratory system and you get it by inhaling the droplet nuclei or dust particles or by touching it and say, transferring it to your nose.

Second, I do not think that the fact that 17 workers in the hospital have caught it in the last month gives us any clue whatsoever that anything other than direct contact, perhaps including airborne droplet transmission, is going on.

It hasn't been even a month since they started shipping the barrier material to Uige. Further, even if they were inundated with barrier preventive material, staff have to be taught to use them properly. Keep in mind that here in the US, under the best kind of circumstances, not the chaotic ones in Uige,we still have a problem with hospital staff remembering to thoroughly wash their hands between patients. Also, the high rate of staff catching the disease is nothing new. Even if, as you appear to think, it has recombined with Ebola, which would be very interesting and you could be right, for all that I know about genetics, the Ebola outbreaks had just as high a rate of transmission and death among health care workers and yet the virus was not considered to be truly airborne.

What makes you think a recombinant would have characteristics that differ from both Ebola and Marburg?

[sharonking21]

107. Here is a link to the infection control

manual. It is 198 pages long and is more complex to implement than you might think.

Infection control for viral haemorrhagic fevers in the African health care setting

http://www.who.int/csr/resources/publications/ebola/WHO_EMC_ESR_98_2_EN/en/

[pandemic_1918]

80. Reuters Headlining WHO Operations Halt = Luanda Panic

Reuters headline of WHO operations halt will create panic in Luanda.

[pandemic_1918]

6. Now Its Adults in Luanda Slums (has airport)

The initial cases were children (possibly contaminated childhood immunization needles).

Now its adults, including those in slums of Luanda (Luanda population is 4 million and they have an International Airport).

[etherealtruth]

7. Aside from my compassion for the people there...

..."and they have an International Airport". As I said earlier, "We are all just one relatively short plane ride away..."

[hadrons]

3. this is a really nasty thing to catch

[pandemic_1918]

16. Marburg Transmitting in South Africa?

Marburg may be transmitting in South Africa - but they can't tell because they don't have any test kits!

Sounds like WHO let this one get away - they didn't do much until health care workers started to die.

[dxdem]

5. With life expectancies going up,

doctors have feared these kind of things running out of control. Scary as hell if you look at them closely.

I attended a presentation on the spread of SARS, and saw how they did the contact tracing, figuring out who the original carriers were, etc, and it was quite interesting. And scary.

[etherealtruth]

8. If there is any "good news" ...

This is transmitted through direct contact and is NOT airborne like SARS----something to be thankful for.

[pandemic_1918]

15. Coughing - 12 Health Care Workers Dead

There is a lot of coughing in early stages before hemorrhaging. I would not bet that coughing doesn't transmit. At least 12 health care workers have already died.

[etherealtruth]

17. Really? I'm relying on "old" knowledge...

It, may be due to poor sanitation, insufficient supplies and the resulting poor hygeine---at least I hope ...

[pandemic_1918]

22. Sanitation Doesn't Travel

The Marburg virus is traveling and transmitting with those fleeing Uige. If it was just sanitation, there would not be 12 heath care workers dead.

It may already be in Johannesburg

http://news.google.com/news?hl=en&lr=&tab=nn&ie=UTF-8&q=marburg+johannesburg+child

[etherealtruth]

28. Oh God, Thanks for keeping me updated ...

The media doesn't pay much attention. Johannesburg proper is like (I'm sure you know) a western city. I wonder if this case was in the "shanty town" areas-----the folk won't have access to care or the ability to take appropriate measures ...

The world really is one community...

Thanks again for the update

[pandemic_1918]

29. No Marburg Testing South Africa

South Africa says they have no "confirmed" Marburg. However, there is no Marburg test in South Africa, so confirmation is from CDC. They have not reported results, so until results come back from Atlanta, there are no confirmed cases.

[Dave Reynolds]

9. Nature always tries to find a balance.

There are too many of us, and we keep combating viruses. New ones pop up that we are unable to stop. It is a matter of time, I think.

[Sufi Marmot]

10. Hopefully they will be able to identify the reservoir...

There is likely some animal or insect reservoir that hasn't been identified yet.

[megatherium]

12. My recollection is that they been searching for the

reservoir for Ebola for a long time, but still haven't found it. They've looked at insects, bats, various other species. No luck.

[Sufi Marmot]

13. This is my understanding also...

It has to be there somewhere, though. Maybe some small rodent or other mammal that nobody has considered... :shrug: Or maybe a heretofore unidentified species of tick or louse? The monkeys with Ebola_Reston must have gotten it from somewhere...

-SM

[frustrated_lefty]

18. Identifying the reservoir isn't enough.

Reservoirs for various strains of Hanta have been known for years, but you still end up with the occasional outbreak in Morth America.

Med types in North America pretty much seem to rely on viral lethality to be self-limiting, at least in regard to the filo- and bunya-viruses.

[Squeegee]

20. My best friend's lab partner in college died from Hanta virus

Probably got it when he went vacationing in the desert southwest. He was the first reported victim of the virus in Washington State. Scary how close to home that one was.

[Sufi Marmot]

23. I realize that...

...but depending on the reservoir and the means of transmission from that reservoir, it might reduce the number of sporadic outbreaks if people knew what animals to avoid and could change their behavior (I wonder whether there is some relatively rare mammal that people use for bushmeat that hasn't been screened as the reservoir...) And once the reservoir is identified it would be useful to know why the reservoir isn't affected by the virus.

It's my understanding that in the case of hantavirus, rodent urine/droppings contain virus particles that can be aerosolized and inhaled, which accounts for the occasional outbreak in North America.

