Epi Corner: 2004 review

Epidemiology Corner

May 6, 2005

Marburg - a viral hemorrhagic disease

Marburg is a viral hemorrhagic disease caused by a filovirus. The filovirus family is a group of RNA viruses that includes Ebola viruses. Marburg was first identified in 1967 when an outbreak of hemorrhagic disease occurred among laboratory workers in Marburg and Frankfort Germany. The source of the outbreak was linked to exposure to African green monkeys imported from Uganda. Between 1967 and 1998, only a few sporadic cases were identified in Africa. Between 1998 and 2000, an outbreak was reported in the Democratic Republic of Congo with 128 deaths. This year an outbreak was reported in Angola. As of April 22, the World Health Organization reported a death toll of 244 people. This current outbreak in Angola has a 92 percent fatality rate. According to the Centers for Disease Control (CDC), approximately 75 percent of the reported cases occurred in children aged less than 5 years old. Adult cases have included health care workers.

Marburg is a zoonotic disease which means it can be spread between animals and humans. The reservoir (non-symptomatic animal host) of Marburg has not been identified. Marburg is spread from person to person through direct contact with the bodily fluids (blood, saliva, urine, etc.) of an infected person. The virus may also be spread through contact with objects contaminated with infected bodily fluids such as medical syringes. Once exposed to the virus, it can take between 5 to 10 days to show signs of illness followed by another 5 to 8 days before onset of severe hemorrhagic symptoms.

Viral hemorrhagic diseases are characterized by sudden onset fever, aching, bleeding in the internal organs, petechiae (tiny pinpoint bruises) and shock. Symptoms of Marburg include sudden onset of fever, chills, headache and myalgia (muscle pain). The initial symptoms may be followed by a rash, nausea, vomiting, chest pain, sore throat, abdominal pain and diarrhea. As the disease progresses, jaundice (yellowing of the skin), inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging (profuse bleeding) and multi-organ dysfunction can occur. Predominant symptoms in the Angola outbreak have included fever, hemorrhage, vomiting, cough, diarrhea and jaundice.

Marburg does not naturally occur in the United States. No cases have ever been identified in Houston. According to the CDC, the likelihood of contracting Marburg during travel is considered extremely low unless there has been travel to an affected area and direct contact occurred with the blood or body fluids (e.g., saliva, urine) of symptomatic infected persons or animals, or objects that have been contaminated with body fluids. Other travel related diseases, such as Malaria, are more likely to be acquired than a viral hemorrhagic illness. Anyone who develops a fever within 10 days of travel to a foreign country should contact their physician and report their symptoms, dates of travel and location of travel for evaluation of potential travel related diseases.

For more information on Marburg or the current outbreak in Angola visit the CDC website at http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg.htm or the ProMed website at http://www.promedmail.org

Negative stain image of an isolate of Marburg virus Photo Source: www.CDC.gov