Marburg Virus Disease

Marburg virus disease (MVD) (formerly known as Marburg haemorrhagic fever) was first identified in 1967 during epidemics in Marburg and Frankfurt in Germany and Belgrade in the former Yugoslavia from importation of infected monkeys from Uganda.

MVD is caused by a virus from the same family as the one that causes Ebola virus disease. Although MVD is rare, it is severe and a fatal disease.

The reservoir host of MVD is the African fruit bat, Rousettus aegyptiacus. This Rousettus bat is typically found in caves and is widely distributed across Africa.

MVD typically appears in sporadic outbreaks throughout Africa; laboratory confirmed cases have been reported in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, Angola, and South Africa.

Cases of MVD have occurred outside Africa, such as during the 1967 outbreak, but are not common. In 2008, a Dutch tourist developed MVD after returning to the Netherlands from Uganda, and subsequently died. 

In 2008, an American developed MVD after returning to the US from Uganda and recovered.

After an incubation period of 5-10 days, the onset of symptom is sudden.

Symptoms may include:

• fever
• chills
• headache
• muscle pain
• severe malaise (body weakness)

Around the fifth day after the onset of symptoms, one may notice a maculopapular rash, which is more likely to be seen on most prominent on the trunk (chest, back, stomach). Other symptoms, such as nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea, may then appear.

After 5-7 days, patients may develop severe bleeding from multiple sites.

Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, and multi-organ dysfunction.

It is unknown how Marburg virus disease (MVD) first transmits from its animal host to humans. However, in the 2 cases in tourists visiting Uganda in 2008, the most likely routes of infection were due to unprotected contact with infected bat feces or aerosols.

Transmission of the virus can also happen by handling ill or dead infected wild monkeys and/or fruit bats.

After the transmission from animal host to humans, the Marburg virus disease (MVD) is transmitted through person-to-person direct contact with blood, body fluids and tissues of infected persons as well as contact with equipment and other objects contaminated with infectious blood or tissues.

Who is at Risk?

People who have close contact with African fruit bats, humans patients, or non-human primates infected with Marburg virus disease (MVD) are at risk.

Family members and hospital staff who care for patients infected with MVD and have not used proper barrier techniques, are at the highest risk for becoming infected with MVD.

Veterinarians and laboratory or quarantine facility workers who handle non-human primates from Africa may also be at increased risk of exposure to MVD.

Travelers who visit endemic regions in Africa, including Uganda and other parts of central Africa, and have contact with fruit bats, or enter areas inhabited by fruit bats, may be at an increased risk.

Many of the signs and symptoms of Marburg virus disease (MVD) are non specific and are similar to those of other diseases such as malaria or typhoid fever, it may become difficult to diagnosis, especially if only a single case is involved.

With that being said, if a person has early symptoms of MVD and there is suspicion it may be due to MVD, the patient should be isolated and public health professionals notified. The medical team will then take samples from the patient and have the samples tested.

Specific tests can be used to confirm MVD as early as a few days of having symptoms.

Ways to prevent transmission of MVD from animals, is avoiding fruit bats, and sick non-human primates in central Africa.

Preventing person-to-person transmission of MVD includes:

• Proper barrier techniques to prevent direct physical contact with the patient (wearing of protective gowns, gloves, and masks)
• Isolating the infected person
• Sterilizing equipment
• Proper disposal of needles, equipment, and patient excretions

There is no specific treatment for Marburg virus disease (MVD). Treatment of MVD includes supportive therapy which includes giving fluids and electrolytes, maintaining oxygen status and blood pressure, replacing lost blood and clotting factors, as well as treating infections.

Experimental treatments have been done in non-human primates models, but have never been tried in humans.

The case-fatality rate for Marburg virus disease (MVD) is between 23-90%.