-SM

[Jose Diablo]

35. There is an account of a Hanta outbreak in Argentina I think it was

in Laurie Garrets "The Coming Plague". In the book she describes how field mice infested the village, living side by side with humans and it was mice excrement that was the vector for the virus. The book described the solution to this problem was bringing in ordinary cats to eat the mice and keep the mice numbers down.

I think there also was a Hanta outbreak here, in Southwest USA attributed to the same cause.

Something in the environment allowed the mice to reproduce unchecked, flooding the area with mice which carried the virus without harm to the mice hosts, but deadly to humans.

Thus the 'original' cause of the disease is not really the mice themselves, but rather whatever allowed the mice to reproduce without limits.

Disease and its cause is very complex and finding the real underlaying causes is not easy.

Edit: I just saw a mention of this book in a earlier post, sorry for the duplicate information.

[frustrated_lefty]

63. Just a note:

If memory serves me correct, that was named the "Four Corner's Virus."

[hatrack]

90. Hanta broke in 1993, I think

The winter of 92-93 was unusually rainy. This produced a bumper crop of pinon pine nuts (along with other seeds and such), which ended up producing large deer mice populations. So, with more mice to go around, there were more vectors for the virus, which was spread in the mouse droppings when they dried and powdered and started to blow around peoples' houses.

And as best I remember, Marburg was discovered through simian transmission - specimens shipped to a laboratory in Germany in (?)1967 (?).

[frustrated_lefty]

62. Your understanding is on the money.

"It's my understanding that in the case of hantavirus, rodent urine/droppings contain virus particles that can be aerosolized and inhaled, which accounts for the occasional outbreak in North America." Yes, no denial.

Generally speaking, the reservoirs for Hanta in particular are rodents. We, generally, avoid or exterminate them when we can. How often do we search out the dried urine or droppings of rodents? It's not my favorite hobby. :) Your point is valid, but I don't really think we CAN avoid the reservoirs more than we do so already.

[sharonking21]

89. Finding the reservoir is necessary

I agree with you, Sufi Marmot. Until you uncover the reservoir, you do not really know the extent to which exposure to it can be altered. In many instances you cannot reduce exposure to zero, but you can minimize it.

Plus as someone else on here says, there are environmental ramifications. If you know say, that something comes from rabbits, for example, and rabbits are multiplying (--uh, when do they not?--), then local physicians can be warned to have a higher index of suspicion for that disease.

[megatherium]

11. Anyone read The Hot Zone,

by Preston?

Came out about 10 years ago. Preston describes the near disaster that resulted when a quarantine facility for imported monkeys in Reston Virginia had an outbreak of a hemorrhagic fever. The authorities (epidemiologists from Fort Dietrich) knew that it was a strain of Ebola and they knew that humans had been exposed and were possibly infecting others in the Washington DC area. They also had reason to believe this strain of Ebola spread from monkey to monkey through the ventilation system. They had to go in and destroy the monkeys, one at a time by hand (particularly challenging to do since these animals were like dogs, strong with large canine teeth, but quite intelligent). Before this operation began, they told the public that a certain virus had infected the monkeys but the virus wasn't something to be alarmed about and the situation was under control. Complete lies, which the local media reported without question.

Fortunately, it turned out that while the human workers had been infected by the virus, the virus does not make humans ill. This virus is now called Ebola Reston.

[etherealtruth]

14. It was a good read n/t

[davsand]

19. There was another similar book out at around that same time.

It was, however, WAY more based in science. It scared hell out of me because it discussed in detail the epidemiological aspects of stuff like Ebola and Marburg.

Marburg was first discovered in Germany in some vaccine factory. Three or four employees reported "flu like" symptoms then began bleeding out within a day or two. Over 30 people became infected in this particular outbreak--including health care workers, co workers, and even household guests. Something like 7 or 8 ended up dying from it. They estimate marburg to carry something like a 25% fatality rate.

What makes this shit so awful to track is it has an ability to lay hidden for a while. The original patients reported some time in the summer and it dragged on up thru the end of the year. The outbreak was ultimately linked to exposure to a shipment of African green monkeys from Uganda.

Outside the body, Marburg is easily killed by methyl alcohol.

Ebola, on the other hand, is capable of a 90% death rate depending on the strain. Ebola is rather fragile, for being such an officiant killer. It doesn't do well with UV and is not inclined to do well in hot and dry places.

Last I read on it, they were saying they still have no idea what the host for Ebola is. It has been linked to monkeys (the Reston outbreak was termed an "Ebola like virus") but I don't think they have ever determined for sure where it comes from.

I'm not making light of what those folks in Africa are facing with this Marburg outbreak--it scares me to think of it here in the US--but certain Ebola strains scare me a whole lot more...


Laura

[megatherium]

21. Wish you could remember that title.

The Hot Zone might have been a bit sensationalistic, but I had no reason to believe it wasn't scientifically accurate. (The bottom line is no humans were made ill by the virus, although it was hell on the Rhesus macaques.)

[Cronquist]

24. try "The coming plague"

NT

[megatherium]

30. Thanx -- I remember seeing that book. nt

[frustrated_lefty]

67. Sorry to break it to you,

but most, if not all, viruses can be killed by methanol, ethanol or UV. If you want to be really anal about it, wipe a surface with 10% bleach and let it sit for 10 minutes. Follow with a wipe of 70% ethanol and let that sit for 10 minutes. Everything that was on the surface will be dead.

[Media_Lies_Daily]

99. The 100% fatality rate of THIS Marburg virus is bothering me a LOT....

...more than Ebola.

