Marburg virus disease
Marburg virus disease | |
---|---|
Other names | Marburg hemorrhagic fever |
supportive care[1] | |
Frequency | Rare |
Deaths | 24–88% case fatality rate[2] |
Marburg virus disease (MVD; formerly Marburg hemorrhagic fever) is a
Egyptian fruit bats are believed to be the normal carrier in nature and Marburg virus RNA has been isolated from them.[4]
Signs and symptoms
The most detailed study on the frequency, onset, and duration of MVD
Clinical phases of Marburg hemorrhagic fever's presentation are described below. Note that phases overlap due to variability between cases.
- Incubation: 2–21 days, averaging 5–9 days.[9]
- Generalization Phase: Day 1 up to Day 5 from the onset of clinical symptoms. MHF presents with a high fever 104 °F (~40˚C) and a sudden, severe headache, with accompanying chills, fatigue, nausea, vomiting, diarrhea, pharyngitis, maculopapular rash, abdominal pain, conjunctivitis, and malaise.[9]
- Early Organ Phase: Day 5 up to Day 13. Symptoms include prostration, ecchymoses, blood leakage from venipuncture sites, mucosal and visceral hemorrhaging, and possibly hematemesis.[9]
- Late Organ Phase: Day 13 up to Day 21+. Symptoms bifurcate into two constellations for survivors and fatal cases. Survivors will enter a convalescence phase, experiencing convulsions, diffuse coagulopathy, metabolic disturbances, shock and death, with death typically occurring between days 8 and 16.[9]
Causes
Species name | Virus name (Abbreviation) |
Marburg marburgvirus *
|
Marburg virus (MARV; previously MBGV) |
Ravn virus (RAVV; previously MARV-Ravn) | |
"*" denotes the type species. |
MVD is caused by two viruses; Marburg virus (MARV) and Ravn virus (RAVV), family Filoviridae.[10]: 458
Marburgviruses are endemic in
Contrary to
Diagnosis
MVD is clinically indistinguishable from
Classification
Marburg virus disease (MVD) is the official name listed in the
Transmission
The details of the initial transmission of MVD to humans remain incompletely understood. Transmission most likely occurs from
Prevention
There are currently no
Endemic zones
The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from bats and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source.[citation needed]
During outbreaks
Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their
In the laboratory
Marburgviruses are World Health Organization Risk Group 4 Pathogens, requiring Biosafety Level 4-equivalent containment,[41] laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.
Treatment
There is currently no effective marburgvirus-specific
Prognosis
Although supportive care can improve survival chances, marburg virus disease is fatal in the majority of cases. As of 2023[update] the case fatality rate was assessed to be 61.9%.[44]
Epidemiology
Pandemic potential
The WHO identifies marburg virus disease as having pandemic potential.[44]
Historical outbreaks
Below is a table of outbreaks concerning MVD from 1967 to 2023:
Year | Country | Virus | Human cases | Human deaths | Case fatality rate | Notes |
---|---|---|---|---|---|---|
1967
|
West Germany Yugoslavia |
MARV | 31 | 7 | 23% | |
1975 | Rhodesia South Africa |
MARV | 3 | 1 | 33% | |
1980 | Kenya | MARV | 2 | 1 | 50% | |
1987 | Kenya | RAVV | 1 | 1 | 100% | |
1988 | Soviet Union | MARV | 1 | 1 | 100% | |
1990 | Soviet Union | MARV | 1 | 0 | 0% | |
1998–2000 | Democratic Republic of the Congo | MARV & RAVV | 154 | 128 | 83% | |
2004–2005 | Angola | MARV | 252 | 227 | 90% | |
2007 | Uganda | MARV & RAVV | 4 | 1 | 25% | [46] |
2008 | Uganda Netherlands United States |
MARV | 2 | 1 | 50% | [47] |
2012 | Uganda | MARV | 18 | 9 | 50% | [48][49] |
2014 | Uganda | MARV | 1 | 1 | 100% | [50][51] |
2017 | Uganda | MARV | 3 | 3 | 100% | [52] |
2021 | Guinea | MARV | 1 | 1 | 100% | [53][54][55] |
