Question and Answer Session about Marburg Virus with Dr Kourouma Kabinet

With cases of the Marburg virus confirmed in West Africa, public concern is growing. Amref Health Africa Bureau Guinee Disease Control Coordinator Dr Kourouma Kabinet MD, MPH tackles some of the most commonly asked questions about how the disease – is spread, its signs and symptoms, how it can be contained and what people can do to protect themselves and their families.

What is Marburg?

Marburg virus (MARV) is an infectious disease caused by the Marburg virus. It is a viral hemorrhagic disease transmitted to humans by bats and spread by direct contact with infected persons’ body fluids, surfaces and materials. During the first seven days, many patients develop signs of severe haemorrhage. It is often fatal in humans.

How is Marburg spread and why is it spreading?

Transmission is primarily human-to-human and results from direct contact (through a wound or through mucous membranes) with blood, secretions, organs, or body fluids of infected persons, or with surfaces and materials (e.g., bedding or clothing) contaminated with these fluids. All recorded MARV outbreaks have originated in Africa where the virus is maintained in a natural reservoir. Several species of bats have been implicated in being reservoir hosts for filoviruses.

How long does it take for someone to clinically “recover” from the virus?

The virus causes severe viral hemorrhagic fever in humans. The average case fatality rate for this disease is approximately 50%. It ranges from 24% to 88% in previous outbreaks, depending on the strain of the virus and the management of cases. Early management with rehydration and symptomatic treatment improves survival. There is currently no approved treatment to neutralise the virus, but several blood-based treatments, immune therapies, and drug therapies are under development. Patients who survive usually do not have severe late-stage symptoms, but may experience sequelae such as arthritis, conjunctivitis, myalgia and symptoms of psychosis during and after recovery.

What are the symptoms, how can it be treated and how bad can it be?

The incubation period (the time between infection and the appearance of symptoms) ranges between two to 21 days. Symptoms observed range from high fever exceeding 38°c, strong headaches and severe malaise, Myalgias and pains, and abdominal disorders that are characterised by profuse watery diarrhoea, abdominal pain and cramps.

In addition, nausea and vomiting may appear on the third day and diarrhoea may persist for a week. Patients at this stage are often described as “ghost-like” with deeply sunken eyes, a blank face and extreme lethargy (a pathological state of sleepiness or deep unresponsiveness and inactivity).

In 1967, during the European outbreak, a non-itchy rash was seen in most patients between the second and seventh day after the onset of symptoms. Fatal cases are usually presented with Hemorrhagic manifestations, which become severe between five to seven days. Furthermore, spontaneous bleeding at venipuncture sites as a result of administering fluids or collecting blood samples is also associated with the virus, which can be problematic.

It can also cause central nervous system involvement leading to confusion, irritability and aggression. Orchitis (inflammation of one or both testes) has sometimes been reported in the late stage of the disease (15 days). In most fatal cases, death occurs eight to nine days after the onset of symptoms and is usually preceded by profuse blood loss and shock.

Should the outbreak of Marburg Virus Disease (MVD) in West Africa be a concern to other African countries?

Given the weakness of African countries’ health systems and migration control mechanisms, the outbreak of the Marburg Virus Disease epidemic should be of concern to other African countries, especially those neighbouring countries that have been declared as an outbreak by World Health Organisation (WHO).

What should be done to ensure the virus does not spread to other countries?

Similar to the Ebola outbreak, there is a need to strengthen border security by implementing a health migration control system, tracking contacts where they are, reinforcing the sensitisation of border populations to respect the measures enacted as well as involving community leaders in the decision-making and awareness-raising processes.

How should the affected countries address misconceptions and misinformation about the virus?

To address misconceptions and misinformation about the virus, we need to set up a system for collecting, processing and deconstructing misconceptions (fact checking), strengthening communication and dissemination of reliable and appropriate information through traditional and modern channels.

Lastly, each health district should establish a rumour management team.

Ends.

For more information & media contact

Maureen Cherongis

Media and External Relations

Amref Health Africa Headquarters maureen.cherongis@amref.org

M: +254 721178827