WHO Marburg Update – Uganda

 

# 9175

Five days ago, in Uganda Reporting Apparent Marburg Outbreak, we learned of what appeared to be the first case of Marburg virus infection since 2012, involving 1 `confirmed’ case in Kampala, Uganda, along with a number of contacts under observation.

Marburg hemorrhagic fever (Marburg HF) is normally found in parts of eastern and central Africa, and is less commonly reported than its more famous Ebola cousins.

 

Today we’ve an update from the World Health Organization that – while confirming the index case – reports that so far, none of this index case’s 146 contacts have tested positive for the virus.

 

Marburg virus Disease - Uganda

Disease outbreak news
10 October 2014

On 5 October 2014, the Ministry of Health (MoH) of Uganda notified WHO of a confirmed case of Marburg virus disease (MVD) in Kampala, Uganda.

The confirmed case was a healthcare worker who had onset of disease on 11 September 2014 while working at Mengo Hospital, Kampala. The case presented to Mpigi District Health Center on 17 September 2014, and transferred to Mengo Hospital, Kampala, on 23 September 2014. On admission the case presented with symptoms including fever, headache, abdominal pain, vomiting and diarrhoea and died on 28 September 2014.

The case reported no history of travel beyond Mpigi, no contact with a person with similar illness. He had not eaten bush meat nor had had contact with bats in the last 4 weeks.

A preliminary result indicating the specimen was positive for Marburg virus disease was received on 3 October 2014, and further confirmed on 4 October 2014 by the Uganda Virus Research Institute (UVRI).

As of today, a total of 146 contacts have been identified and are being monitored for signs and symptoms compatible with MVD. Eleven of the contacts developed signs and symptoms compatible with Marburg virus disease. All samples from symptomatic contacts have tested negative so far. Second samples have been taken from them and are being tested at the Uganda Virus Research Institute (UVRI). One contact, Kenyan mortician who travelled back to Kenya, developed a fever and cough but tested negative for both Marburg and Ebola virus. The contact in Kenya continues to be followed up by the Kenyan Rapid Response Team.

Public health response

The Ministry of Health of Uganda has activated the National Task Force which is meeting regularly and sub-committees have been established.

WHO, Médecins Sans Frontières (MSF) and the US Centers for Disease Control (CDC) are supporting the national Ugandan authorities in the investigation and response operations including, enhancements and establishment of isolation and treatment units; prepositioning personal protective equipment (PPE), and training health workers on infection control and prevention, as well as in case management and social mobilization.

Four multi-disciplinary teams have been deployed to perform an in-depth risk assessment. Surveillance and contact tracing, and follow-up activities are currently being implemented in Kampala, Mpigi and Kasese.

WHO recommendations

Marburg virus disease is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola virus disease. Both viruses can cause large outbreaks such as the ongoing Ebola virus disease outbreak in West Africa. The last outbreak of MVD in Uganda occurred in 2012 during which 20 cases, including 9 fatal cases were reported from Kabale District, Kampala, Ibanda, Mbarara, and Kabarole.

WHO advises against the application of any travel or trade restrictions on Uganda based on the current information available on this outbreak.

Uganda Reporting Apparent Marburg Outbreak

 

 

 

# 9150

 

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.

(Continue . . .)

Another Marburg outbreak confirmed in Uganda

October 5, 2014 in   

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 30^th 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.

(Continue . . . )

 

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.

(Continue . . .)

 

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

Abstract

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.

 

Marburg hemorrhagic fever (Marburg HF)

WHO Update On Marburg Outbreak In Uganda

Credit CDC PHIL

# 6735

 

The World Health Organization has updated the Marburg Virus outbreak situation in Uganda, with encouraging news that no new laboratory confirmed cases have been hospitalized since October 31st.

 

Marburg haemorrhagic fever in Uganda - update

23 November 2012 - As of 23 November 2012, a total of 20 (probable or confirmed) cases, including 9 deaths have been reported from4 districts in Uganda (Kabale, Ibanda, Mbarara, and Kampala).

 

The last confirmed case was hospitalised on 31 October 2012.

 

The Ministry of Health continues to conduct active surveillance and investigation on all cases alerted in the 4 districts. Close contacts of the Marburg cases are being followed-up for a period of 21 days.

 

WHO and international partners, including the US Centers for Disease Control and Prevention (CDC), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET), Plan Uganda and Médecins Sans Frontières (MSF) are supporting the national authorities in the investigation and response to the outbreak. Experts have been deployed through the Global Outbreak Alert and Response Network (GOARN) to strengthen the field team.

