Marburg virus disease (MVD)

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. In 2021 there was a confirmed case for the first time in Guinea, amidst an ongoing Ebola outbreak. The average MVD case fatality rate is around 50 per cent. Case fatality rates in outbreaks have ranged from 24 per cent to 88 per cent, depending on virus strain and case management. Early supportive care with rehydration and symptomatic treatment improves survival. People can get MVD through direct contact with an infected animal (zoonotic disease) or a sick or dead person infected with Marburg virus.

The following are standard case definitions to allow national health authorities to interpret data in an international context. However, during an outbreak case definitions may be adapted to the local context and the Red Cross Red Crescent should use those agreed/established by national health authorities. NB: Consider that during community-based surveillance, volunteers should use broad (simplified) case definitions (referred to as community case definitions) to recognize most or all possible cases, provide relevant risk communication and appropriate actions and encourage them to seek care. Other actors such as healthcare workers or investigators studying the cause of a disease, on the other hand, can use more specific case definitions that may require laboratory confirmation.

Case definitions are the same for both Ebola and Marburg:

Routine surveillance

Suspected case: Illness with onset of fever and no response to treatment for usual causes of fever in the area, and at least one of the following signs: bloody diarrhoea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine.

Confirmed case: A suspected case with laboratory confirmation (positive IgM antibody, positive Polymerase chain reaction (PCR) or viral isolation).

Community-based surveillance

Alert case: Illness with onset of fever and no response to treatment of usual causes of fever in the area OR with at least one of the following signs: bleeding, bloody diarrhoea, bleeding into urine OR any sudden death.

If the Red Cross Red Crescent is doing community-based surveillance, a community case definition should be agreed upon with the relevant health authority.

WHO case definition source of information: https://apps.who.int/iris/bitstream/handle/10665/146397/WHO_EVD_CaseDef…

https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease

• Infection when caring for those suffering from the disease may occur through close contact with patients when infection control precautions are not strictly practised.
• Mourners at burial ceremonies that involve direct contact with the body of the deceased, and those involved in preparing bodies for or conducting funeral rites are at increased risk.
• Prolonged exposure to mines or caves inhabited by fruit bat colonies.
• Eating bushmeat that is not thoroughly cooked before consumption during outbreaks.
• Preparing bushmeat during outbreaks.
• Unsafe sex presents an additional risk. WHO recommends that male survivors of Marburg virus disease practise safer sex for 12 months from onset of symptoms or until their semen twice tests negative for Marburg virus. 
• Overcrowded areas where it is impossible to avoid close physical contact, where person-to-person spread is easily possible.
• Poor access to or practice of sanitation and hygiene measures.

• Around 23 per cent for family members sleeping in the same room with the patient.
• Around 81 per cent for those providing direct care when infection control precautions are not strictly practised.

• Infants, young children.
• Older people with weakened immune systems.
• Immunosuppressed persons such as those receiving chemotherapy, transplant recipients or HIV carriers.
• People with chronic diseases such as renal disease, cancer, chronic liver and lung disease and diabetes.

Marburg virus.

Zoonotic disease:

• Reservoir: fruit bats (Rousettus aegyptiacus bats)
• Hosts: non-human primates, monkeys, pigs, humans.

Contact transmission:

• Close contact with the blood, secretions, organs or other bodily fluids of infected persons and materials such as bedding contaminated with the infected fluid.
• Contact with the body of the deceased during burial ceremonies.
• Contact with fruit bats and probably apes and monkeys.

Sexual transmission:

•  Sexual contact with a man who has recovered from MVD up to 12 months after recovery.

Vehicle-borne transmission:

• Transmission through contact with objects (like needles and syringes) that have been contaminated with blood or other body fluids from a person who is sick with MVD or the body of a person who has died from MVD. 

Average five to ten days (range 2—21 days).

People remain infectious as long as their blood contains the virus. Recovering patients are no longer contagious to others once they test negative, and their return home or transfer to a general hospital is safe. Sperm may still be contagious for a period of 12 months after a patient’s recovery. Case reports reveal that Marburg virus might persist in the eyes in some people who have recovered from Marburg virus disease as well as in breast milk or amniotic fluid of pregnant women. This can become extremely dangerous because the virus might emerge many months after an epidemic had ended, triggering another outbreak. Further research is needed to confirm these findings.

• Starts abruptly with fever, severe headache, malaise, muscle pain, nausea, vomiting and diarrhoea, progressing to severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting.
• Sometimes followed by a rash and/or bleeding under the skin and from the nose, vagina and/or gums, blood with vomitus and in the stools.
• In severe cases patients may have confusion, irritability and aggression.

Other haemorrhagic fevers (Ebola fever, Rift Valley fever, Lassa fever, Crimean-Congo fever, dengue fever, yellow fever), malaria, typhoid fever, measles, meningitis.

• Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing.
• Polymerase chain reaction (PCR).
• IgM-capture ELISA can be used to confirm a case of MVD within a few days of symptom onset.

Please refer to the appropriate local or international guidelines for clinical management. All clinical management including the administration of any treatment should be conducted by health professionals.

• Prompt isolation of probable and confirmed cases is required.
• Cases require intensive supportive care, as patients are frequently in need of intravenous fluids or oral rehydration with solutions containing electrolytes.
• No specific treatment or vaccine is yet available for MVD.

No information available.