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NPR interview included comments by Christa Kitz, who is coordinating the work of Medecins Sans Frontieres. She indicated that cases in and around Luanda have been identified who have not been to Uige and have no contacts in Uige, indicating the urban transmission of Marburg has begun.

This update clearly demonstrated that controlling Marburg in Angola will be a major challenge, and fears of Marburg racing through the slums of Luanda have been realized.

Several sourced quotes below suggest that this could be an outbreak of a new recombinant form of hemorrhagic virus larger, more deadly, and harder to control than we've previously seen, or anticipated. Of particular concern is its spread to Zaire with a population of 4 million, and home to an international airport.

>> Dr. Mike Ryan is managing WHO's response from Geneva. He said that: "The cases counted so far don't include victims who died outside hospitals. Some WHO experts expect a doubling of the current toll. That would make this Angolan outbreak the largest Marburg epidemic ever...and larger than almost any Ebola [hemorrhagic fever] outbreak. <<

The current outbreak in Angola is particularly virulent, eventually killing all infected patients. There is little evidence to support a more limited transmission. Marburg is killing quicker and at a higher death rate than Ebola. There is a good possibility that Marburg has recombined and picked up some additional genetic information that is leading to this high case fatality rate and rapid spread.

It is useful to describe the Marburg virus in Angola as Ebola-like because its behavior is much more like the Ebola virus found in western Africa, than the Marburg virus discussed above, which originate from eastern Africa.

Much of the genetic similarity in the Marburg isolates listed above stems from the fact that the four 1967 isolates from Europe, all were transported to Europe via infected African green monkeys used for research purposes in the European labs.

All of the transported monkeys came from Uganda, which is located in eastern Africa. Similarly, the other Marburg isolates listed above are from locations in eastern Africa (Kenya and Zimbabwe).

These isolates produce a milder disease with case fatality rates of about 25-30%. The record killing for Marburg was in the Democratic Republic of Congo, in the northeast corner of the country, near Uganda and Kenya. In contrast, Ebola virus is found in western Africa, near the current outbreak in Angola.

The isolates are more complex genetically and they produce a higher case fatality rate. The Marburg virus in Angola is killing at or near 100%. It is more like the record Ebola outbreak in the western portion of the Democratic Republic of Congo, not far from the current Marburg outbreak in Angola.

Thus, the Ebola outbreaks, as well as the current Marburg outbreak in Angola, were all in western Africa. The milder outbreaks of Marburg in eastern Africa have little relevance to the current outbreak in Angola, which is spreading at a record pace. the outbreak will almost certainly top the kill record of 280 set by Ebola in Republic of Congo (Zaire) in 1976.

As stated above, of additional concern is that the virus has now been detected in Zaire, which includes a population of 4 million as well as an International airport. Recombinomics, founded by USC PhD Henry L Niman writes, "The Marburg virus is ahead of contact tracers, and well ahead of WHO updates on transmission."

The above update indicates Marbug has now spread to Zaire. WHO just announced Kwanza-sul yesterday, although the above report indicates there have been deaths there since March 20, and the spread to Kwanza-sul was reported earlier. Provinces previously reported, but not listed above include Cabinda, Kwanza-Norte, and Malange.

The update on Luanda is most alarming because there is a population of 4 million and an international airport.

This post also available on Blogger News.

Dan Riehl blogs at Riehl World View.