Our vocabulary of diseases has had an astronomical growth in recent years due to the outbreaks of virus caused diseases starting with Ebola, then monkeypox and now, marburg.
Marburg virus disease (MVD) is a severe and highly fatal disease caused by the Marburg virus from the Filoviridae family; the same family as the Ebola virus. This virus is among the most virulent pathogens known to infect humans. The incubation period is 2-21 days, and symptom onset is sudden and marked by fever, chills, headache, and myalgia. Although MVD is rare, it can result in large outbreaks with high case fatality rates (CFR range from 23 to 90%). Like monkeypox, the disease is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).
The disease got its name from the city of Marburg in Germany. Two large outbreaks that occurred simultaneously in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, in 1967, led to the initial recognition of the disease. The outbreak was associated with laboratory work using African green monkeys (Cercopithecus aethiops) imported from Uganda. Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic Republic of the Congo, Kenya, South Africa (in a person with recent travel history to Zimbabwe) and Uganda. In 2008, two independent cases were reported in travelers who had visited a cave inhabited by Rousettus bat colonies in Uganda.
The outbreak of the disease is now ravaging Uganda and Kenya. As of 14 November, three cases have been reported including two confirmed cases, and one probable case. All three cases have died, resulting in a case fatality rate of 100%. The cases were epidemiologically linked and all belong to the same family.
The World Health Organization, WHO has been implementing the Emergency Response Plan since 20 October 2017 when the Ministry of Health officially declared the outbreak. WHO released US$ 624 000 from the Contingency Fund for Emergencies (CFE) to rapidly respond which has proven to help contain the outbreak.
Marburg virus disease is a rare disease with a high mortality rate for which there is no specific treatment. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Muscle aches and pains are a common feature. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Diarrhoea can persist for a week. The appearance of patients at this phase has been described as showing “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy. In the 1967 European outbreak, non-itchy rash was a feature noted in most patients between 2 and 7 days after onset of symptoms.
Many patients develop severe haemorrhagic manifestations between 5 and 7 days, and fatal cases usually have some form of bleeding, often from multiple areas. Fresh blood in vomitus and faeces is often accompanied by bleeding from the nose, gums and vagina. In fatal cases, death occurs most often between 8 and 9 days after symptom onset, usually preceded by severe blood loss and shock.
Though no proven treatment for Marburg, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival.