7 Things to Know About Marburg Virus Disease

On September 27, Rwanda's Ministry of Health reported the country's first outbreak of Marburg virus disease (MVD), a contagious viral infection that affects multiple organ systems and can lead to death. Rwanda has confirmed 66 cases and 15 deaths as of November 1st, making this the third largest known outbreak of MVD.

The Rwandan government is leading a comprehensive and notably effective response. The World Health Organization (WHO) and other partner organizations are supporting the Rwandan government in their efforts to prevent further spread of the disease by deploying experts, providing critical supplies needed to contain the outbreak and care for infected patients, and running critical vaccine and therapeutic clinical trials.

Inshuti Mu Buzima (IMB), as Partner's In Health is known in Rwanda, and the University of Global Health Equity (UGHE) are closely aligned with the Rwandan government and have also supported the coordinated response effort. IMB is providing support and technical expertise through response pillars established by the national government, specifically in the Mental Health and Psychosocial Support pillar (co-led by IMB) and the Continuity of Essential Services pillar. UGHE is providing technical expertise to the effort, identifying the first documented patient and confirming the transmission source.

As a result, the number of new cases has decreased from several a day at the beginning to four reported over the course of two weeks, indicating the outbreak is successfully under control.

Considered a neglected tropical disease, progress toward the elimination of MVD has historically been slow. Limited MVD‐specific funding, research, and drug and vaccine development has heightened the importance of public awareness and community involvement in reducing viral transmission.

Infectious disease specialist Dr. Marta Lado, PIH's director of clinical programs and health policy in Sierra Leone, and MVD response clinical lead Dr. Erick Baganizi, head of the division for clinical programs at IMB, agree that broader and more detailed clinical data is required to better understand the disease.

As candidate vaccines and therapeutics emerge, Lado and Baganizi are focused on prevention methods and improved patient care. Below are seven things they think you should know about MVD:

1. MVD is not a new disease.

Since its initial detection in 1967, simultaneously in Germany and Serbia, cases and outbreaks have been sporadic. Often found in remote regions, the disease has previously been reported in Angola, the Democratic Republic of Congo, Ghana, Guinea, Kenya, South Africa, and Uganda, with the most recent outbreaks occurring in Equatorial Guinea and Tanzania between February and June 2023.

2. MVD is a contagious viral infection.

MVD spreads through direct contact with the blood, organs, or bodily fluids of infected humans or animals, and with surfaces, objects, and materials contaminated with the virus.

The disease is introduced to human populations through infected bats and primates, usually after prolonged exposure to mines or caves inhabited by wildlife. In fact, the first outbreaks in Frankfurt and Marburg, Germany, and in Belgrade, Serbia, were associated with laboratory work using green monkeys imported from Uganda. The current outbreak in Rwanda is linked to transmission from a fruit bat.

Once MVD is transmitted from animals to humans, it can spread to other people through contact with contaminated bodily fluids from those who are infected.

People infected with MVD can infect others as soon as they are symptomatic, and they remain infectious as long as the virus is present in their blood.

3. Symptoms can develop quickly as the illness advances.

The time between exposure to MVD and the appearance of symptoms varies from two to 21 days. Once symptoms appear, the disease can progress rapidly.

In the first stage of MVD, symptoms can seem malaria-like and occur abruptly with high fever, headaches, fatigue, feelings of weakness, and localized pain in joints and muscles. Gastrointestinal symptoms, such as diarrhea, abdominal pain, nausea, and vomiting can also occur in this stage of the disease; but amid the current and most recent outbreaks, they have not been commonly observed.

As it advances, MVD can become more severe, leading to multi-organ dysfunction. In days, renal and liver failure can develop, as well as respiratory distress, seizures, loss of consciousness, anemia, hepatitis, hemorrhaging, blood vessel damage, and delirium.

4. MVD can be fatal.

The average MVD case fatality rate is around 50%, ranging from 24% to 88% in past outbreaks. Through supportive care facilitated by a robust health care system, many of Rwanda's infected patients have survived, putting the case mortality rate for MVD at around 23%, among the lowest ever recorded for the disease.

Some patients only experience fever symptoms that resolve on their own, without treatment. Others, however, arrive at care facilities already suffering from organ failure, difficulty breathing, and central nervous system disruptions, making their cases more difficult to manage and lowering their chances of recovery.

Moreover, the time needed to accurately diagnose MVD can put patients and health care workers at a lethal disadvantage. Symptoms of the disease, similar to other infectious diseases commonly found in areas where MVD is detected, are often mistaken for typhoid fever, food poisoning, and malaria, as was the case in Rwanda.

In fatal cases, death is usually preceded by severe blood loss and shock, occurring most often between eight to nine days after symptoms start.

5. Survival depends on effective supportive care.

While other medical conditions can further complicate the disease, even people who are considered healthy can have poor outcomes.

There are currently no fully approved vaccines or antiviral treatments for MVD.

The most effective approach to managing the disease, proven to increase chances of survival, is the delivery of intensive supportive care, which includes rehydration, antibiotics to prevent complications and super infections from bacteria, blood transfusions, medical oxygen therapy, and other treatments for specific symptoms.

Access to supportive care played a critical role in lowering the MVD case fatality rate in Rwanda.

6. Health care workers are especially vulnerable to MVD.

Clinicians, laboratory workers, and other people caring for individuals sick with the disease face an increased risk of infection. Because of difficulties clinically distinguishing MVD from other diseases, health care workers not yet aware of the need for isolation protocols and proper protective equipment are vulnerable to prolonged and potentially deadly virus exposure.

Despite a swift and effective response to challenges posed by MVD, over 80% of Rwanda's confirmed cases are among health care workers, emphasizing the need for enhanced protections, surveillance and contact tracing, and additional resources towards infection prevention and control training within health facilities.

Once confirmed in the country, access to diagnostics, less common in countries where outbreaks are normally found, significantly slowed the transmission of MVD in Rwanda.

7. There are ways to reduce your risk of infection.

• Avoid direct skin-to-skin contact with individuals suspected or confirmed to be infected with MVD
• Avoid contact with anything that may have touched infected bodily fluids
• Wear protective garments such as impermeable gowns or coveralls, gloves, masks, and face shields when caring for someone with MVD
• Wash your hands before touching your eyes, nose, and mouth
• Isolate and seek medical care by contacting your local health department right away if you've been exposed or are developing symptoms