 

Trainings are being provided to health professionals on infection prevention and control (IPC), and on field information management. Social mobilization activities are being conducted to raise awareness on prevention and control of Marburg haemorrhagic fever.

 

With respect to this outbreak, WHO does not recommend that any travel or trade restriction be applied to Uganda.

 

Earlier blogs on this outbreak include:

CDC Travelers’ Notice:The Ugandan Marburg outbreak

WHO Update: Marburg Virus In Uganda

Marburg Virus Reported In Western Uganda

 

Meanwhile, their second Ebola outbreak of the year (see Ugandan MOH Statement On New Ebola Outbreak) continues in the Luweero district, which is  located in the central part of the country.

 

Today the WHO posted this update:

 

Ebola in Uganda

23 November 2012 - As of 23 November 2012, the Ministry of Health (MoH) of Uganda has reported 10 cases (6 confirmed and 4 probable,), including 5 deaths in Luweero and Kampala.

 

The last confirmed case was hospitalised on 17 November 2012. Close contacts of the Ebola cases are being identified and followed up for a period of 21 days. All the cases alerted to the field teams are being investigated.

 

WHO and partners, including the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Plan Uganda are supporting the national authorities in the investigation and response to the outbreak.

 

Experts in the area of field epidemiology, health promotion, logistics management, and infection prevention and control , have been mobilized by WHO through the Global Outbreak Alert and Response Network (GOARN), to provide support to the response.

 

With respect to this event, WHO does not recommend that any travel or trade restriction be applied to Uganda.

WHO Update: Marburg Virus In Uganda

 

Credit CDC PHIL

 

# 6684

 

 

The World Health Organization has updated the situation in Uganda, where authorities are dealing with a rare outbreak of Marburg virus.

 

The Marburg virus was first isolated after an outbreak at a lab in Germany (hence the name) imported via African Green Monkeys, but is normally found in parts of equatorial Africa.  It is closely related to the Ebola viruses, and is of the same family; Filoviridae.

Two weeks ago, in Marburg Virus Reported In Western Uganda, I recounted a bit of the history of the virus since it’s discovery in 1967.

 

As of now, there are 18 confirmed cases (9 deaths), and perhaps of most concern, cases have now been detected in 5 districts;  Kabale district, Kampala (the capital city), Ibanda, Mbarara and Kabarole.

 

 

 

Marburg haemorrhagic fever in Uganda - update

31 October 2012 - As of 28 October 2012, a total of 18 cases and 9 deaths, including a health worker, have been reported from 5 districts namely Kabale district, in south-western Uganda, Kampala (the capital city), Ibanda, Mbarara and Kabarole. The case fatality rate is 50%. The outbreak was declared by the Ministry of Health in Uganda on 19 October 2012. Blood samples from 9 cases have been confirmed for Marburg virus at the Uganda Virus Research Institute (UVRI).

 

Currently, 13 patients have been admitted to hospital (2 in Kampala, 8 in Kabale, 3 in Ibanda) and their contacts are listed for daily follow up. The latest confirmed case was admitted to Ibanda district isolation ward on 26 October 2012.

 

The World Health Organization (WHO) and international partners including, the Centers for Disease Control and Prevention (CDC), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Médecins-Sans-Frontières (MSF) are supporting the national authorities in outbreak investigation and response. The national task force has identified additional health care workers and epidemiologists to strengthen the teams in the field. Training of health workers on infection prevention and control, surveillance and clinical case management is ongoing. Social mobilization activities are being conducted which include the dissemination of IEC (Information Education Communication) material, sensitization on Marburg prevention and control and broadcast of information through radio channels. The first shipment of personal protective equipment (PPE) provided by WHO arrived over the weekend.

 

The WHO Regional office has deployed an epidemiologist and a logistician to Uganda to support the response teams on the ground. In addition, a social mobilization expert from WHO Zambia Country Office and a logistician from the Regional Rapid Response Team network have been mobilized for immediate deployment. More experts are being identified by the Global Outbreak Alert and Response Network (GOARN).

 

As the investigation into the outbreak continues, WHO and partners continue to support the national authorities as needed in the areas of coordination, infection prevention and control, surveillance, epidemiology, public information and social mobilization, anthropological analysis and logistics for outbreak response.

