What is the deadly Marburg virus and where did it spread? | Health News

Rwanda is battling its first outbreak of the “highly virulent” Marburg virus, which was first reported in late September.

As of Thursday, eleven people in Rwanda are said to have died from the virus. The health minister announced that the country would begin clinical trials of experimental vaccines and treatments.

So what is Marburg virus and how worried should we be?

What is the Marburg virus?

Marburg belongs to the same family as Ebola, namely the family Filoviridae (filoviruses). It has been described as more serious than Ebola.

According to the Mayo Clinic, it causes hemorrhagic fever, a type of fever that can damage the walls of blood vessels. Other diseases that cause this type of fever include dengue fever and yellow fever.

According to the Mayo Clinic, hemorrhagic fever causes internal bleeding, which can be fatal.

The virus was first identified in 1967 in a German city called Marburg, from which it got its name. At the same time it was identified in Belgrade, Serbia.

The World Health Organization (WHO) estimates the mortality rate to be between 24 and 88 percent. On average, around half of all those affected die from it.

According to the WHO, it can take between two and 21 days for symptoms to appear after a person is exposed to the virus.

“In fatal cases, bleeding usually occurs, often from multiple areas,” the website says, adding that bleeding can occur within five to seven days.

Bleeding in vomit or feces is often accompanied by bleeding from the nose, gums and vagina, says the WHO website.

In severe cases, death can occur eight to nine days after symptoms appear.

“People with weakened immune systems are more vulnerable to severe illness and death from this virus,” infectious disease expert Amira Roess told Al Jazeera. Roess is a professor of global health and epidemiology at George Mason University's College of Public Health.

What are the symptoms?

According to the Centers for Disease Control and Prevention (CDC), symptoms of Marburg virus include fever, headache, muscle and joint pain, fatigue, loss of appetite, bleeding, and gastrointestinal distress.

How does the Marburg virus spread?

Some people have become infected with the Marburg virus after coming into contact with Rousettus bats, a species of flying fox found in mines and caves that transmits the virus.

However, the source of the Rwanda outbreak remains unclear.

Once a person becomes infected with the virus, they can spread it to others through direct contact with body fluids through broken skin or mucous membranes. The WHO website states that even surfaces contaminated with bodily fluids, such as bed sheets or clothing, can spread the virus.

According to the CDC, the virus is not airborne.

What is the situation in Rwanda?

According to the government's latest update, there are currently 36 confirmed cases of Marburg in Rwanda, with 25 people being treated in isolation.

According to the WHO, as of September 30, when there were 26 confirmed cases, 70 percent of the cases affected health workers at two unnamed health facilities in the country.

“It is not uncommon for outbreaks to occur in health care facilities, particularly low-resource health care facilities that may not have adequate infection control in place,” Roess said.

In addition, Rwanda is monitoring 300 people who have come into contact with known cases.

Where did the Marburg virus spread?

On September 27, the Rwandan Ministry of Health confirmed the latest outbreak of Marburg virus.

The current outbreak has so far only been reported in Rwanda.

There were fears that the virus had entered Germany when two passengers on a train from Frankfurt to Hamburg contacted doctors because they feared they had the virus.

However, local authorities announced on Thursday that both had tested negative in a polymerase chain reaction (PCR) test, which involves testing a sample from the inside of the cheek, called a buccal swab, or blood. It tests genetic material from a specific organism, in this case the virus.

There have been small outbreaks of the virus in recent years, including the first outbreak in West Africa in Guinea in 2021, the first outbreak in Ghana in 2022, and the first outbreaks in Tanzania and Equatorial Guinea in 2023.

These were quickly contained. In Equatorial Guinea, 17 confirmed and 23 probable cases have been reported. “12 of the 17 confirmed cases died and all probable cases were reported deaths,” the WHO said. In Tanzania, there was one probable and eight confirmed cases, five of which resulted in death.

According to the CDC, only one case in Guinea was diagnosed after the patient's death; Three cases occurred in Ghana, resulting in two deaths.

“We know that an infectious disease that occurs in one area has the potential to become a problem worldwide,” Roess said.

How dangerous is the latest outbreak in Marburg?

The WHO assesses the risk of this outbreak as “very high at the national level, high at the regional level and low at the global level.”

Is there a vaccine or treatment?

There are no approved vaccines or treatments for the virus.

Rwanda's Health Minister Sabin Nsanzimana announced on Thursday that the country is seeking to develop a vaccine.

The WHO said some vaccine candidates are being produced. These include vaccines developed by the International AIDS Vaccine Initiative (IAVI) and the Sabin Vaccine Institute, which says it is working with the Rwandan government.

The Oxford University team that developed the AstraZeneca COVID-19 vaccine began a trial of its Marburg vaccine candidate in the United Kingdom this summer, using similar technology to the COVID vaccine.

The WHO told Reuters it had released funding for vaccine trials in collaboration with the Canadian government and the European Union's Health Emergency Preparedness and Response Authority (HERA).

Patients diagnosed with the disease should immediately seek treatment for symptoms with pain-relieving medication and drink enough fluids.

How to avoid getting caught in Marburg?

Roess said, “The best thing you can do is practice good hygiene and limit contact with sick people.”

She recommended wearing masks when in contact with people who have symptoms of the virus and sharing food with people who may be infected.

“If you think you have been exposed to the virus, limit your contact with other people, monitor your symptoms and report to your local health worker or health department official,” she said.

She added that the situation is difficult in most disease outbreaks because many health facilities worldwide do not have the resources to properly monitor how many people are infected.

“It is very important for the global community to work together to fund preventive, active surveillance and other programs. If we don’t take this seriously, more lives will be lost.”

Why are outbreaks becoming more and more common in Marburg?

In the 50 years between 1967 and 2017, 13 outbreaks were recorded.

Five outbreaks have been recorded since 2021, suggesting that the outbreaks are becoming more frequent.

Roess said outbreaks and rising cases will likely continue for several reasons.

“First, people around the world are coming into closer contact with wildlife,” she said, adding that wildlife is adapting to contact with humans and both wildlife and humans are becoming less afraid of each other.

She added that cases are also increasing due to increases in chronic illnesses and immunocompromised conditions such as diabetes and heart disease. These make people more susceptible to infection with the virus.

Because of technological advances, people with such conditions are living longer, “which is great, but that also means there are now more people who are more susceptible to illness when exposed to pathogens,” Roess said.

She added that the spread of the virus is more likely in places with limited health infrastructure. “People come for treatment when they are very sick. [At which point] They may excrete a lot of viruses.” This also increases the likelihood of transmission.