Marburg virus disease

{{Short description|Human viral disease}} {{Redirect|MHF}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Infobox medical condition (new) | name = | synonyms = Marburg hemorrhagic fever | image = Marburg virus.jpg | caption = Transmission electron micrograph of [[Marburg virus]] | symptoms = Fever, weakness, muscle pain<ref name=cdcmar/> | complications = | onset = 2–21 days after exposure<ref name=cdcmar/> | duration = | types = | causes = MV<ref name=cdcmar/> | risks = Direct contact with bodily fluids of individuals infected with the virus<ref name=cdcmar/> | diagnosis = Blood test<ref name=cdcmar/> | differential = Ebola virus disease<ref name=cdcmar/> | prevention = | treatment = There is no treatment, only immediate [[supportive care]]<ref name=cdcmar/> | medication = | deaths = 24–88% [[case fatality rate]]<ref>{{Cite web |title=Marburg virus disease |url=https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease |url-status=live |archive-url=https://web.archive.org/web/20200411123405/https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease |archive-date=11 April 2020 |access-date=8 February 2020 |website=www.who.int |language=en}}</ref> | frequency = Rare | alt = }}

'''Marburg virus disease''' ('''MVD'''), formerly known as '''Marburg hemorrhagic fever''' ('''MHF'''), is a [[viral hemorrhagic fever]] in human and non-human [[primate]]s caused by either of the two [[Marburgvirus]]es: [[Marburg virus]] (MARV) and [[Ravn virus]] (RAVV).<ref name="Spickler">{{Cite web |last=Spickler |first=Anna |title=Ebolavirus and Marburgvirus Infections |url=http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_filovirus.pdf |url-status=live |archive-url=https://web.archive.org/web/20150430165458/http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_filovirus.pdf |archive-date=2015-04-30 |access-date=2014-10-19}}</ref> Its clinical symptoms are very similar to those of [[Ebola virus disease]] (EVD).<ref name="cdcmar">{{Cite web |title=Ebola Virus Disease & Marburg Virus Disease - Chapter 3 - 2018 Yellow Book {{!}} Travelers' Health {{!}} CDC |url=https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/ebola-virus-disease-and-marburg-virus-disease |url-status=live |archive-url=https://web.archive.org/web/20190719013822/https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/ebola-virus-disease-and-marburg-virus-disease |archive-date=19 July 2019 |access-date=19 July 2019 |website=wwwnc.cdc.gov |language=en-us}}</ref>

[[Egyptian fruit bat]]s are believed to be the normal carrier in nature and Marburg virus [[RNA]] has been isolated from them.<ref name="Kortepeter2020">{{Cite journal |last1=Kortepeter |first1=MG |last2=Dierberg |first2=K |last3=Shenoy |first3=ES |last4=Cieslak |first4=TJ |last5=Medical Countermeasures Working Group of the National Ebola Training and Education Center's (NETEC) Special Pathogens Research Network (SPRN) |date=October 2020 |title=Marburg virus disease: A summary for clinicians |journal=International Journal of Infectious Diseases |volume=99 |pages=233–242 |doi=10.1016/j.ijid.2020.07.042 |pmc=7397931 |pmid=32758690}}</ref> {{TOC limit|3}}

== Signs and symptoms == The most detailed study on the frequency, onset, and duration of MVD [[medical sign|clinical signs]] and [[symptom]]s was performed during the 1998–2000 mixed MARV/RAVV disease outbreak.<ref name="Bausch2006">{{Cite journal |last1=Bausch |first1=D. G. |last2=Nichol |first2=S. T. |last3=Muyembe-Tamfum |first3=J. J. |last4=Borchert |first4=M. |last5=Rollin |first5=P. E. |last6=Sleurs |first6=H. |last7=Campbell |first7=P. |last8=Tshioko |first8=F. K. |last9=Roth |first9=C. |last10=Colebunders |first10=R. |last11=Pirard |first11=P. |last12=Mardel |first12=S. |last13=Olinda |first13=L. A. |last14=Zeller |first14=H. |last15=Tshomba |first15=A. |year=2006 |title=Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus |url=https://researchonline.lshtm.ac.uk/11474/1/nejmoa051465.pdf |url-status=live |journal=New England Journal of Medicine |volume=355 |issue=9 |pages=909–919 |doi=10.1056/NEJMoa051465 |pmid=16943403 |archive-url=https://web.archive.org/web/20190921112222/https://researchonline.lshtm.ac.uk/11474/1/nejmoa051465.pdf |archive-date=2019-09-21 |access-date=2019-12-10 |last16=Kulidri |first16=A. |last17=Libande |first17=M. L. |last18=Mulangu |first18=S. |last19=Formenty |first19=P. |last20=Grein |first20=T. |last21=Leirs |first21=H. |last22=Braack |first22=L. |last23=Ksiazek |first23=T. |last24=Zaki |first24=S. |last25=Bowen |first25=M. D. |last26=Smit |first26=S. B. |last27=Leman |first27=P. A. |last28=Burt |first28=F. J. |last29=Kemp |first29=A. |last30=Swanepoel |first30=R.}}</ref> A skin [[rash]], red or purple spots (e.g. [[petechia]]e or [[purpura]]), [[bruises]], and [[hematoma]]s (especially around needle injection sites) are typical hemorrhagic manifestations. However, contrary to popular belief, hemorrhage does not lead to [[hypovolemia]] and is not the cause of [[death]] (total blood loss is minimal except during [[Childbirth|labor]]). Instead, death occurs due to [[multiple organ dysfunction syndrome|multiple organ dysfunction syndrome (MODS)]] due to fluid redistribution, [[hypotension]], [[disseminated intravascular coagulation]], and focal [[tissue (biology)|tissue]] [[necrosis|necroses]].<ref name=Bausch2006/><ref name="Martini1968">{{Cite journal |last1=Martini |first1=G. A. |last2=Knauff |first2=H. G. |last3=Schmidt |first3=H. A. |last4=Mayer |first4=G. |last5=Baltzer |first5=G. |year=2009 |title=Über eine bisher unbekannte, von Affen eingeschleppte Infektionskrankheit: Marburg-Virus-Krankheit |journal=Deutsche Medizinische Wochenschrift |volume=93 |issue=12 |pages=559–571 |doi=10.1055/s-0028-1105098 |pmid=4966280 |s2cid=260056835}}</ref><ref name="Stille1968">{{Cite journal |last1=Stille |first1=W. |last2=Böhle |first2=E. |last3=Helm |first3=E. |last4=Van Rey |first4=W. |last5=Siede |first5=W. |year=2009 |title=Über eine durch Cercopithecus aethiops übertragene Infektionskrankheit |journal=Deutsche Medizinische Wochenschrift |volume=93 |issue=12 |pages=572–582 |doi=10.1055/s-0028-1105099 |pmid=4966281 |s2cid=260058558}}</ref><ref name="Martini1971">{{Cite book |last=Martini |first=G. A. |title=Marburg Virus Disease |publisher=Springer-Verlag |year=1971 |isbn=978-0-387-05199-4 |editor-last=Martini |editor-first=G. A. |location=Berlin, Germany |pages=1–9 |chapter=Marburg Virus Disease. Clinical Syndrome |editor-last2=Siegert |editor-first2=R.}}</ref><ref>{{Cite news |date=4 October 2024 |title=Marburg virus kills 11 in Rwanda. What to know about the Ebola-like outbreak and symptoms |url=https://www.cbsnews.com/news/marburg-virus-what-to-know-symptoms |url-status=live |archive-url=https://web.archive.org/web/20241004094820/https://www.cbsnews.com/amp/news/marburg-virus-what-to-know-symptoms/ |archive-date=4 October 2024 |access-date=4 October 2024 |work=[[CBS News]]}}</ref>