2022 | Ghana | MARV | 3 | 2 | 66.66% | [56] |
2023 | Equatorial Guinea | MARV | 40 | 35 | 88% | [57][58][59] |
2023 | Tanzania | MARV | 9 | 6 | 66% | [60][61] |
1967 outbreak
MVD was first documented in 1967, when 31 people became ill in the
1975 cases
In 1975, an Australian tourist became infected with MARV in Rhodesia (today Zimbabwe). He died in a hospital in Johannesburg, South Africa. His girlfriend and an attending nurse were subsequently infected with MVD, but survived.[66][67][68]
1980 cases
A case of MARV infection occurred in 1980 in Kenya. A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to Bungoma) at the base of Mount Elgon (which contains Kitum Cave), became infected by unknown means and died on 15 January shortly after admission to Nairobi Hospital.[69] The attending physician contracted MVD, but survived.[70] A popular science account of these cases can be found in Richard Preston's book The Hot Zone (the French man is referred to under the pseudonym "Charles Monet", whereas the physician is identified under his real name, Shem Musoke).[71]
1987 case
In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in Kisumu, Kenya. He had visited Kitum Cave on Mount Elgon prior to travelling to Mombasa, where he developed clinical signs of infection. The boy died after transfer to Nairobi Hospital.[72] A popular science account of this case can be found in Richard Preston's book The Hot Zone (the boy is referred to under the pseudonym "Peter Cardinal").[71]
1988 laboratory infection
In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of
1990 laboratory infection
Another laboratory accident occurred at the Scientific-Production Association "Vektor" (today the
1998–2000 outbreak
A major MVD outbreak occurred among illegal
2004–2005 outbreak
In early 2005, the
2007 cases
In 2007, four miners became infected with marburgviruses in Kamwenge District, Uganda. The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection.[14][85]
2008 cases
On July 10, 2008, the
2017 Uganda outbreak
In October 2017 an outbreak of Marburg virus disease was detected in Kween District, Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to Kenya before the death. A close contact of the second confirmed case traveled to Kampala. It is reported that several hundred people may have been exposed to infection.[88][89]
2021 Guinean cases
In August 2021, two months after the re-emergent Ebola epidemic in the Guéckédou prefecture was declared over, a case of the Marburg disease was confirmed by health authorities through laboratory analysis.[54] Other potential case of the disease in a contact awaits official results. This was the first case of the Marburg hemorrhagic fever confirmed to happen in West Africa. The case of Marburg also has been identified in Guéckédou.[53] During the outbreak, a total of one confirmed case, who died (CFR=100%), and 173 contacts were identified, including 14 high-risk contacts based on exposure.[90] Among them, 172 were followed for a period of 21 days, of which none developed symptoms. One high-risk contact was lost to follow up.[90] Sequencing of an isolate from the Guinean patient showed that this outbreak was caused by the Angola-like Marburg virus.[91] A colony of Egyptian rousettus bats (reservoir host of Marburg virus) was found in close proximity (4.5 km) to the village, where the Marburg virus disease outbreak emerged in 2021.[92] Two sampled fruit bats from this colony were PCR-positive on the Marburg virus.[92]
2022 Ghanaian cases
In July 2022, preliminary analysis of samples taken from two patients – both deceased – in Ghana indicated the cases were positive for Marburg. However, per standard procedure, the samples were sent to the Pasteur Institute of Dakar for confirmation.[93] On 17 July 2022 the two cases were confirmed by Ghana,[94] which caused the country to declare a Marburg virus disease outbreak.[95] An additional case was identified, bringing the total to three.[96]