 

Neighbouring countries have been contacted to strengthen cross border surveillance and preparedness to prevent cross border spread of the outbreak.

 

WHO advises that there is no need for any restrictions on travel or trade with Uganda.

Uganda MOH: Update On Marburg Outbreak

  Credit Wikipedia

 

 

# 6675

 

The Ugandan Minister of Health, Dr. Christine Ondoa, has issued the following update on the Marburg virus outbreak which has been ongoing in that nation since October 19th.

 

The major points are that there are now 8 deaths confirmed, and that cases have now been confirmed in three districts; Kabale , Ibanda, and Mbarara.

 

This from the Ugandan Media Centre.

 

 

PRESS STATEMENT ON THE UPDATE OF MARBURG OUTBREAK

October 29th 2012

Today on behalf of the Ministry of Health, I take this opportunity to welcome you all to this press briefing organized to update you on the outbreak of Marburg in the country. You will recall that we declared an outbreak of this highly infectious disease on October 19th and since then the Ministry of Health and its partners have undertaken a number of interventions to control the spread of the disease.

 
I wish to inform you that cases are now reported in the neighbouring districts of Ibanda and Mbarara. However, I want to assure you that the Ministry of Health and its partners are on the ground in the mentioned districts to contain the spread and manage the identified cases.

 

To date, the death toll of both the probable and confirmed cases stands at eight, with the latest being a case that died at the isolation facility at Rushoroza Health Centre III on October 27th (Saturday). The case that was referred from Ibanda Hospital – Ibanda to Mbarara Regional Referral Hospital died on October 24th.

 

I wish to clarify that since the onset of the outbreak, we have collected a total of 45 samples of which nine were confirmed positive; five in Kabale, two in Kampala and two from Ibanda.

 

Working closely with the US Center for Disease Control and Prevention (CDC), we have set up a field diagnostic laboratory at Kabale Regional Referral Hospital. All samples from the affected neighbouring districts will hence be taken to this laboratory for quick diagnostics. This will shorten the time when we get results to three hours from the original 24 hours due to distance. Further serological testing will be undertaken at the Uganda Virus Research Institute (UVRI).

 

Due to the presence of cases in other districts, we have established temporary isolation facilities to accommodate the suspected and confirmed cases. In Ibanda, a temporary isolation ward has been created at Ibanda Hospital, while plans are underway to set up a proper isolation facility by tomorrow.

 

At Mbarara Regional Referral Hospital, a separate temporary has been designated for the suspect Marburg cases. A triage has also been set up at the causality ward.

 

We have assembled a team of experts to work in the newly established isolation facilities and they are expected in these districts today.  We also plan to undertake infection control procedures in these facilities as safety measures for the workers and the admitted patients.

 

Today, the total number of cases admitted is 12. Eight are currently admitted at Rushoroza Health Center III in Kabale. Two confirmed cases, a couple (husband and wife) still remain admitted at Mulago National Referral Hospital. Another two suspect cases are currently admitted at Mayanja Memorial Hospital in Mbarara.

 

There are seven suspect cases (student nurses) quarantined at Ibanda. These cases attended to the confirmed case that later died at Mbarara Regional Referral Hospital on October 24th. Other health workers who attended to the patient are closely being monitored.

 

We have line-listed a total of 436 contacts for close observation in four districts of  Kabale, Kam-pala, Ibanda, Mbarara, Fort Portal and Rukungiri. Those being monitored got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 21 days without showing any signs and symptoms.

 

We have completed an orientation of the Kabale district taskforce on Marburg case presentation and prevention, barrier nursing and infection control. Plans are underway to conduct the orien-tation at Ibanda and at Mbarara Regional Referral Hospital.
We have trained a total of 42 volunteers from the Uganda Red Cross Society and deployed them to conduct house to house community sensitization and active case tracing.

 

We plan to set up burial committees in Ibanda district to manage burials of people suspected to have died of the disease. The committee will be oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly con-tiguous disease.

The Ministry of Health would also wish to clarify on media reports that one of its officers, Dr. Sheila Ndyanabangi, the head of the Mental Health Unit Division, had contracted Marburg and had been isolated. Dr. Ndyanabangi has not been isolated but has been advised to exercise social distancing. She is one of the contacts who are being monitored. She has not developed any signs or symptoms of the disease and therefore cannot be isolated from the community. She is due to complete the 21 days of observation.

 

I once again urge the public to take the following measures to avert the spread of the disease.

