We've word today of what appears to be an outbreak of Marburg Virus – another hemorrhagic fever similar to Ebola – coming out of Uganda. That country saw a similar outbreak in 2012 which involved a total of 20 cases, including 9 deaths from 4 districts in Uganda (Kabale, Ibanda, Mbarara, and Kampala) (see Marburg haemorrhagic fever in Uganda – update).
First a couple of press reports on the current outbreak, then I’ll return with some background on the Marburg virus.
Over 60 health workers monitored after Marburg outbreak in Uganda
Xinhua, October 5, 2014
Over 60 health workers in central Uganda are being monitored after the deadly Marburg hemorrhagic fever broke out in the East African country, a senior health official said Sunday.
Elioda Tumwesigye, minister of state for health who announced the outbreak here on Sunday said that the health workers interacted with the index case which died on Sept. 28.
The index case was a health worker who worked at Mengo Hospital in the capital Kampala and at a health center in Mpigi district, all in central Uganda.
The minister said 38 health workers are being monitored at Mengo Hospital while 22 others are monitored at a health center in Mpigi.
Tumwesigye said 20 other people who were involved in the burial process of the deceased are also being monitored in Kasese district in western Uganda.
He said World Health Organization (WHO) has provided technical and logistical support to contain the disease.
Another Marburg outbreak confirmed in Uganda
The ministry of health has confirmed an outbreak of Marburg fever in the country following the death of a medical worker.
This has been revealed by the Minister of State for Health Elioda Tumwesigye at a news conference held this afternoon at the Ministry Headquarters in Wandegeya.
He says the victim who died on September 30th has only been identified as a 30 year old man recently recruited as a radiographer at Mengo hospital.
“8O suspected cases have been isolated, 38 are Mengo workers, 22 are from Mpigi Health Center Four, while 20 are in Mukunyu village in Kasese district where the deceased was buried” Dr. Tumwesigye explained.
He added that one of them who had obvious symptoms has been referred the Virus Research Institute in Entebbe and the results are expected tomorrow.
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.
In 2004-2005, the largest known outbreak occurred in Angola, where 90% of the 252 cases died. This from the CDC’s MMWR in 2005.
Outbreak of Marburg Virus Hemorrhagic Fever — Angola, October 1, 2004–March 29, 2005
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 .
Response to Imported Case of Marburg Hemorrhagic Fever, the Netherlands
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.
While similar, Marburg is antigenically distinct from Ebolaviruses, and the CDC maintains a separate webpage for it on their Viral Special Pathogens Branch (VSPB) website.