2023 Equatorial Guinea outbreak
A disease outbreak was first reported in Equatorial Guinea on 7 February 2023, and on 13 February 2023, it was identified as being Marburg virus disease. It was the first time the disease was detected in the country.[97] Neighbouring Cameroon detected two suspected cases of Marburg virus disease on 13 February 2023,[98] but they were later ruled out.[99] On 25 February, a suspected case of Marburg was reported in the Spanish city of Valencia,[100] however this case was subsequently discounted.[101] As of 4 April 2023, there were 14 confirmed cases and 28 suspected cases, including ten confirmed deaths from the disease in Equatorial Guinea.[102][58] On 8 June 2023, the World Health Organization declared the outbreak over.[103] In total, 17 laboratory-confirmed cases and 12 deaths were recorded. All the 23 probable cases reportedly died. Four patients recovered from the virus and have been enrolled in a survivors programme to receive psychosocial and other post-recovery support.[104]
2023 Tanzania outbreak
A Marburg virus disease outbreak in Tanzania was first reported on 21 March 2023 by the Ministry of Health of Tanzania.[105] This was the first time that Tanzania had reported an outbreak of the disease. On 2 June 2023, Tanzania declared the outbreak over.[106] There were 9 total infections, resulting in 6 total deaths.[60][61]
Research
Experimentally, recombinant
See also
References
- ^ a b c d e f g h "Ebola Virus Disease & Marburg Virus Disease - Chapter 3 - 2018 Yellow Book | Travelers' Health | CDC". wwwnc.cdc.gov. Retrieved 19 July 2019.
- ^ "Marburg virus disease". www.who.int. Retrieved 8 February 2020.
- ^ Spickler A. "Ebolavirus and Marburgvirus Infections" (PDF).
- ^ PMID 32758690.
- ^ PMID 16943403.
- S2CID 260056835.
- S2CID 260058558.
- ISBN 978-0-387-05199-4.
- ^ PMID 22046196.
- ISBN 978-1-4398-8431-7. Retrieved 28 October 2017.
- PMID 15078595.
- ^ PMID 16267968.
- PMID 16837700.
- ^ PMID 19649327.
- ^ S2CID 116556454.
- ^ Tucker CJ, Wilson JM, Mahoney R, Anyamba A, Linthicum K, Myers MF (2002). "Climatic and Ecological Context of the 1994–1996 Ebola Outbreaks". Photogrammetric Engineering and Remote Sensing. 68 (2): 144–52.
- PMID 2665013.
- PMID 565951.
- PMID 16267962.
- PMID 9612907.
- PMID 4988544.
- ^ Ksiazek TG (1991). "Laboratory diagnosis of filovirus infections in nonhuman primates". Lab Animal. 20 (7): 34–6.
- PMID 8837880.
- PMID 11735297.
- PMID 12089242.
- PMID 15072761.
- PMID 17079496.
- PMID 17360231.
- S2CID 24207187.
- PMID 16603611.
- PMID 17060700.
- ISBN 978-0-323-95389-4, retrieved 2023-03-05
- PMID 15113924.
- ^ PMID 16973570.
- ^ S2CID 23200723.
- PMID 12922144.
- PMID 9813200.
- S2CID 5450135.
- ^ "Ebola/Marburg Vaccine Development" (Press release). National Institute of Allergy and Infectious Diseases. 2008-09-15. Archived from the original on 2010-03-06.
- ^ Centers for Disease Control and Prevention and World Health Organization (1998). Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). Atlanta, Georgia, USA: Centers for Disease Control and Prevention. Archived from the original (PDF) on 2009-05-07. Retrieved 2009-05-31.
- ^ US Department of Health and Human Services. "Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition". Retrieved 2011-10-16.
- PMID 17940941.
- S2CID 101015.
- ^ PMID 38040006.
- ^ "Outbreak Table | Marburg Hemorrhagic Fever | CDC". www.cdc.gov. Centers for Disease Control and Prevention. Retrieved 4 August 2018.
- ^ "WHO | Marburg haemorrhagic fever in Uganda". www.who.int. Archived from the original on October 8, 2014. Retrieved 23 October 2017.
