WHO /Christopher Black
Marburg hemorrhagic fever is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever. Both diseases are rare, but can cause dramatic outbreaks with high fatality. There is currently no specific treatment or vaccine. Two cases of Marburg virus infection were reported in Uganda. One of the people, a miner, died in July, 2007. A public information campaign was developed as well as training courses for local health workers. An international team of experts and scientists meanwhile worked to identify the hosts of the virus and its mode of natural transmission in the environment. They explored the mine cave where the outbreak appeared to have started in search of the reservoir of the Marburg virus. The bats captured from the Kitaka mine were taken to a nearby laboratory, just set up for this purpose. The scientists there worked through the night, taking blood and organ samples to look for Marburg virus antibodies. This photo story documents the combined efforts of WHO and its partners in the Global Outbreak Alert and Response Network to monitor, investigate and control the outbreak of Marburg fever in Uganda.
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Marburg virus disease

    Overview

    Marburg virus disease is a highly virulent disease that causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. 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 travellers who visited a cave inhabited by Rousettus bat colonies in Uganda. 

    Human infection with Marburg virus disease initially results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Once an individual is infected with the virus, Marburg can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. 

    Symptoms

    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. A non-itchy rash has been noted between 2 and 7 days after the onset of symptoms. 
     
    Many patients develop severe haemorrhagic manifestations within 7 days, and fatal cases usually have bleeding, often from multiple areas. Fresh blood in vomitus and faeces is often accompanied by bleeding from the nose, gums and vagina. Spontaneous bleeding at venepuncture sites (where intravenous access is obtained to give fluids or obtain blood samples) can be particularly troublesome. During the severe phase of illness, patients have sustained high fevers. Involvement of the central nervous system can result in confusion, irritability and aggression. Orchitis (inflammation of the testicles) has been reported occasionally in the late phase (15 days). 
     
    In fatal cases, death usually occurs between 8 and 9 days after onset, usually preceded by severe blood loss and shock. 

    Treatment

    Supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms improves survival. There is as yet no proven treatment available for Marburg virus disease. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.

    Diagnosis 

    It can be difficult to clinically distinguish Marburg virus disease (MVD) from other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis and other viral haemorrhagic fevers. Confirmation that symptoms are caused by Marburg virus infection are made using the following diagnostic methods: 

    • antibody enzyme-linked immunosorbent assay (ELISA); 
    • antigen detection tests; 
    • serum neutralization tests; 
    • reverse-transcriptase polymerase chain reaction (RT-PCR) assay; and 
    •  virus isolation by cell culture. 

    Samples collected from patients are an extreme biohazard risk and laboratory testing on non-inactivated samples need to be conducted under maximum biological containment conditions. All biological specimens must be packaged using the triple packaging system when transported nationally and internationally. 

     

    Publications

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    Preferred Product Characteristics for Personal Protective Equipment for the Health Worker on the Frontline Responding to Viral Hemorrhagic Fevers*in Tropical Climates

    ObjectivesTo provide a review and summary of current evidence on protective effects of PPE and applicable standards, and to identify the knowledge gaps...

    Guideline on hand hygiene in health care in the context of filovirus disease outbreak response : rapid advice guideline

    This document provides a summary of the recommendations for hand hygiene best practices to be performed by health workers providing care and/or support...

    How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola or Marburg virus disease

    This protocol provides information on the safe management of dead bodies and burial of patients who died from suspected or confirmed Ebola or Marburg virus...

    Technical guidance

    All →

    Case management and infection prevention and control

    16 November 2016

    Personal protective equipment for use in a filovirus disease outbreak

    2 January 2016

    Clinical management of patients with viral haemorrhagic fever: A pocket guide for front-line health workers

    28 January 2015

    Steps to take off personal protective equipment (‎PPE)‎ including coverall

    24 January 2015

    How to put on and how to remove personal protective equipment (PPE)

    4 December 2014

    Infection prevention and control  for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola

    1 December 2014

    Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola

    28 November 2014

    Guideline on hand hygiene in health care in the context of filovirus disease outbreak response : rapid advice guideline

    7 May 2010

    Guide to local production: WHO-recommended handrub formulations