Ebola tends to exhaust itself rather quickly because of a relatively quick incubation period and symptoms that are pretty well known, allowing for quaranting of the affected area.

This strain of Marburg appears to have a longer incubation period allowing the victims to travel who knows how far away from their infection point, and interact with other people before they begin to exhibit symptoms.

[sharonking21]

26. Reposting from addition to earlier thread

I just posted this on an earlier thread. Seems to more properly belong here.

Here is an update report, immediately below. 6th province added.

Death toll from Marburg virus hits 173, Reuters
Fri Apr 8, 2005 7:34 AM BST

http://today.reuters.co.uk/news/newsArticle.aspx?type=worldNews&storyID=2005-04-08T073400Z_01_SIN827114_RTRUKOC_0_HEALTH-ANGOLA.xml

Also I got to looking for things about the Congo Marburg outbreak and found that it differed in character from this outbreak in Angola, in that in the Congo the cases were mostly young men working in a gold mine and there appeared to be little spread from hospital settings (One thing I immediately wondered was whether or not there were any hospitals close to the epicenter of the outbreak?? Article doesn't say).

Further, most of the cases in the Congo, although not all, appeared to be primary cases and not cases due to secondary transmission. We know that in Angola it has been centered more around children under the age of 5 and that in Angola there have been several nosocomial (medical care setting infections).

As an epidemiologist I sure would want to follow up on these clues. I'd be asking things about the children like common habits, recent injections, were they mostly primary cases, and trying to map cases geographically, separating out children under age 5, primary and secondary cases, nosocomial vs. non-nosocomial etc.

If anyone comes across information on these things, please post!

I cannot get enough on-line information on either outbreak to even begin to think about it.


Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo

Emerging Infectious Diseases Vol. 9, No. 12m December 2003

http://www.cdc.gov/ncidod/EID/vol9no12/03-0355.htm


Who, Weekly Epidemiological Record

http://www.who.int/docstore/wer/pdf/1999/wer7420.pdf

Infection control for viral haemorrhagic fevers in the African health care setting , 1998

http://www.who.int/csr/resources/publications/ebola/WHO_EMC_ESR_98_2_EN/en/

[Sufi Marmot]

33. Is it known whether there are multiple independent initial infections?

Undoubtedly the CDC/WHO is trying to map out the relationships between people who are infected, in order to follow the spread of the virus from person to person. Is it known whether all the patients infected to date can be plausibly traced to one primary infection, or are there multiple independent primary infections in the region? (Or have things gotten sufficiently out of control as to make it impossible to determine?)


-SM

[MetaTrope]

34. That Congo gold mine had been taken by rebels

from an obscure Canadian company called Barrick Gold.

Might ring a bell for one or two people here?

[truthisfreedom]

27. using simple math

20 in jan to 31 in feb = 1.5X growth
31 in feb to 75 in mar = 2.4X growth
75 in mar to (let's say it's linear) 370 in apr = 5X growth

but it's not linear. so there may be several thousand cases in april.

this estimate is exceedingly conservative. uncontrolled, growth will be tens of thousands of cases within 2 months. which will explode to hundreds of thousands of cases shortly thereafter.

this is a very very bad thing. it's definitely not a fun study in exponential curves. it's just plain evil. we need to throw a lot of science and medicine at this right now, and keep throwing money, resources and people at it until we put this fire out.

[frictionlessO]

31. Im a layman here, so help me out.

1st, is this something to actually really worry about here in the States, yet?

2nd, is this as bad or worse than bird flu (H5N1 ? I think thats it, right?)in regards to potential spreads here in the States.

3rd, Which one scares you all more in regards to 1 and 2...

Im a HS dropout and well...
plainly quite ignorant on most subjects but this viral/bug stuff is really starting to make very paranoid which is easy enough to deal with, im just wondering if I should be getting my friends and family paranoid yet as well??

Thanks in advance!

[Jose Diablo]

36. Marburg is real nasty, but

by and large it is self-limiting because it has a short incubation time and it kills with a very high rate of infection.

What is interesting is normally Marburg and Ebola must be transmitted via direct blood contact. Contaminated needles for example.

What is mentioned in above posts is the possibility of a Marburg or Ebola virus that can be transmitted via aerosol, coughing for example. That type of virus normally has a thick protein coat to allow it to survive in the air and not need direct contact to transmit to another host. This is what is called going airborne.

If Marburg or Ebola type virus mutates to allow a longer incubation time, it is airborne and it stays as deadly as it is, then yes, we are in deep trouble as humans. Because with modern transportation and the number of people living close together in cities, It would be very very bad.

I think Steven King called it Dr. Tripps in one of his fiction books and it literally cleaned the slate of humans, everyplace.

Edit: It should also be said that a virus as deadly as Marburg or Ebola has only a small and limited number of encodable genes in its genetic make-up. For it to mutate to code for a thicker protein coat for example can only be achieved at the expense of some other attribute, such as deadliness. Thus the possibility of a naturally mutated 'super' virus like Dr. Tripps, are slim.

[frictionlessO]

37. Ahh some good info thank you! But which one at this point is more of

a threat?? Maybe thats just way to vague and unfocused at this juncture??

I'm sort of freaked by this because if this Marburg has gone "airborne" or is able to sustain itself for very long outside its host... well it sounds horrible. It bodes very ill for human existance in general.

Guess Im just very very scared with this on top of Bird Flu.