Clinical phases of Marburg hemorrhagic fever's presentation are described below. Note that phases overlap due to variability between cases. # Incubation: 2–21 days, averaging 5–9 days.<ref name=clini/> # Generalization Phase: Day 1 up to Day 5 from the onset of clinical symptoms. MHF presents with a high fever 104&nbsp;°F (~40˚C) and a sudden, severe headache, with accompanying chills, fatigue, nausea, vomiting, diarrhea, pharyngitis, maculopapular rash, abdominal pain, [[conjunctivitis]], and [[malaise]].<ref name=clini/> # Early Organ Phase: Day 5 up to Day 13. Symptoms include prostration, [[dyspnea]], [[edema]], [[conjunctival injection]], viral [[exanthema]], and CNS symptoms, including encephalitis, confusion, delirium, apathy, and aggression. Hemorrhagic symptoms typically occur late and herald the end of the early organ phase, leading either to eventual recovery or worsening and death. Symptoms include bloody stools, [[ecchymoses]], blood leakage from [[venipuncture]] sites, mucosal and visceral hemorrhaging, and possibly [[hematemesis]].<ref name=clini/> # Late Organ Phase: Day 13 up to Day 21+. Symptoms bifurcate into two constellations for survivors and fatal cases. Survivors will enter a convalescence phase, experiencing [[myalgia]], [[fibromyalgia]], [[hepatitis]], [[asthenia]], ocular symptoms, and [[psychosis]]. Fatal cases continue to deteriorate, experiencing continued fever, [[obtundation]], [[coma]], [[convulsions]], diffuse [[coagulopathy]], metabolic disturbances, [[Shock (circulatory)|shock]] and death, with death typically occurring between days 8 and 16.<ref name="clini">{{Cite journal |last1=Mehedi |first1=Masfique |last2=Allison Groseth |last3=Heinz Feldmann |last4=Hideki Ebihara |date=September 2011 |title=Clinical aspects of Marburg hemorrhagic fever |journal=Future Virol. |volume=6 |issue=9 |pages=1091–1106 |doi=10.2217/fvl.11.79 |pmc=3201746 |pmid=22046196}}</ref>

The WHO also writes that at the phase of gastrointestinal symptoms' predomination, "the appearance of patients...has been described as showing 'ghost-like' drawn features, deep-set eyes, expressionless faces, and extreme lethargy."<ref>{{Cite news |date=3 October 2024 |title=Marburg virus outbreak: What you need to know as Europe fears cases |url=https://www.independent.co.uk/news/health/marburg-virus-outbreak-germany-rwanda-symptoms-b2623181.html |url-status=live |archive-url=https://web.archive.org/web/20241004023607/https://www.independent.co.uk/news/health/marburg-virus-outbreak-germany-rwanda-symptoms-b2623181.html |archive-date=4 October 2024 |access-date=4 October 2024 |work=[[The Independent]]}}</ref>

== Causes == {{Main| Marburgvirus}} {| class="wikitable" style = "float: right; margin-left:15px; text-align:center" |+ Genus ''Marburgvirus'': species and its MVD-causing viruses |- | [[International Committee on Taxonomy of Viruses|Species name]] | [[International Committee on Taxonomy of Viruses|Virus name (Abbreviation)]] |- | rowspan="2" | ''[[Marburg marburgvirus]]''* | [[Marburg virus]] (MARV; previously MBGV) |- | [[Ravn virus]] (RAVV; previously MARV-Ravn) |- |colspan="2"| "*" denotes the type species. |}

MVD is caused by two viruses; [[Marburg virus|Marburg virus (MARV)]] and [[Ravn virus|Ravn virus (RAVV)]], family Filoviridae.<ref>{{Cite book |last1=Steven B. Bradfute |title=Viral Hemorrhagic Fevers |last2=Sina Bavari |last3=Peter B. Jahrling |last4=Jens H. Kuhn |date=2014 |publisher=CRC Press |isbn=978-1-4398-8431-7 |editor-last=Singh |editor-first=Sunit K. |location=Boca Raton |pages=457–480 |language=en |chapter=Marburg Virus Disease |doi=10.1201/b15172-30 |access-date=28 October 2017 |editor-last2=Ruzek |editor-first2=Daniel |chapter-url=https://books.google.com/books?id=WzzOBQAAQBAJ&q=MVD+is+caused+by+:+Marburg+virus+and+Ravn+virus&pg=PA458}}</ref>{{rp|458}}

Marburgviruses are endemic in [[arid]] [[woodland]]s of [[equatorial Africa]].<ref name="Peterson2004">{{Cite journal |last1=Peterson |first1=A. T. |last2=Bauer |first2=J. T. |last3=Mills |first3=J. N. |year=2004 |title=Ecologic and Geographic Distribution of Filovirus Disease |journal=Emerging Infectious Diseases |volume=10 |issue=1 |pages=40–47 |doi=10.3201/eid1001.030125 |pmc=3322747 |pmid=15078595}}</ref><ref name="Pinzon2005">{{Cite journal |last1=Pinzon |first1=E. |last2=Wilson |first2=J. M. |last3=Tucker |first3=C. J. |year=2005 |title=Climate-based health monitoring systems for eco-climatic conditions associated with infectious diseases |journal=Bulletin de la Société de Pathologie Exotique |volume=98 |issue=3 |pages=239–243 |pmid=16267968}}</ref><ref name="Peterson2006">{{Cite journal |last1=Peterson |first1=A. T. |last2=Lash |first2=R. R. |last3=Carroll |first3=D. S. |last4=Johnson |first4=K. M. |year=2006 |title=Geographic potential for outbreaks of Marburg hemorrhagic fever |journal=The American Journal of Tropical Medicine and Hygiene |volume=75 |issue=1 |pages=9–15 |doi=10.4269/ajtmh.2006.75.1.0750009 |hdl=1808/6529 |pmid=16837700 |doi-access=free |hdl-access=free}}</ref> Most marburgvirus infections were repeatedly associated with people visiting natural [[cave]]s or working in [[mining|mines]]. In 2009, the successful isolation of infectious MARV and RAVV was reported from healthy [[Egyptian fruit bat]]s caught in caves.<ref name="Kortepeter2020" /><ref name="Towner2009">{{Cite journal |last1=Towner |first1=J. S. |last2=Amman |first2=B. R. |last3=Sealy |first3=T. K. |last4=Carroll |first4=S. A. R. |last5=Comer |first5=J. A. |last6=Kemp |first6=A. |last7=Swanepoel |first7=R. |last8=Paddock |first8=C. D. |last9=Balinandi |first9=S. |last10=Khristova |first10=M. L. |last11=Formenty |first11=P. B. |last12=Albarino |first12=C. G. |last13=Miller |first13=D. M. |last14=Reed |first14=Z. D. |last15=Kayiwa |first15=J. T. |year=2009 |editor-last=Fouchier |editor-first=Ron A. M. |title=Isolation of Genetically Diverse Marburg Viruses from Egyptian Fruit Bats |journal=PLOS Pathogens |volume=5 |issue=7 |article-number=e1000536 |doi=10.1371/journal.ppat.1000536 |pmc=2713404 |pmid=19649327 |doi-access=free |last16=Mills |first16=J. N. |last17=Cannon |first17=D. L. |last18=Greer |first18=P. W. |last19=Byaruhanga |first19=E. |last20=Farnon |first20=E. C. |last21=Atimnedi |first21=P. |last22=Okware |first22=S. |last23=Katongole-Mbidde |first23=E. |last24=Downing |first24=R. |last25=Tappero |first25=J. W. |last26=Zaki |first26=S. R. |last27=Ksiazek |first27=T. G. |last28=Nichol |first28=S. T. |last29=Rollin |first29=P. E.}}</ref> This isolation strongly suggests that [[Old World]] [[Megabat|fruit bats]] are involved in the natural maintenance of marburgviruses and that visiting bat-infested caves is a risk factor for acquiring marburgvirus infections. Further studies are necessary to establish whether Egyptian rousettes are the actual hosts of MARV and RAVV or whether they get infected via contact with another animal and therefore serve only as intermediate hosts. Another risk factor is contact with nonhuman primates, although only one outbreak of MVD (in 1967) was due to contact with infected monkeys.<ref name=Siegert1967/>

Contrary to [[Ebola virus disease|Ebola virus disease (EVD)]], which has been associated with heavy [[rain]]s after long periods of dry weather,<ref name=Pinzon2005/><ref>{{Cite journal |last1=Tucker |first1=C. J. |last2=Wilson |first2=J. M. |last3=Mahoney |first3=R. |last4=Anyamba |first4=A. |last5=Linthicum |first5=K. |last6=Myers |first6=M. F. |year=2002 |title=Climatic and Ecological Context of the 1994–1996 Ebola Outbreaks |journal=Photogrammetric Engineering and Remote Sensing |volume=68 |issue=2 |pages=144–152}}</ref> triggering factors for spillover of marburgviruses into the human population have not yet been described.

