A pandemic-weary nation probably wants to hear about a viral outbreak as much as they’d like a hole in the head, but my role as medical preparedness advocate requires that I note one when it occurs. On Jan. 7th, 2020, I reported on 60 cases of pneumonia in a place called Wuhan, China. At the time, no one had yet died from the unknown virus. 683 million cases and 6.83 million deaths later, well…So, it’s probably good to know about these things as early as possible, even if there’s only a small chance they’ll become a concern. Let me tell you about Marburg virus.
This time, with any luck, no such outbreak will happen, but recently, the African countries of Equatorial Guinea and Tanzania have reported cases of a hemorrhagic fever known as Marburg virus. So far, 13 cases have been confirmed in Guinea, with nine deaths and one recovery so far. In Tanzania, eight cases with five deaths have been documented. The last hemorrhagic fever to reach major epidemic status was Ebola in 2014, with 28,616 total cases and 11,310 deaths.
Marburg is very similar to Ebola in many ways. Both are viruses in the filoviridae family. Like Ebola, Marburg causes a disease that severely impacts various organs of humans and non-human primates in a short period of time.
Both are zoonotic infections, which means that they can be passed from animals to people. Even the original animal source of the virus (the “reservoir”) is similar: local fruit bats, in this case, Rousettus aegyptiacus, the Egyptian fruit bat. Neither virus seems to sicken the bats, but both cause significant numbers of deaths among their human and primate victims. Like Ebola, it’s thought that humans may have first contracted the Marburg virus from undercooked bushmeat.
The Marburg virus was first identified in 1967 in, of all places, German and Serbian (then Yugoslavian) labs after several simultaneous cases were linked to infected laboratory monkeys. Unlike the situation with COVID-19 and the Wuhan virology lab, the fact that Marburg was first identified in a lab doesn’t mean it was manufactured or otherwise developed there. It turns out that laboratory monkeys imported from Guinea arrived with the previously-unknown disease, which spread to lab workers. 31 people were infected, with seven deaths, before the virus was contained.
The very contagious Marburg virus can be transmitted whenever there’s contact with the bodily fluids, bedding, clothing, or other personal items of an infected person. The symptoms start, often suddenly, between 2 to 21 days after exposure (average 5-10). Infected individuals experience high fever, headaches, muscle aches, abdominal pain, malaise, and watery diarrhea at first, followed, several days later, by bleeding in the urine, bowel movements, from the nose, or under the skin. Bleeding may even occur from the gums, eyes, and ears. Blood loss is, not uncommonly, severe enough to cause shock, leading to death. In fatal cases, death occurs around day eight or nine.
Those most at risk of getting infected with Marburg are people who have direct contact with infected individuals, such as family members and health care workers. One contributing factor to Marburg’s spread is the custom in parts of Africa of having the family wash the body of the deceased before burial. This may explain why the infection seems to run rampant among family members. Heath care workers are also at high risk for infection.
In previous outbreaks, case fatality rates have ranged from 24% to 88%, depending on the strain of the virus involved and the availability of medical treatment, such as intravenous fluids and blood products.
Patients with suspected Marburg virus should be placed in isolation. Those caring for them should wear personal protective gear like gowns, aprons, gloves, face shields, and masks. Treatment consists of supportive care: fluids, oxygen, and transfusions are often needed.
No vaccine has been developed against the Marburg virus, though some are in development. It has been suggested that, due to its close relation to Ebola, that existing Ebola vaccines may be effective.
The World Health Organization (WHO) considers the risk of an epidemic to be very high for Guinea and Tanzania, but previous outbreaks of Marburg, including on in Ghana last year, have all petered out on their own. The countries involved and their neighbors are initiating containment protocols with contact tracing and other methods of identifying and isolating those at risk for being infected. The chance for worldwide spread is considered to be low. Still, it’s imperative to be aware of Marburg, even if it’s still beyond the horizon. Let’s hope it stays there.
Joe Alton MD
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