Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.

Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).

Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not  contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.

Incubation period: usually five to ten days (range 2-21 days).

Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas. 

Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.

Further information, see ECDC Factsheet Marburg Virus, CDC.

Follow media and official reports! Follow all the recommendations of the local health authorities!

Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.

Preventive measures:

• Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
  
• Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
  
• Avoid contact with blood and other body fluids.
  
• Avoid visiting healthcare facilities in the MVD-affected areas for no urgent medical care or non-medical reasons.
  
• Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial. 
  
• Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
  
• Wash and peel fruit and vegetables before consumption.
  
• Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
  
• If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
  
• Practice safer sex.

Upon return from Rwanda:

• Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).

In case of symptoms:

If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:

• you should separate yourself from others (isolate) immediately and
  
• directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
  
• alert the healthcare providers of your recent travel to an area with a Marburg outbreak.

For clinicians:

• Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
• Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.