== Transmission == The details of the initial transmission of MVD to humans remain incompletely understood. Transmission most likely occurs from [[Egyptian fruit bat]]s or another natural host, such as [[non-human primate]]s or through the consumption of [[bushmeat]], but the specific routes and body fluids involved are unknown. Human-to-human transmission of MVD occurs through direct contact with infected bodily fluids such as blood.<ref name="Kortepeter2020" /> Transmission events are relatively rare – there have been only 11 recorded outbreaks of MARV between 1975 and 2011, with one event involving both MARV and RAVV.<ref>{{cite book |last=von Csefalvay |first=Chris |title=Computational Modeling of Infectious Disease |date=2023 |publisher=Elsevier |isbn=978-0-323-95389-4 |pages=121–149 |language=en |chapter=Host-vector and multihost systems |doi=10.1016/b978-0-32-395389-4.00013-x |access-date=2023-03-05 |chapter-url=https://linkinghub.elsevier.com/retrieve/pii/B978032395389400013X |archive-url=https://web.archive.org/web/20230418221153/https://www.sciencedirect.com/science/article/abs/pii/B978032395389400013X?via%3Dihub |archive-date=2023-04-18 |url-status=live}}</ref>

== Diagnosis == [[File:Marburg virus liver injury.jpg|thumb|Marburg virus liver injury]] MVD is clinically indistinguishable from [[Ebola virus disease|Ebola virus disease (EVD)]], and it can also easily be confused with many other diseases prevalent in [[Equatorial Africa]], such as other [[viral hemorrhagic fever]]s, [[malaria|falciparum malaria]], [[typhoid fever]], [[shigellosis]], [[rickettsia|rickettsial diseases]] such as [[typhus]], [[cholera]], [[Gram-negative bacteria|gram-negative]] [[sepsis]], [[borreliosis]] such as [[relapsing fever]] or [[Verotoxin-producing Escherichia coli|EHEC enteritis]]. Other infectious diseases that ought to be included in the [[differential diagnosis]] include [[leptospirosis]], [[scrub typhus]], [[plague (disease)|plague]], [[Q fever]], [[candidiasis]], [[histoplasmosis]], [[trypanosomiasis]], [[visceral]] [[leishmaniasis]], hemorrhagic [[smallpox]], [[measles]], and fulminant [[viral hepatitis]]. Non-infectious diseases that can be confused with MVD are [[acute promyelocytic leukemia]], [[hemolytic uremic syndrome]], [[snake]] [[envenomation]], [[coagulation|clotting factor]] deficiencies/platelet disorders, [[thrombotic thrombocytopenic purpura]], [[hereditary hemorrhagic telangiectasia]], [[Kawasaki disease]], and even [[warfarin]] intoxication.<ref name="Gear1989">{{Cite journal |last=Gear |first=J. H. |year=1989 |title=Clinical aspects of African viral hemorrhagic fevers |journal=Reviews of Infectious Diseases |volume=11 |issue=Suppl 4 |pages=S777–S782 |doi=10.1093/clinids/11.supplement_4.s777 |pmid=2665013}}</ref><ref name="Gear1978">{{Cite journal |last1=Gear |first1=J. H. |last2=Ryan |first2=J. |last3=Rossouw |first3=E. |year=1978 |title=A consideration of the diagnosis of dangerous infectious fevers in South Africa |journal=South African Medical Journal |volume=53 |issue=7 |pages=235–237 |pmid=565951}}</ref><ref name="Grolla2005">{{Cite journal |last1=Grolla |first1=A. |last2=Lucht |first2=A. |last3=Dick |first3=D. |last4=Strong |first4=J. E. |last5=Feldmann |first5=H. |year=2005 |title=Laboratory diagnosis of Ebola and Marburg hemorrhagic fever |journal=Bulletin de la Société de Pathologie Exotique |volume=98 |issue=3 |pages=205–209 |pmid=16267962}}</ref><ref name="Bogomolov1998">{{Cite journal |last=Bogomolov |first=B. P. |year=1998 |title=Differential diagnosis of infectious diseases with hemorrhagic syndrome |journal=Terapevticheskii Arkhiv |volume=70 |issue=4 |pages=63–68 |pmid=9612907}}</ref>

The most important indicator that may lead to the suspicion of MVD at clinical examination is the [[medical history]] of the patient, in particular the travel and occupational history (which countries and caves were visited) and the patient's exposure to wildlife (exposure to bats or bat excrements). MVD can be confirmed by isolation of marburgviruses from or by detection of marburgvirus antigen or genomic or subgenomic RNAs in patient [[blood]] or [[Blood serum|serum]] samples during the acute phase of MVD. Marburgvirus isolation is usually performed by [[inoculation]] of [[grivet]] kidney epithelial [[Vero cell|Vero E6]] or MA-104 [[cell culture]]s or by inoculation of human adrenal carcinoma SW-13 cells, all of which react to infection with characteristic [[cytopathic effect]]s.<ref name="Hofmann1968">{{Cite journal |last1=Hofmann |first1=H. |last2=Kunz |first2=C. |year=1968 |title="Marburg virus" (Vervet monkey disease agent) in tissue cultures |journal=Zentralblatt für Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene. 1. Abt. Medizinisch-hygienische Bakteriologie, Virusforschung und Parasitologie. Originale |volume=208 |issue=1 |pages=344–347 |pmid=4988544}}</ref><ref>{{Cite journal |last=Ksiazek |first=Thomas G. |year=1991 |title=Laboratory diagnosis of filovirus infections in nonhuman primates |journal=Lab Animal |volume=20 |issue=7 |pages=34–36}}</ref> Filovirions can easily be visualized and identified in cell culture by [[electron microscopy]] due to their unique filamentous shapes, but electron microscopy cannot differentiate the various filoviruses alone despite some overall length differences.<ref name="Geisbert1995">{{Cite journal |last1=Geisbert |first1=T. W. |last2=Jahrling |first2=P. B. |year=1995 |title=Differentiation of filoviruses by electron microscopy |url=https://zenodo.org/record/1258399 |url-status=live |journal=Virus Research |volume=39 |issue=2–3 |pages=129–150 |doi=10.1016/0168-1702(95)00080-1 |pmid=8837880 |archive-url=https://web.archive.org/web/20191217015555/https://zenodo.org/record/1258399 |archive-date=2019-12-17 |access-date=2019-06-29}}</ref> [[Immunofluorescence|Immunofluorescence assays]] are used to confirm marburgvirus presence in cell cultures. During an outbreak, virus isolation and electron microscopy are most often not feasible options. The most common diagnostic methods are therefore [[Reverse transcription polymerase chain reaction|RT-PCR]]<ref name="Gibb2001">{{Cite journal |last1=Gibb |first1=T. |last2=Norwood Jr |first2=D. A. |last3=Woollen |first3=N. |last4=Henchal |first4=E. 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C. |last3=Fukushi |first3=S. |last4=Mizutani |first4=T. |last5=Philippe |first5=M. |last6=Georges |first6=A. J. |last7=Kurane |first7=I. |last8=Morikawa |first8=S. |year=2006 |title=Marburgvirus nucleoprotein-capture enzyme-linked immunosorbent assay using monoclonal antibodies to recombinant nucleoprotein: Detection of authentic Marburgvirus |journal=Japanese Journal of Infectious Diseases |volume=59 |issue=5 |pages=323–325 |doi=10.7883/yoken.JJID.2006.323 |pmid=17060700}}</ref> which can be performed in field or mobile hospitals and laboratories. [[Immunofluorescence|Indirect immunofluorescence assays (IFAs)]] are not used for diagnosis of MVD in the field anymore.{{citation needed|date=July 2019}}

=== Classification === Marburg virus disease (MVD) is the official name listed in the [[World Health Organization]]'s [[International Statistical Classification of Diseases and Related Health Problems]] 10 (ICD-10) for the human disease caused by any of the two marburgviruses; [[Marburg virus]] (MARV) and [[Ravn virus]] (RAVV). In the scientific literature, Marburg hemorrhagic fever (MHF) is often used as an unofficial alternative name for the same disease. Both disease names are derived from the [[Germany|German]] city [[Marburg]], where MARV was first discovered.<ref name="Siegert1967">{{Cite journal |last1=Siegert |first1=R. |last2=Shu |first2=H. L. |last3=Slenczka |first3=W. |last4=Peters |first4=D. |last5=Müller |first5=G. |year=2009 |title=Zur Ätiologie einer unbekannten, von Affen ausgegangenen menschlichen Infektionskrankheit |journal=Deutsche Medizinische Wochenschrift |volume=92 |issue=51 |pages=2341–2343 |doi=10.1055/s-0028-1106144 |pmid=4294540 |s2cid=116556454}}</ref>

