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Previous Volume 355:909-919 August 31, 2006 Number 9 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Feldmann, H. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background An outbreak of Marburg hemorrhagic fever was first observed in a gold-mining village in northeastern Democratic Republic of the Congo in October 1998.

Methods We investigated the outbreak of Marburg hemorrhagic fever most intensively in May and October 1999. Sporadic cases and short chains of human-to-human transmission continued to occur until September 2000. Suspected cases were identified on the basis of a case definition; cases were confirmed by the detection of virus antigen and nucleic acid in blood, cell culture, antibody responses, and immunohistochemical analysis.

Results A total of 154 cases (48 laboratory-confirmed and 106 suspected) were identified (case fatality rate, 83 percent); 52 percent of cases were in young male miners. Only 27 percent of these men reported having had contact with other affected persons, whereas 67 percent of patients who were not miners reported such contact (P<0.001). Most of the affected miners (94 percent) worked in an underground mine. Cessation of the outbreak coincided with flooding of the mine. Epidemiologic evidence of multiple introductions of infection into the population was substantiated by the detection of at least nine genetically distinct lineages of virus in circulation during the outbreak.

Conclusions Marburg hemorrhagic fever can have a very high case fatality rate. Since multiple genetic variants of virus were identified, ongoing introduction of virus into the population helped perpetuate this outbreak. The findings imply that reservoir hosts of Marburg virus inhabit caves, mines, or similar habitats.

Source Information

From the Centers for Disease Control and Prevention, Atlanta (D.G.B., S.T.N., P.E.R., T.K., S.Z., M.D.B.); Tulane School of Public Health and Tropical Medicine, New Orleans (D.G.B.); Ministry of Health (J.J.M.-T., S. Mulangu) and Institut National de Recherche Biomédicale (J.J.M.-T.), Kinshasa, Democratic Republic of the Congo; Institute of Tropical Medicine, Antwerp, Belgium (M.B., R.C.); Médecins sans Frontières, Belgium (M.B., H.S., R.C., P.P.) and the Netherlands (P.C.); World Health Organization, Kinshasa/Kisangani, Democratic Republic of the Congo (F.K.T.) and Geneva (C.R., S. Mardel, P.F., T.G.); the Ministry of Health, Kisangani, Democratic Republic of the Congo (L.A.O.); Institut Pasteur, Paris (H.Z.); Offices de Mines d'Or de Kilo Moto Hospital (A.T.) and Ministry of Health (A. Kulidri, M.L.L.), Watsa, Democratic Republic of the Congo; Danish Pest Infestation Laboratory, Lyngby, Denmark (H.L.); South African National Parks Board, Pretoria (L.B.); and National Institute for Communicable Diseases, Johannesburg (S.B.S., P.A.L., F.J.B., A. Kemp, R.S.).

Address reprint requests to Dr. Swanepoel at the National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa, or at bobs{at}nicd.ac.za.

Full Text of this Article

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