Marburg Virus

What’s Marburg?

Marburg virus disease (MVD) commonly known as Marburg, was formerly referred to as Marburg haemorrhagic fever. It is a severe and highly infectious viral disease.

What causes Marburg virus Disease

Marburg is caused by a virus from the same family as the one that causes Ebola virus disease. These viruses are among the most severe disease causing organisms known to infect humans. Both diseases are rare, but have a capacity to cause dramatic outbreaks with high fatality.

Signs and symptoms

Symptoms appear 5 to 10 days following the infection but can extend to 21 days. Onset is abrupt with the following manifestation

  • Severe headache and muscle pains
  • Severe malaise
  • Fever and chills
  • Severe watery diarrhoea that may persist for a week
  • Nausea and vomiting
  • A non-itchy rash may appear on the chest, back or abdomen
  • Bleeding, often from multiple sites –Vomiting fresh blood, Blood in faeces, bleeding from nose, gums and spontaneous bleeding following needle prick

Note: The appearance of patients in active phase is perceived as “ghost-like” due to deep-set eyes, expressionless faces, and extreme lethargy.

Loss of blood and shock are the leading causes of deaths usually about the 10th days after onset of symptoms.

Transmission

The Marburg virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Transmission of the Marburg virus also occurred by handling ill or dead infected wild animals mainly monkeys, and fruit bats.

Treatment

  • No specific treatment or vaccine is yet available. Therefore, the predominant treatment is general supportive therapy.
  • Severe cases require intensive supportive care in specialised units as patients are frequently in need of intravenous fluids or oral rehydration with solutions containing electrolytes.
  • However, drug therapies are being developed with promising results in laboratory studies and are currently being evaluate for use in humans.
  • Fruit bats (of the Pteropodidae family), are considered to be natural hosts of Marburg virus. The Marburg virus is transmitted to people from fruit bats and spreads among humans through human-to-human transmission.

Prevention

Prevention measures include:Precautionary measures for pig farms in endemic zones

1.Precautionary measures for pig farms in endemic zones

Precautionary measures are needed in pig farms in Africa to avoid pigs becoming infected through contact with fruit bats. Such infection could potentially amplify the virus and cause or contribute to Marburg outbreaks.

2.Reducing the risk of infection in people

Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key ways to reduce human infections and deaths.

  • Avoid prolonged exposure to mines and caves inhabited by fruit bats. In addition wear protective clothing, gloves and mask when in the prone areas. This is to avoid bat to human transmission.
  • Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick in hospital, as well as after taking care of ill patients at home.
  • Awareness about the disease process should be promoted in with emphasis on containment measures, including reporting referring suspects to health facility, prompt and safe burial of the dead among others.
  • Controlling infection in health-care settings

Appropriate infection control measures MUST be observed in all health facility at all times. Samples taken from suspected human and animal Marburg cases for diagnosis should be handled by well trained staff and processed in suitably equipped laboratories.

Origin of Marburg virus Disease

Marburg virus was first recognized in 1967, following simultaneous outbreaks of haemorrhagic fever in laboratories in Marburg and Frankfurt, in Germany and in Yugoslavia.  The first people to be infected had been exposed to African green monkeys or their tissues. (The monkeys had been imported to in Marburg for research) Subsequently, Medical personnel and family members who had cared for patients with the virus got infected by the virus as well. In this incident about 37 people became ill.

Previous incidences

Although the native origin is unknown, Marburg virus may be indigenous to Africa. Suspected regions being Uganda, Western Kenya, and Zimbabwe.

While the 1967 outbreak occurred in Europe, the disease agent had arrived with imported monkeys from Uganda. In 1975, a traveller most likely exposed in Zimbabwe became ill in Johannesburg, South Africa.

One case was reported in Western Kenya and another in Uganda in 1980.

Outbreak in Uganda

In early October 2014, a confirmed case of Marburg virus disease (MVD) was reported in Kampala, Uganda.

So far, about 140 contacts have been identified and are being monitored for signs and symptoms compatible with MVD. Eleven of the contacts developed signs and symptoms compatible with Marburg virus disease. One of them is under close observation in Kenya.

Public health response

Multi-disciplinary teams have been set up to carry out risk assessment, surveillance, and contact tracing. Follow-up activities are currently being implemented in different parts of Uganda.

WHO advises against the application of any travel restrictions based on the current information available on this outbreak in Uganda.

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