• Report immediately any suspected patient to a nearby health unit
• Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks
• Persons who have died of Marburg must be handled with strong protective wear and buried immediately
• Avoid eating dead animals
• Avoid unnecessary public gathering especially in the affected district
• Burial of suspicious community deaths should be done under close supervision of well trained burial teams
• Report all suspicious deaths to a nearby health facility 

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

 

For a history of the Marburg virus, you may wish to revisit Marburg Virus Reported In Western Uganda.

Ugandan MOH Statement On Marburg Outbreak

Credit Wikipedia

 

# 6662

 

While we’ve been following reports of a Marburg virus outbreak in Uganda since late last week, the Ugandan government has had very little public comment. Even today, the front page of the Ugandan Ministry of Health makes no mention of the outbreak.

 

But earlier today (h/t Treyfish on FluTrackers) the MOH published the following statement on the Uganda Media Centre Website providing details on the outbreak.

 

 

PRESS STATEMENT ON THE UPDATE ON THE MARBURG OUTBREAK

October 25th 2012 MINISTRY OF HEALTH

The Ministry of Health declared an outbreak of Marburg in Kabale district on October 19th 2012 after receiving laboratory results from the Uganda Virus Research Institute (UVRI) confirming that two family members had died of the highly infectious viral hemorrhagic fever.  Three other members of the same family had earlier died of a strange disease in a period of one month.

 

The death of these people prompted the District Health Office to undertake further investigations of this strange disease that had ravaged Kitumba parish in Kitumba sub-county, Kabale district.

 

According to the reports, the patients presented with symptoms of diarrhoea, vomiting, fever, headache, dizziness and generalized convulsions. Initial samples of blood and cerebral spiral fluid taken from the sick people ruled out Malaria and Meningitis. The family then invited a cult leader, a retired Reverend from Rukungiri, district to visit their household and pray for the sick.

 

The index case is believed to have been a member of a family in Rwabirondo village, Kitumba parish in Kitumba sub-county which occurred on 20th September 2012.  After the death of the index case, two other people, a sister and mother reportedly got sick and died.

 

This outbreak comes barely two weeks after the Ministry declared an end to another viral Hemorrhagic Fever (Ebola) on October 4th 2012. The last Marburg outbreak was witnessed in October 2007 in Kamwenge district.

 

Marburg is a highly infectious viral hemorrhagic fever which kills in a short time but can be prevented. Marburg is spread through direct contact with, body fluids like blood, saliva, vomitus, stool and urine of an infected person.

 

A person suffering from Marburg presents with sudden onset of high fever with any of the following; headache, vomiting blood, joint and muscle pains and bleeding through the body openings, i.e. eyes (red eyes), nose, gums, ears, anus and the skin.

How is Marburg Spread?

• It is spread through;
• Direct contact with wounds, body fluids like blood, saliva, vomitus, droplets, stool and urine of a person suffering from Marburg.
• Unsterilised injections, contaminated linen, beddings and clothes.
• Using skin piercing instruments that have been used by an infected person.
• Direct physical handling of persons who have died of Marburg

Current Status (Update)

The Ministry of Health has developed a response plan and budget for the Marburg control amounting to sh2.3b of which sh1.75 is for central level activities including Ministry of Health, six general hospitals and Kampala Capital City Authority. This will be majorly for case management, surveillance, research and social mobilisation and procurement of protective gears. The district budget totals 651,047,576 and it covers case management, surveillance, research and social mobilisation.

• Out of the six people who have died so far, only three were confirmed positive for Marburg. 
• Currently, there is only one confirmed case admitted in our isolation facility at Mulago National Referral Hospital. One convalescent case is detained at  Rushoroza Health Center III while five suspect cases linked to the initial cases  are admitted there awaiting blood results.  Special teams of doctors and nurses have been assigned to attend to the patients in both the isolation facilities. The patient admitted at Mulago National Referral Hospital is from Kitumba sub-county and is a relative of the index case. 
  
• The Ministry of Health surveillance team has listed up a total of 196 contacts for close monitoring. These contacts are mainly in Kabale, Rukungiri and Ibanda districts while 29 are from Kampala. Those being monitored reportedly got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 10 days without showing any signs and symptoms. 
  
• A team of experts from the Ministry of Health, U.S Center for Disease Control and Prevention and World Health Organization have so far collected a total of 18 n  samples from suspected cases for further investigations. The samples are being analyzed at the Uganda Virus Research Institute, Entebbe.
  
