Marburg virus disease

Overview

Marburg virus disease, also known as Marburg hemorrhagic fever, is a highly virulent and contagious illness caused by the Marburg virus. This disease has garnered significant attention due to its high case fatality rate and the challenges it poses in diagnosis and treatment. In this article, we will delve into the transmission, signs and symptoms, diagnosis, prevention, and the World Health Organization's (WHO) response to this deadly disease.

What is Marburg Virus Disease?

Marburg virus disease is a severe, viral hemorrhagic fever that belongs to the Filoviridae family, which also includes the Ebola virus. This disease was first detected in 1967 during simultaneous outbreaks in Marburg, Germany, and Frankfurt, Germany, as well as Belgrade, Serbia. The virus has since been reported in various regions, including Angola, the Democratic Republic of the Congo, Kenya, South Africa, and Uganda.

Transmission

The transmission of Marburg virus disease is complex and involves multiple pathways. Initially, human infection typically results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. These bats are considered natural hosts of the virus, and there is no apparent disease in them. Once the virus is transmitted to humans, it can spread through human-to-human contact via direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals. This contact can occur through broken skin or mucous membranes.

Additionally, transmission can occur through surfaces and materials contaminated with these fluids. Burial ceremonies where mourners have direct contact with the body of the deceased can also play a significant role in the transmission of Marburg. Moreover, health-care workers have frequently been infected while treating patients with suspected or confirmed MVD, primarily through close contact without the use of correct infection control precautions.

Signs and Symptoms

The incubation period of Marburg virus disease varies from 2 to 21 days. Illness begins abruptly, with high fever, severe headache, and severe malaise. Muscle aches and pains are common features, and severe watery diarrhea, abdominal pain, and cramping, nausea, and vomiting can begin on the third day. Diarrhea can persist for a week. Patients often appear "ghost-like," with drawn features, deep-set eyes, expressionless faces, and extreme lethargy.

A non-itchy rash has been noted in most patients between 2 and 7 days after the onset of symptoms. In the later stages of the disease, patients may develop severe hemorrhagic manifestations, including bleeding from multiple areas such as the nose, gums, and vagina. Spontaneous bleeding at venepuncture sites can be particularly troublesome. Involvement of the central nervous system can result in confusion, irritability, and aggression.

Diagnosis

Diagnosing Marburg virus disease can be challenging as the symptoms are similar to other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis, and other viral hemorrhagic fevers. Confirmation that symptoms are caused by Marburg virus infection is made using several diagnostic methods:

• Antibody enzyme-linked immunosorbent assay (ELISA)
• Antigen detection tests
• Serum neutralization tests
• Reverse-transcriptase polymerase chain reaction (RT-PCR) assay
• Virus isolation by cell culture

All biological specimens must be packaged using the triple packaging system when transported nationally and internationally due to the extreme biohazard risk involved.

Prevention

Preventing the spread of Marburg virus disease requires strict adherence to infection control measures. This includes:

• Use of personal protective equipment to avoid direct contact with blood and body fluids
• Hand hygiene to reduce the risk of transmission
• Prevention of injuries from needle sticks and other sharp instruments
• Environmental controls to minimize contamination

Health-care workers play a crucial role in preventing the spread of the disease. They must follow strict infection control precautions, including the use of proper equipment and techniques to handle patients and their bodily fluids. Additionally, the correct disposal of contaminated materials is essential to prevent further transmission.

WHO Response

The World Health Organization (WHO) has developed a comprehensive strategy to prevent and control Marburg virus outbreaks. This includes:

• Surveillance: Monitoring for Marburg virus disease to detect outbreaks early
• Community engagement: Informing and engaging communities to raise awareness about the disease
• Case management: Providing medical care to infected individuals
• Laboratory services: Conducting diagnostic tests to confirm infections
• Contact tracing: Identifying individuals who have been in contact with infected persons
• Infection control: Ensuring that health-care workers adhere to strict infection control measures
• Logistical support: Providing necessary resources, including vaccines and medications
• Training and assistance: Educating health-care workers on the proper care and handling of patients with suspected or confirmed infections
• Safe burial practices: Ensuring that burials are conducted safely to prevent further transmission.

Conclusion

Marburg virus disease is a formidable public health threat that requires immediate attention and action. Understanding its transmission, signs and symptoms, diagnosis, and prevention strategies is crucial in combating this deadly disease. The WHO's comprehensive response plan underscores the importance of global collaboration and preparedness in preventing and controlling outbreaks. As we continue to monitor the situation, it is essential to remember that early detection and proper treatment can significantly improve survival rates.

References

• WHO Fact Sheet on Marburg Haemorrhagic Fever
• WHO Marburg Virus Disease
• CDC Marburg Communication Resources
• AHO Fact Sheet on Marburg Haemorrhagic Fever