Marburg virus causes a severe and highly lethal hemorrhagic fever in humans with clinical symptoms similar to that of another African virus, Ebola. An outbreak of Marburg in Equatorial Guinea puts the spotlight on this infectious disease.
Liberian nurse working on the removal and burial of an Ebola victim in Virginia, Monrovia (Liberia) in 2014. EFE/Ahmed Jallanzo
The Centers for Disease Control and Prevention in Africa (Africa CDC) of the African Union (AU) assure that the outbreak of the Marburg virus disease, confirmed in Equatorial Guinea, should not “sow panic” and highlight that experts are working to contain it.
So far, at least 9 fatalities have been reported and around 4,000 people in quarantine.
The World Health Organization (WHO) is in contact with the Ministry of Health of Equatorial Guinea for the start of possible experimental treatments against the Marburg virus since there are currently no treatments or vaccines against this disease similar to Ebola, but several sera and candidate molecules.
This is how the Marburg virus works
Although Marburg and Ebola are different viruses, both belong to the Filoviridae family and cause diseases with similar clinical characteristics. Both are rare, but the fatality rates of their outbreaks can be high, according to the WHO.
The transmission
- Initially, human infection by marburg is due to prolonged stay in mines or caves inhabited by colonies of bats Rousettus.
- Transmission between people occurs through direct contact with injured skin or mucous membranes with blood, secretions, organs or other body fluids of infected people, as well as with surfaces and materials contaminated with these fluids, such as personal clothing or bedding.
- Cases have been described of transmission to health personnel that cares for patients through close contact without proper infection control precautions.
- The contagion through materials for contaminated injection or needlesticks is associated with greater severity of illness, more rapid exacerbation, and possibly a higher case fatality rate.
- This can also be given broadcast at funeral ceremonies in which mourners have direct contact with the body of the deceased.
- The infectivity persists as long as there is virus in the blood.
The symptoms
- The disease begins abruptly with high fever, intense headache and great discomfort, as well as frequent muscle pains.
- On the third day they can appear diarrhea intense, abdominal pain and colic, nausea and vomiting.
- In this phase we have described what the patients present “ghost look” due to sunken eyes, facial expressionlessness and extreme lethargy.
- Many patients have hemorrhagic manifestations severe at 5 to 7 days and fatal cases usually have some form of bleeding, often in multiple organs.
- During the severe phase of the disease, patients present persistent high fever.
- Central nervous system involvement can occur confusion, irritability and aggression.
- Occasional cases of orchitis (inflammation of one or both testicles) in the late phase of the disease (within 15 days of its onset).
- In fatal cases, the death usually occurs 8 or 9 days after the onset of symptoms preceded by heavy blood loss.
The measures
The outbreak was detected in the province of Kié-Ntem, in the west of the continental region of Equatorial Guinea, which officially reported it last February 13.
The measures that have been taken include:
- Limitation of movements
- Awareness campaign and the deployment of health personnel to “give” people who present the symptoms of this disease “the opportunity to be treated and have them tested”.
Likewise, the Africa CDC is cooperating “closely” with Cameroon and Gabon “to prevent the spread” of the outbreak beyond the borders of Equatorial Guinea, the country where an outbreak of this virus was reported for the first time.
In the past, outbreaks and sporadic cases of this disease have been detected in other countries in Africa, including Ghana, Guinea-Conakry, Angola, the Democratic Republic of the Congo (DRC), Kenya, South Africa and Uganda.
The disease is as deadly as Ebola, which struck Sierra Leone, Liberia and Guinea in 2014-2015 and for the first time jumped to Europe and America without outbreaks, just isolated cases.
The Marburg virus is estimated to have killed more than 3,500 people in Africa.
It was detected for the first time in 1967 in the German city of Marburg – origin of its name – by laboratory technicians who were infected while investigating monkeys brought from Uganda.
And if it came to Spain…
The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) offers some recommendations for the clinical management of patients should a case of an infected person from Marburg arrive in Spain.
- Marburg virus disease it is transmitted by close contact with a sick person and has a high mortality according to the previous series.
- Pending the definition of a suspected case or under investigation by the health authorities, consider performing the diagnostic determination for all patients with a compatible clinical picture.
- We consider it a priority preparation of all levels of care for safe care for patients and health workers until confirmation.
- In no case should the existence of this outbreak condition a denial or delay in access to healthcare patients from Equatorial Guineawho could risk their lives for not receiving a correct diagnosis and treatment of other infectious problems such as malaria, covid-19, bacterial infections or non-infectious diseases.
- In the face of cases under investigation of Marburg, both for the possibility of diagnosing this hemorrhagic fever and for the existence of a risk of bleeding from other endemic infectious diseases such as dengue, we recommend avoid the administration of non-steroidal anti-inflammatories, anticoagulants or antiplateletsunless its administration is essential, to patients from Equatorial Guinea with fever until the microbiological diagnosis is completed.
- We recommend making one malaria test to all patients from Equatorial Guinea with fever.
- The priority in the treatment of confirmed cases is those support measures.
- At the moment, there are no specific treatments that have proven effective against Marburg in controlled clinical trials in humans.
- From SEIMC remember that, once again, emerging infectious diseases put in public health risk of our country