Heres my longwinded breakdown of "The Stand"

In Kings' book "The Stand" he called the virus Captain Trips ( I can't remember how it related out to the original Capt. Trips- Jerry Garcia) I believe. Having read the book when I was around 18 it freaked me out for about a year. The storyline is basically two parted with the first part being about the disease itself and using the growing epidemic as a platform to build up the main characters for the second part which is basically another confrontation between ultimate good and evil (which is what many storylines are... a derivative of hero/antihero triumph or loss w/ moral underpinnings that the audience will directly relate with). The book was best and at its most creepy (because of believeability) in the beggining when focused on the disease, by the time the supernatural part of the plot rolls in a reader is already heavily invested in characters so they finish the bible size book. If you ask anyone though what scared them more the Antichrist or Capt Trips it'll be Trips hands down.

Right now in this day and age that would be the last thing I could read!

[Jose Diablo]

38. A person could go nuts just trying to think about all the "What Ifs".

I think a lot of the news is like background noise more designed to keep people on the edge. The terror alerts sort of thing.

The point is, if Captain Tripps (you are right on that name, I forget details) becomes reality, there is nothing any of us could do anyway. So why worry?

But like I said, it is possible but not likely Tripps can come into existence, at least naturally.

[amazona]

102. captain tripps was the flu, ya'll

During the mid 70s, we had a swine flu hysteria that as far as I know led to the first time that large numbers of college students were vaccinated against a flu strain. Some small number of the people who were vaccinated during that hysteria became paralyzed and may still be for all I know. It has always seemed to me that swine flu hysteria played a part in the inspiration for The Stand although I don't doubt that the Spanish Flu of 1918 played its part as well.

Captain Tripps was indeed a weaponized flu that escaped from a lab in the U.S.

Me, if I really wanted to go "tinfoil," I'd ask what the good Stephen Hatfill was doing these days. Despite his lack of credentials, he was working with Ebola and Marburg virus, if you think back to one of our previous disease hysterias.

Despite having used false credentials to gain access to these materials, hmmm, he wasn't ever arrested, was he?

The conservation movement is a breeding ground of communists
and other subversives. We intend to clean them out,
even if it means rounding up every birdwatcher in the country.
--John Mitchell, US Attorney General 1969-72

[Jose Diablo]

39. As for who is more scary, the antichrist of tripps?

Tripps is far more scary because there is no way for humans to 'win'.

The antichrist, he is more like just a evil superpower with human attributes we ourselves have. Like a man but meaner and a little more powerful. He can be beaten, although not easily. Witness in the novel, 'Trashcan'. He hauls a A-bomb to Vegas and thats the end of the evil. Boom, the antichrist is reduced to atoms and his vaporous soul/spirit. He is gone.

But Tripps? No getting away. It is a crapshoot if you live or die. Thats much worse than any charecter with human traits.

Thats my opinion anyway.

[frictionlessO]

41. I do believe youre pretty much right.

Also as I said its the most common storyline with Trashcan being a sorta antihero overcomeing the obstacle (his own darkness) and triumphing. I think readers eventually get really tired of this storyline so that in combination with what you said severely limits the overall "creepyness" post novel on that end. Again the novels truly scary part is the virus for exactly those reasons you listed...

which is again why Im getting more and more paranoid about viruses, seems like they keep bubbling up and we dodge a bullet and then comes another new strain or mutant. Seriously Ive never found myself hoping with such fervency that this is in some regards just professionists lineing up background for larger research grants??!!

Thanks for your words Diablo!

[Jose Diablo]

45. As for Trashcan, I think he is the most interesting character in the

whole story.

Think about it, after tripps comes and kills whole cities, Trashcan cames after and burns them to the ground. Thus, also destroying any after effects from tripps.

Then Trashcan meets Flagg and says "My life for yours". Now what does that mean "My life for yours"? Does he mean he will do anything for Flagg or does he mean he will sacrifice his life to destroy Flagg.

Clearly Flagg believes Trashcan is his man.

But in the end, I think we see Trashcan for what he really was. Crazy, you bet. But he also was a force for good for he took-out Flagg. Well actually, a fist slammed the bomb but Trashcan did haul the bomb there for that fist. And not only that, but Flagg himself created that fist which was used to slam the bomb.

In a way, Trashcan is an enigma. Who can really know evil or good? And for what or whos purpose do we work? In the end, concepts like evil and good are really man made concepts, from the book we can see there is really only one purpose. That purpose cannot be altered or changed to suit what we think is a evil or good purpose. The purpose just is and the book shows how that purpose cannot be changed by us or Flagg. It is a form of destiny/fate and we are just along to help make that fate reality. As the ancient Hebrew believed, good and bad all came from God as He decided.

I don't know if King planned it that way, but thats how I see Trashcan.

Edit: Anyway, this is way off topic. Sorry.

[frictionlessO]

48. No way Jose! (sorry had to)

It may OT in being directly about Marburg but that was a beuatifully well put analysis of Trashcan. Its been so long since I read it but your insight sounds dead on from what I remember and while King is not my fave or the best author ever, I would tend to think that it is pretty damn close to what he intended for those who would contemplate such meanings within his characters.

Yes, very well written and thought out. Bravo!
:applause: :applause:

[dansolo]

103. "Chain letter of death"

The part that freaked me out the most was the two page chapter that described the transmission from one person to another, through seemingly innocuous activities.

[Media_Lies_Daily]

55. For whatever reason, this version of Marburg appears to have....

1. a longer incubation period;

2. an airborne capability;

3. gone out of control because of the slowness of the Angolan government to report the disease to WHO. If it has reached one or more major metropolitan areas, the chances of it expending the "fuel" it feeds upon is slim, IMHO.

