Outbreak of Viral Haemorrhagic Fever : Marburg Virus
Updated: July 29, 2005
The Public Health Agency of Canada (PHAC) continues to monitor an outbreak of Marburg haemorrhagic fever in Angola.
According to the World Health Organization (WHO), as of July 28, 2005, health authorities in Angola have reported a total of 368 cases, including 323 deaths, of Marburg haemorrhagic fever in north-western Angola. Of the 368 reported cases, 157 cases have been laboratory confirmed.
Although transmission of the virus continues, reports indicate that it is limited to Uige province and that the number of new cases being reported has significantly declined. The province of Uige, accounting for over 95% of the total cases and deaths, remains the epicentre of the outbreak [map].
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 three to nine days. Following the incubation period, the onset of the disease is sudden and initially includes the following symptoms: high fever, malaise, myalgia (muscle pain/soreness). A rash (maculopapular) 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 north-western Angola and are
caring for an ill individual infected with the Marburg virus
or exposed to blood, other body fluids, secretions, or excretions of a person
or animal suspected of having 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
or exposed to blood, other body fluids, secretions, or excretions of a person
or animal suspected of having Marburg virus, should practice stringent contact
precautions in addition to Routine
Practices for infection and control,
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.
For additional information on Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting, click here! 
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