MARBURG HEMORRHAGIC FEVER
Marburg hemorrhagic fever is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates.
Incubation period : 3-9 days
Mode of Transmission:
The virus can be spread to humans:
a. through direct contact with or droplets of body fluids (e.g., blood, saliva, and urine) of an infected person or animal.
b. contact with objects (e.g., medical equipment) that have been contaminated with infectious material.
Signs and symptoms:
Onset of the disease is sudden, marked by fever, chills, headache, and myalgia. Approximately on the fifth to the seventh day after onset of illness, severe hemorrhagic manifestations develop, most frequently affecting the gastrointestinal tract and the lungs. A characteristic rash usually appears at this time, sometimes involving the whole body. These may be accompanied by nausea, vomiting, chest pain, sore throat, abdominal pain, and diarrhea.
Clinical condition worsens and patient's signs and symptoms include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhage, and multi-organ dysfunction.
Complications:
Recovery from Marburg hemorrhagic fever may be prolonged and accompanied by orchitis, recurrent hepatitis, transverse myelitis or uveitis.
Other possible complications include inflammation of the testis, spinal cord, eye, parotid gland, or by prolonged hepatitis.
Fatality rates for outbreaks of Marburg VHF:
Ranges from approximately 25% to 80%; mortality has been higher in outbreaks in which effective case management was lacking.
No vaccine or curative treatment is available, and supportive treatment should be used.
The virus has been reported to survive for as long as several days on contaminated surfaces.
Protection:
Hospital infection-control practices for infected patients should include contact and droplet precautions, in addition to wearing eye protection or a face shield.
The risk:
Reports of Marburg virus disease are rare, and its occurrence has been limited to countries in sub-Saharan Africa . The environmental reservoir of the virus is unknown.
The risk for persons outside of the area where the outbreak is occurring is very low. Persons in northern Angola are not allowed to leave while under quarantine for 21 days.
Persons who should be watched out for Marburg VHF:
Marburg VHF should be watched for among febrile patients who, within 10 days before onset of fever, have either
1) traveled in northern Angola ;
2) had direct contact with blood, other body fluids, secretions, or excretions of a person or animal suspected of having VHF; or
3) worked in a laboratory or animal facility that handles hemorrhagic fever viruses
Advise to travelers:
During travel
- Clean your hands often, using soap and water. When soap and water are not available, or alcohol-based hand rubs.
- If gloves are worn, wash the gloves with soap and water before removing them, and then wash your hands.
- Avoid contact with ill or dead animals, especially primates.
- Do not eat meat of wild animals, including that of primates, sold for consumption as food in local markets.
- If you or your family members become ill with fever or develop other symptoms such as chills, muscle aches, nausea, vomiting, or rash, visit your physician immediately . Limit your contact with others while in transit to the health care facility. Avoid travel to other areas.
Upon return of travelers:
- Persons returning from the affected area should monitor their health for 10 days. Any traveler who becomes ill, even if only with fever, should consult a health-care provider immediately and tell him or her about their recent travel and potential contacts. Tell the provider about your symptoms prior to going to the office or emergency room so arrangements can be made, if necessary, to prevent transmission to others in the health-care setting.
History of Marburg virus:
Marburg virus - belongs to the virus family of Filoviridae which includes 4 species of Ebola
1967 - Marburg virus was first recognized; outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt , Germany and in Belgrade , Yugoslavia (now Serbia ).
A total of 37 people who were laboratory workers and several medical personnel and family members who had cared for them. The first people infected had been exposed to African green monkeys imported from Uganda for research.
1975 - A traveler most likely exposed in Zimbabwe became ill in Johannesburg , South Africa . His traveling companion and a nurse also contracted the illness.
1980 - Two other cases, one in Western Kenya not far from the Ugandan source of the monkeys implicated in the 1967 outbreak and patient's attending physician in Nairobi .
1987- A young man who had traveled extensively in Kenya , including western Kenya , became ill and later died of Marburg hemorrhagic fever.
1998 - An outbreak occurred in Durba , Democratic Republic of the Congo . The outbreak which led to 149 cases, 123 of whom were fatal, was initially concentrated in workers at a gold mine in Durba. After the outbreak subsided, there were still some sporadic cases that occurred in the region.
Prepared by: Unit for Emerging and Re-emerging Infectious Diseases
National Center for Disease Prevention and Control
Department of Health