Marburg Virus Disease (MVD) – Everything You Need to Know

Marburg Virus Disease (MVD) is a highly contagious, severe, and often fatal disease in humans.

It is thought to be contracted from a species of fruit bat and can be passed from human-to-human through close contact but also occurs in non-human primates

It has similarities to Ebola as they are both members of the Filoviridae family of viruses, although different viruses, they are clinically very similar. Both diseases are rare but have the capacity to cause usually localised outbreaks with high mortality rates. Together with Lassa fever Marburg Virus Disease and ebola form a group of diseases called Hemmorhagic Fevers, characterized by a sudden onset, fever, aching, bleeding in the internal organs, petechiae (small red marks on the skin caused by localised bleeding), and shock.

Marburg Virus Transmission

It was first reported that humans contracted the virus following prolonged time spent in mines and caves inhabited by Rousettus bats.

Marburg Virus Disease spreads from human to human through direct contact of broken skin, mucus membranes, blood, secretions, organs, and bodily fluids or through contact with infected surfaces and materials such as bedding, clothing, and medical equipment e.g., giving sets needles, ventilators etc.

Healthcare workers are usually infected when using inadequate Personal Protective Equipment whilst treating patients with the virus or when infection control procedures are not followed adequately.  Needlestick injuries and use of infected equipment will see an even higher fatality risk in those workers with associated rapid deterioration.

Burial ceremonies that involve direct contact with the body of the deceased can also be a transmission route.

People remain infectious as long as the virus remains in their blood.

Marburg Virus Symptoms

Many of the signs and symptoms of MVD are similar to other infectious diseases or viral hemorrhagic fevers, therefore diagnosis can be difficult. Incubation period varies from 2 to 21 days

• The virus begins abruptly
• High fever
• Severe headaches
• Muscle aches and pains
• Nausea and vomiting
• Severe malaise (tiredness)
• Severe watery diarrhoea
• Abdominal pain and cramping
• The appearance of the patient has been described as ‘ghost like’ drawn features, deep set eyes, expressionless face, and extreme lethargy.
• In a 1967 European outbreak a non-itchy rash developed in some patients between 2- 7 days.
• Most fatal cases usually have some form of bleeding (see Hemmorhagic fever above).
• During the severe phase patients have high fevers, central nervous symptoms can result in confusion irritability and aggression.
• Death occurs between 8-10 days usually proceeded by severe blood loss and shock.

Marburg Virus Vaccines & Treatment

Currently there are no vaccines or medication approved for MVD.

Supportive care – rehydration with oral or intravenous fluids improves survival.

Reducing the Risk of MVD

• Reduce the risk of bat to human transmission – during work, research activities or tourism. Gloves and masks should be worn. During outbreaks all animal products should be thoroughly cooked before consumption.
• Reduce the risk of human-to-human transmission in the community. PPE and infection control should be practiced. Close physical contact should be avoided. Regular hand washing should be practiced.
• Communities affected should be kept well informed. About the disease and the necessary outbreak containment measures.
• Outbreak containment measures: quick burial of the deceased.
• Identify the people who may have been in contact with the infected, monitoring their health for 21 days
• Separating the healthy from the sick to prevent further infections
• Maintain good hygiene practices and a clean environment to be observed.

Marburg Viral Persistence in Recovering Patients

The virus can persist in some people who have recovered from MVD

• In males it can persist in the testicles and sperm with infection seen up to 7 weeks after clinical recovery. More research is being carried out into sexual transmission.
• Male survivors should be enrolled onto semen testing programmes.
• Males and their partners should be offered counselling
• Survivors should be provided with condoms.
• All women that have been infected whilst pregnant: the virus persists in the placenta, amniotic fluid and foetus.
• In women that have been infected whilst breast feeding: the virus may persist in breast milk.

All survivors, their partners and families should be shown respect, dignity and compassion.

Reference

Information gathered and reproduced from UKFO  07 August 2022
WHO websites
Sheena Lewinsohn RGN 19/8/2022