Marburg Virus Disease: What We Need to Know

Overview

Marburg virus – one of the deadliest viral pathogens resurfaces in Africa. Recently the Republic of Rwanda reports 62 confirmed cases and 15 deaths from the Marburg virus. Rwanda reports the outbreak on September 27, 2024. This is the country’s first outbreak.⁽¹⁾ Initially, the infected patients showed malaria-like symptoms. They were treated for their symptoms but their condition worsened resulting in the intervention of the Rwandan Biomedical Centre and National Reference Laboratory.

The blood samples of the patients were collected and tested using the RT-PCR (Real-Time Reverse Transcription Polymerase Chain Reaction) test. The test results confirmed the presence of the Marburg virus in the patients. Rwanda reported 62 confirmed cases, of which 44 recovered,15 succumbed to the infection, and 3 remained under treatment. Most of the infected individuals were healthcare workers who treated the infected patients.

How Rwanda Managed the Outbreak

With the record of the cases, the Rwandan Government initiated contact tracing and isolation efforts to contain the outbreak. Rwanda’s Health minister during a media briefing on the virus outbreak on October 20 in Kigali, informed that there had been no new infections or deaths in the past six days in the country, underlining the country’s proactive efforts to fight against the Marburg virus.
In collaboration with the World Health Organization (WHO), Rwanda launches clinical trials to test the safety and efficacy of remdesivir and MBP091 (specially developed monoclonal antibodies) in the treatment of Marburg virus patients.
Considering the outbreak condition, the Sabin Vaccine Institute (A nonprofit organisation dedicated to vaccine development and delivery, with a focus on preventing neglected and emerging infectious diseases.) also delivered it investigational Marburg vaccine to Rwanda.

Marburg virus Disease

Marburg virus disease (MVD) is a fatal hemorrhagic fever caused by the Marburg virus of the Filoviridae family. The disease is named after a German city after identifying outbreaks of the virus in the Marburg city. ^(3,4)
The virus was first discovered in 1967 in laboratory personnel while handling African green monkeys imported from Uganda for the development of the poliomyelitis vaccine.⁽²⁾ The initial outbreaks were reported in Marburg, and Frankfurt in Germany; Belgrade in Serbia, and subsequent outbreaks were also reported in Kenya, South Africa, Angola, Uganda, and Ghana in Africa, and the USA and Europe.

Transmission

Marburg virus is a zoonotic virus (spreads from animals to humans) and its natural hosts are Rousettus aegyptiacus bats (fruit bats). The virus belongs to the same family of viruses that causes Ebola. ^(2,3,4)
The virus is transmitted from Rousettus aegyptiacus bats to humans through their bodily secretions (saliva, urine, and faeces) and further spreads among humans via direct contact with the infected peoples’ blood, saliva, urine, and through direct contact with broken skin and mucous membrane with virus-contaminated objects and surfaces. ^(3,4)
The virus also infects non-human primates such as monkeys and apes.

Signs and symptoms

The incubation period is varied and ranges from 2 to 21 days which makes it challenging to recognize and isolate virus-infected people leading to the spread of infection.
The initial symptoms of the virus include:

• High fever
• Muscle aches
• Severe headache
• Malaise
• Abdominal pain
• Severe watery diarrhoea
• Nausea
• Vomiting
• Development of non-itchy rash

Patients may develop severe hemorrhagic symptoms from day 5 of the onset of infection including:

• Blood in vomit and faeces
• Bleeding from gums, nose, and venepuncture sites (injection sites)

During the late phase of the disease, patients may experience:

• Neurological issues – aggression, irritability, and confusion
• Orchitis – inflammation of one or both of the testicles
• In severe cases death usually occurs mostly between 8 and 9 days after the onset of symptoms typically as a result of severe bleeding and shock.

Diagnosis

The diagnostic tests for Marburg virus infection are: ^(2,3)

• Antigen-capture detection tests
• Serum neutralization test
• Antibody-capture ELISA (Enzyme-Linked Immunosorbent Assay) test
• Virus isolation by cell culture
• RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) Assay

Treatment

Presently, there are no specific treatments to treat Marburg virus infection. Early supportive care includes hydration, rest, monitoring the levels of blood pressure and oxygen, and treatment of secondary infections can help to increase the survival chance.⁽⁴⁾

Prevention and control measures

With a high case fatality rate ranging from 24% to 88% Marburg virus poses a threat to global public health. Community engagement and public awareness play a key role in controlling the outbreak.

People should follow protective measures to prevent human-to-human transmission of the
virus. Such as:

• Avoid contact with fruit bat-inhabited caves or mines – as fruit bats are the natural reservoirs of the Marburg virus
• Wear protective clothing like gloves and masks while working in bats dwelling caves or mines
• Avoid direct contact with the infected individuals and their bodily secretions
• Avoid direct contact with infected non-human primates
• Healthcare personnel should follow strict preventive measures and wear personal protective equipment (PPE) while treating infected patients
• Samples of the infected individuals and animals should be handled by properly trained staff in well-equipped laboratories
• Burial ceremonies of the deceased should be performed safely and respectfully to prevent the further spread from the deceased individuals
• Follow strict hygiene measures such as regular hand washing, especially after visiting infected individuals and their relatives
• Raise awareness on the nature of the Marburg virus and its preventive measures

Conclusion

The recent occurrences of zoonotic diseases especially from fruit bats raising concerns about the transmission of dangerous pathogens to humans. With its high fatality rates and outbreaks Marburg virus is one of the deadly viruses to become a possible threat to public health. Yet, there is no licensed medicine or treatment available to treat the virus a complete study, research, and development of the Marburg virus is immediately needed to develop effective treatments and control and prevent the infection rate.

References:

1. ‌CDC. Marburg virus disease (Marburg) Situation Summary [Internet]. Marburg Virus Disease. 2024. Available from: https://www.cdc.gov/marburg/situation- summary/index.html
2. Mohapatra RK, Sarangi AK, Kandi V, Chakraborty S, Chandran D, Alagawany M, Chakraborty C, Dhama K. Recent re-emergence of Marburg virus disease in an African country Ghana after Guinea amid the ongoing COVID-19 pandemic: Another global threat? Current knowledge and strategies to tackle this highly deadly disease having feasible pandemic potential. Int J Surg. 2022 Oct;106:106863. doi: 10.1016/j.ijsu.2022.106863. Epub 2022 Sep 8. PMID: 36087848; PMCID:
   PMC9451927.
3. World Health Organization. Marburg Virus Disease [Internet]. Who.int. World Health Organization: WHO; 2021. Available from: https://www.who.int/news- room/fact-sheets/detail/marburg-virus-disease
4. CDC. About Marburg Disease [Internet]. Marburg virus disease. 2024. Available from: https://www.cdc.gov/marburg/about/index.html

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