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Home Topics Infectious Diseases Infections A-Z Marburg virus disease General Information about Marburg virus disease

General Information about Marburg virus disease

Introduction

Marburg virus is one of two viruses belonging to the Filovirus family, along with Ebola virus. Marburg virus causes a severe and highly fatal haemorrhagic fever which is clinically almost indistinguishable from Ebola virus disease. Both humans and non-human primates can be affected.

The disease was first recognised in 1967, when outbreaks of haemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt in Germany, and Belgrade in Yugoslavia. A total of 31 people became ill, including 25 laboratory workers, and medical personnel and a family member who had cared for them. The laboratory workers all had contact with the blood, organs or cell-cultures from a batch of imported African green monkeys from north-western Uganda.

It is generally accepted that Marburg virus is a zoonotic (animal borne) virus, and fruit bats (Rousettus aegyptii) are considered the natural host of the virus. Monkeys are susceptible to Marburg virus infection but are not considered to be reservoir hosts as they die rapidly once infected.

Geographical occurrence

Recorded cases of Marburg virus disease are rare. Outbreaks and sporadic cases have been reported in Angola, Democratic Republic of Congo, Kenya, and South Africa (in a person who had recently travelled to Zimbabwe). The largest outbreak on record occurred in 2005 in Angola, and involved 374 cases, including 329 deaths. Two unrelated sporadic cases occurred during 2008 following visits to the "python cave” in the Maramagambo Forest in western Uganda; this cave is home to a large colony of Egyptian fruit bats. Both cases became ill after return to their home country; one in the Netherlands and one in the USA.  The most recent outbreak was in 2012 in southwestern Uganda.

A map showing the location of the outbreaks is available here Map of cases and outbreaks of Ebola and Marburg virus disease to July 2014 (PDF, 536 KB) 

Table: Recorded outbreaks to 2012

Year(s)

Country

Apparent or suspected origin

Reported number of cases

Reported number of deaths (%)

Situation

1967

Germany and Yugoslavia

Uganda

31

7 (22%)

Simultaneous outbreaks occurred in laboratory workers who had handled imported African green monkeys.

1975

Johannesburg, South Africa

Zimbabwe

3

1 (33%)

A young man who had recently travelled through Zimbabwe was admitted to hospital in Johannesburg and later died. Infection transmitted to his travelling companion and a nurse, both of whom recovered.

1980

Kenya

Kenya

2

1 (50%)

A male patient with a recent travel history including a visit to Kitum Cave in Kenya’s Mount Elgon National Park. The doctor who attempted resuscitation became infected but recovered.

1987

Kenya

Kenya

1

1 (100%)

A fatal case occurred in a 15 year old Danish boy who had been in Kenya for one month. He had visited Kitum Cave in Mouth Elgon National Park.

1998 - 2000

Democratic Republic of Congo (DRC)

Durba (DRC)

154

128 (83%)

The first large outbreak of Marburg under natural conditions. Majority in young male workers at a mine in Durba, cases also detected in neighbouring village, and among family members.

2004 - 2005

 

Angola

Uige (Angola)

374

329 (88%)

Largest outbreak on record. Cases reported in 5 provinces, the majority in Uige. Significant number of healthcare workers and family members affected. Cultural practices, civil unrest and weakened healthcare systems hampered control.

2007

Uganda

Kitaka mine

4

2 (50%)

Mine workers in western Kamwenge province.

2008 (Jan)  USA Python cave Uganda 1 0 A tourist who had visited this cave, reknowned for its thousands of bats, became unwell after returning to the USA.
 2008 (July)  Netherlands Python cave Uganda   1  1 A tourist who had visited the same cave.
2012  Uganda southwestern Uganda 20 9 4 districts (Kabale, Ibanda, Mbarara, and Kampala)
 TOTAL     590 478 (82%)  

 Symptoms

The incubation period of Marburg haemorrhagic fever is 3-10 days. The onset of illness is sudden, with severe headache, malaise and high fever, with progressive and rapid debilitation. This is followed by watery diarrhoea, abdominal pain, cramping, nausea and vomiting by about the third day.  Symptoms become increasingly severe, and many patients develop severe haemorrhagic fever after 5-7 days. Fatal cases usually have bleeding, which is often from multiple sites.  Many of the symptoms of Marburg haemorrhagic fever are similar to those of other infectious diseases, such as malaria or typhoid, and diagnosis of the disease may be difficult.

Transmission

The intial infection is acquired through exposure in mines or caves inhabited by Rousettus bat colonies. Subsequent transmission of virus from person to person requires close contact with an infected patient. The virus is transmitted through contact with blood or other bodily fluids (faeces, vomit, urine, saliva and respiratory secretions) containing a high concentration of virus, particularly when these fluids contain blood. Sexual transmission of the virus can occur, and Marburg virus may remain in semen for up to 7 weeks after clinical recovery. Transmission of the virus via contaminated injection equipment or needle-stick injuries is associated with more severe disease. Close contact with the body or body fluids of the dead during preparation for burial is also a recognised source of infection.

Diagnosis

Marburg virus behaves similarly to Ebola and is readily detectable in the blood and tissues of infected individuals. An early positive PCR test may confirm the diagnosis, but a negative test does not refute it. IgM antibodies are detectable by ELISA within the first week of illness, and cell culture can be performed using blood, urine or fresh tissue samples. These tests must be carried out under maximum biological containment conditions. See here for reference laboratories

Treatment

There is no specific treatment or vaccine available for Marburg haemorrhagic fever. Patients receive supportive therapy, including balancing fluids and electrolytes, maintaining oxygen status and blood pressure, replacing lost blood and clotting factors.

Control and Prevention

Measures for prevention of secondary transmission of Marburg virus are similar to those used for other haemorrhagic fever viruses, and focus on avoidance of contact with infected bodily fluids. Strict barrier nursing techniques are essential. Patients should be isolated, and those in contact with them should wear masks, gloves and gowns. Invasive procedures such as the placing of intravenous lines, handling of blood, secretions, catheters and suction devices are a particular risk and sterilisation or proper disposal of needles, equipment and patient excretions is essential. Hospital staff should have their own individual gowns, gloves, masks and goggles. Non-disposable protective equipment must be properly disinfected before re-use. Other infection control measures include proper use, disinfection, and disposal of instruments and equipment used in caring for patients.

UK Guidelines

In the UK, the procedures outlined in "The Management and Control of Viral Haemorrhagic Fevers"must be followed for any suspected case. The guidance is available here 

Other information:

[This page updated 15 April 2014]