== Prevention == {{Main|Prevention of viral hemorrhagic fever}} Marburgviruses are highly [[infection|infectious]], but not very [[Contagious disease|contagious]]. They do not get transmitted by [[aerosol]] during natural MVD outbreaks. Due to the absence of an approved vaccine, prevention of MVD therefore relies predominantly on [[quarantine]] of confirmed or high probability cases, proper [[personal protective equipment]], and [[sterilization (microbiology)|sterilization]] and [[disinfection]].{{citation needed|date=October 2017}}

=== Vaccine development === {{main|Marburg vaccine}} There are currently no [[Food and Drug Administration]]-approved [[vaccine]]s for the prevention of MVD. Many candidate vaccines have been developed and tested in various animal models.<ref name="Garbutt2004">{{Cite journal |last1=Garbutt |first1=M. |last2=Liebscher |first2=R. |last3=Wahl-Jensen |first3=V. |last4=Jones |first4=S. |last5=Möller |first5=P. |last6=Wagner |first6=R. |last7=Volchkov |first7=V. |last8=Klenk |first8=H. D. |last9=Feldmann |first9=H. |last10=Ströher |first10=U. |year=2004 |title=Properties of Replication-Competent Vesicular Stomatitis Virus Vectors Expressing Glycoproteins of Filoviruses and Arenaviruses |journal=Journal of Virology |volume=78 |issue=10 |pages=5458–5465 |doi=10.1128/JVI.78.10.5458-5465.2004 |pmc=400370 |pmid=15113924}}</ref><ref name="Daddario-DiCaprio2006">{{Cite journal |last1=Daddario-Dicaprio |first1=K. M. |last2=Geisbert |first2=T. W. |last3=Geisbert |first3=J. B. |last4=Ströher |first4=U. |last5=Hensley |first5=L. E. |last6=Grolla |first6=A. |last7=Fritz |first7=E. A. |last8=Feldmann |first8=F. |last9=Feldmann |first9=H. |last10=Jones |first10=S. M. |year=2006 |title=Cross-Protection against Marburg Virus Strains by Using a Live, Attenuated Recombinant Vaccine |journal=Journal of Virology |volume=80 |issue=19 |pages=9659–9666 |doi=10.1128/JVI.00959-06 |pmc=1617222 |pmid=16973570}}</ref><ref name="Swenson2008">{{Cite journal |last1=Swenson |first1=D. L. |last2=Warfield |first2=K. L. |last3=Larsen |first3=T. |last4=Alves |first4=D. A. |last5=Coberley |first5=S. S. |last6=Bavari |first6=S. |year=2008 |title=Monovalent virus-like particle vaccine protects guinea pigs and nonhuman primates against infection with multiple Marburg viruses |journal=Expert Review of Vaccines |volume=7 |issue=4 |pages=417–429 |doi=10.1586/14760584.7.4.417 |pmid=18444889 |s2cid=23200723}}</ref> Of those, the most promising ones are [[DNA vaccination|DNA vaccines]]<ref name="Riemenschneider2003">{{Cite journal |last1=Riemenschneider |first1=J. |last2=Garrison |first2=A. |last3=Geisbert |first3=J. |last4=Jahrling |first4=P. |last5=Hevey |first5=M. |last6=Negley |first6=D. |last7=Schmaljohn |first7=A. |last8=Lee |first8=J. |last9=Hart |first9=M. K. |last10=Vanderzanden |first10=L. |last11=Custer |first11=D. |last12=Bray |first12=M. |last13=Ruff |first13=A. |last14=Ivins |first14=B. |last15=Bassett |first15=A. |year=2003 |title=Comparison of individual and combination DNA vaccines for B. Anthracis, Ebola virus, Marburg virus and Venezuelan equine encephalitis virus |url=https://zenodo.org/record/1259961 |url-status=live |journal=Vaccine |volume=21 |issue=25–26 |pages=4071–4080 |doi=10.1016/S0264-410X(03)00362-1 |pmid=12922144 |archive-url=https://web.archive.org/web/20210828155902/https://zenodo.org/record/1259961/preview/article.pdf |archive-date=2021-08-28 |access-date=2019-06-29 |last16=Rossi |first16=C. |last17=Schmaljohn |first17=C.}}</ref> or based on [[Venezuelan equine encephalitis virus]] [[Replicon (genetics)|replicons]],<ref name="Hevey1998">{{Cite journal |last1=Hevey |first1=M. |last2=Negley |first2=D. |last3=Pushko |first3=P. |last4=Smith |first4=J. |last5=Schmaljohn |first5=A. |date=Nov 1998 |title=Marburg virus vaccines based upon alphavirus replicons protect guinea pigs and nonhuman primates |journal=Virology |volume=251 |issue=1 |pages=28–37 |doi=10.1006/viro.1998.9367 |issn=0042-6822 |pmid=9813200 |doi-access=free}}</ref> [[vesicular stomatitis virus|vesicular stomatitis Indiana virus (VSIV)]]<ref name=Daddario-DiCaprio2006/><ref name="Jones2005">{{Cite journal |last1=Jones |first1=M. |last2=Feldmann |first2=H. |last3=Ströher |first3=U. |last4=Geisbert |first4=J. B. |last5=Fernando |first5=L. |last6=Grolla |first6=A. |last7=Klenk |first7=H. D. |last8=Sullivan |first8=N. J. |last9=Volchkov |first9=V. E. |last10=Fritz |first10=E. A. |last11=Daddario |first11=K. M. |last12=Hensley |first12=L. E. |last13=Jahrling |first13=P. B. |last14=Geisbert |first14=T. W. |year=2005 |title=Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses |journal=Nature Medicine |volume=11 |issue=7 |pages=786–790 |doi=10.1038/nm1258 |pmid=15937495 |s2cid=5450135 |doi-access=free}}</ref> or [[virus-like particle|filovirus-like particles (VLPs)]]<ref name=Swenson2008/> as all of these candidates could protect nonhuman primates from marburgvirus-induced disease. DNA vaccines have entered clinical trials.<ref name="NIAIDVaccineDevelopment">{{Cite press release |title=Ebola/Marburg Vaccine Development |date=2008-09-15 |publisher=National Institute of Allergy and Infectious Diseases |url=http://www3.niaid.nih.gov/topics/ebolaMarburg/default.htm |archive-url=https://web.archive.org/web/20100306223732/https://www3.niaid.nih.gov/topics/ebolaMarburg/default.htm |archive-date=2010-03-06}}</ref>

There is not yet an approved vaccine, because of [[economics of vaccines|economic factors in vaccine development]], and because filoviruses killed few before the 2010s.<ref>{{Cite journal |vauthors=Reynolds P, Marzi A |date=August 2017 |title=Ebola and Marburg virus vaccines |journal=Virus Genes |volume=53 |issue=4 |pages=501–515 |doi=10.1007/s11262-017-1455-x |pmc=7089128 |pmid=28447193}}</ref>

=== Endemic zones === The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from [[bat]]s and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source.{{citation needed|date=October 2017}}

=== During outbreaks === Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their [[excretion]]s and [[body fluids]], and any possibly [[contamination|contaminated]] materials and utensils. Patients should be isolated, but still are safe to be visited by family members. Medical staff should be trained in and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional [[burial]] rituals, especially those requiring [[embalming]] of bodies, should be discouraged or modified, ideally with the help of local [[traditional healer]]s.<ref>{{Cite book |last=Centers for Disease Control and Prevention and World Health Organization |url=https://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/entire.pdf |title=Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting |publisher=Centers for Disease Control and Prevention |year=1998 |location=Atlanta, Georgia, USA |ref=CITEREFCDCWHO1998 |access-date=2009-05-31 |archive-url=https://web.archive.org/web/20090507233051/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/entire.pdf |archive-date=2009-05-07}}</ref>

=== In the laboratory === Marburgviruses are [[World Health Organization]] Risk Group 4 Pathogens, requiring [[Biosafety|Biosafety Level 4-equivalent containment]],<ref name="BMBL5">{{Cite web |last=US Department of Health and Human Services |title=Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition |url=https://www.cdc.gov/biosafety/publications/bmbl5/ |url-status=live |archive-url=https://web.archive.org/web/20200423220253/https://www.cdc.gov/biosafety/publications/bmbl5/ |archive-date=2020-04-23 |access-date=2011-10-16}}</ref> laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.