• The Ministry is conducting an orientation of local healthcare workers in Kabale Regional Referral Hospital and in the other peripheral health facilities on infection prevention and control, barrier nursing, surveillance and clinical case management. This is being done to build health workers’ capacity to handle such cases.  
  
• In Rushoroza Health Centre, a burial committee has  been set up to manage burials of people suspected to have died of Marburg. The committee has been oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly contiguous disease. The committee has so far supervised two burials.
  

A team from the Centers for Disease Control (CDC) is expected in the country to undertake anthropological studies.

 

The Ministry of Health once again urges the public to take the following measures to avert the spread of the disease.

• 
  Report immediately any suspected patient to a nearby health unit 
  
• Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks 
  
• Persons who have died of Marburg must be handled with strong protective wear and buried immediately
  
• Avoid eating dead animals 
  
• Avoid unnecessary public gathering especially in the affected district 
  
• Burial of suspicious community deaths should be done under close supervision of well trained burial teams   
  
• Report all suspicious deaths to a nearby health facility 

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation. 

Hon. Dr. Christine Ondoa
Minister of Health

 

 

I’ve blogged (here & here) on this outbreak earlier in the week, including a history of the Marburg virus. To keep up with breaking news, you’ll want to visit this FluTrackers Thread.

Virology Journal: Ebola Virus In Chinese Bats

Common pipistrelle (Pipistrellus pipistrellus) – Credit Wikipedia

 

# 6655

 

We are ten months into 2012, and so far it has been a pretty good year for Chiroptologists (scientists that study bats). 

 

While bats are often associated with diseases like rabies and histoplasmosis, over the past year we’ve seen bats linked to at least five exotic disease outbreaks around the globe and one rather unexpected discovery. 

 

In January we watched as Nipah Claimed 5 Lives in Bangladesh. Nipah, and its close cousin Hendra from Australia, are bat borne viruses that occasionally jump to humans (or other mammals) and can spark outbreaks.

 

Nipah, you may recall, was used as the basis for the fictional MEV-1 virus in the movie Contagion last year (see The Scientific Plausibility of `Contagion’).

 

 

Although no human cases are involved, last February the CDC announced the unusual discovery of a novel flu strain in little yellow-shouldered bats (Sturnira lilium) captured at two locations in Guatemala.(see A New Flu Comes Up To Bat).

While common in waterfowl, this was the first time that influenza had been detected in bats.

 

In July we saw an outbreak of Ebola Sudan in western Uganda (see Uganda: Ebola Sudan And A Timely Dispatch From The EID Journal), followed in August by an outbreak of Ebola-Bundibugyo in the Democratic Republic of the Congo (see WHO: DRC Ebola Update).

 

The natural reservoir for Ebola viruses are believed to be fruit bats of the Pteropodidae family, although the virus in humans is usually linked to the consumption of infected bushmeat (considered an intermediate host).  

 

In early September, we learned of the discovery of two cases of a novel coronavirus out of the Middle East, and once again a bat host is considered likely (see Coronavirus `Closely Related’ To HK Bat Strains).

 

And only last week, news emerged of a Marburg Virus outbreak in Uganda, which is still ongoing (WHO Update on Marburg Virus In Uganda). 

 

A close cousin to Ebola, Marburg is also believed carried by fruit bats of the Pteropodidae family, which can pass the virus on to other intermediate hosts, or directly to humans.

 

There are currently five known strains of the Ebola virus - Ebola-Zaire, Ebola-Sudan, Ebola-Reston, Ebola-Ivory Coast and Ebola-Bundibugyo – which along with the Marburg virus make up the family Filoviridae.

 

Of these, only Ebola-Reston – found in the Philippines – does not cause illness in humans. It is pathogenic in non-human primates, and has been found to infect pigs, which gives scientists some cause for concern.

 

Ebola Reston is also the only ebolavirus known to circulate outside of Africa.

 

That is . . . until now.

 

We’ve a new open access study, published this month in the Virology Journal, that has found evidence suggesting that Ebola viruses are circulating in Chinese bats, although the exact strain involved isn’t clear.

