Marburg virus is a zoonotic RNA virus from the same family as Ebola, the flavovirus family. This virus is a highly contagious infectious disease that inflicts humans and primates causing Marburg virus disease (MVD), also known as Marburg hemorrhagic fever. The African fruit bat, Rousettus aegyptiacus, is the reservoir host for Marburg fever. It is unclear how the virus is transmitted from fruit bats to humans, however, it is predicted that it could be through contact with infected bat feces or aerosols . Once the virus has crossed over to people, it spreads person-to-person via direct contact with blood, bodily fluids, or objects contaminated with bodily fluids from an infected person. Those most at risk for contracting MVD include family members and hospital staff caring for sick MVD patients, laboratory workers, and those in close contact with non-human primates. With a case-fatality rate of 23-90% depending on the strain and outbreak, it is critical to identify MVD quickly to prevent a widespread epidemic . After exposure, it takes between 2-21 days for symptoms to present. Symptoms occur suddenly and include fever, chills, headache, and myalgia. Approximately a week after symptom onset, severe symptoms including delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction occur. Due to similar symptoms as other infectious diseases, MVD can be difficult to diagnosis and is sometimes confused with malaria, typhoid fever, Lassa fever, and Ebola. Currently, no treatments aside from supportive hospital therapy exist, however, potential monoclonal antibodies and antiviral treatments are being studied .
First Marburg Virus Case in Guinea
On August 6, 2021, the Ministry of Health of Guinea reported the first known case of MVD to ever be recorded in West Africa. The case was confirmed to be a resident from Temessadou, located in Guéckédou Prefecture, Nzérékoré Region, south-western Guinea . Both Sierra Leone and Liberia closely border this area. The case was a 46-year-old male who began experiencing symptoms on July 25. After feeling ill for a number of days, the patient visited a local healthcare facility in the Koundou area. He described symptoms including fever, headache, fatigue, abdominal pain, and gingival hemorrhage. Upon receipt of negative malaria test results, local healthcare providers gave him supportive care to manage symptoms . Approximately a week after symptom onset, on August 2, the patient died. Following his sudden death, the sub-prefecture public health care facility raised an alert to the Guéckédou Prefecture department of health, initiating a disease investigation. A team consisting of WHO experts and national authorities were deployed to the village where they obtained post-mortem oral swab samples from the patient which were shown to be positive for Marburg virus and negative for Ebola on August 3 by real-time PCR in the viral haemorrhagic fever reference laboratory in Guéckédou. The National Reference Laboratory in Conakry and the Institut Pasteur Dakar in Sengal both later confirmed the diagnosis .
Public Health Outbreak Response
Collaborative efforts between the Ministry of Health, WHO, CDC, ALIMA, Red Cross, UNICEF, The International Organization for Migration, and other partners were initiated to prevent the spread of disease. About 150 contacts were identified and followed-up with by the disease investigation team, including three family members and a healthcare worker involved in the patient’s treatment. In addition, public health education on Marburg virus is being implemented in communities to spread awareness among Guinea citizens. Due to the location of the case, cross-border surveillance has also been heightened to identify potential cases in Sierra Leone and Liberia. This has been implemented quickly by utilizing the Ebola control systems already in place in Guinea, as well as neighboring countries. No additional cases have been identified at this time.
Guinea’s Challenges with Hemorrhagic Fever Outbreaks
Guinea has a fragile healthcare system which has been plagued by a magnitude of infectious disease outbreaks in the past decade. Based on the Integrated Core Survey for the Evaluation of Poverty (EIBEP), less than 40% of Guineans have access to healthcare within 30 minutes . Further, the rate of health service utilization is reported to be only about 19% . The sub-prefecture of Gouécké, Nzérékoré Region, located close to where the Marburg virus case originated, has battled Ebola outbreaks in 2021 and between 2014-2016. The 2014-2016 outbreak was the largest Ebola outbreak in history, spreading to Sierra Leone and Liberia and resulting in over 28,000 cases and 11,000 deaths across ten countries . The 2021 Ebola outbreak recently ended on June 19, 2021 resulting in 16 confirmed and seven probable cases, as well as 12 deaths . Due to the existing treatment infrastructure, laboratories, and infection prevention measures in place from this outbreak, the Marburg virus case was identified quickly . Nevertheless, these epidemics have exacerbated the healthcare system in Guinea.
Marburg Virus in Africa
Previously, there have been outbreaks of Marburg virus in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda . The deadliest outbreak of Marburg virus occurred between 2004-2005 in Angola, claiming 252 lives with a 90% case-fatality rate . Since then, all Marburg virus outbreaks have occurred or been traced back to Uganda until now .