Earlier this week, the World Health Organization (WHO) informed its Member States about a possible outbreak of Marburg virus infection in the Kagera region of Tanzania. On January 10, the first suspected cases of the disease in the country were reported to the entity – six people were infected, five of whom died.
“All cases had similar symptoms, including headache, high fever, back pain, diarrhea, hematemesis (bloody vomiting), malaise (body weakness) and, at a more advanced stage of the disease, external hemorrhage (bleeding from the holes)”, highlighted the WHO in a note.
The following day, nine suspected cases had already been recorded in at least two districts, Biharamulo and Muleba, including eight deaths – a fatality rate of 89%. Samples from two patients were collected and left by the country’s National Public Health Laboratory and results remain pending.
“Close bystanders, including healthcare workers, have been identified and are being monitored in both districts,” the WHO added. The Bukoba district, also in Tanzania, had already recorded an outbreak of Marburg virus infection in March 2023 that lasted two months, totaling nine cases and six deaths.
The entity defines Marburg disease as highly virulent and with a high mortality rate, depending on the strain and case management. Belonging to the same family as Ebola, the virus causes symptoms that begin abruptly, including high fever, headache and severe discomfort. Many patients develop severe bleeding symptoms within a few days.
>> Check out the main questions and answers about Marburg (information from the WHO and the Center for Disease Control and Prevention on the African Continent – Africa CDC):
What is Marburg virus disease?
It is classified as a serious and often fatal illness caused by the Marburg virus. The infection leads to severe viral hemorrhagic fever in humans, characterized by fever, severe headache, back pain, intense muscle pain, abdominal pain, vomiting, mental confusion, diarrhea and, in very advanced stages, bleeding.
The disease was first identified in the municipality of Marburg, Germany, in 1967. Since then, there have been a limited number of outbreaks, reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa, Uganda and, now in Rwanda.
In 2023, two distinct outbreaks of Marburg were identified in two countries: Equatorial Guinea and Tanzania. According to the WHO, the disease represents a serious threat to public health due to its high mortality rate, in addition to the absence of an antiviral treatment or even a vaccine capable of containing the spread of the virus.
What does the virus infection look like?
Initially, humans can become infected by coming into contact with Rousettus bats, a type of fruit bat (which feeds on fruit) often found in mines and caves. Person-to-person transmission occurs mainly through contact with bodily fluids from infected people, including blood, feces, vomit, saliva, urine, sweat, breast milk, semen and pregnancy fluids.
Infection also occurs through contact with surfaces and materials contaminated with these bodily fluids. The disease does not spread through the air.
The WHO warns that the virus often spreads from one family member to another or from a patient to a healthcare professional who does not use adequate protective equipment.
Infected people continue to transmit Marburg as long as there is a viral load in their blood, which means that patients must receive treatment in specific health units and wait for laboratory tests to confirm the time to safely return to the community.
What are the signs and symptoms?
The first symptoms may appear soon after infection and include high fever, chills, severe headache and intense tiredness. Muscle pain is also a common initial symptom.
The condition tends to worsen over time, when nausea, vomiting, stomach and/or chest pain, skin rashes and diarrhea appear, which can last for around a week.
In the late stages of the disease, bleeding is common in various parts of the body, such as gums, nose and anus. Patients may experience shock, delirium and organ failure.
According to the WHO, the most reported symptoms of Marburg infection are:
* fever;
* back pain;
* muscle pain;
* stomach pain;
* loss of appetite;
* vomiting;
* lethargy;
* skin irritation;
* difficulty swallowing;
* headache;
* diarrhea;
* hiccup;
*difficulty breathing.
What is the time interval before symptoms begin to appear?
The time window between Marburg infection and the onset of symptoms varies from two to 21 days. Some patients experience bleeding between five and seven days, with the majority of fatal cases usually presenting some type of bleeding – usually in multiple areas of the body. Blood in vomit and/or feces, for example, is usually accompanied by bleeding in the nose, gums and vagina.
“Death can occur quickly and is generally caused by viral sepsis, multiple organ failure and bleeding,” warns the WHO.
Do Marburg and Ebola viruses cause the same disease?
The WHO classifies the two infections as rare and similar, but caused by different viruses, both members of the filovirus family and capable of causing outbreaks with high mortality rates.
Marburg disease can be confused with other infectious conditions such as Ebola, malaria, typhoid fever and dengue fever, due to the similarity of the symptoms.
For this reason, only testing carried out in a laboratory, using samples of the patient’s blood, tissue or other body fluids, can confirm the infection.
What to do in case of Marburg symptoms?
If you or someone close to you has symptoms similar to those of Marburg infection, WHO guidance is to contact a local healthcare professional for up-to-date and accurate advice.
In cases where there is a positive test result for the infection, early care at a specific treatment center is considered essential, in addition to increasing the chances of survival.
There is no specific treatment for the disease. However, in order to maximize the chances of recovery and increase the safety of those close to us, all patients must receive care and remain in a treatment center designated for this type of case until they are allowed to leave. The WHO does not recommend home treatment.
“If you or a loved one tests negative for Marburg disease but still has compatible symptoms, remain vigilant until they disappear and until you are cleared by your doctor,” the organization highlighted.
“Always follow the advice of healthcare professionals, as additional laboratory tests may be necessary in cases of a negative laboratory result but with a symptomatic patient.”
How to protect from the virus?
The best way to prevent Marburg infection is to avoid contact with infected individuals or animals and practice good hygiene, in addition to following other measures possibly recommended by governments and local health authorities.
If you live in or are traveling to areas where the presence of the virus has been reported – even if you do not have symptoms and have not come into contact with an infected patient –, the guidance is to follow preventive measures such as:
* seek care if signs of infection appear;
* wash your hands regularly with soap or an alcohol-based hand rub solution;
* avoid contact with bodily fluids from people with symptoms of Marburg infection, in addition to avoiding handling the body of someone who died with symptoms of the disease;
* when stopping at official health checkpoints, adhere to any preventive measures in place, including temperature screening and filling out health declaration forms.
Is there a treatment for the disease?
There is currently no treatment available for patients diagnosed with the virus. Therefore, the WHO considers it essential that people who present similar symptoms seek early care.
Supportive care, including providing adequate hydration, controlling pain and other symptoms that may arise, should be provided by healthcare professionals and is considered the safest and most effective way to manage the infection.
The treatment of co-infections, such as malaria, a very common disease on the African continent, is also defined as crucial for supportive care against Marburg.
According to the WHO, therapies in the testing phase and not yet approved for the treatment of the infection were prioritized for evaluation by the entity through randomized clinical trials.
Are there vaccines?
To date, there are no approved vaccines to prevent Marburg virus infection. There are, however, some doses currently in the development process. “The WHO has identified Marburg disease as a high priority disease for which a vaccine is urgently needed,” says the WHO.