== Treatment == There is currently no effective marburgvirus-specific [[therapy]] for MVD. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and [[electrolyte]]s to counter [[dehydration]], administration of [[anticoagulants]] early in infection to prevent or control [[disseminated intravascular coagulation]], administration of [[coagulation|procoagulants]] late in infection to control [[bleeding|hemorrhaging]], maintaining [[oxygen]] levels, [[pain management]], and administration of [[antibacterial|antibiotics]] or [[antifungal medication|antifungals]] to treat secondary infections.<ref>{{Cite journal |last1=Bausch |first1=D. G. |last2=Feldmann |first2=H. |last3=Geisbert |first3=T. W. |last4=Bray |first4=M. |last5=Sprecher |first5=A. G. |last6=Boumandouki |first6=P. |last7=Rollin |first7=P. E. |last8=Roth |first8=C. |last9=Winnipeg Filovirus Clinical Working Group |year=2007 |title=Outbreaks of Filovirus Hemorrhagic Fever: Time to Refocus on the Patient |journal=The Journal of Infectious Diseases |volume=196 |pages=S136–S141 |doi=10.1086/520542 |pmid=17940941 |doi-access=free}}</ref><ref>{{Cite journal |last=Jeffs |first=B. |year=2006 |title=A clinical guide to viral haemorrhagic fevers: Ebola, Marburg and Lassa |journal=Tropical Doctor |volume=36 |issue=1 |pages=1–4 |doi=10.1258/004947506775598914 |pmid=16483416 |s2cid=101015}}</ref>

== Prognosis == Although supportive care can improve survival chances, Marburg virus disease is fatal in the majority of cases. The [[case fatality rate]] has been estimated to be 61.9%.<ref name=lid/>

== Epidemiology ==

=== Pandemic potential === The WHO identifies marburg virus disease as having [[pandemic]] potential.<ref name="lid">{{Cite journal |vauthors=Cuomo-Dannenburg G, McCain K, McCabe R, Unwin HJ, Doohan P, Nash RK, Hicks JT, Charniga K, Geismar C, Lambert B, Nikitin D, Skarp J, Wardle J, Kont M, Bhatia S, Imai N, van Elsland S, Cori A, Morgenstern C |date=November 2023 |title=Marburg virus disease outbreaks, mathematical models, and disease parameters: a systematic review |journal=Lancet Infect Dis |type=Systematic review |volume=24 |issue=5 |pages=e307–e317 |doi=10.1016/S1473-3099(23)00515-7 |pmc=7615873 |pmid=38040006}}</ref>

=== Historical outbreaks === Below is a table of outbreaks concerning MVD from 1967 to 2025: {| class="wikitable sortable" |+ Marburg virus disease outbreaks <ref>{{Cite web |title=Outbreak Table {{!}} Marburg Hemorrhagic Fever {{!}} CDC |url=https://www.cdc.gov/vhf/marburg/resources/outbreak-table.html |url-status=live |archive-url=https://web.archive.org/web/20150121181229/http://www.cdc.gov/vhf/marburg/resources/outbreak-table.html |archive-date=21 January 2015 |access-date=4 August 2018 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention |language=en}}</ref> |- ! Year ! Country ! Virus ! data-sort-type="number" | Human cases ! data-sort-type="number" | Human deaths ! data-sort-type="number" | [[Case fatality rate]] ! Notes |- | [[1967 Marburg virus outbreak in West Germany|1967]] | {{FRG}}<br />{{YUG}} | MARV | 31 | 7 | 23% | |- | 1975 | {{flagcountry|Rhodesia}}<br />{{flag country|Union of South Africa}} | MARV | 3 | 1 | 33% | |- | 1980 | {{KEN}} | MARV | 2 | 1 | 50% | |- | 1987 | {{KEN}} | RAVV | 1 | 1 | 100% | |- | 1988 | {{URS}} | MARV | 1 | 1 | 100% | |- | 1990 | {{URS}} | MARV | 1 | 0 | 0% | |- | 1998–2000 | {{COD}} | MARV & RAVV | 154 | 128 | 83% | |- | 2004–2005 | {{ANG}} | MARV | 252 | 227 | 90% | |- | 2007 | {{UGA}} | MARV & RAVV | 4 | 1 | 25% | <ref>{{Cite web |title=WHO {{!}} Marburg haemorrhagic fever in Uganda |url=https://www.who.int/csr/don/2007_08_03/en/ |archive-url=https://web.archive.org/web/20141008044427/http://www.who.int/csr/don/2007_08_03/en/ |archive-date=October 8, 2014 |access-date=23 October 2017 |website=www.who.int}}</ref> |- | 2008 | {{UGA}}<br />{{NED}}<br />{{USA}} | MARV | 2 | 1 | 50% | <ref>{{Cite web |title=Imported Case of Marburg Hemorrhagic Fever --- Colorado, 2008 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm |url-status=live |archive-url=https://web.archive.org/web/20170523210515/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm |archive-date=23 May 2017 |access-date=23 October 2017 |website=cdc.gov}}</ref> |- | 2012 | {{UGA}} | MARV | 18 | 9 | 50% | <ref name="healio.com">{{Cite web |date=October 2012 |title=Marburg hemorrhagic fever outbreak continues in Uganda |url=http://www.healio.com/pediatrics/emerging-diseases/news/online/%7B52F1CE80-ACF7-4302-AB14-05428DDDA440%7D/Marburg-hemorrhagic-fever-outbreak-continues-in-Uganda- |url-status=live |archive-url=https://web.archive.org/web/20180612184447/https://www.healio.com/pediatrics/emerging-diseases/news/online/%7B52F1CE80-ACF7-4302-AB14-05428DDDA440%7D/Marburg-hemorrhagic-fever-outbreak-continues-in-Uganda- |archive-date=2018-06-12 |access-date=2014-10-08}}</ref><ref>{{Cite web |title=WHO {{!}} Marburg haemorrhagic fever in Uganda – update |url=https://www.who.int/csr/don/2012_10_31/en/ |archive-url=https://web.archive.org/web/20140810103334/http://www.who.int/csr/don/2012_10_31/en/ |archive-date=August 10, 2014 |access-date=29 October 2017 |website=www.who.int}}</ref> |- | 2014 | {{UGA}} | MARV | 1 | 1 | 100% | <ref name="china.org.cn">{{Cite web |date=October 5, 2014 |title=1st LD-Writethru: Deadly Marburg hemorrhagic fever breaks out in Uganda |url=http://www.china.org.cn/world/Off_the_Wire/2014-10/05/content_33686011.htm |url-status=live |archive-url=https://web.archive.org/web/20171205045905/http://www.china.org.cn/world/Off_the_Wire/2014-10/05/content_33686011.htm |archive-date=December 5, 2017 |access-date=October 8, 2014}}</ref><ref>{{Cite web |title=WHO {{!}} Marburg virus disease – Uganda |url=https://www.who.int/csr/don/13-november-2014-marburg/en/ |archive-url=https://web.archive.org/web/20141117004432/http://www.who.int/csr/don/13-november-2014-marburg/en/ |archive-date=November 17, 2014 |access-date=29 October 2017 |website=www.who.int}}</ref> |- | '''[[2017 Uganda Marburg virus outbreak|2017]]''' | {{UGA}} | MARV | 3 | 3 | 100% | <ref name="abc">{{Cite web |title=Uganda controls deadly Marburg fever outbreak, WHO says |url=https://abcnews.go.com/Health/wireStory/uganda-controls-deadly-marburg-fever-outbreak-51664552 |archive-url=https://web.archive.org/web/20171208164055/https://abcnews.go.com/Health/wireStory/uganda-controls-deadly-marburg-fever-outbreak-51664552 |archive-date=8 December 2017 |access-date=8 December 2017 |publisher=ABC News}}</ref> |- | '''[[2021 Marburg virus disease outbreak in Guinea|2021]]''' | {{GUI}} | MARV | 1 | 1 | 100% | <ref name="reuters">{{Cite web |date=7 August 2021 |title=Guinea records probable case of Ebola-like Marburg virus |url=https://www.reuters.com/business/healthcare-pharmaceuticals/guinea-records-probable-case-ebola-like-marburg-virus-2021-08-06/ |access-date=7 August 2021 |website=Reuters}}</ref><ref name="mvdwho">{{Cite web |date=9 August 2021 |title=West Africa's first-ever case of Marburg virus disease confirmed in Guinea |url=https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea |url-status=live |archive-url=https://web.archive.org/web/20241002211223/https://www.afro.who.int/news/west-africas-first-ever-case-marburg-virus-disease-confirmed-guinea |archive-date=2 October 2024 |access-date=9 August 2021 |website=who.int}}</ref><ref name="reuters2">{{Cite news |date=August 10, 2021 |title=Guinea records West Africa's first Marburg virus death, WHO says |url=https://www.reuters.com/world/africa/guinea-records-west-africas-first-marburg-virus-death-who-says-2021-08-09/ |access-date=August 10, 2021 |work=Reuters}}</ref> |- | '''[[2022 Marburg virus disease outbreak in Ghana|2022]]''' | {{GHA}} | MARV | 3 | 2 | 66.66% | <ref>{{Cite news |date=18 July 2022 |title=Ghana confirms first cases of deadly Marburg virus |url=https://www.bbc.co.uk/news/world-africa-62202240 |url-status=live |archive-url=https://web.archive.org/web/20241002211224/https://www.bbc.com/news/world-africa-62202240 |archive-date=2 October 2024 |access-date=18 July 2022 |work=BBC News}}</ref> |- | '''[[2023 Marburg virus disease outbreak in Equatorial Guinea|2023]]''' | {{GNQ}} | MARV | 40 | 35 | 88% | <ref>{{Cite news |date=13 February 2023 |title=Equatorial Guinea declares outbreak of Ebola-like Marburg virus |url=https://bnonews.com/index.php/2023/02/equatorial-guinea-declares-outbreak-of-ebola-like-marburg-virus/ |url-status=live |archive-url=https://web.archive.org/web/20230220120932/https://bnonews.com/index.php/2023/02/equatorial-guinea-declares-outbreak-of-ebola-like-marburg-virus/ |archive-date=20 February 2023 |access-date=14 February 2023 |work=[[BNO News]]}}</ref><ref name="cidrap1">{{Cite news |last=Schnirring |first=Lisa |date=4 April 2023 |title=Equatorial Guinea confirms another Marburg virus case |url=https://www.cidrap.umn.edu/marburg/equatorial-guinea-confirms-another-marburg-virus-case |url-status=live |archive-url=https://web.archive.org/web/20230404100508/https://www.cidrap.umn.edu/marburg/equatorial-guinea-confirms-another-marburg-virus-case |archive-date=4 April 2023 |access-date=4 April 2023 |publisher=University of Minnesota |agency=CIDRAP}}</ref><ref>{{Cite news |last=Schnirring |first=Lisa |date=24 April 2023 |title=New fatal Marburg case reported in Equatorial Guinea |url=https://www.cidrap.umn.edu/marburg/new-fatal-marburg-case-reported-equatorial-guinea |url-status=live |archive-url=https://web.archive.org/web/20230425013302/https://www.cidrap.umn.edu/marburg/new-fatal-marburg-case-reported-equatorial-guinea |archive-date=25 April 2023 |access-date=25 April 2023 |publisher=University of Minnesota |agency=CIDRAP}}</ref> |- | [[2023 Marburg virus disease outbreak in Tanzania|'''2023''']] | {{TAN}} | MARV | 9 | 6 | 66% | <ref name="tanz">{{Cite news |last=Schnirring |first=Lisa |date=22 March 2023 |title=Tanzania declares Marburg virus outbreak |url=https://www.cidrap.umn.edu/marburg/tanzania-declares-marburg-virus-outbreak |url-status=live |archive-url=https://web.archive.org/web/20241002211223/https://www.cidrap.umn.edu/marburg/tanzania-declares-marburg-virus-outbreak |archive-date=2 October 2024 |access-date=22 March 2023 |publisher=University of Minnesota |agency=CIDRAP}}</ref><ref name="tanz2">{{Cite news |date=24 April 2023 |title=Tanzania reports additional Marburg virus disease case |url=http://outbreaknewstoday.com/tanzania-reports-additional-marburg-virus-disease-case-47802/ |url-status=dead |archive-url=https://web.archive.org/web/20230424235514/https://outbreaknewstoday.com/tanzania-reports-additional-marburg-virus-disease-case-47802/ |archive-date=24 April 2023 |access-date=25 April 2023 |agency=Outbreak News Today}}</ref> |- | [[Rwanda Marburg virus disease outbreak|'''2024''']] | {{RWA}} | MARV | 58 | 13 | 22% | <ref>{{Cite web |date=28 September 2024 |title=Rwanda reports first-ever Marburg virus disease outbreak, with 26 cases confirmed |url=https://www.afro.who.int/countries/rwanda/news/rwanda-reports-first-ever-marburg-virus-disease-outbreak-26-cases-confirmed |url-status=live |archive-url=https://web.archive.org/web/20240928210038/https://www.afro.who.int/countries/rwanda/news/rwanda-reports-first-ever-marburg-virus-disease-outbreak-26-cases-confirmed |archive-date=28 September 2024 |access-date=29 September 2024 |publisher=World Health Organization Africa}}</ref> |- |2025 |{{TAN}} |MARV |9 |8 |88% |<ref>{{Cite web |date=January 15, 2025 |title=Kenya on high alert as Marburg virus kills 8 in Tanzania |url=https://www.the-star.co.ke/news/2025-01-15-kenya-on-high-alert-as-marburg-virus-kills-8-in-tanzania |access-date=January 15, 2025 |website=The Star}}</ref><ref>{{Cite web |date=January 15, 2025 |title=Suspected outbreak of Marburg virus kills eight in Tanzania, WHO says |url=https://www.reuters.com/world/africa/suspected-outbreak-marburg-virus-kills-eight-tanzania-who-says-2025-01-15/ |access-date=January 15, 2025 |website=Reuters}}</ref> |- | |TOTAL |MARV & RAVV |593 |446 |75% | |}