[Matriot]

81. I hate to be the bearer of bad news but here's what CDC has to

say about transmission

How do humans get Marburg hemorrhagic fever?

Just how the animal host first transmits Marburg virus to humans is unknown. However, as with some other viruses which cause viral hemorrhagic fever, humans who become ill with Marburg hemorrhagic fever may spread the virus to other people. This may happen in several ways. Persons who have handled infected monkeys and have come in direct contact with their fluids or cell cultures, have become infected. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease.

http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/qa.htm


Body fluids includes saliva and since it's close contact setting it means I could get sneezed or coughed on and catch it, so the virus is airborne.

[sharonking21]

85. There is a difference between

a virus that can be transmitted through someone coughing and getting airborne droplets directly into your eye or in an open wound or on other mucous membranes and a virus that is adapted to hang around a long time in the air or on surfaces. Airborne droplet transmission is not the same thing as regular airborne transmission. For example, it is thought that the flu can be transmitted both ways--either truly airborne or airborne droplet.

[obxhead]

104. I think Steven King called it Dr. Tripps

Captain Trips, tube neck etc. read it 5 times (the stand)

[sharonking21]

43. Here are some links to an earlier thread

In general there is much more to fear from a mutating flu--as to the potential for a worldwide pandemic killing millions.

For background information go here.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=102&topic_id=1332019

Without a radical mutation, about which nothing has been published yet, Marburg is likely to be more limited in geographic scope because, unlike the flu, it is thought to mainly be spread from human to human through contact with bodily fluids, especially blood and semen.

That does not mean that people taking care of Marburg patients cannot get it, say, through the patient coughing droplets into the eyes or into open wounds of those caring for the infected person. This mode of transmission remains uncertain because they are "up to their ass in alligators" at present just trying to stop the disease.

The disease is so rare that not everything is known about it.

[frictionlessO]

47. Thank you very much Sharon!

Its time to really get edumacating myself, I think.

Thank you for your explanation on why the flu is a more substantial threat as well.

The Marburg situation sounds intense, those are very brave souls down there caring for the ill.

[sharonking21]

51. Ages, other factors

In addition to the above on the large proportion of early cases being children under the age of 5, it would be helpful to know the extent to which these were infants and non-infants. Different kinds of risk factors you would look for in the two groups. I would also look to see if any sex differential among children.

Additionally, I would want to know if there was some other common factor such as:

*living in an institution,

*going to a common ante-natal clinic etc., where they had any kind of invasive procedure, (including injections),

*recent repatriation into Angola from areas further north and east, and,

*not only if recently there were childhood immunizations given in Uige area, but even more importantly,

*whether or not the practice of folk medicine there (as is the case in other parts of Africa) includes the practice of getting injections from non-Western-medicine practitioners.

*Also have to look at any custom that calls for cutting the skin--such as circumcision or scarification to create artful patterns.

The reason I harp so much on injections is that often in Africa, even still in the AIDS era, in the poorer parts, you cannot be sure that injections are given with sterile needles. They often don't have the money to use throwaway needles.

[Matriot]

86. I stand corrected about it being a truly airborne virus and

hopefully it never mutates to that stage. Also, you're right in the fact that WHO and CDC don't have enough information about this virus. So with that information you would think that the CDC would restrict travel to these areas but on their website they still recommend no restrictions for travel. Are they trying to invite it to the US?

[sharonking21]

32. Link to map of Angola

For those who want to see the placement of the provinces and cities mentioned in different reports, here is a link.

http://www.reliefweb.int/rw/fullMaps_Af.nsf/luFullMap/9B3869E204F4A19685256AA8004EC2ED/$File/accessible_ang701.pdf?OpenElement

It is old--from 2001, but will serve for this purpose.

[sharonking21]

42. Maps

Let's see if this link works--the one I provided above does not.

http://www.angola.org/referenc/maps/northmp1.html

[Sufi Marmot]

40. This bit from the WHO website is troubling...

From today's update:
WHO update April 8th

Mobile surveillance teams in Uige were forced to suspend operations yesterday when vehicles were attacked and damaged by local residents. As the situation has not improved, no surveillance teams were operational today in this province, which remains the epicentre of the outbreak.

It sounds like the local residents aren't cooperating, which could make things much worse...

-SM

[sharonking21]

44. Yes, it is

I imagine at this point no one wants to admit they might have been exposed because they are afraid what will happen to them re: quarantine etc. and they see that being taken to a hospital doesn't help. Probably want to remain mobile in case they feel they need to flee--not sure of situation re: travel restrictions and, if any, of enforcement of same. But UN vehicles are probably not too welcome.

[pandemic_1918]

46. Uige Residents Killing Health Care Workers

Its worse than you think. The bodies were health care workers killed by the local residents in Uige

http://news.google.com/news?q=marburg%20uige%20health%20care&hl=en&lr=&sa=N&tab=wn

[sharonking21]

50. Hoo boy! (N/T)

[frictionlessO]

52. Is that good or bad or both???

bittersweet?

[sharonking21]

61. Bad

If they are turning on health care workers or on UN, WHO, CDC personnel it will be much more difficult to contain the outbreak.

[sharonking21]

101. Has this ever been confirmed?

I haven't heard.

[robcon]

49. It's a fairly deadly disease...

Is the disease ever fatal?

Yes. The case-fatality rate for Marburg hemorrhagic fever is between 23-25%.

http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/qa.htm

[pandemic_1918]

53. Case Fatality Rate is Near 100%

The case fatality rate for Marburg in Angola is at or near 100%

http://www.recombinomics.com/News/04080502/Marburg_Death_Rate_174.html

[robcon]

57. I don't accept the alarmist site you linked to.

I think they overstate the impact of the virus.