 

 

Serological evidence of ebolavirus infection in bats, China

Junfa Yuan, Yuji Zhang, Jialu Li, Yunzhi Zhang, Lin-Fa Wang and Zhengli Shi

Background

The genus Ebolavirus of the family Filoviridae currently consists of five species. All species, with the exception of Reston ebolavirus, have been found in Africa and caused severe human diseases. Bats have been implicated as reservoirs for ebolavirus. Reston ebolavirus, discovered in the Philippines, is the only ebolavirus species identified in Asia to date. Whether this virus is prevalent in China is unknown.

Findings

In this study, we developed an enzyme linked immunosorbent assay (ELISA) for ebolavirus using the recombinant nucleocapsid protein and performed sero-surveillance for the virus among Chinese bat populations. Our results revealed the presence of antibodies to ebolavirus in 32 of 843 bat sera samples and 10 of 16 were further confirmed by western blot analysis.

Conclusion

To our knowledge, this is the first report of any filovirus infection in China.

 

While researchers were able to detect cross-reactive antibodies to two types of Ebola viruses (Zaire and Reston), identification of the exact EBOV strain in China was not possible.  The author’s write:

 

The unsuccessful identification of ebolavirus-related genes in the samples is likely attributable to the often low-level of virus replication, the similarly transient nature of the infection in bats or the sequence mismatch of the PCR primers used and the target sequence of the potential unknown ebolavirus genomes.

 

 

Until the late 1990s, little thought was given to bats as reservoirs of epidemic diseases. Outbreaks of Nipah in Malaysia in 1998 - which lead to  265 cases of acute encephalitis and more than 100 deaths (cite) – put bats suddenly under the spotlight. 

 

Four years later - after the SARS outbreak in China - the SARS coronavirus was detected in horseshoe bats in China (cite), solidifying bats as important reservoirs of emerging infectious diseases. 

 

Since then scientists have discovered an increasing array of viral diseases that are carried by bats, although in many cases in isn’t clear how big a threat they actually pose to humans.

 

None of this is meant to demonize bats, as we are surrounded by a great many different hosts of zoonotic diseases.

 

Still, the CDC offers some sage advice when it comes to avoid coming in contact with bats.

 

 Take Caution When Bats Are Near

Bats play an important role in our ecosystem. However, they are also associated with diseases deadly to humans. Learn how you can stay safe when bats are near.

WHO Update on Marburg Virus In Uganda

 

 

# 6653

 

 

The World Health Organization has posted a brief update on the Marburg virus outbreak in Uganda, which I blogged about on Friday (see Marburg Virus Reported In Western Uganda).

 

Marburg haemorrhagic fever in Uganda - update

22 October 2012 - As of 21 October 2012, nine (9) probable and confirmed cases, including 5 deaths have been reported with Marburg haemorrhagic fever in Kitumba sub-county, Kabale district in South-western Uganda. Of these, 3 have been laboratory confirmed by the Uganda Virus Research Institute (UVRI).

 

An investigation into the outbreak is ongoing. Preliminary investigations indicate that all these cases belong to the same cluster – family and relatives of the index case.

 

WHO is supporting the Ministry of Health and partners in controlling the outbreak.

 

Marburg virus - like its better known cousins the Ebola viruses – produce hemorrhagic fevers with a high fatality rate. 

The natural host for the Marburg virus is believed to be fruit bats of the Pteropodidae family, which can pass the virus on to other intermediate hosts, or directly to humans.

 

The red areas of the map above show the areas where Marburg is found in Africa, while the purple outline shows the range of the Pteropodidae fruit bat.

While most cases have occurred in central Africa, a few cases have been exported, via humans or lab animals, to other regions.  The first known outbreak (in 1967) occurred at a laboratory working with green monkeys from Uganda in Marburg, Germany. 

 

For more on the Marburg Virus, including narratives of previous outbreaks,  you may wish to visit the WHO’s Marburg Resources page.

 

Information resources

Marburg Virus Reported In Western Uganda

 

 

Credit Wikipedia

 

# 6647

 

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:

 

Three Ugandans die in Marburg virus outbreak

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.

(Continue  . . . )

 

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.

(Continue . . .)

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

Abstract

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.

(Continue . . . )

 

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.

 

Questions and Answers About Marburg Hemorrhagic Fever

View PDF [PDF - 310 KB]

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.

<SNIP>

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.

<SNIP>

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.

 

Ironically, getting far less respect are common killers like pneumonia, which claims 1.8 million lives each year (cite) and Malaria which claims between one half, to one million lives a year (cite).

 

We’ll keep track of this story on AFD, but you may wish to visit this thread on FluTrackers for the latest reports.