=== 1967 outbreak === {{main|1967 Marburg virus disease outbreak}}

MVD was first documented in 1967, when 31 people became ill in the [[Germany|German]] towns of [[Marburg]] and [[Frankfurt am Main]], and in [[Belgrade]], [[Socialist Federal Republic of Yugoslavia|Yugoslavia]]. The outbreak involved 25 primary MARV infections and seven deaths, and six nonlethal secondary cases. The outbreak was traced to infected [[grivet]]s (species ''Chlorocebus aethiops'') imported from an undisclosed location in [[Uganda]] and used in developing [[poliomyelitis]] [[vaccines]]. The monkeys were received by Behringwerke, a Marburg company founded by the first winner of the [[Nobel Prize in Medicine]], [[Emil von Behring]]. The company, which at the time was owned by [[Hoechst AG|Hoechst]], was originally set up to develop [[blood plasma|sera]] against [[tetanus]] and [[diphtheria]]. Primary infections occurred in Behringwerke [[laboratory]] staff while working with grivet tissues or tissue cultures without adequate [[personal protective equipment]]. Secondary cases involved two [[physician]]s, a [[nurse]], a post-mortem attendant, and the wife of a [[veterinarian]]. All secondary cases had direct contact, usually involving blood, with a primary case. Both physicians became infected through accidental skin pricks when drawing blood from patients.<ref name="Kissling1968">{{Cite journal |last1=Kissling |first1=R. E. |last2=Robinson |first2=R. Q. |last3=Murphy |first3=F. A. |last4=Whitfield |first4=S. G. |year=1968 |title=Agent of disease contracted from green monkeys |journal=Science |volume=160 |issue=830 |pages=888–890 |bibcode=1968Sci...160..888K |doi=10.1126/science.160.3830.888 |pmid=4296724 |s2cid=30252321}}</ref><ref name="Bonin1969">{{Cite journal |last=Bonin |first=O. |year=1969 |title=The Cercopithecus monkey disease in Marburg and Frankfurt (Main), 1967 |journal=Acta Zoologica et Pathologica Antverpiensia |volume=48 |pages=319–331 |pmid=5005859}}</ref><ref name="Jacob1971">{{Cite journal |last1=Jacob |first1=H. |last2=Solcher |first2=H. |year=1968 |title=An infectious disease transmitted by Cercopithecus aethiops ("marbury disease") with glial nodule encephalitis |journal=Acta Neuropathologica |volume=11 |issue=1 |pages=29–44 |doi=10.1007/bf00692793 |pmid=5748997 |s2cid=12791113}}</ref><ref name="Stojkovic1971">{{Cite book |last1=Stojkovic |first1=L. |title=Marburg Virus Disease |last2=Bordjoski |first2=M. |last3=Gligic |first3=A. |last4=Stefanovic |first4=Z. |publisher=Springer-Verlag |year=1971 |isbn=978-0-387-05199-4 |editor-last=Martini |editor-first=G. A. |location=Berlin, Germany |pages=24–33 |chapter=Two Cases of Cercopithecus-Monkeys-Associated Haemorrhagic Fever |editor-last2=Siegert |editor-first2=R.}}</ref>