[pandemic_1918]

65. WHO Figures

The data is put out by WHO from CDC data for THIS outbreak (not 1967 in Europe, including Marburg) where lab workers were infected with virus from African green monkeys imported from Uganda for research purposes.

You are VERY lost. You need a map of Africa. Uganda is in EAST Africa. Angola is in WEST Africa. The total number of discharges in Angola is 0 or 1. The number dead is 180.

What does 180 divided by 181 equal? I think it is more than 25%.

[pandemic_1918]

97. WHO Site on Marburg - Case Fatality Rate Higher than Previous 80%

This is directly from WHO site on Marburg. They won't say at or near 100% (which is the real number),

http://www.recombinomics.com/News/04080502/Marburg_Death_Rate_174.html

but they will say "even higher" than 80% seen previously. The math is easy, but WHO doesn't want to say "no survivors" and let the cat out of the bag. Instead others can rationalize the rate lower by thinking new admissions are "survivors", but Marburg clearly doesn't read press releases and doesn't care who rationalizes what - it takes NO PRISONERS:

http://www.who.int/csr/disease/marburg/en/

"Illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Many patients develop severe haemorrhagic manifestations between days 5 and 7, and fatal cases usually have some form of bleeding, often from multiple sites. The disease has no vaccine and no specific treatment. Case fatality rates have varied greatly, from 25% in the initial laboratory-associated outbreak in 1967, to more than 80% in the Democratic Republic of Congo from 1998-2000, to even higher in the outbreak that began in Angola in late 2004.
"

[Theres-a]

98. Any word on the 9 quarantined in Italy?

[sharonking21]

108. The articles about the isolation

seem to have come out around April 1. It is now April 10. I haven't heard anything about them becoming ill but I would like to know that in the sense of finding something directly saying so.

[Theres-a]

112. Isolation,you're right,my mistake,not a quarantine.

Still,I'm curious about those people.

[Media_Lies_Daily]

56. That rate of 23-25% is not even remotely close to what's happening....

...in Angola.

[robcon]

58. I accept the cdc before the recombinomics site.

I think, until further research is available, the 25% number should be accepted as more accurate.

[sharonking21]

59. Please see this earlier explanation about case fatality rates

Case Fatality Rates that Differ by Outbreak

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=1332019&mesg_id=1349544

Note also that a case fatality rate is quite different from a death (or mortality rate)

[pandemic_1918]

60. Math Made Easy

The CDC site has data from 1967. It is 2005. The death toll has been published countless times. It is above 99% using numbers from WHO for THIS outbreak

http://www.recombinomics.com/News/04080502/Marburg_Death_Rate_174.html

There are 174 dead and at MOST, 1 survivor (30 out of 31 died in February according to Red Cross figures, but the ONE survivor may simply be in the hospital or result from someone walking out of the hospital and dying elsewhere). The death rate is somewhere between 99.4% and 100% (it is 99.4% is the ONE patient really recovered - but even the one is unlikely).

25% is nonsense. It applies to Marburg in EAST Africa years ago. Angola is in WEST Africa (where Ebola is and fatality rates are much higher).

[robcon]

64. That's untrue, pandemic_1918

The WHO statistic, which I will accept a long time before the alarmist site you have linked to several times on this thread, is 80%, which is an update compared to the CDC's 23-25%.

"...Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said."

http://www.nytimes.com/2005/04/09/health/09angola.html?th&emc=th

[sharonking21]

69. The Congo outbreak CFR is more like it, but

this particular outbreak is somewhat different in character and seems to be, on the face of it, more severe than was the case in the Congo. However, I do think Pandemic's way of calculating CFRs is somewhat idiosyncratic and may in the long run slightly overstate the CFR. What we do not know at present is the number of such cases who contracted Marburg, but never got counted, because they

*didn't become as ill, didn't go for care, etc.

* or, died without making it into the counting system.

The CFR can be misleading. You can have an extremely high CFR and still not have anything like a pandemic. What really counts in regard to spread is how many actually get the disease, especially from other humans, along with how easy or difficult it is for them to infect others. The reason this is more important is because the more people who are infected and the easier it is to transmit, the more opportunity for the virus to be given to others--it will determine how extensive the spread of the virus will be.

[pandemic_1918]

74. No Survivors = 100% Case Fatality Rate

The simple fact is there are no documented survivors in Angola (while there are in other outbreaks of Marburg and Ebola).

The math is simple and not idiosyncratic. It is how case fatality rates are calculated ("case" is the key word).

[pandemic_1918]

71. 99.4% is More Than 80%

Ebola can kill at 88%. "More than 80%" simply means he doesn't want to do the math. There are NO survivors (Red Cross monthly numbers). That is why there is civil unrest.

http://www.recombinomics.com/News/04090502/Marburg_Lack_Survivors.html

The only patients alive are those who just entered the hospital. They will be dead in a few days.

[sharonking21]

72. CDC should update their site

Their site fails to take the Congo outbreak into account when they cite this low CFR. I can think of two possible reasons for this.

CDC is having to get by on less money than they did previously and the first things to go are things like website maintenance.

Also, I think C.J. Peters is still the head of the special pathogens branch and I have read that he is more of a "doer" and pays little attention to things like actually publishing results. This might sound rather heroic, but that means that others cannot keep up with what is going on.

