Marburg virus disease (MVD), a severe viral hemorrhagic fever, which has been confirmed in some patients in Rwanda, is caused by the Marburg virus, and can result in severe illness. It has a case fatality ratio as high as 88%, according to the World Health Organization (WHO).

The UN health agency warns that MVD can cause severe viral hemorrhagic fever in humans. The symptoms typically begin abruptly and may escalate quickly, leading to severe health complications.

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How marburg virus spreads

Marburg virus initially infects humans through prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Once the virus has entered the human population, it spreads primarily through human-to-human transmission via direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals. Surfaces and materials contaminated with these fluids, including bedding and clothing, also pose a transmission risk.

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Healthcare workers are particularly vulnerable, often contracting the virus through close contact with infected patients when proper infection control measures are not followed. Burial ceremonies involving direct contact with the body of the deceased can contribute to further spread. The virus does not spread through the air.

Signs and symptoms

The incubation period for MVD can range from two to 21 days, which means, symptoms can take some time to appear after exposure. Initial symptoms typically manifest suddenly and include, high fever, severe headache, muscle aches, and severe malaise.

On the third day, patients may begin experiencing severe watery diarrhea, abdominal pain, cramping, nausea, and vomiting. As the illness progresses, many patients develop severe hemorrhagic manifestations, including bleeding from multiple areas such as the nose, gums, and in vomitus or feces.

Patients at this phase may exhibit "ghost-like” features, characterised by deep-set eyes and extreme exhaustion. In fatal cases, hemorrhaging is common, emphasising the need for immediate medical attention for anyone displaying these symptoms.

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What to do if you experience symptoms

Rwandans are urged to remain vigilant. If anyone experiences symptoms such as high fever, severe headaches, vomiting, muscle aches, or stomach aches, it is crucial to call the Rwanda Biomedical Centre (RBC) at 114 or visit the nearest health facility immediately. Early identification and isolation of cases are vital for effective treatment and containment of the virus, according to the ministry of health.

Diagnosis of marburg virus disease

Diagnosing MVD can be challenging due to the similarity of its symptoms with other infectious diseases such as malaria, typhoid fever, and other viral hemorrhagic fevers, according to WHO.

Confirmation of Marburg virus infection can be achieved through various diagnostic methods, including, antibody-capture enzyme-linked immunosorbent assay (ELISA), antigen-capture detection tests, reverse transcriptase polymerase chain reaction (RT-PCR) assay, virus isolation by cell culture.

Given the biohazard risk associated with samples collected from suspected cases, laboratory testing must be conducted under maximum biological containment conditions.

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Treatment

Currently, there are no approved vaccines or antiviral treatments for MVD.

However, supportive care, including rehydration with oral or intravenous fluids and management of specific symptoms, can improve survival rates. Ongoing research is focusing on developing monoclonal antibodies and testing existing antivirals used for other viral infections.

Preventive measures and public awareness

To control the outbreak, the Ministry of Health stresses the importance of community engagement. Public education about the nature of Marburg virus disease and outbreak containment measures is crucial.

Some recommended preventive actions include reduce the risk of bat-to-human transmission by avoiding mines or caves inhabited by fruit bats. When necessary, wear protective clothing and gloves.

Prevent human-to-human transmission by avoiding direct contact with infected individuals and their bodily fluids. Healthcare workers must adhere to strict infection control protocols.

Ensure that burial ceremonies are conducted safely and respectfully to prevent transmission from deceased individuals.

Maintain high hygiene standards, such as regular hand washing, particularly after visiting sick relatives or caring for infected individuals.

Addressing viral persistence and sexual transmission

Marburg virus can persist in immune-privileged sites in individuals who have recovered from MVD, including the testicles and eyes. For male survivors, sexual transmission can occur up to seven weeks after clinical recovery. The WHO recommends that male survivors practice safer sex and hygiene for 12 months from the onset of symptoms or until their semen tests negative for the virus.

Survivors are advised to receive counseling on safe sexual practices and the significance of good hygiene to reduce the risk of transmission to partners.