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WHO /Christopher Black
Marburg hemorrhagic fever is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola hemorrhagic fever. Both diseases are rare, but can cause dramatic outbreaks with high fatality. There is currently no specific treatment or vaccine. Two cases of Marburg virus infection were reported in Uganda. One of the people, a miner, died in July, 2007. A public information campaign was developed as well as training courses for local health workers. An international team of experts and scientists meanwhile worked to identify the hosts of the virus and its mode of natural transmission in the environment. They explored the mine cave where the outbreak appeared to have started in search of the reservoir of the Marburg virus. The bats captured from the Kitaka mine were taken to a nearby laboratory, just set up for this purpose. The scientists there worked through the night, taking blood and organ samples to look for Marburg virus antibodies. This photo story documents the combined efforts of WHO and its partners in the Global Outbreak Alert and Response Network to monitor, investigate and control the outbreak of Marburg fever in Uganda.
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Marburg virus disease

    Overview

    乐动体育登录Human infection with Marburg virus disease (MVD) initially results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies.

    Once an individual is infected with the virus, Marburg can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

    The incubation period (the time that passes from infection to onset of symptoms) varies from 2 to 21 days.

    Symptoms and treatment

    Symptoms

    Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Muscle aches and pains are a common feature. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Diarrhoea can persist for a week. The appearance of patients at this phase has been described as showing “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy. In the 1967 European outbreak, non-itchy rash was a feature noted in most patients between 2 and 7 days after the onset of symptoms.

    Many patients develop severe haemorrhagic manifestations between 5 and 7 days, and fatal cases usually have some form of bleeding, often from multiple areas. Fresh blood in vomitus and faeces is often accompanied by bleeding from the nose, gums, and vagina. Spontaneous bleeding at venepuncture sites (where intravenous access is obtained to give fluids or obtain blood samples) can be particularly troublesome. During the severe phase of illness, patients have sustained high fevers. Involvement of the central nervous system can result in confusion, irritability, and aggression. Orchitis (inflammation of one or both testicles) has been reported occasionally in the late phase of the disease (15 days).

    In fatal cases, death occurs most often between 8 and 9 days after symptom onset, usually preceded by severe blood loss and shock.

    Diagnosis

    乐动体育登录It can be difficult to clinically distinguish Marburg virus disease (MVD) from other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis and other viral haemorrhagic fevers. Confirmation that symptoms are caused by Marburg virus infection are made using the following diagnostic methods:

    • antibody enzyme-linked immunosorbent assay (ELISA);
    • antigen detection tests;
    • serum neutralization tests;
    • reverse-transcriptase polymerase chain reaction (RT-PCR) assay; and
    •  virus isolation by cell culture.

    Samples collected from patients are an extreme biohazard risk and laboratory testing on non-inactivated samples need to be conducted under maximum biological containment conditions. All biological specimens must be packaged using the triple packaging system when transported nationally and internationally.

    Treatment

    Supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for Marburg virus disease. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.

    Prevention and control

    Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe and dignified burials, and social mobilization. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Marburg infection and protective measures that individuals can take is an effective way to reduce human transmission.

    乐动体育登录Healthcare workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe and dignified burial practices.

    How to put on and how to remove personal protective equipment

    Steps to put on personal protective equipment (‎PPE)‎ including coverall

    Personal protective equipment for use in a filovirus disease outbreak (Rapid advice guideline)

    How to safely collect blood samples by phlebotomy from patients suspected to be infected with Ebola or Marburg

    How to safely collect oral swabs from deceased patients suspected to be infected with Ebola or Marburg

    How to safely ship human blood samples from suspected Ebola or Marburg cases within a country by road, rail and sea

    Hand hygiene in health care in the context of filovirus disease outbreak response

    Local production of WHO-recommended Handrub Formulations

    A toolkit for behavioural and social communication in outbreak response

    Field workbook for COMBI planning steps in outbreak response

    How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola or Marburg virus disease

     

    2 - 21 days

    incubation period

    The incubation period for Marburg virus disease varies from 2 to 21 days