An outbreak of Marburg virus was declared in northern Equatorial Guinea on 13 February, the first time the country has seen cases of the virus. They have been identified in two districts close to the borders of neighbouring Cameroon and Gabon, and while two cases were subsequently reported in Cameroon, the country’s health minister, Manaouda Malachie, has said they both tested negative.
Nine deaths have been reported in Equatorial Guinea, with 16 suspected cases admitted to health facilities with mild symptoms, and 21 contacts being monitored at home, according to World Health Organisation (WHO) director general, Dr Tedros Adhanom Ghebreyesus.
Belonging to the same virus family as Ebola, Marburg virus disease causes similar symptoms – an abrupt and high fever, severe headache and malaise. The WHO reports that the average fatality rate for Marburg virus disease (MVD) is around 50 per cent, but cases in past outbreaks have varied from 24 per cent to 88 per cent.
According to the Africa Centres for Disease Control and Prevention, the initial confirmed case and other suspected cases presented with fever, fatigue, bloodstained vomit and diarrhoea. While humans are not the natural host for these filoviruses, which normally live in wild animals, both Ebola and Marburg viruses can cause the most severe forms of haemorrhagic fever in humans, with internal bleeding and the failure of blood clotting.
Marburg is usually transmitted to humans by fruit bats, often as a result of prolonged exposure in caves or mines. It is transmitted between humans through direct contact – through broken skin or mucous membranes in the eyes, nose and mouth or bodily fluids – and is not an airborne virus.
The WHO has deployed experts in epidemiology, clinical care, risk communication, community engagement, and infection prevention and control to Equatorial Guinea and is supporting Cameroon and Gabon’s governments to prepare to “rapidly detect, isolate and provide care for any suspected cases.”
There are no approved vaccines or treatments for Marburg virus disease, and few are in development. However, early detection and support, with symptomatic treatment, improves survival.
Equatorial Guinea is one of Africa’s least-visited countries, but international arrivals are higher in Gabon and Cameroon. The UK Foreign Office cautions that travel is restricted in and around Kie Ntem Province in Equatorial Guinea, where the outbreak has been detected and advises travellers in the region to be “be extremely vigilant” as well as in the neighbouring areas of Ambam, Kye-Ossi and Olamze in southern Cameroon, and Ntem and Woleu in Gabon. It also advises to check with local authorities before travelling.
Marburg virus was first recognised in 1967 when outbreaks occurred in laboratories in Marburg and Frankfurt, Germany and in Belgrade (now Serbia).