Marburg virus disease: origins, reservoirs, transmission and guidelines
Marburg virus is a filovirus which, along with Ebola virus, can cause a severe and often fatal viral haemorrhagic fever (VHF).
Marburg virus belongs to the Filovirus family, along with Ebola. It can cause a severe and often fatal haemorrhagic fever called Marburg virus disease (MVD) which is clinically almost indistinguishable from Ebola virus disease.
Marburg virus is known to affect both humans and non-human primates.
MVD was first recognised in 1967, when outbreaks of haemorrhagic fever occurred simultaneously in laboratories in both Marburg and Frankfurt in Germany, and Belgrade in Yugoslavia (now Serbia). A total of 31 people became ill, including 25 laboratory workers, medical personnel and a family member who had cared for them. The laboratory workers all had contact with the blood, organs or cell-cultures from a batch of imported African green monkeys from north-western Uganda.
It is generally accepted that Marburg virus is a zoonotic (animal borne) virus. Fruit bats (Rousettus aegyptii) are considered to be the natural host of the virus. Monkeys are susceptible to Marburg virus infection but are not considered the reservoir hosts as they usually die rapidly once infected. Experimental infections have shown how pigs are susceptible to filovirus infection and can shed the virus.
Epidemiology
Recorded cases of MVD are rare.
Outbreaks and sporadic cases have been reported in Angola, Democratic Republic of Congo, Equatorial Guinea, Kenya, Ghana, Guinea, Uganda, South Africa (in a person who had recently travelled to Zimbabwe) and Tanzania.
The largest outbreak on record to date occurred in 2005 in Angola and involved 374 cases, including 329 deaths.
Two unrelated sporadic cases in travellers occurred during 2008 following visits to the ‘python cave’ in the Maramagambo Forest in western Uganda; this cave is home to a large colony of Egyptian fruit bats. Both people became ill upon return to their home country; one in the Netherlands and one in the US.
In October 2017, 3 fatal cases of MVD were reported in eastern Uganda, near the Kenyan border.
While reports of MVD outbreaks in West Africa are rare, sporadic cases have been identified, including 1 fatal case reported from Guinea in August 2021, and 2 fatal cases reported from Ghana in July 2022.
Map of countries which have reported human MVD cases, up to August 2023
See the HCID: country specific risk webpage for further information on incidents and outbreaks. There is currently an active outbreak of MVD in Rwanda: this map will be updated when further information about this outbreak becomes available.
Symptoms
The incubation period of MVD is typically 3 to 10 days, but can take up to 21 days from the date of exposure to the virus for symptoms to appear. There have been rare reports of longer incubation periods up to 28 days (although the precise mechanism of transmission in these cases was not well documented).
The onset of illness is sudden, with:
- severe headache
- malaise
- high fever
- progressive and rapid debilitation
By about the third day symptoms include:
- watery diarrhoea
- abdominal pain
- abdominal cramping
- nausea
- vomiting
Symptoms can become increasingly severe, and many patients develop a maculopapular rash after 5 to 7 days.
Severe cases usually exhibit some form of bleeding, including bleeding under the skin, bleeding from mucous membranes and from venepuncture sites.
Many of the early symptoms of MVD are similar to those of other infectious diseases, such as malaria or typhoid. Confirmation of the disease requires laboratory testing.
Transmission
Evidence gathered to date suggests that natural infection is most likely associated with contact with Rousettus bat colonies.
Subsequent transmission of virus from person-to-person requires close contact with blood or bodily fluids from an infected patient. Faeces, vomit, urine, saliva and respiratory secretions contain a high concentration of virus, particularly when these fluids contain the patient’s blood.
Sexual transmission of the virus can occur, and the virus may remain in semen for several weeks after clinical recovery, with some reports of virus present up to 203 days after disease onset.
Transmission of the virus via contaminated injection equipment or needle-stick injuries is associated with more severe disease.
Close contact with the body or body fluids of people who have died of MVD during preparation for burial is a recognised source of infection.
Diagnosis
In the UK, clinicians who suspect that a patient may have MVD should seek urgent advice from the UK Health Security Agency (UKHSA)’s Imported Fever Service (IFS) on 0844 778 8990.
The IFS operates 24/7 and provides advice on risk assessment, immediate management and infection control. The IFS will also coordinate urgent testing at UKHSA’s Rare and Imported Pathogens Laboratory (RIPL), Porton Down.
RIPL provides polymerase chain reaction (PCR) testing for MVD including out of hours if indicated. See VHF sample testing advice.
Treatment
There are currently no licensed vaccines or specific antivirals to treat MVD. Treatment is therefore mainly supportive and includes:
- replacing blood components
- balancing fluids and electrolytes
- maintaining oxygen status and blood pressure
- organ support as needed
UK guidelines
The UK has specialist guidance on the management (including infection control) of patients with viral haemorrhagic fevers (VHFs) including MVD.
The guidelines provide advice on risk assessment, testing and management of suspected MVD cases presenting to healthcare services within the UK.
Prevention and control
MVD is a VHF: measures for prevention of secondary transmission of Marburg virus are similar to those used for other haemorrhagic fever viruses, and focus on avoiding contact with infected bodily fluids.
Suspected cases must be immediately isolated and assessed using appropriate VHF assessment personal protective equipment. See the ACDP algorithm and guidance on management of patients and the NIPCM for further information.
In the UK, confirmed cases will be notified immediately to the High Consequence Infectious Diseases Network to arrange urgent transport to a High Level Isolation Unit.
*[IFS]; Imported Fever Service
Updates to this page
Last updated 4 October 2024 + show all updates
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Added map and guidance updates.
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Updated to reflect the end of 2 MVD outbreaks.
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Update to reflect Marburg virus disease outbreak in Tanzania.
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Update to reflect Marburg virus disease outbreak in Equatorial Guinea.
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Updated epidemiological information relating to a Marburg virus outbreak.
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Updated with latest MVD information.
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Updated text to reflect 2021 case of MVD in Guinea.
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Updated as the Marburg outbreak in Uganda was declared over.
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Added new outbreak in Uganda.
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First published.