Marburg Virus Disease

Marburg virus disease (MVD), formerly known as Marburg hemorrhagic fever, is a rare but severe disease in humans caused by Marburg virus (MARV).

Prevalence

Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia).

Over 600 cases have been reported since then in outbreaks in Uganda, Democratic Republic of   Congo (DRC), Angola, Equatorial Guinea, and most recently Tanzania. 

No case has been reported in India so far. 

Causal agent and transmission

MVD is caused by the Marburg virus, a genetically unique zoonotic (or animal-borne) RNA virus of the Filoviridae family(filovirus). The six species of Ebola virus are the only other known members of the filovirus family. 

The reservoir host of Marburg virus is the African fruit bat, Rousettus aegyptiacus. 

After the initial crossover of virus from host animal to people, transmission occurs mainly through person-to-person by intimate contact. The virus spreads through contact (such as through broken skin or mucous membranes in the eyes, nose, or mouth).

The average case fatality rate is around 50%. Case fatality rates have varied from 23% to 90% in past outbreaks depending on virus strain and case management. 

Risk assessment  

People may be at risk of exposure to Marburg virus if they have close contact with:

• African fruit bats (Rousettus aegyptiacus – the reservoir host of Marburg virus), or their urine and/or excretions;
• People sick with Marburg virus disease; or
• Non-human primates infected with Marburg virus 

Symptoms

Any person who has or had an acute onset of

• Fever  AND
• One or more of the following signs/symptoms:
  • severe headache
  • muscle pain
  • erythematous maculopapular rash  
  • vomiting
  • bloody diarrhoea
  • abdominal pain
  • bleeding from gums
  • bleeding from other body orifices AND
• Epidemiologic Linkage  

After an incubation period of 2-21 days, symptom onset is sudden and marked by fever, chills, headache, and myalgia. Around the fifth day after the onset of symptoms, a nonpruritic, maculopapular centripetal rash, most prominent on the trunk (chest, back, stomach), may occur. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Diarrhea can persist for a week. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.

Treatment

 Currently there are no antiviral treatments approved for MVD. 

Prevention

• Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bat colonies.
• During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).
• During outbreaks all animal products (blood and meat) should be thoroughly cooked before consumption.  
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids.
• Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home. 
• Communities affected by Marburg should make efforts to ensure that the population is well informed, both about the nature of the disease itself and about necessary outbreak containment measures. 
• Vaccines: Currently there are no vaccines approved for MVD.  

For detailed information of the National Centre for Disease Control alert, click here