=== 1975 cases === In 1975, an Australian tourist became infected with MARV in [[Rhodesia]] (today [[Zimbabwe]]). He died in a hospital in [[Johannesburg]], [[South Africa]]. His girlfriend and an attending nurse were subsequently infected with MVD, but survived.<ref name="Gear1975">{{Cite journal |last1=Gear |first1=J. S. |last2=Cassel |first2=G. A. |last3=Gear |first3=A. J. |last4=Trappler |first4=B. |last5=Clausen |first5=L. |last6=Meyers |first6=A. M. |last7=Kew |first7=M. C. |last8=Bothwell |first8=T. H. |last9=Sher |first9=R. |last10=Miller |first10=G. B. |last11=Schneider |first11=J. |last12=Koornhof |first12=H. J. |last13=Gomperts |first13=E. D. |last14=Isaäcson |first14=M. |last15=Gear |first15=J. H. |year=1975 |title=Outbreake of Marburg virus disease in Johannesburg |journal=British Medical Journal |volume=4 |issue=5995 |pages=489–493 |doi=10.1136/bmj.4.5995.489 |pmc=1675587 |pmid=811315}}</ref><ref name="Gear1977">{{Cite journal |last=Gear |first=J. H. |year=1977 |title=Haemorrhagic fevers of Africa: An account of two recent outbreaks |journal=Journal of the South African Veterinary Association |volume=48 |issue=1 |pages=5–8 |pmid=406394}}</ref><ref name="Conrad1978">{{Cite journal |last1=Conrad |first1=J. L. |last2=Isaacson |first2=M. |last3=Smith |first3=E. B. |last4=Wulff |first4=H. |last5=Crees |first5=M. |last6=Geldenhuys |first6=P. |last7=Johnston |first7=J. |year=1978 |title=Epidemiologic investigation of Marburg virus disease, Southern Africa, 1975 |journal=The American Journal of Tropical Medicine and Hygiene |volume=27 |issue=6 |pages=1210–1215 |doi=10.4269/ajtmh.1978.27.1210 |pmid=569445}}</ref>

=== 1980 cases === A case of MARV infection occurred in 1980 in [[Kenya]]. A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to [[Bungoma]]) at the base of [[Mount Elgon]] (which contains [[Kitum Cave]]), became infected by unknown means and died on 15 January shortly after admission to [[Nairobi]] Hospital.<ref>{{Cite journal |last=Dellatola |first=Lesley |date=May 1980 |title=Victory for Virology |url=https://archive.org/details/sim_south-african-panorama_1980-05_25_5/page/n3/mode/2up?view=theater |journal=South African Panorama |volume=25 |issue=5 |pages=2–6 |via=Internet Archive}}</ref> The attending physician contracted MVD, but survived.<ref name="Smith1982">{{Cite journal |last1=Smith |first1=D. H. |last2=Johnson |first2=B. K. |last3=Isaacson |first3=M. |last4=Swanapoel |first4=R. |last5=Johnson |first5=K. M. |last6=Killey |first6=M. |last7=Bagshawe |first7=A. |last8=Siongok |first8=T. |last9=Keruga |first9=W. K. |year=1982 |title=Marburg-virus disease in Kenya |journal=Lancet |volume=1 |issue=8276 |pages=816–820 |doi=10.1016/S0140-6736(82)91871-2 |pmid=6122054 |s2cid=42832324}}</ref> A popular science account of these cases can be found in [[Richard Preston]]'s book ''[[The Hot Zone]]'' (the French man is referred to under the [[pseudonym]] "Charles Monet", whereas the physician is identified under his real name, Shem Musoke).<ref name="Preston1994">{{Cite book |last=Preston |first=Richard |author-link=Richard Preston |title=The Hot Zone – A Terrifying New Story |publisher=Random House |year=1994 |isbn=978-0-385-47956-1 |location=New York, USA}}</ref>

=== 1987 case === In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in [[Kisumu]], [[Kenya]]. He had visited [[Kitum Cave]] on [[Mount Elgon]] prior to travelling to [[Mombasa]], where he developed clinical signs of infection. The boy died after transfer to [[Nairobi]] Hospital.<ref name="Johnson1996">{{Cite conference |last1=Johnson |first1=E. D. |last2=Johnson |first2=B. K. |last3=Silverstein |first3=D. |last4=Tukei |first4=P. |last5=Geisbert |first5=T. W. |last6=Sanchez |first6=A. N. |last7=Jahrling |first7=P. B. |year=1996 |editor2-last=Günter Siegl |title=Imported Virus Infections |series=Archives of Virology Supplement II |publisher=Springer |volume=11 |pages=101–114 |doi=10.1007/978-3-7091-7482-1_10 |isbn=978-3-211-82829-8 |issn=0939-1983 |pmid=8800792 |chapter=Characterization of a new Marburg virus isolated from a 1987 fatal case in Kenya |editor1=Tino F. Schwarz}}</ref> A popular science account of this case can be found in [[Richard Preston]]'s book ''[[The Hot Zone]]'' (the boy is referred to under the [[pseudonym]] "Peter Cardinal").<ref name=Preston1994/>

=== 1988 laboratory infection === In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of [[guinea pig]]s. The accident occurred at the Scientific-Production Association "Vektor" (today the [[State Research Center of Virology and Biotechnology VECTOR|State Research Center of Virology and Biotechnology "Vektor"]]) in [[Koltsovo, Novosibirsk Oblast|Koltsovo]], [[USSR]] (today [[Russia]]).<ref name="Beer1999">{{Cite journal |last1=Beer |first1=B. |last2=Kurth |first2=R. |last3=Bukreyev |first3=A. |year=1999 |title=Characteristics of Filoviridae: Marburg and Ebola viruses |journal=Die Naturwissenschaften |volume=86 |issue=1 |pages=8–17 |bibcode=1999NW.....86....8B |doi=10.1007/s001140050562 |pmid=10024977 |s2cid=25789824 |doi-access=free}}</ref> Very little information is publicly available about this MVD case because Ustinov's experiments were classified. A popular science account of this case can be found in [[Ken Alibek]]'s book ''Biohazard''.<ref name="Alibek1999">{{Cite book |last1=Alibek |first1=Ken |author-link1=Ken Alibek |url=https://archive.org/details/biohazardchillin00alib_0 |title=Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World—Told from Inside by the Man Who Ran It |last2=Handelman |first2=Steven |publisher=Random House |year=1999 |isbn=978-0-385-33496-9 |location=New York, USA}}</ref>

=== 1990 laboratory infection === Another laboratory accident occurred at the Scientific-Production Association "Vektor" (today the [[State Research Center of Virology and Biotechnology VECTOR|State Research Center of Virology and Biotechnology "Vektor"]]) in [[Koltsovo, Novosibirsk Oblast|Koltsovo]], [[USSR]], when a scientist contracted MARV by unknown means.<ref name="Nikiforov1994">{{Cite journal |last1=Nikiforov |first1=V. V. |last2=Turovskiĭ |first2=I. |last3=Kalinin |first3=P. P. |last4=Akinfeeva |first4=L. A. |last5=Katkova |first5=L. R. |last6=Barmin |first6=V. S. |last7=Riabchikova |first7=E. I. |last8=Popkova |first8=N. I. |last9=Shestopalov |first9=A. M. |last10=Nazarov |first10=V. P. |year=1994 |title=A case of a laboratory infection with Marburg fever |journal=Zhurnal Mikrobiologii, Epidemiologii, I Immunobiologii |issue=3 |pages=104–106 |pmid=7941853}}</ref>

=== 1998–2000 outbreak === A major MVD outbreak occurred among illegal [[gold mine]]rs around Goroumbwa mine in [[Durba, Democratic Republic of the Congo|Durba]] and [[Watsa]], [[Democratic Republic of Congo]] from 1998 to 2000, when co-circulating MARV and RAVV caused 154 cases of MVD and 128 deaths. The outbreak ended with the flooding of the mine.<ref name=Bausch2006/><ref name="Bertherat1999">{{Cite journal |last1=Bertherat |first1=E. |last2=Talarmin |first2=A. |last3=Zeller |first3=H. |year=1999 |title=Democratic Republic of the Congo: Between civil war and the Marburg virus. International Committee of Technical and Scientific Coordination of the Durba Epidemic |journal=Médecine Tropicale: Revue du Corps de Santé Colonial |volume=59 |issue=2 |pages=201–204 |pmid=10546197}}</ref><ref name="Bausch2003">{{Cite journal |last1=Bausch |first1=D. G. |last2=Borchert |first2=M. |last3=Grein |first3=T. |last4=Roth |first4=C. |last5=Swanepoel |first5=R. |last6=Libande |first6=M. L. |last7=Talarmin |first7=A. |last8=Bertherat |first8=E. |last9=Muyembe-Tamfum |first9=J. J. |last10=Tugume |first10=B. |last11=Colebunders |first11=R. |last12=Kondé |first12=K. M. |last13=Pirad |first13=P. |last14=Olinda |first14=L. L. |last15=Rodier |first15=G. R. |year=2003 |title=Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo |journal=Emerging Infectious Diseases |volume=9 |issue=12 |pages=1531–1537 |doi=10.3201/eid0912.030355 |pmc=3034318 |pmid=14720391 |last16=Campbell |first16=P. |last17=Tomori |first17=O. |last18=Ksiazek |first18=T. G. |last19=Rollin |first19=P. E.}}</ref>

