THE DEADLY MARBURG VIRUS DISEASE.

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Marburg virus was first discovered in 1967, when an outbreak occurred in Marburg and Frankfurt laboratory, Germany and in Belgrade, Serbia. During these outbreaks, thirty-one people became ill and seven of them died. Germans working at the city’s former main industrial plant, Behringwerke then part of Hoechst , today CSL Behring were exposed to infected tissue of grivet monkeys.Other countries have also experienced the fangs of the deadly marburg virus disease outbreak including:South Africa(1975), Kenya(1980and 1987), DRC Congo(1998 to 2000), Angola(2005), USA(2008), Netherlands(2008) and Uganda(2007, 2012, 2014 and 2017).Recently on 19th October 2017 Uganda declared a marburg virus disease outbreak in Kween district, Eastern Uganda. Five cases have been reported so far.One case is confirmed, another case has an epidemiological link to the confirmed case and three suspected cases.Uganda is working hand in hand with World Health Organization to effectively contain the outbreak.Kenya is also on high alert at the borders and working in collaboration with the same organization so that the virus does not cross the border and spread to the country.

Marburg virus disease(MVD) is a rare severe and fatal illness in humans. This disease also affects animals(non humans). Marburg virus is the agent that causes Marburg disease with a case fatality of up to 88% according to WHO. Clinically Ebola and Marburg virus are similar. Despite different  virus strains, they belong to the same filoviridae family. Both have a high capacity of causing rapid outbreak with high fatality rate.

Fruits bats of the Pteropodidae family; Rousettus aegyptia are the natural habitat of the Marburg virus.

It is associated with severe viral hemorrhagic fever in human beings.

.The case fertility rate varies from 24% to 88% in previous outbreaks depending on the strain and case management. However, the overall MVD case fertility rate is around 50%

 

Transmission.

Initially unprotected contact with infected feces and aerosols is one of the routes of entry. This usually happens because of the prolonged exposure in areas inhabited by Rousettus bats colonies normally cave and mines. After the first crossover, the virus from natural host to human transmission can also occur through person-to-person contact.This can happen in many ways:

  • Direct contact with body fluids like blood, organs and other body fluids.
  • Direct contact with surfaces, materials and equipment contaminated with infected fluids.
  • Obsequies involving direct contact with the dead body can also add to the ways of transmiting the deadly Marburg virus.

Mostly infected are healthcare workers and close family members while handling victims with suspected or confirmed MVD.This is because of the close or direct contact with the patient when proper nursing precautions are not strictly followed. Transmission, which occurs through percutaneous injury or through injection injury, causes a disease of more severity with a rapid patient slump and possible high fatality rate.

As long as a person is human blood contains the virus, the person will remain infectious.

Symptoms

After an incubation of 2 to 21 days, the illness begins abruptly and is involved with high fever, chills, severe headache and severe malaise. On the third day, the patient experiences severe abdominal pain, cramps and watery diarrhea. At this stage, the victim exhibits ghost-like features, which include an expressionless face, drawn features, despotic eyes, and extreme lethargy. Between 2 and 7 days after symptoms onset, a maculopapular rash may appear prominently on the trunk of the patient. Symptoms become more severe and can include pancreas inflammation, jaundice, shock, liver failure, delirium, severe weight loss, multi-organ dysfunction and massive hemorrhage.

Massive hemorrhagic manifestation and fatal cases have some form of bleeding often from multiple areas. Fresh blood in feces and vomitus is often seen together with nose, gum and vaginal bleeding. Impulsive bleeding at the venipuncture sites can be particularly vexing.

Moreover Central nervous system involvement can result in irritability, aggression and confusion. Orchitis has been reported in the late phase of the disease. Death usually occurs after 8 to 9 days of symptom onset in fatal cases and is usually preceded by massive bleeding and shock.

Persistent virus in the people recovering from Marburg virus disease is known to persist in immune privileged sites, which include

  • Inside the eyes and testicles.
  • For the pregnant women, the virus persists in the amniotic fluid, placenta and fetus.
  • For the breastfeeding women, the virus may persist in the breast milk.

Relapse symptomatic illness in someone who has recovered from MVD in the absence of reinfection is a rare event, which has not yet been fully understood.

Diagnosis

Marburg virus has similar symptoms to other infectious diseases such as typhoid fever, malaria, meningitis, shigellosis and other viral hemorrhagic fever. Due to this fact, it is very difficult to clinically distinguish it from other diseases.

Confirmatory diagnostic test methods for Marburg virus infection include:

  • Electron microscopy
  • Virus isolation by cell culture
  • Antibody capture enzyme-linked immunosorbent assay (ELISA)
  • Serum neutralization test
  • Antigen capture detachment test
  • Reverse transcriptase polymerase chain reaction (RT PCR) assay.

Treatment and vaccination.

Palliative care: This includes treatment of specific symptoms, rehydration with intravenous fluid or oral fluid and maintaining oxygen state and blood pressure. This improves survival.

Currently there is no validated treatment method for MVD, however, a range of potential treatments are being evaluated including immunotherapies, blood products, and dry therapies.

 

Prevention and control measures.

According to WHO Successful, outbreak control is dependent on the application of a package of interventions, which include case management, surveillance and contact tracing, a good laboratory service ,Safe and dignified burials and social mobilization.

Community engagement is key to effective outbreak control. Additionally raising risk awareness for the virus and protective measures an individual can take is an effective way of reducing human transmission.

The message of risk reduction should focus and touch on several factors which include:

  1. Reducing the risk of human to human transmission in the community through direct contact with infected patients.
  2. Reducing the risk of transmission through sexual transmission by practicing safe sex and hygiene for 12 months from the onset of symptoms or until the semen test negative twice for Marburg virus disease.
  3. Community affected by Marburg should make efforts of educating the population about the nature of the disease and preventive and control measures.
  4. Reducing the risk of the bat to the human transmission, which comes about due to prolonged exposure to mines and caves inhabited by bat colonies.
  5. Effective outbreak containment measures which includes safe burial for the deceased, identifying the suspected victims(people who may have come in close contact with patients infected by Marburg virus) and monitor their health for 21 days, selecting the infected people, Isolating the sick form the healthy people to foil further spread of infections and lastly maintaining good hygiene and clean environment.

 

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