- ^ "Imported Case of Marburg Hemorrhagic Fever --- Colorado, 2008". cdc.gov. Retrieved 23 October 2017.
- ^ "Marburg hemorrhagic fever outbreak continues in Uganda". October 2012.
- ^ "WHO | Marburg haemorrhagic fever in Uganda – update". www.who.int. Archived from the original on August 10, 2014. Retrieved 29 October 2017.
- ^ "1st LD-Writethru: Deadly Marburg hemorrhagic fever breaks out in Uganda". October 5, 2014.
- ^ "WHO | Marburg virus disease – Uganda". www.who.int. Archived from the original on November 17, 2014. Retrieved 29 October 2017.
- ^ "Uganda controls deadly Marburg fever outbreak, WHO says". ABC News. Archived from the original on 8 December 2017. Retrieved 8 December 2017.
- ^ a b "Guinea records probable case of Ebola-like Marburg virus". Reuters. 7 August 2021. Retrieved 7 August 2021.
- ^ a b "West Africa's first-ever case of Marburg virus disease confirmed in Guinea". who.int. 9 August 2021.
- ^ "Guinea records West Africa's first Marburg virus death, WHO says". Reuters. August 10, 2021. Retrieved August 10, 2021.
- ^ "Ghana confirms first cases of deadly Marburg virus". BBC News. 18 July 2022. Retrieved 18 July 2022.
- ^ "Equatorial Guinea declares outbreak of Ebola-like Marburg virus". BNO News. 13 February 2023. Retrieved 14 February 2023.
- ^ a b Schnirring L (4 April 2023). "Equatorial Guinea confirms another Marburg virus case". University of Minnesota. CIDRAP. Retrieved 4 April 2023.
- ^ Schnirring L (24 April 2023). "New fatal Marburg case reported in Equatorial Guinea". University of Minnesota. CIDRAP. Retrieved 25 April 2023.
- ^ a b Schnirring L (22 March 2023). "Tanzania declares Marburg virus outbreak". University of Minnesota. CIDRAP. Retrieved 22 March 2023.
- ^ a b "Tanzania reports additional Marburg virus disease case". Outbreak News Today. 24 April 2023. Retrieved 25 April 2023.
- S2CID 30252321.
- PMID 5005859.
- S2CID 12791113.
- ISBN 978-0-387-05199-4.
- PMID 811315.
- PMID 406394.
- PMID 569445.
- ^ Dellatola L (May 1980). "Victory for Virology". South African Panorama. 25 (5): 2–6 – via Internet Archive.
- S2CID 42832324.
- ^ ISBN 978-0-385-47956-1.
- PMID 8800792.
- S2CID 25789824.
- ISBN 978-0-385-33496-9.
- PMID 7941853.
- PMID 10546197.
- PMID 14720391.
- PMID 20441515.
- PMID 16038348.
- PMID 15917379.
- PMID 16775337.
- PMID 17940944.
- PMID 17940945.
- PMID 18838150. Archived from the original(PDF) on 2017-08-09. Retrieved 2018-04-29.
- PMID 21987753.
- PMID 19751577.
- PMID 20019654.
- ^ "Marburg virus disease – Uganda and Kenya". WHO. 7 November 2017. Archived from the original on November 9, 2017. Retrieved 2017-12-04.
- ^ Dana Dovey (18 November 2017). "WHAT IS MARBURG? THIS VIRUS CAUSES VICTIMS TO BLEED FROM EVERY ORIFICE AND DIE". Newsweek. Retrieved 2017-12-04.
- ^ a b "Marburg virus disease - Guinea". www.who.int. Retrieved 2022-11-29.
- S2CID 250114159.
- ^ bioRxiv 10.1101/2022.11.03.514981v1.
- ^ "Ghana reports first-ever suspected cases of Marburg virus disease". World Health Organization. 7 July 2022. Retrieved 7 July 2022.