[pandemic_1918]

79. Red Cross Data on Monthly Fatalities - 100% CFR

The Red Cross has published monthly figures on Marburg cases and deaths in Angola. There is no doubt that the case fatality rate is at or near 100%

http://www.reliefweb.int/rw/RWB.NSF/db900SID/DDAD-6B6KXM?OpenDocument

[Silverhair]

92. The other 20% just haven't died yet.

Even with a rapid disease like Marburg, it still takes some time to die from it. So for a while, a person sick with it but not yet dead is listed as diagnosed. That does NOT mean they got well.

You need to look at how many people, who were diagnosed one month ago are alive now. That give you your real fatality rate. So far there have been no survivors for one month.

That is were the 100% case fatality rate comes from.

[pandemic_1918]

96. Globe & Mail Says 98% Case Fatality Rate in Uige

Here is 98% case fatality rate quote in today's Globe & Mail

http://www.mg.co.za/articlepage.aspx?area=/breaking_news/breaking_news__africa/&articleid=201234

Reporters frequently have problems doing math or using anything not spoon fed to them. WHO knows there are no survivors as does anyone else who is paying attention. When WHO announced it was Marburg on March 23, there were 102 cases and 95 were dead.

http://www.recombinomics.com/News/04100501/Marburg_Airborne_213.html

The 7 alive then are dead now (or in the hospital). They were alive then because they had just been diagnosed.

The latest NY Times cites only 12 patients in Uige main hospital (and those 12 will be dead in a few days - the others that are still alive are scattered throughout Angola and are cases that have just been diagnosed).

The math is pretty easy. There are 184 dead and maybe 1 survivor. Case fatality ratio is above 99.4%. Anything lower is simply counting patients in the hospital who have not bee sick long enough to be dead.

[pandemic_1918]

113. 231 cases = 210 dead + 21 ill (what's missing)?

Below is the description of the 231 Marnurg cases in Angola. If the 231 cases include 210 dead and 21 ill, what does that say about the number of survivors?

http://health.dailynewscentral.net/content/view/000630/31/


Marburg hemorrhagic fever had claimed the lives of 210 people in Angola, and 21 individuals currently were ill with the usually fatal disease, as of April 11, the World Health Organization (WHO) reported on Wednesday. Almost all of the cases occurred among residents of Uige Province in the northwestern part of the stricken country.

[sharonking21]

66. Actually it applies to Western Europe

mostly. Supportive health care was much better there in 1967 than it currently is in Angola. And the people of Europe had a more sturdy immune system status, given that they were well fed and not under attack by other pathogens. Angola has just ended a 27 year civil war. People are coming back from other parts of Africa to resettle but health care is not well organized there yet. Also the workers who got it in Europe may have received less of a "dose" than the people currently coming down with it. And the strain could also have changed.

Most peple do not understand the abject poverty of some of the areas in which these diseases are hitting. They do not have the money to devote much to sterile needles or to protective barrier methods that would reduce nosocomial transmission.

[frustrated_lefty]

68. Nosocomial infections....

The phrase always makes me laugh. For those unfamiliar with the term, it's a bug you picked up while you were seeing the doctor. And, funny enough, it happens so often, they had to make a name for it.

[sharonking21]

70. Yup

It has always occurred, but the problem has become worse.

1. In Westernized countries, we had a period after the introduction of antibiotics where the rate of nosocomial infections dropped. However, that was a mere illusion, as the bugs were busy mutating and adapting and such rates have been rising over the last 20 years at least. (So perhaps we can be --ugh--I hate to say it--glad that the insurance companies toss us out of hospitals as soon as we can stagger out of there. Need I say that I don't think their motivations are altruistic.)

2. In non-Western countries which have nevertheless adopted Western medicine, it is a horrible problem because they do not have the money to take proper precautions to stem the spread of infection.

(Edited to insert a missing word)

[pandemic_1918]

73. Marburg in Eastern Africa is Not Marburg in Angola

There have been outbreaks in Kenya and Zimbabwe with lower case fatality rates for Marburg there. Marburg in Angola is more lethal. There are NO documented survivors (including health care workers, one was Italian).

[sharonking21]

76. Yes there have been small outbreaks in Eastern Africa

See:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=1332019&mesg_id=1349544

The numbers of cases there were so small that no calculation regarding them means too much.

I agree with you Pandemic that the virus appears to be taking a much heavier toll of those who become cases in Angola.

When I speak of the way you calculate case fatality rates, the only thing I am talking about is that normally you give the case the benefit of the doubt and do not count him or her as dead when you do not have actual confirmation that they are dead yet. Instead they remain in the denominator of CFR calculation.

[pandemic_1918]

77. Benefit of the Doubt Creates Confusion

No, assuming that someone diagnosed will live simply creates confusion and misrepresents the facts. WHO and CDC did this with SARS. They generated an artificially low case fatality rate by counting newly diagnosed patients (most CFRs are calculated after the outcomes are known), and then when the hospitalized patients began to die the rate started to go up. But it was artificial. If you just counted known outcomes (deaths and discharges), the rate was steady.

It is even more absurd for Marburg in Angola because the there are no survivors. As the the infections spread and those coming into the hospital exceed those leaving (dead), the rate appears to come down.

The rate is supposed to indicate the chances of dying from the disease, and those chances do not decrease when people enter the hospital more quickly.

Right now the case fatality rate in Angola is at or near 100%. The true rate cannot fall without recovered patients, and at this time there are NO reported recoveries (maybe 1 in February - but not likely).

[sharonking21]

83. CFRs

1. I understand your logic.

2. However, because you calculate them in a different way, it makes your CFRs non-comparable to statistics calculated in the usual way.

