Global Outbreak Update: Marburg virus disease case in Guinea

A male patient reported onset of symptoms on 25 July 2021, dying on 2 August. The case is located in the Guéckédou Prefecture, Nzérékoré Region, and is the first known case of MVD in Guinea and West Africa.

• Update Date: 09 August 2021
   
• Time frame and cases:
  25 July 2021: The case, a male, had onset of symptoms.
  1 August 2021: The case attended a small health facility near his village of residence with symptoms of fever, headache, fatigue, abdominal pain, and gingival hemorrhage.
  2 August 2021: The case died in the community and an alert was raised by the sub-prefecture public health care facility to the prefectorial department of health in Guéckédou.
  3 August 2021: A real-time PCR was conducted which confirmed the sample was positive for Marburg virus disease and negative for Ebola virus disease.
  5 August 2021: The National Reference Laboratory in Conakry provided confirmation by real-time PCR of the positive Marburg result.
  6 August 2021: The Guinean Ministry of Health informed WHO of a confirmed case of Marburg virus disease (MVD).
  8 August 2021: 145 contacts were identified and have been followed-up.
  9 August 2021: Institut Pasteur Dakar in Senegal provided reconfirmation that the result was positive for Marburg virus disease and negative for Ebola virus disease. A total of 146 contacts with the case were identified.
   
• Regions: The case is located in the Guéckédou Prefecture, Nzérékoré Region, south-western Guinea. The village is near Guinean borders with Sierra Leone and Liberia.
   
• Background: This is the first known case of Marburg virus disease in Guinea and in West Africa. Marburg virus disease was initially detected in 1967 after simultaneous outbreaks in Marburg and Frankfurt in Germany; and in Belgrade, Serbia. Outbreaks and sporadic cases have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa (in a person with recent travel history to Zimbabwe) and Uganda. In 2008, two independent cases were reported in visitors of a cave inhabited by Rousettus bats in Uganda. The WHO factsheet page for the MVD offers a detailed chronology table of major outbreaks.
   
• Virus / Vector / Disease Information: Marburg virus disease (MVD) is a highly virulent, epidemic-prone disease associated with high case fatality rates (CFR) of 24-90%. In the early course of the disease, clinical diagnosis is difficult to distinguish from other tropical febrile illnesses, because of similarities in clinical symptoms. Differential diagnoses to be excluded include, Ebola virus disease, malaria, typhoid fever, leptospirosis, rickettsial infection, and plague. MVD is transmitted by direct contact with the blood, bodily fluids and/or tissues of infected persons or wild animals (e.g. monkeys and fruit bats).
   
• Existing Treatments: There is no specific therapeutic or drug approved for MVD. Some monoclonal antibodies (Mabs) are under development and other antivirals such as Galidesvir, Favipiravir, Remdesivir are being explored in clinical trials but without clear results.
   
• Key Responses:

1. Coordiantion between the Guinean Ministry of Health (MoH), WHO, US Centers for Disease Control and Prevention, Alliance for International Medical Action (ALIMA), Red Cross, UNICEF, the International Organization for Migration (IOM) and other partners, have initiated measures to control the outbreak and prevent further spread.
2. Contact tracing is ongoing, along with active case searching in health facilities and at the community level.
3. Following the recent declaration of the end of a Ebola virus outbreak in Guinea on 19 June 2021, a community health workers network and a WHO technical team that were supporting the government’s post-Ebola surveillanc is being repurposed to tackle the MVD outbreak.
4. A public health emergency operations center has been activated and a base to support response workers will be set up in the sub-prefecture of Koundou.
5. Active searching for suspected cases in the community and health facilities is ongoing.
6. A surveillance team has been deployed and briefings for health workers are underway, with particular focus on the village where the index case was identified along with villages within a 15 kilometer radius.
7. Point of entry surveillance is being reinforced and two health control entry points were recently revitalized (Kiesseneye and Nongoa). The three main entry points with Sierra Leone and Liberia are active and the others are under evaluation.
8. In collaboration with ALIMA, there is an ongoing assessment of the case management capacity in the health facilities.
9. Risk communication activities are ongoing in the community.

• Recommendations:

1. Health workers should always implement standard precautions during patient care, regardless of their presumed diagnosis. These include hand hygiene, respiratory hygiene and cough etiquette, use of risk based personal protective equipment (PPE), safe injection practices, environmental cleaning and disinfection, appropriate linen and waste management, and decontamination of reusable medical equipment.
2. Health workers caring for patients with suspected or confirmed Marburg virus should apply additional precautionary infection control measures to prevent contact with the patient’s body fluids and/or contaminated surfaces. This includes the following PPE items: face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves. This further emphasizes the importance of readily available PPE at health care facilities, appropriate donning/doffing areas, IPC/WASH supplies and training on their proper uses.
3. Surveillance activities, including contact tracing and active case searching, must be strengthened within all affected health zones.
4. Risk communication and community engagement (RCCE) is key to successfully controlling outbreaks.
5. Based on the current risk assessment and prior evidence on Ebola outbreaks, WHO advises against any restriction of travel and trade to and from Guinea.

More information on this update here. For more information about the disease,including latest news, research, fact sheets and training, please visit the dedicated Marburg Virus Disease.

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