13 Marburg Virus Cases Now Confirmed in Equatorial Guinea – More May Be Passing Under Radar
Outbreaks 30/03/2023 •
Ahmed Ouma, Acting African CDC Director – told reporters Thursday that Marburg virus case count for Equatorial Guinea was unchanged – even after Ministry of Health reported 4 new cases.

Authorities in Equatorial Guinea have confirmed another four cases of deadly Marburg virus disease, bringing the total number of cases for the country’s current outbreak to 13 – although some sources warn that the case count could be much higher, due to the lack of lab capacity and reporting delays.

In a Twitter post late Thursday evening, the Ministry of Health reported that here had been”13 positive cases since the beginning of the epidemic; two hospitalized with mild symptoms, one patient recovered; 9 deceased” as of Tuesday, 28 March.

The ministry’s post came just hours after World Health Organization Director General Dr Tedros Adhanom Ghebreyesus challenged the country to report on new cases officially, stating: “WHO is aware of additional cases, and we have asked the government to report these cases officially to WHO.”

Tedros added that the dispersion of already confirmed cases, which are spread across the provinces of Kié-Ntem, Litoral and Centro Sur, areas some 150 kilometers apart, also is “suggesting wider transmission of the virus.”

CDC Acting Director unaware of new Marburg case count during Thursday briefing

However, at an African Centers for Disease Control press briefing on Thursday, CDC Acting Director Dr Ahmed Ouma, seemed to be unaware of the new numbers, telling Health Policy Watch that the case count remained unchanged.

“We are not aware, as Africa CDC, that any country is holding back any data of cases that have been confirmed for any outbreak, including Marburg virus disease,” Ouma said at the briefing, referring to the earlier reported count of 8 reported cases.

Marburg
Historical geographic distribution of Marburg virus infections in human and bat populations, which traditionally harbour the disease, as of July 2022.

As of late Thursday evening, neither WHO’s Headquarters, nor WHO’s African Regional Office had updated their official statistics on the outbreak either – with WHO’s latest news report on the eight cases associated with Equatorial Guinea’s outbreak dating to March 23.

Meanwhile, other sources were suggesting that there could be three times as many cases – if 20 probable cases,  which had not been confirmed, were counted.

The data lag highlighted the continuing political and technical challenges faced by both Africa CDC and the global health agency in reporting fast-moving outbreaks in real time.

Under the International Health Regulations (IHR), governments are required to share information regarding new cases of pathogens that pose an outbreak risk. However the data often has to go through political channels before it is actually released, admitted Dr Abdi Rahman Mahamud, WHO’s acting Director, Alert and Response Coordination, at WHO’s global briefing on Wednesday. And that leads to delays in public reporting by WHO and other official bodies on vital information. 

Public health experts becoming alarmed

Elsewhere, public health experts expressed alarm over the potential mushrooming of cases in remote settings where the technical difficulties of reporting on cases could potentially be compounded by official reluctance to acknowledge the outbreak’s real spread.  “Keep and eye on the Marburg virus outbreak” tweeted Isaac Bogoch, of the University of Toronto. “Cases near border regions & in urban areas.. some cases are distant from others, with no known epidemiological link. This has the potential to grow.”

‘One Health’ approach needs more attention to prevent spread of new and re-emerging pathogens

Speaking at the WHO briefing on Wednesday, Tedros also stressed that the spread of the Marburg virus within both Equatorial Guinea, as well as Tanzania, is yet “another reminder” of the linkages between environmental, animal and human health, which requires a more holistic “One Health” approach to prevent pathogen spread.

He repeated a joint call made by WHO together with the heads of the Food and Agriculture Organization (FAO), the UN Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH) to prioritize “One Health” approaches “by strengthening the policies, strategies, plans, evidence, investment and workforce needed to properly address the threats that arise from our relationship with animals and the environment”.

The risk of virus spillover from animal habitats to humans is becoming all the more common in the face of massive logging and deforestation or other degradation of wildlife areas, encroachment of human habitats in forested areas, as well as hunting of wild animals and bush meat consumption.  All of those processes are rapidly accelerating in the face of road building, oil, gas and mineral exploitation, and the expansion of industrial farms or  agricultural plantations in Africa, Asia and the Americas, environmental critics say – increasing the intermingling of disease carrying rodents, bats, birds and wild mammals, with people.

“A ‘One Health’ approach will be essential for preventing viruses from spilling over from animals to humans,” he stated, adding “that’s how many outbreaks have started, including HIV, Marburg, Ebola, avian influenza, mpox, MERS and the SARS epidemic in 2003”.

Tedros said that he was pleased to see “One Health” included as a key principle in the “zero draft” of a future agreement on pandemic prevention, preparedness and response, currently under negotiation.

– with Paul Adepoju reporting from Ibadan, Nigeria 

Image Credits: WHO, Paul Adepoju , World Health Organization .

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