Outbreak of Viral Haemorrhagic
Fever : Marburg Virus
Update: April 8, 2005
The Public Health Agency of Canada (PHAC) is monitoring an outbreak
of Marburg, a viral haemorrhagic fever disease, in Angola.
As of April 07, 2005, the World Health Organization (WHO) and health
authorities in Angola have confirmed 205 cases including 180 deaths,
in an outbreak of Marburg virus in northern Angola. Cases have been recorded
in the following 7 provinces: Uige, Luanda Cabinda, Malange, Kuanza Norte,
Kuanza Sul and
Zaire. All cases are concentrated in the north-western
part of the country and are all thought to have originated in the province
of Uige - the epicentre
of the outbreak.
A suspected case of Marburg virus in a patient in the Democratic Republic
of Congo is currently under investigation.
The WHO and several multi-disciplinary international teams are supporting
the Ministry of Health, in Angola, in the assessment and management of
this outbreak.
Source: World Health Organization (WHO)
The Marburg virus is derived from the Filoviriade family.
It occurs rarely and causes a severe type of acute febrile illness. It
is an animal-borne disease that affects humans and certain non-human
primates, such as the African green monkey, although the natural reservoir
of the virus is unknown.
The virus has an incubation period of 3-7 days. Following the incubation
period, the onset of the disease is sudden and initially includes the
following generalized symptoms: high fever, malaise, myalgia (muscle
pain/soreness). A maculopapular rash may develop around the trunk (chest,
back, stomach) roughly five days after symptom onset. Nausea, vomiting,
chest pain, sore throat, abdominal pain, and diarrhea may also occur.
Symptoms increase in severity and may progress to include jaundice, inflammation
of the pancreas, severe weight loss, delirium, shock, liver failure,
massive haemorrhaging, and multi-organ dysfunction.
Marburg virus is acquired by direct contact with blood, body fluids,
respiratory secretions and organs of infected human and non-human primates.
Casual transmission of this virus from person-to-person has not been
reported. Hospital acquired infections have occurred due to contaminated
syringes and needles.
Although the African green monkey was responsible for carrying the
virus in a 1967 epidemic, no further information is available as to what
other animals carry the agent.
There is no vaccine, preventative prophylactic medication or curative
treatment for Marburg virus. Treatment is directed at maintaining kidney
function, electrolyte balance and combating haemorrage and shock.
Globally, except for laboratory outbreaks in Germany and Yugolsavia,
Marburg has been reported in Zimbabwe, Kenya, and the Democratic Republic
of Congo.
Marburg virus was first identified in 1967, in laboratory workers in
Germany and in Yugoslavia when they developed an acute viral haemorrhagic
fever following contact with infected African green monkeys imported
from Uganda. The outbreak resulted in 31 cases including seven deaths.
It was not until a decade later in 1975, that the virus surfaced again,
when it was reported in a traveller believed to have been exposed to
the virus in Zimbabwe. The traveller transmitted the virus to his travelling
companion and also to a nurse who was caring for him during his hospitalization
in South Africa. Although the traveller/man died, both the travellers
companion and the nurse recovered.
The virus then appeared in Kenya, in both 1980 (two cases, including
one death) and in 1987 (a single fatal case).
Between 1998 and late 2000, the Democratic Republic of Congo recorded
the largest outbreak of Marburg virus on record, when 149 cases were
reported with 123 deaths.
Recommendations
With respect to the current outbreak in northern Angola, unless
travellers are in the province of Uige in northern Angola and are
caring for an ill individual infected with the Marburg virus, the
Public Health Agency of Canada advises that the risk of acquiring
Marburg virus is extremely low.
Health-care professionals or general travellers travelling to
a Marburg-outbreak area and who are providing care for ill individuals,
should practice stringent contact precautions in addition to Routine
Practices and be fully informed about how to reduce
direct exposure to blood and bodily fluids. |
As a reminder to Canadians Travelling Internationally
PHAC strongly recommends that travel plans include contacting a travel
medicine clinic or physician six to eight weeks before
departure. Based on each individual's risk assessment, a health
care professional can determine the need for immunizations and/or
preventive medication (prophylaxis) and advise on precautions to
avoid disease risks.
PHAC recommends as well, that travellers who become sick or feel unwell
on their return to Canada should seek a medical assessment with their
personal physician. Travellers should inform their physician, without
being asked, that they have been travelling or living outside of Canada,
and where they have been.
For additional information on travel visit the Public Health Agency
of Canada's page on General
Advice for Travellers
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