This is the first Marburg virus disease (MVD) outbreak reported in Equatorial Guinea.
On 7 February 2023, the Ministry of Health and Social Welfare of Equatorial Guinea reported at least eight deaths that occurred between 7 January and 7 February 2023, in two villages located in the district of Nsock Nsomo, eastern province of Kie-Ntem, Río Muni Region. According to the ongoing epidemiological investigation, the cases presented with fever, followed by weakness, vomiting, and blood-stained diarrhoea; two cases also presented with skin lesions and otorrhagia (bleeding from the ear).
On 9 February 2023, eight blood samples were collected from contacts and sent to the Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF) in Gabon, where they tested negative for both Ebola and Marburg viruses by real-time polymerase chain reaction (RT-PCR).
An additional eight blood samples were collected from other contacts and sent to the Institute Pasteur in Dakar, Senegal, on 12 February 2023. One of these samples was taken from a suspected case that was confirmed positive for Marburg virus by RT-PCR. This case presented with fever, non-bloody vomiting, bloody diarrhoea, and convulsions and died on 10 February 2023 at Ebebiyin District Hospital. The case also had epidemiological links to four deceased cases from one of the villages in Nsoc-Nsomo district.
As of 21 February 2023, the cumulative number of cases is nine, including one confirmed case, four probable cases and four suspected cases. All the cases have died, one in a health facility and the other eight in the community. There are no cases among healthcare workers. Thirty-four contacts are currently under follow-up.
Epidemiology of Marburg virus disease
Marburg virus is the causative agent of Marburg virus disease (MVD), which has a case-fatality ratio of up to 88%. Marburg virus disease was initially detected in 1967 after simultaneous outbreaks in Marburg and Frankfurt in Germany, and in Belgrade, Serbia.
Rousettus aegyptiacus fruit bats are considered natural hosts for Marburg virus, from which the virus is then transmitted to people.
Marburg spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Healthcare workers have previously been infected while treating patients with suspected or confirmed MVD. Burial ceremonies that involve direct contact with the body of the deceased can also contribute to the transmission of Marburg.
The incubation period varies from two to 21 days. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Severe haemorrhagic manifestations appear between five and seven days from symptoms onset, and fatal cases usually have some form of bleeding, often from multiple areas. In fatal cases, death occurs most often between eight and nine days after symptom onset, usually preceded by severe blood loss and shock.
PS: Marburg is a RNA virus of the filovirus family. The six species of Ebola virus are the only other known members of the filovirus family.
On 7 February 2023, the Ministry of Health and Social Welfare of Equatorial Guinea reported at least eight deaths that occurred between 7 January and 7 February 2023, in two villages located in the district of Nsock Nsomo, eastern province of Kie-Ntem, Río Muni Region. According to the ongoing epidemiological investigation, the cases presented with fever, followed by weakness, vomiting, and blood-stained diarrhoea; two cases also presented with skin lesions and otorrhagia (bleeding from the ear).
On 9 February 2023, eight blood samples were collected from contacts and sent to the Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF) in Gabon, where they tested negative for both Ebola and Marburg viruses by real-time polymerase chain reaction (RT-PCR).
An additional eight blood samples were collected from other contacts and sent to the Institute Pasteur in Dakar, Senegal, on 12 February 2023. One of these samples was taken from a suspected case that was confirmed positive for Marburg virus by RT-PCR. This case presented with fever, non-bloody vomiting, bloody diarrhoea, and convulsions and died on 10 February 2023 at Ebebiyin District Hospital. The case also had epidemiological links to four deceased cases from one of the villages in Nsoc-Nsomo district.
As of 21 February 2023, the cumulative number of cases is nine, including one confirmed case, four probable cases and four suspected cases. All the cases have died, one in a health facility and the other eight in the community. There are no cases among healthcare workers. Thirty-four contacts are currently under follow-up.
Epidemiology of Marburg virus disease
Marburg virus is the causative agent of Marburg virus disease (MVD), which has a case-fatality ratio of up to 88%. Marburg virus disease was initially detected in 1967 after simultaneous outbreaks in Marburg and Frankfurt in Germany, and in Belgrade, Serbia.
Rousettus aegyptiacus fruit bats are considered natural hosts for Marburg virus, from which the virus is then transmitted to people.
Marburg spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Healthcare workers have previously been infected while treating patients with suspected or confirmed MVD. Burial ceremonies that involve direct contact with the body of the deceased can also contribute to the transmission of Marburg.
The incubation period varies from two to 21 days. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Severe haemorrhagic manifestations appear between five and seven days from symptoms onset, and fatal cases usually have some form of bleeding, often from multiple areas. In fatal cases, death occurs most often between eight and nine days after symptom onset, usually preceded by severe blood loss and shock.
PS: Marburg is a RNA virus of the filovirus family. The six species of Ebola virus are the only other known members of the filovirus family.
