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Background 

Marburg virus causes severe and acute viral hemorrhagic fever in humans, a disease with a case fatality rate of up to 88%. The symptoms begin with a sudden fever, headache, fatigue and myalgia. Around 3 to 5 days after disease onset, a maculopapular rash, accompanied by diarrhea, abdominal pain, nausea, and vomiting may occur. During this phase, the patients have been described as ghost-like features, with expressionless faces and lethargy. Severe hemorrhagic manifestations with sustained high fever may develop 5 and 7 days after disease onset. Patients may develop confusion, irritability, and aggression if the central nervous system is affected. During the late phase, orchitis may develop. 8 to 9 days after disease onset, most patients develop severe blood loss and shock, and then die. Marburg virus is introduced into the human population through exposure to fruit bats in mines and caves, and spreads through human-to-human transmission. No specific antiviral treatment or vaccine is available. Marburg and Ebola viruses are the two members of the Filoviridae family (filovirus).  

Epidemiology

Marburg virus was first recognized in 1967, when two large outbreaks occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). In 1975, there were three cases in South Africa. Between 1980 and 2007, outbreaks had been reported in Kenya, Congo, Angola and Uganda. Among them, the epidemic in Angola was the largest. In 2008, one American and one Dutch traveler who visited a cave inhabited by Rousettus bat colonies in Uganda were reported to have Marburg hemorrhagic fever after returning to their countries. In 2012 and 2014, outbreaks occurred in Uganda again. So far, no confirmed case has been reported in Taiwan. 

Marburg Hemorrhagic Fever Surveillance in Taiwan

1. Taiwan National Infectious Disease Statistics System- Marburg Hemorrhagic Fever
2. Fever screening at international airports and seaports.
3. Self–reporting through the toll–free 1922 hotline or local public health authority. 

Prevention and Control

1. In affected areas, avoid contact with and consumption of wild animals such as fruit bats and primates. Wear gloves and appropriate protective clothing when contacting with animals (especially when visiting or working in mines and caves inhabited by fruit bat colonies). Animal products should be well-cooked before consumption.
2. Avoid direct contact with the patient’s blood, secretions, body fluids, organs, semen, or contaminated environment. Wear gloves and appropriate protective equipment when caring for patients. Patients should avoid all types of sex until their semen tests negative for the virus.
3. The symptoms in the early stage are not specific. Healthcare workers taking care of all patients should practice standard precautions closely.
4. Patients with Marburg fever should be placed in a negative pressure isolation ward. Healthcare workers entering a ward where a suspected or confirmed case is isolated should wear advanced personal protective equipment such as coveralls, masks (e.g., N95 mask), face shields, double gloves, water-proof boot covers. Apron is required if the patient has symptoms of diarrhea or vomiting. Avoid direct contact with the patient’s blood and bodily fluids.

FAQs

1. Is the disease ever fatal?
   • Yes, the case fatality rates of Marburg hemorrhagic fever for the past outbreaks ranged from 24% to 88%.
2. Where did cases of Marburg hemorrhagic fever occur?
   • Recorded cases of the disease are rare, and have appeared in only a few locations. The first outbreak occurred in Europe and was associated with African green monkeys imported from Uganda. Southern Africa, Kenya, Zimbabwe, Congo, and Angola have also reported cases.
3. Who is at risk of Marburg hemorrhagic fever?
   • People who have close contact with African fruit bats, infected patients, or infected non-human primates, or indirect contact with contaminated items (e.g., clothes, bedding or needles) are at risk of infection. Travelers visiting mines or caves inhabited by fruit bats may have a higher risk of infection. During an outbreak, healthcare workers, family members, friends, close contacts and those who handle infected bodies have a higher risk of infection. Veterinarians, laboratory or quarantine workers who handle non-human primates are also at risk of exposure.
4. How is Marburg hemorrhagic fever treated?
   • No specific treatment or vaccine is yet available for Marburg hemorrhagic fever. Severe cases require intensive supportive care.
5. How do humans get Marburg hemorrhagic fever?
   • Transmission is mainly human­to­human, resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons, or indirect contact with contaminated items (e.g., clothes, bedding or needles). Transmission to healthcare workers has been reported while treating Marburg patients through close contact without the use of appropriate infection control precautions.
6. Can Marburg hemorrhagic fever be prevented?
   • (1) In Marburg hemorrhagic fever-affected areas, avoid contact with and consumption of wild animals such as fruit bats and primates. Wear gloves and appropriate protective clothing when contacting with animals (especially when visiting or working in mines and caves inhabited by fruit bat colonies). Animal products should be well-cooked before consumption.
   • (2) Avoid direct contact with the patient’s blood, secretions, body fluids, organs, semen, or contaminated environment. Wear gloves and appropriate protective equipment when caring for patients. Patients should avoid all types of sex until their semen tests negative for the virus.

More information

• WHO/Marburg haemorrhagic fever
• USA CDC/Marburg hemorrhagic fever (Marburg HF)