- ^ "Ghana confirms its first outbreak of highly infectious Marburg virus". Reuters. 2022-07-18. Retrieved 2022-07-18.
- ^ "Ghana Declares First Marburg Virus Disease Outbreak". Bloomberg.com. 2022-07-18. Retrieved 2022-07-18.
- ^ We are Ghana [@Ghana] (July 28, 2022). "Update on Marburg Virus Disease Outbreak in Ghana" (Tweet) – via Twitter.[dead link]
- ^ "Equatorial Guinea confirms first-ever Marburg virus disease outbreak". World Health Organization. 13 February 2023. Retrieved 13 February 2023.
- ^ "Cameroon detects two suspected cases of Marburg virus near Eq. Guinea". Reuters. Archived from the original on 2023-02-21. Retrieved 14 February 2023.
- ^ "| By Ministère de la Santé Publique du Cameroun | Facebook". www.facebook.com. Archived from the original on 2023-02-28. Retrieved 2023-02-28.
- El Pais. Archivedfrom the original on 2023-02-25. Retrieved 25 February 2023.
- ^ "Spain says patient does not have Marburg disease". Reuters. Archived from the original on 2023-02-27. Retrieved 28 February 2023.
- ^ "Equatorial Guinea declares outbreak of Ebola-like Marburg virus". BNO News. Archived from the original on 20 February 2023. Retrieved 13 February 2023.
- ^ "WHO declares end to Marburg virus outbreak in Equatorial Guinea". France 24. Retrieved 19 June 2023.
- ^ "Marburg Virus Disease outbreak in Equatorial Guinea ends". WHO | Regional Office for Africa. 2023-06-08. Retrieved 2023-07-05.
- ^ "Tanzania confirms first-ever outbreak of Marburg Virus Disease". WHO | Regional Office for Africa. 21 March 2023. Retrieved 2023-04-19.
- ^ "Tanzania declares end of Marburg viral outbreak". Reuters. 2 June 2023. Retrieved 19 June 2023.
- from the original on 2017-09-27. Retrieved 2018-04-29.
- PMID 35622847.
- S2CID 205387144.
- ^ "Sarepta Therapeutics Announces Positive Safety Results from Phase I Clinical Study of Marburg Drug Candidate - Business Wire" (Press release). 2014-02-10. Retrieved 12 October 2014.
- ^ "Successful Marburg Virus Treatment Offers Hope for Ebola Patients". National Geographic. 2014-08-20. Archived from the original on August 22, 2014. Retrieved 12 October 2014.
Further reading
- Klenk HD (1999). Marburg and Ebola Viruses. Current Topics in Microbiology and Immunology, vol. 235. Berlin, Germany: Springer-Verlag. ISBN 978-3-540-64729-4.
- Klenk HD, Feldmann H (2004). Ebola and Marburg Viruses: Molecular and Cellular Biology. Wymondham, Norfolk, UK: Horizon Bioscience. ISBN 978-0-9545232-3-7.
- Kuhn JH (2008). Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement, vol. 20. Vienna, Austria: SpringerWienNewYork. ISBN 978-3-211-20670-6.
- Martini GA, Siegert R (1971). Marburg Virus Disease. Berlin, Germany: Springer-Verlag. ISBN 978-0-387-05199-4.
- Ryabchikova EI, Price BB (2004). Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy. Columbus, Ohio, USA: Battelle Press. ISBN 978-1-57477-131-2.
External links
- ViralZone: Marburg virus
- Centers for Disease Control, Infection Control for Viral Haemorrhagic Fevers In the African Health Care Setting.
- Center for Disease Control, Marburg Haemorrhagic Fever.
- Center for Disease Control, Known Cases and Outbreaks of Marburg Haemorrhagic Fever
- Ebola and Marburg haemorrhagic fever (10 July 2008) factsheet from European Centre for Disease Prevention and Control
- World Health Organization, Marburg Haemorrhagic Fever.
- Red Cross PDF
- Virus Pathogen Database and Analysis Resource (ViPR): Filoviridae