3. People need to understand that CFRs are interesting and can be roughly calculated immediately, but a high CFR or even a 100% CFR does not translate by any means into a forecast that the disease is going to spread wildly.

[Media_Lies_Daily]

91. Show us a link that discusses any survivor of this Marburg strain...

...until then, I'll stick with what pandemic_1918 is telling us.

I have an opinion about the real purpose of WHO and CDC. IMHO, their job is to reduce or eliminate panic by reporting statistics that show CFRs in the best light possible.

[Media_Lies_Daily]

88. Believe what you want to believe...we'll go on with this thread anyway.

[sharonking21]

75. This is interesting

In this article they mention that:

"The initial outbreak appears to have spread through a pediatric ward in Uige, a town in a farming district about 180 miles north of the capital of Luanda. More than 60 percent of the victims so far have been children.

http://www.theledger.com/apps/pbcs.dll/article?AID=/20050409/ZNYT03/504090450

If they are correct, the amplification may have occurred in this single place.

[pandemic_1918]

78. Dirty Needles - Childhood Vaccinations

The hypothesis is that the initial spread was driven by dirty needles used for childhood vaccinations (most initial cases were under 5). However, now most of the new cases are adults and the cases are in 7 provinces.

[justsomegirl]

106. question

Why is it that so many of these diseases come from the African subcontinent?

[pandemic_1918]

109. Lots of Virus

Africa is breeding ground for new and improved viruses,

[sharonking21]

82. Age of initial cases

This older Medicines Sans Frontieres article says that most of the intitial cases were infants under the age of 1

http://www.msf.org/countries/page.cfm?articleid=CC85E827-D9A2-4E4C-AE285F40D9505424

[norml]

95. Lack of Marburg Virus Survivors Creates Civil Unrest in Angola

Commentary

Lack of Marburg Virus Survivors Creates Civil Unrest in Angola

Recombinomics Commentary
April 9, 2005

>> Allarangar Yokouidé, an epidemiologist with the World Health Organization, told reporters that more than 80 percent of those who contracted the virus in Angola had died, a mortality rate that surpassed previous Ebola epidemics in the region. "Marburg is a very bad virus, even worse than Ebola," he said. <<

The case fatality rate for Marburg in Angola is above 99.4%. There is at most 1 survivor out of 181 outcomes. Thus, hospitalization offers little hope for survival, which has led to mistrust by local residents.

Mobile surveillance operations in Uige have ceased because of damage to vehicles and threats of violence. It is unclear if health care workers have been killed because of the unrest, but clearly contact tracing has been limited in the Uige, which is the epicenter of the outbreak.

Therefore management by contact tracing and quarantine will be difficult. The lack of survivors has also led to relatives hiding sick patients because no one has come out of the hospital alive. However, care by untrained and unprotected relatives leads to further transmission. This transmission has now reached Luanda, Angola's capital.



snip


http://www.recombinomics.com/News/04090502/Marburg_Lack_Survivors.html

[sharonking21]

105. Updates, WHO resumes operations in Uige

Edited to put in a second article and to correct case of title.

WHO resumes work in Angolan province stricken by Ebola-like virus
03:31 PM EDT Apr 10
JOANA MATEUS

http://www.cbc.ca/cp/world/050410/w041036.html

LISBON, Portugal (AP) - The World Health Organization has resumed operations in a western Angolan province hit by a deadly Ebola-like virus, after suspending work last week when residents attacked its teams, the WHO said Sunday.

Residents in Uige province had mistakenly feared the WHO teams were spreading - instead of helping contain - the rare Marburg virus, which has killed 184 people out of a total 200 people infected, WHO's spokesman in Angola Dave Daigle told the Associated Press by phone.

"Three teams have already resumed activities and are now following up on anyone who had contact with infected people recently," Daigle said. . . .


'Astronauts' take away bodies' 10/04/2005 20:26 - (SA)

http://www.news24.com/News24/Africa/News/0,,2-11-1447_1687762,00.html

Uige - Epidemiologists in the northern Angolan town of Uige are working overtime to trace new cases of the deadly Marburg virus, which has claimed 184 lives and sparked panic in the war-devastated southern African nation.

Every morning, teams from the World Health Organisation comb the town, devastated by a 27-year civil war, to try and pinpoint new cases of the haemorrhagic fever, which has so far killed 184 people in the world's worst outbreak.

"We visit our contacts and look for suspected cases," Francois Libama, a WHO epidemiologist told AFP as 4X4's set out to scan the derelict . . .

[sharonking21]

111. NYTs: Training Is First Task in Deadly Outbreak

Training Is First Task in Deadly Outbreak
By DENISE GRADY

Published: April 11, 2005

http://www.nytimes.com/2005/04/11/international/africa/11doctors.html?

LUANDA, Angola, April 10 - "Being scared is realistic," Dr. Gail Thomson said. "You must always respect the virus and the situation you're in."

Dr. Thomson, a physician from Manchester, England, who treated Ebola virus victims in Uganda, has been working for the World Health Organization here, teaching doctors how to avoid becoming infected when taking care of patients with the deadly Marburg virus.

The Marburg virus in the outbreak here, thought to have begun in October, has been fatal in 193 out of 218 known cases; at least a dozen of the victims have been health care workers, including an Italian pediatrician. Training is considered essential to prevent more deaths and to convince doctors and nurses that they can do their jobs safely. At hospitals in Uíge, the northern province that is the epicenter of the outbreak, some hospital employees have been afraid to go to work.

"To be able to provide the dignified supportive care patients deserve, you have to have workers," Dr. Thomson said. "Otherwise the system breaks down. We don't want to just isolate patients and not provide care." . . .