under the microscope
By Priya Dhagat , MS , MLS ( ASCP ) CM , CIC
Marburg Virus : Reflections and Reminders Amidst a Current Outbreak
Nearly one month after the end of an Ebola virus outbreak in Uganda , another viral hemorrhagic fever outbreak strikes again . This time , Marburg virus strikes Equatorial Guinea , a small Central African country nestled between Cameroon and Gabon on the west coast of Africa .
On
February 13 , 2023 , a Marburg virus disease ( MVD ) outbreak was confirmed in the North Western part of the country , making it the first MVD outbreak that has ever been declared in Equatorial Guinea .
Outbreaks and sporadic cases have historically been reported across Africa , including Angola , the Democratic Republic of the Congo , Kenya , South Africa , and Uganda .
The confirmed and suspected cases presented with fever , fatigue , bloodstained vomit and diarrhea . Contact tracing and emergency responses are ongoing as
vaccine candidates are evaluated for potential clinical trials , and epidemiological surveillance has intensified in Equatorial Guinea , Cameroon , and Gabon .
What is Marburg Virus Disease ?
Marburg virus is an enveloped RNA virus in the filovirus family and is typically transmitted to humans from fruit bats . Human-to-human transmission occurs through direct contact with blood or body fluids from an infected person or contact with contaminated equipment or materials . Following entry into the body , the virus attaches to and
replicates in monocytes , macrophages and dendritic cells , and further disseminates to hepatocytes , endothelial cells , fibroblasts , and epithelial cells . As viral replication and pathogenesis continues , clinical manifestations begin abruptly and include flu-like symptoms such as a high fever , severe headache , chills , myalgia , gastrointestinal symptoms , rash , eventually leading to multi-organ failure . With a case fatality rate of 23 percent to 90 percent , supportive care is critical for survival .
An Imported U . S . Case in 2008
Important Reminders
While it may seem like a distant threat , imported cases of viral hemorrhagic fevers over the past several years ( for example ,
Lassa Fever in the UK and
Ebola in the U . S .) continue be a reminder that in our increasingly interconnected world , an outbreak anywhere can still pose a risk , albeit low , to healthcare facilities and may lead to a heavy toll on response and recovery efforts if cases go undetected . Restoring the fundamentals of infection prevention and control and providing ongoing education to healthcare professionals on the importance of travel screening and the “ identify , isolate , inform ” approach will support ongoing healthcare readiness for high-consequence diseases like Marburg .
Infection prevention and control guidelines for MVD are similar to those for Ebola and other viral hemorrhagic fevers . Patients should be isolated in a private room with dedicated bathroom or commode . Preventing direct physical contact is vital to prevent exposures ; strict adherence to transmission-based precautions and the use of PPE is required . A U . S . Environmental Protection Agency ( EPA ) -registered hospital disinfectant with efficacy against enveloped viruses should be used to disinfect surfaces and single-use medical equipment should be used by healthcare workers . A waste management plan for handling , storage , treatment , and disposal of waste should be developed in compliance with state and local regulations .
The CDC offers guidance for emergency room clinicians to assess viral hemorrhagic fever risk in returning travelers and has developed guidelines for Ebola , which can also be used for Marburg . For more information , refer to :
https :// www . cdc . gov / vhf / abroad / assessing-vhfreturning-traveler . html https :// www . cdc . gov / vhf / ebola / clinicians / index . html ? CDC _ AA _ refVal = https % 3A % 2F % 2Fwww . cdc . gov % 2Fvhf % 2Fabroad % 2Fvhf-manual . html
Priya Dhagat , MS , MLS ( ASCP ) CM , CIC , is an infection preventionist and the associate director of the system-wide Special Pathogens Program within the Department of Emergency Management at New York City Health + Hospitals , overseeing special pathogen preparedness and response efforts across New York City Health + Hospitals frontline healthcare facilities . Additionally , she supports and offers subject matter expertise for infection prevention topics for the National Emerging Special Pathogens Training and Education Center ( NETEC ).