The outbreak of the deadly virus, from the same Filoviridae family as Ebola, occurred in Equatorial Guinea (EG) and nine deaths and 16 suspected cases have been reported so far.
Like Ebola, Marburg virus disease (MVD) spreads from human to human through the bodily fluids of infected people, with symptoms including fever, fatigue and blood-stained vomit and diarrhoea, and there are currently no specific vaccines or antiviral treatments approved to prevent or treat the disease.
The World Health Organization (WHO) issued a statement on 13 February 2023 that preliminary tests, carried out following the 9 deaths in the country’s western Kie Ntem Province, returned a positive result for the viral haemorrhagic fever and EG public health delegate, Mr Robert Bidjang, said that two more suspected cases were also reported at the time.
“These are two 16-year-old children, a boy and a girl, who have no previous travel history to the affected areas in Equatorial Guinea,” Mr Bidjang explained.
“Forty-two people who came into contact with the two children have been identified [with 5 more suspected cases] and contact tracing is ongoing.”
The WHO said that a range of potential treatments, including blood products, immune therapies, and drug therapies, as well as candidate vaccines with phase one data are being evaluated, but noted that while experimental treatments have been validated in non-human primate models, they have never been tried in humans.
According to an open access letter published on Elsevier on 6 October 2022, the long incubation period of MVD – which could be up to three weeks – combined with a mortality rate of up to 88%; and recent increases in international travel; means that the disease has pandemic potential and should be treated as major public health threat.
“The virus is transmitted to people from African fruit bats (Rousettus aegyptiacus) and spreads among primates, including humans, through direct contact with the bodily fluids of infected people, surfaces, and materials,” the authors explained.
“Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise and many patients develop severe haemorrhagic symptoms within 7 days.”
The team, from Inner Mongolia University, China, Brac University, Bangladesh, and the Bangladesh Agricultural University, led by Dr Chunfu Zheng from the University of Calgary, Canada, concluded that further study is needed to determine if other species may also host the virus.
MVD originally emerged in a scene that reads like a horror movie, when haemorrhagic fever broke out simultaneously at German labs in Marburg and Frankfurt, as well as in Belgrade, Serbia, in 1967. Lab workers fell sick, followed by several medical personnel and family members who had cared for them, and of the 31 infected, 7 people died.
It later emerged that the first people infected had been exposed to African green monkeys or their tissue, imported from Uganda, while conducting research.
The largest known outbreak of MVD was in Angola in 2004, with 227 deaths among 252 infected people – a 90% fatality rate – and according to the CDC (Centre for Disease Control), the most recent outbreak was reported among a family in the Ashanti region of Ghana on 7 July 2022.
Two additional family members were also confirmed to have MVD and the WHO declared that while there was a considerable risk of the disease spreading nationally, the international risk was low.
The outbreak was declared over in September 2022 when no additional cases outside the family cluster were identified.
“However, there is a risk that this outbreak will spread to other nations because the first reported patient with Marburg virus disease had travelled from Ghana’s Western region (which borders Côte d’Ivoire) to the Ashanti region a few days before symptom onset…,” the WHO noted.
Which is exactly what has just occurred.
The WHO said that further investigations in the current case are ongoing and advance teams have been deployed in the affected districts to trace contacts, isolate, and provide medical care to people showing symptoms of MVD.
Efforts are also underway to rapidly mount an emergency response, with the WHO deploying health emergency experts in epidemiology, case management, infection prevention, laboratory, and risk communication to support the national response efforts and secure community collaboration in the outbreak control.
Even though EG is third largest oil exporter in Sub-Saharan Africa, the nation is crippled by the authoritarian regime, ruled by President Teodor Obiang Nguema Mbasogo, who took power in the 1979 military coup.
Subsistence farming is still the main livelihood in EG and healthcare facilities are almost non-existent in many parts of the country.
WHO Regional Director for Africa, Dr Matshidiso Moeti, said that they were also facilitating the shipment of laboratory glove tents for sample testing as well as one viral haemorrhagic fever kit that includes personal protective equipment that can be used by 500 health workers.
“Marburg is highly infectious. Thanks to the rapid and decisive action by the Equatorial Guinean authorities in confirming the disease, emergency response can get to full steam quickly so that we save lives and halt the virus as soon as possible,” Dr Moeti said.
“[While] there are currently no vaccines or antiviral treatments approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival.”
Diagnosing early MVD can be difficult as it shares many of the signs and symptoms of other infectious diseases such as malaria, typhoid fever, or dengue, as well as other viral haemorrhagic fevers such as Lassa fever or Ebola, however, antigen-capture enzyme-linked immunosorbent assay (ELISA) testing and PCRs can be used to confirm a case of MVD within a few days of those symptoms emerging.
“With no therapeutics and a high fatality rate, future outbreaks and a pandemic remain possible. Therefore, urgent consideration of MVD and ways in which to prevent a pandemic due to this virus is essential,” Dr Zheng’s team pointed out back in October.
“Vaccines against Marburg virus need to be developed, and antivirals specific to the virus need to be produced and Governments of all countries should ensure the availability of therapeutics for MVD for their citizens.”