MARBURG VIRUS DISEASE

A Deadly Haemorhagic Fever

After Covid 19 Pandemic, another deadly viral fever –the Marburg Virus Disease, caused by a rare virus
the Marburg virus, with a case fatality ratio of up to 88%is gaining attention in the World. This disease (MVD) was initially detected in 1967 after simultaneous outbreaks in Marburg and Frankfurt in Germany; and in Belgrade &Serbia. Marburg and Ebola viruses belong to the Filo viridae family (filovirus).

Initially, human MVD infection occurs due to prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Rousettus aegyptiacus bats are considered natural hosts for Marburg virus. MVD spreads through human-to-human 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. Pigs can be considered as a potential amplifier host during filovirus infections.

The disease begins abruptly, with high fever, severe headache, severe malaise, muscle aches and
pains. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on
the third day. Diarrhoea can persist for a week. The Patients at this phase will show “ghost-like” drawn
features, deep-set eyes, expressionless faces, and extreme lethargy. The incubation period varies from 2 to 21 days.

Many patients develop Haemorrhagic manifestations between 5 and 7 days, and in severe
cases, bleeding from multiple areas, fresh blood in vomitus and faeces, accompanied by bleeding
from the nose, gums, and vagina. Spontaneous bleeding at vene puncture sites can be fatal. During
severe phase, patients have sustained high fevers. Involvement of CNS can result in confusion, irritability, and aggression. Inflammation of the testicles has reported in the late phase of disease (15 days).

In critical cases, death occurs within 9 days after onset of symptoms due to severe blood loss and shock

DIAGNOSIS

MVD can be diagnosed using the following diagnostic methods:

• Antibody-capture enzyme-linked immune sorbent assay (ELISA)
• Antigen-capture detection tests
• Serum neutralization test
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay
• Electron Microscopy
• Virus isolation by cell culture

Samples must be collected under maximum biological containment conditions and the
specimens should be packaged using the triple packaging system when transported nationally and internationally for testing.

Supportive therapy using ORS (oral rehydration salts) or IV (intravenous) fluids and Symptomatic treatments are given for survival. There is no specific treatment for MVD. But a range of methods using blood products, immune and drug therapies are suggested.

The outbreaks can be controlled using case management, surveillance and contact tracing, a
good laboratory service, safe and dignified burials, and social mobilization. Human transmission can
be reduced by giving awareness on risk factors of the infection and protective measures.

During works or research or guest visits in mines or caves inhabited by fruit bat colonies,
people should wear protective clothes, gloves and masks. During outbreaks all animal products must
be cooked properly before use. Avoid close physical contact with patients. Always use protective wears.
After visiting the sick patients, do regular hand washing.

Inform the Public regarding the nature of the disease and outbreak containment measures ( like
prompt and safe burial of the dead, identification and monitoring of health of contact people for
21 days, separating the healthy from the sick to prevent spread, and maintaining good hygiene and
a clean environment)

WHO recommends that male survivors should practice safe sex and hygiene for 12 months
from onset of symptoms or until their semen twice tests negative for the virus. Avoid contact with body
fluids, and wash regularly with soap and water.

Healthcare team must follow basic hand and respiratory hygiene, use of PPE kit, safe injection
practices and safe and dignified burial practices. When in close contact with patients, wear face
protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown,
and gloves.

Since our population is familiar with the preventive measures taken against the Covid 19,
the Marburg Virus Disease can easily be managed and protect ourselves from transmitting the deadly
incurable epidemic.