Ghana is racing against time to contain the outbreak of one of the highly lethal viruses in human history. Two people in the southern part of Ghana tested positive for the Marburg virus.  The Institute Pasteur, a WHO-collaborating laboratory, corroborates the results. 

Ninety-eight (98) people identified as contacts of the 2 confirmed cases were immediately placed in quarantine. However, none of the 98 people has shown symptoms nor tested positive for the virus.

When a condition requires an immediate and collective international response, it is most likely uncommon, unexpected, and sudden, with implications for public health far beyond the borders of the originating country.

Here are ten (10)  facts we need to know about the Marburg virus disease.

Fact 1.  What is Marburg Virus Disease

Marburg virus is a disease-causing agent that belongs to the same filovirida family as the Ebola virus.  It was first identified in 1967 in a German City called Marburg hence its name.  It is part of the family of viruses that causes hemorrhagic fever.

Fact 2: How common is Marburg Virus Disease.

Marburg virus disease is relatively rare.  About 522 cases of Marburg virus disease have been recorded across 11 countries since its discovery.  The largest outbreak to date occurred in the Uige province in Angola, where 374 cases were detected, of which 329 died.  Ghana and Guinea are the only two west African countries with recorded cases of this deadly virus.

Fact 3: How is it transmitted

           Two ways

1. Natural

Most of the natural outbreaks of Marburg are linked to human encroaching on the natural habitats of wildlife.  Human  Entry into bat-infested caves and mines poses a significant risk of infection.  Additionally, contact and consumption of bush meat can be a potential source of infection.

• Human-to-human transmission

Once a person is infected.  The chain of transmission can continue via direct contact with infected fluids or surfaces contaminated with Saliva, urine, faeces, vomit, breast milk, semen, and amniotic fluids of infected persons.

Inter-human transmission is not airborne and only occurs when the symptoms appear.

Fact 4.  What are the symptoms of Marburg Virus Disease

The symptoms typically occur between day 3 to day 21 following infection.  The first stage is characterized by a sudden onset of flu-like symptoms like high fever, general body weakness and headache, similar to other infectious diseases such as malaria, typhoid and covid-19.  Later stage symptoms are typically hallmarked by bleeding from multiple places such as the nose, mouth, skin, and eyes with severe vomiting and diarrhoea.

Fact 5:  How do you know if someone has Marburg disease

Because of its similitude with other infectious diseases, clinical diagnosis in the early stages can be challenging and requires a very high index of suspicion.  History of direct contact with an infected person and abrupt onset of symptoms can help identify potential cases.  Families and front-line health workers should notify public health professionals as early as possible.

Fact 6.  How severe is Marburg Virus Disease

Marburg's fatality rate, which measures how deadly the disease can be, varies.  The original outbreak in Marburg (Germany) and Serbia recorded a fatality rate of 24%.  Subsequent outbreaks have recorded a fatality of up to 100%.  The average Marburg virus fatality ratio is about 90% (475 deaths/522 cases).

Fact 7: Can Marburg Virus Disease be treated or Cured

Unfortunately, there is no treatment, cure or approved vaccine for the Marburg Virus disease.  Some antivirals are in the early phases of clinical trials.  Management of Marburg virus disease is, therefore, symptoms based.

Fact 8:  How can the risk of infection be reduced

Avoiding direct contact with potentially infected people can disrupt the transmission of Marburg virus disease.  Also, we can prevent transmission if we avoid or wear proper personal protective equipment before direct contact with infected persons or when encroaching on the natural habitats of wildlife.

Fact 9: Can the outbreak of Marburg be stopped

Yes.  The control of the Marburg virus disease outbreak can be stopped if we interrupt human-to-human transmission.  Public health strategies like early detection, case isolation, contact tracing, community engagement and social mobilization, safe conduct of burials and strict infection prevention and control protocols at our hospitals can effectively stop the chain of transmission.  In 2021 guinea recorded a single case of Marburg outbreak.  With adequate control, the outbreak was declared over without any propagation.

Fact 10: what is the difference between COVID-19, Marburg and Monkeypox

Covid-19 is easily transmissible but has a very low case fatality ratio (less deadly) compared to Marburg and Monkeypox.  Covid-19 has a fatality ratio of about 1-3% compared to 24-100% for

Rare fact:  It is recommended that men who recover from Marburg virus disease should continue to practice safe sexual practices (barrier protection) until their semen twice tests negative for Marburg virus.

Marburg and 1-10% for monkeypox.  Treatment and Vaccine for Covid-19 and, to some extent, monkeypox exist, but none is available for Marburg.

With increasing population growth and human connectivity, climate change and changing interactions between humans and wildlife resulting in habitat destruction, emerging and re-emerging diseases will continue to threaten global health security.

Want more?  Check the following sources.

https://www.cdc.gov/vhf/marburg/index.html

https://www.ecdc.europa.eu/en/all-topics-z/ebola-virus-disease/facts/factsheet-about-marburg-virus-disease

https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease

https://www.intechopen.com/chapters/68376

https://www.nejm.org/doi/10.1056/NEJMoa051465

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62385-0/fulltext

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This article was put together by Banda Khalifa MD, MPH, MBA. He is a Global Health Expert and a Health & Vaccine Delivery Advisor at Tony Blair Institute for Global Change.