Just a couple of weeks after the declared end of an Ebola outbreak in Uganda, media reports today are indicating that at least three cases of Marburg virus – another virulent hemorrhagic fever of the same family - have been detected in the Kabale district in western Uganda
This report from Reuters, after which I’ll return with more:
Fri, 19 Oct 2012 13:25 GMT
KAMPALA, Oct 19 (Reuters) - Three people have died in southwest Uganda from an outbreak of Marburg virus disease, officials said on Friday, a severe and highly fatal infection, just two weeks after the east African nation said it was free of the deadly Ebola virus.
Another four people who have died since October 4 were also suspected to have been killed by the disease, the Ugandan government said in a statement.
While rare, Marburg was the first of the filovirus family of hemorrhagic diseases to be recognized. Normally only found in parts of eastern and central Africa, Marburg – surprisingly - was first detected in Germany in the late 1960s.
Negative stain image of an isolate of Marburg virus, showing filamentous particles as well as the characteristic "Shepherd's Crook." Magnification approximately 100,000 times. Image courtesy of Russell Regnery, Ph.D., DVRD, NCID, CDC.
In 1967, several workers involved with Polio research at a laboratory in Marburg, Germany fell ill with an unknown illness. What began with fever, vomiting, and diarrhea progressed rapidly to internal bleeding, shock, and for 7 of the 31 victims, death.
An investigation identified the source of the virus: Green monkeys imported from Uganda for research, and in time, the virus was isolated.
It lead to the creation of a new virus family; the Filoviridae, of which Marburg and the five Ebola viruses are the principal members.
For the next three decades, the virus only showed up sporadically. In South Africa in 1975 (3 cases), Kenya in 1980 (2 cases) and again in 1987 (1 case), and in a pair of laboratory accidents in the Soviet Union in 1988 and 1990.
Between 1998 and 2000 more than 150 cases were recorded in the Democratic Republic of the Congo, and a second marburgvirus (RAVV) was identified.
On March 23, 2005, the World Health Organization
(WHO) confirmed Marburg virus (family Filoviridae, which includes Ebola virus) as the causative agent of an outbreak ofviral hemorrhagic fever (VHF) in Uige Province in northernAngola. Testing conducted by CDC’s Special Pathogens Branchdetected the presence of virus in nine of 12 clinical specimens from patients who died during the outbreak.
During October 1, 2004–March 29, 2005, a total of 124 cases were identified; of these, 117 were fatal (1). Approximately 75% of the reported cases occurred in children aged <5 years; cases also have occurred in adults, including health care workers.
Predominant symptoms have included fever, hemorrhage, vomiting, cough, diarrhea, and jaundice.
Another small outbreak (3 cases) was reported in 2007, and quite famously, alarm bells rang when a Dutch tourist returned to the Netherlands from a trip to Uganda and was diagnosed with Marburg in 2008.
This from the CDC’s EID Journal .
Aura Timen , Marion P.G. Koopmans, Ann C.T.M. Vossen, Gerard J.J. van Doornum, Stephan Günther, Franchette van den Berkmortel, Kees M. Verduin, Sabine Dittrich, Petra Emmerich, Albert D.M.E. Osterhaus, Jaap T. van Dissel, and Roel A. Coutinho1
On July 10, 2008, Marburg hemorrhagic fever was confirmed in a Dutch patient who had vacationed recently in Uganda. Exposure most likely occurred in the Python Cave (Maramagambo Forest), which harbors bat species that elsewhere in Africa have been found positive for Marburg virus.
A multidisciplinary response team was convened to perform a structured risk assessment, perform risk classification of contacts, issue guidelines for follow-up, provide information, and monitor the crisis response. In total, 130 contacts were identified (66 classified as high risk and 64 as low risk) and monitored for 21 days after their last possible exposure.
The case raised questions specific to international travel, postexposure prophylaxis for Marburg virus, and laboratory testing of contacts with fever. We present lessons learned and results of the follow-up serosurvey of contacts and focus on factors that prevented overreaction during an event with a high public health impact.
For more on this rare but highly feared virus we turn to the CDC’s Special Pathogens Branch, which deals with the most virulent of viral pathogens.
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What is Marburg hemorrhagic fever?
Marburg hemorrhagic fever is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates. Caused by a genetically unique zoonotic (that is, animal-borne) RNA virus of the filovirus family, its recognition led to the creation of this virus family. The five species of Ebola virus are the only other known members of the filovirus family.
Where is Marburg virus found in nature?
Recent scientific studies implicate the African fruit bat (Rousettus aegyptiacus) as the reservoir host of the Marburg virus. The African fruit bat is a sighted, cave-dwelling bat which is widely distributed across Africa. Fruit bats infected with Marburg virus do not to show obvious signs of illness. Primates, including humans, can become infected with Marburg virus, which can progress to serious disease with high mortality. Further study is needed to determine if other species may also host the virus. Given the fruit bat's wide distribution, more areas are at risk for outbreaks of Marburg HF than previously suspected. The virus is not known to be native to other continents, such as North America.
How do humans get Marburg hemorrhagic fever?
Just how the animal host first transmits Marburg virus to humans is unknown. However, as with some other viruses which cause viral hemorrhagic fever, humans who become ill with Marburg hemorrhagic fever may spread the virus to other people. This may happen in several ways. Persons who have handled infected monkeys and have come in direct contact with their fluids or cell cultures, have become infected. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease.
Despite the fact that fewer than a thousand deaths have been attributed to the Marburg virus – its vivid hemorrhagic symptoms and its portrayal in movies and books has made it a high profile disease.