Marburg Virus Disease in Rwanda: Causes,Symptoms & Treatment

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Marburg virus disease (MVD), previously known as Marburg hemorrhagic fever, is a severe and often fatal illness in humans. It causes viral hemorrhagic fever, with an average case fatality rate of around 50%. This rate can range from 24% to 88% depending on the virus strain and the quality of case management.

Early supportive care, including rehydration and symptomatic treatment, can improve survival rates. Currently, there is no licensed treatment proven to neutralize the virus, but various blood products, immune therapies, and drug therapies are in development.

The natural hosts of the Marburg virus are fruit bats, specifically “Rousettus aegyptiacus”. The virus spreads to humans from these bats and then from person to person. Effective community engagement is crucial for controlling outbreaks.

MVD was first detected in 1967 during outbreaks in Marburg and Frankfurt in Germany and in Belgrade, Serbia. The outbreaks were linked to laboratory work with African green monkeys imported from Uganda. Since then, sporadic cases have occurred in several African countries, including Angola, the Democratic Republic of the Congo, and Uganda. In 2008, cases were reported in travelers who visited bat-inhabited caves in Uganda.

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Transmission

Initial human infection typically occurs through prolonged exposure to mines or caves housing Rousettus bat colonies. Marburg spreads through direct contact with the blood, secretions, organs, and other bodily fluids of infected individuals. It can also spread through contaminated surfaces and materials.

Health-care workers are often at risk when treating patients, especially if infection control measures are not strictly followed. Transmission can also occur via contaminated injection equipment or needle-stick injuries, which are linked to more severe disease and higher fatality rates. Burial practices that involve direct contact with the deceased can further contribute to the spread.

Infected individuals remain contagious as long as the virus is present in their blood.

Symptoms of Marburg Virus Disease

The incubation period for MVD ranges from 2 to 21 days. Symptoms typically begin suddenly, with high fever, severe headache, and intense malaise. Muscle aches and severe watery diarrhea may follow within a few days. Patients can exhibit “ghost-like” features, deep-set eyes, and extreme lethargy.

Many develop severe bleeding manifestations between 5 and 7 days after symptom onset. Fatal cases often involve bleeding from multiple sites, including the nose and gums. High fever persists, and neurological involvement can lead to confusion and irritability.

Death usually happens 8 to 9 days after symptoms appear, often preceded by severe blood loss and shock.

Diagnosis

MVD can be challenging to distinguish from other infectious diseases, such as malaria and typhoid fever. Diagnosis is confirmed using various tests, including:

  • Antibody-capture ELISA
  • Antigen-capture detection tests
  • Serum neutralization tests
  • RT-PCR assays
  • Electron microscopy
  • Virus isolation through cell culture

Laboratory testing requires maximum biohazard containment. Biological specimens must be packaged securely during transport.

Treatment and Vaccines

Currently, there are no approved vaccines or antiviral treatments for MVD. Supportive care, especially rehydration, can improve survival rates. Some monoclonal antibodies and antiviral drugs, like Remdesivir and Favipiravir, have shown potential in studies for Ebola and could be tested for MVD.

In May 2020, the EMA approved two vaccines for Ebola that may also protect against MVD, although their efficacy for MVD is unproven.

Prevention and Control

Controlling outbreaks relies on a combination of measures, including:

  • Case management
  • Surveillance and contact tracing
  • Laboratory services
  • Safe burials
  • Community engagement

Key prevention strategies include:

  1. Reducing Bat-to-Human Transmission: Avoid prolonged exposure to bat-inhabited areas. Wear gloves and protective gear during such activities.
  2. Reducing Human-to-Human Transmission: Avoid close contact with infected individuals and their bodily fluids. Use personal protective equipment when caring for sick patients, and practice regular handwashing.
  3. Community Awareness: Educate communities about the disease and outbreak control measures.
  4. Outbreak Containment: Implement safe burials, monitor contacts of infected individuals for 21 days, and maintain hygiene.
  5. Sexual Transmission Risks: Male survivors should practice safer sex and hygiene for 12 months after symptom onset, or until their semen tests negative for the virus.

Isolation of convalescent patients with negative test results is not recommended.


Sara

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