MARBURG VIRUS DISEASE: COULD IT BE FROM MARBURG IN GERMANY?
August 23, 2017
Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Serbia (formerly Yugoslavia). Thirty-one people fell ill, exhibiting the same symptoms, including fever, diarrhoea, vomiting, massive bleeding from many different organs, shock and collapse of the circulatory system. The victims were initially laboratory workers followed by several medical personnel and family members who had cared for them. Seven people died eventually out of the infected thirty-one people, bringing about a fatality rate of 23% in the outbreak.
The source of the infection was traced to a virus infecting African green monkeys that were imported from Uganda, Africa, and were being used for polio vaccine research.
Marburg virus disease (MVD), formerly known as Marburg haemorrhagic fever (MHF) is a severe and highly fatal disease caused by a virus belonging to a virus family termed Filoviridae, the same family as the one that causes Ebola virus disease.
Illness from Marburg virus begins abruptly with severe headache and severe malaise. Many patients develop severe haemorrhagic manifestations between days 5 and 10, and fatal cases usually have some form of bleeding, often from multiple sites.
The most recent outbreaks of Marburg virus disease have occurred in Uganda. In 2012, fifteen individuals were diagnosed and four people died resulting to 27% fatality rate.
Again, the Ugandan Ministry of Health reported on Oct. 5, 2014, that a health-care worker died of Marburg virus disease on Sept. 30, 2014. The source of his exposure is not clear. Health officials said that about eighty people who were in contact with the man who died were identified and observed for 21 days for signs and symptoms of the disease. No one else contracted the disease.
Marburg Virus Disease Outbreak Distribution Map
Countries that had outbreaks of Marburg virus disease includes:
- DR Congo
- South Africa
The largest Marburg hemorrhagic fever outbreak to date occurred in north-eastern Angola in the spring of 2005, with over 90 cases and 90% mortality rate.
Causes and Transmission
Marburg virus is considered to be a zoonotic infection (transmitted to humans from life cycles in other animals). Marburg virus is transmitted to humans from monkeys and/or bats, specifically the African fruit bat and Rousettus bat.
Although it is unclear how humans contract this virus from other animals, perhaps by eating them or by contamination of animal body fluids through butchering of infected animals. Scientists who have operated on infected animals as part of their research have also contracted the virus like in the case of the first outbreak. Tourists in certain African caves and some underground mine workers have been infected with the Marburg virus, possibly through contact with the faeces or urine of infected bats.
But it is clear that human-to-human transfer occurs by direct contact with an infected person's bodily fluids for example, saliva, tears, excretions, vomitus (vomit) and blood. The Marburg viruses are not thought to be spread by air droplets.
Infected people typically don't become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial.
Medical personnel can be infected if they don't use protective gear, such as surgical masks and gloves. Medical centres in Africa are often ill equipped that they must reuse needles and syringes.
There's no evidence that Marburg virus can be spread via insect bites.
What are the Signs and Symptoms?
The symptoms of Marburg virus infection usually come on suddenly after an incubation period of about five to 10 days. Early symptoms are as follows:
- Joint and Muscle aches
About five days after the symptoms first occur, other symptoms may occur as follows:
- A rash occurs on the chest, back, and stomach in some individuals.
- Chest pain
- Sore throat
- Abdominal pain
- Diarrhoea (may be bloody)
Over time, symptoms become increasingly severe and may include:
- Pancreatic inflammation
- Severe weight loss
- Delirium (state of mental confusion often accompanied by hallucinations)
- Liver failure
- Massive haemorrhaging with organ dysfunction
Many of the symptoms are similar to those of other infectious diseases such as Ebola, malaria, typhoid fever, and others; so diagnostic tests are useful to rule out other causes of the symptoms. People exposed to Marburg virus usually show signs of infection no later than about 14 days after exposure, but because the clinical symptoms resemble Ebola virus disease, most people are placed in isolation for 21 days.
Marburg virus disease is difficult to diagnose because early signs and symptoms resemble those of other diseases such as Ebola, typhoid and other viral haemorrhagic fevers.
The diagnosis of Marburg virus disease is usually done by specialized laboratories using a number of different tests such as:
* enzyme-linked immunosorbent assay (ELISA);
* antigen detection tests;
* serum neutralization test;
* reverse-transcriptase polymerase chain reaction (RT-PCR) assay; and
* virus isolation by cell culture.
Tests on clinical samples present an extreme biohazard risk and are conducted only under maximum biological containment conditions.
There is no specific treatment for Marburg virus infection. Supportive hospital therapy should be utilized, which includes:
1. Providing fluids
2. Maintaining blood pressure
3. Providing oxygen as needed
4. Replacing lost blood
5. Treating other infections that develop
Experimental treatments are validated in non-human primates’ models, but have never been tried in humans.
Risk factors majorly include exposure to African green monkeys and certain bats. Also, exposure to an infected human is a high risk factor.
For most people, the risk of contracting Marburg virus infection is low. The risk increases if you:
- Travel to endemic regions. You're at increased risk if you visit or work in areas where Marburg virus outbreaks have occurred.
- Conduct animal research. People are more likely to contract Marburg virus if they conduct animal research with infected monkeys especially the African green monkey.
- Provide medical or personal care. Family members are often infected as they care for sick relatives. Medical personnel also can be infected if they don't use protective gear, such as surgical masks and gloves.
- Prepare people for burial. The bodies of people who have died of Marburg virus disease are still contagious. Helping prepare these bodies for burial can increase your risk of developing the disease.
Prevention of Marburg viral disease focuses on avoiding contact with monkeys and bats that may carry the disease and using strict isolation procedures to avoid any bodily fluids or tissues from humans infected with Marburg viruses. The following precautions can help prevent infection and spread of Marburg:
1. Wash your hands frequently. As with other infectious diseases, one of the most important preventive measures is frequent hand-washing. Use soap and water, or use alcohol-based hand rubs containing at least 60 percent alcohol when soap and water aren't available.
2. Avoid bush meat. In developing countries, avoid buying or eating the wild animals, including nonhuman primates, sold in local markets.
Avoid contact with infected people. In particular, caregivers should avoid contact with an infected person's body fluids and tissues, including blood, semen, vaginal secretions and saliva. People with Marburg are most contagious in the later stages of the disease.
3. Follow infection-control procedures. Those health-care professionals who treat Marburg virus-infected patients must use barrier protections such as gowns, gloves, masks, and shoe coverings; most experts say the best barrier is a hazmat suit and a well-informed person who knows how to decontaminate a hazmat suit. Keep infected people isolated from others. Dispose of used needles and sterilize other instruments.
4. Don't handle remains of dead infected people. The bodies of people who have died of Marburg disease are still contagious. Specially organized and trained teams should bury the remains, using appropriate safety equipment.
Scientists are working on a variety of vaccines that would protect people from Marburg virus. Some of the results have been promising, but further testing is needed.
What is the Prognosis for a Marburg Virus Infection?
The prognosis for Marburg virus infection ranges from fair to poor; fatality rates vary from about 23%-90%. Individuals cared for in an intensive-care unit have a better chance of survival. If a patient survives, recovery may be prompt and complete, or protracted with sequelae.
Importantly, Marburg virus is known to be able to persist in some survivors and to either reactivate and cause a secondary bout of Marburg virus disease or to be transmitted via sperm, causing secondary cases of infection and disease.