On 13 February 2023, the World Health Organization received a case report of Marburg virus disease originating from Equatorial Guinea. Based on the case reports received by WHO, there were 9 deaths and 16 suspected cases reported in Kie Ntem Province. Symptoms include fever, fatigue, bloody vomiting, and diarrhea.
Marburg virus disease is a hemorrhagic fever caused by the Marburg virus (a filovirus in the same family as the Ebola virus) that can be transmitted from bats and between humans. The disease is rare but can cause outbreaks with high mortality rates (24-88% or about 50%).
Marburg virus was first identified in 1967 simultaneously in Marburg and Frankfurt in Germany and in Belgrade, Serbia. Since 1967 to date, 593 confirmed cases of Marburg virus disease with 481 deaths (case fatality rate/CFR: 81%) have been reported in Africa, the Americas, or Europe. The three countries with the highest reported cases of Marburg virus disease since 1967 are Angola (374 cases), DR Congo (154 cases), and Germany (29 cases).
Currently, Marburg virus disease outbreaks are occurring in two countries:
Equatorial Guinea: From 7 February 2023 to 25 February 2023, 1 confirmed case, 6 suspected cases, 4 probable cases, and 11 deaths have been reported (CFR of confirmed cases: 100%) in Kie-Ntem Province.
Tanzania: On 21 March 2023, the Tanzania Ministry of Health reported 8 confirmed cases with 5 deaths (CFR of confirmed cases: 62.5%) in the Kagera region.
Symptoms of Marburg Virus Disease
The onset of symptoms (incubation period) is generally 2-21 days after exposure to the Marburg virus. Symptoms of Marburg virus disease may appear suddenly, including high fever, severe headache, malaise, and muscle pain. On day 3, a person may experience severe watery diarrhea for up to 1 week, abdominal pain, cramps, nausea, and vomiting. In addition, during this phase, a person may appear to have sunken eyes. 2-7 days after the onset of symptoms, a non-itchy rash may appear.
Severe symptoms in the form of bleeding may occur on days 5 to 7 in areas such as the nose, gums, and vagina, and may occur through vomiting and in the feces. During the severe phase of the disease, patients suffer from high fever, and central nervous system disorders, resulting in confusion and irritability. In fatal cases, death most often occurs between 8 and 9 days after the onset of symptoms, usually preceded by severe blood loss and shock.
Transmission of Marburg Virus Disease
Marburg virus can be transmitted between people through blood and other body fluids, including urine, saliva, sweat, feces, vomit, breast milk, and semen/sperm, from living or deceased humans infected with the Marburg virus. Marburg virus can enter through injured skin or unprotected mucous membranes, such as the eyes, nose, and mouth. It can also spread through items such as clothing, bedding and equipment, needles, syringes, and medical devices that have been contaminated with blood or body fluids from someone infected with the Marburg virus.
Groups at risk of contracting the Marburg virus include:
- Family and medical staff who care for patients with Marburg virus disease without implementing infection prevention and control measures.
- Individuals with a history of traveling to endemic countries in Africa and having contact with fruit bats (Rousettus aegyptiacus) or entering caves/mines where these bats live.
The fruit bat Rousettus aegyptiacus is thought to be the natural reservoir host of the Marburg virus. However, to date, there is no clear disease in fruit bats. Potential transmission from animals to humans can occur through contact with bodily fluids (saliva, feces, and urine) from animals infected with the Marburg virus.
Prevention of Marburg Virus Disease Transmission
1. Reduce contact with Marburg virus reservoir bats. If you must visit the bat habitat area, you can use gloves and other protective equipment such as masks.
2. Consume meat thoroughly, including when in Marburg virus outbreak areas
3. Avoid contact with suspected or infected people including their body fluids 4.
4. For healthcare workers, implement infection prevention and control (PPI) 5.
5. Wash hands regularly, especially when visiting someone who is sick or after handling someone who is sick at home
6. Postpone traveling to areas where there is currently an outbreak. If this is not possible, pay attention to the risks and recommendations of the government of the destination region/country.
Treatment
There is no specific treatment for Marburg virus disease. Treatment is more supportive and symptomatic, and there is no vaccine for Marburg virus disease.
There have been no reported cases or suspects of Marburg disease in Indonesia but the government has asked the public to be vigilant.
Image: Illustration (Source: xb100 - Freepik)
References:
1.Kementerian Kesehatan. Frequently asked questions (FAQ) penyakit virus Marburg [Internet]. 2023 Mar 22 [cited 2023 Apr 03]. Available from: https://infeksiemerging.kemkes.go.id/penyakit-virus/frequently-asked-questions-faq-penyakit-virus-marburg
2.Kementerian Kesehatan. Fatalitas tinggi akibat virus Marburg, RI waspada [Internet]. 2023 Mar 29 [cited 2023 Apr 03]. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20230328/3142658/fatalitas-tinggi-akibat-virus-marburg-ri-waspada/