=== 2004–2005 outbreak === In early 2005, the [[World Health Organization]] (WHO) began investigating an outbreak of [[viral hemorrhagic fever]] in [[Angola]], which was centered in the northeastern [[Uíge Province]] but also affected many other provinces. The Angolan government had to ask for international assistance, as there were only approximately 1,200 doctors in the entire country and provinces that had few as two. Health care workers also complained about a shortage of basic [[personal protective equipment]]. [[Médecins Sans Frontières]] (MSF) reported that when their team arrived at the provincial hospital at the center of the outbreak, they found it operating without water and electricity. [[Contact tracing]] was complicated by the fact that the country's roads and other infrastructure were devastated after nearly three decades of [[Angolan War of Independence|civil war]] and the countryside remained littered with [[land mine]]s.<ref name="Roddy2010" />

Americo Boa Vida Hospital in the Angolan capital, [[Luanda]], set up a special isolation ward to treat patients from the countryside. Due to the high fatality rate of MVD, some people came to be suspicious of and hostile towards hospitals and medical workers. For instance, a specially-equipped isolation ward at the provincial hospital in Uíge was reported to be empty during much of the epidemic, even though the facility was at the center of the outbreak. WHO was forced to implement what it described as a "harm reduction strategy" by distributing disinfectants to affected families who refused hospital care. Of the 252 people who contracted MVD, 227 died.<ref name="Roddy2010">{{Cite journal |last1=Roddy |first1=P. |last2=Thomas |first2=S. L. |last3=Jeffs |first3=B. |last4=Nascimento Folo |first4=P. |last5=Pablo Palma |first5=P. |last6=Moco Henrique |first6=B. |last7=Villa |first7=L. |last8=Damiao Machado |first8=F. P. |last9=Bernal |first9=O. |last10=Jones |first10=S. M. |last11=Strong |first11=J. E. |last12=Feldmann |first12=H. |last13=Borchert |first13=M. |year=2010 |title=Factors Associated with Marburg Hemorrhagic Fever: Analysis of Patient Data from Uige, Angola |journal=The Journal of Infectious Diseases |volume=201 |issue=12 |pages=1909–1918 |doi=10.1086/652748 |pmc=3407405 |pmid=20441515}}</ref><ref name="Hovette2005">{{Cite journal |last=Hovette |first=P. |year=2005 |title=Epidemic of Marburg hemorrhagic fever in Angola |journal=Médecine Tropicale: Revue du Corps de Santé Colonial |volume=65 |issue=2 |pages=127–128 |pmid=16038348}}</ref><ref name="Ndayimirije2005">{{Cite journal |last1=Ndayimirije |first1=N. |last2=Kindhauser |first2=M. K. |year=2005 |title=Marburg Hemorrhagic Fever in Angola—Fighting Fear and a Lethal Pathogen |journal=New England Journal of Medicine |volume=352 |issue=21 |pages=2155–2157 |doi=10.1056/NEJMp058115 |pmid=15917379 |doi-access=free}}</ref><ref name="Towner2006">{{Cite journal |last1=Towner |first1=J. S. |last2=Khristova |first2=M. L. |last3=Sealy |first3=T. K. |last4=Vincent |first4=M. J. |last5=Erickson |first5=B. R. |last6=Bawiec |first6=D. A. |last7=Hartman |first7=A. L. |last8=Comer |first8=J. A. |last9=Zaki |first9=S. R. |last10=Ströher |first10=U. |last11=Gomes Da Silva |first11=F. |last12=Del Castillo |first12=F. |last13=Rollin |first13=P. E. |last14=Ksiazek |first14=T. G. |last15=Nichol |first15=S. T. |year=2006 |title=Marburgvirus Genomics and Association with a Large Hemorrhagic Fever Outbreak in Angola |journal=Journal of Virology |volume=80 |issue=13 |pages=6497–6516 |doi=10.1128/JVI.00069-06 |pmc=1488971 |pmid=16775337}}</ref><ref name="Jeffs2007">{{Cite journal |last1=Jeffs |first1=B. |last2=Roddy |first2=P. |last3=Weatherill |first3=D. |last4=De La Rosa |first4=O. |last5=Dorion |first5=C. |last6=Iscla |first6=M. |last7=Grovas |first7=I. |last8=Palma |first8=P. P. |last9=Villa |first9=L. |last10=Bernal |first10=O. |last11=Rodriguez-Martinez |first11=J. |last12=Barcelo |first12=B. |last13=Pou |first13=D. |last14=Borchert |first14=M. |year=2007 |title=The Médecins Sans Frontières Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. I. Lessons Learned in the Hospital |journal=The Journal of Infectious Diseases |volume=196 |pages=S154–S161 |doi=10.1086/520548 |pmid=17940944 |doi-access=free}}</ref><ref name="Roddy2007">{{Cite journal |last1=Roddy |first1=P. |last2=Weatherill |first2=D. |last3=Jeffs |first3=B. |last4=Abaakouk |first4=Z. |last5=Dorion |first5=C. |last6=Rodriguez-Martinez |first6=J. |last7=Palma |first7=P. P. |last8=De La Rosa |first8=O. |last9=Villa |first9=L. |last10=Grovas |first10=I. |last11=Borchert |first11=M. |year=2007 |title=The Médecins Sans Frontières Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. II. Lessons Learned in the Community |journal=The Journal of Infectious Diseases |volume=196 |pages=S162–S167 |doi=10.1086/520544 |pmid=17940945 |doi-access=free}}</ref><ref name="Roddy2009">{{Cite journal |last1=Roddy |first1=P. |last2=Marchiol |first2=A. |last3=Jeffs |first3=B. |last4=Palma |first4=P. P. |last5=Bernal |first5=O. |last6=De La Rosa |first6=O. |last7=Borchert |first7=M. |year=2009 |title=Decreased peripheral health service utilisation during an outbreak of Marburg haemorrhagic fever, Uíge, Angola, 2005 |url=http://fieldresearch.msf.org/msf/bitstream/10144/41786/1/Roddy%20Haemorrhagic%20fever%20Trans.pdf |journal=Transactions of the Royal Society of Tropical Medicine and Hygiene |volume=103 |issue=2 |pages=200–202 |doi=10.1016/j.trstmh.2008.09.001 |hdl=10144/41786 |pmid=18838150 |archive-url=https://web.archive.org/web/20170809065650/http://fieldresearch.msf.org/msf/bitstream/10144/41786/1/Roddy%20Haemorrhagic%20fever%20Trans.pdf |archive-date=2017-08-09 |access-date=2018-04-29 |hdl-access=free}}</ref>

=== 2007 cases === In 2007, four [[miner]]s became infected with marburgviruses in [[Kamwenge District]], [[Uganda]]. The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection.<ref name=Towner2009/><ref name="Adjemian2011">{{Cite journal |last1=Adjemian |first1=J. |last2=Farnon |first2=E. C. |last3=Tschioko |first3=F. |last4=Wamala |first4=J. F. |last5=Byaruhanga |first5=E. |last6=Bwire |first6=G. S. |last7=Kansiime |first7=E. |last8=Kagirita |first8=A. |last9=Ahimbisibwe |first9=S. |last10=Katunguka |first10=F. |last11=Jeffs |first11=B. |last12=Lutwama |first12=J. J. |last13=Downing |first13=R. |last14=Tappero |first14=J. W. |last15=Formenty |first15=P. |year=2011 |title=Outbreak of Marburg Hemorrhagic Fever Among Miners in Kamwenge and Ibanda Districts, Uganda, 2007 |journal=Journal of Infectious Diseases |volume=204 |issue=Suppl 3 |pages=S796–S799 |doi=10.1093/infdis/jir312 |pmc=3203392 |pmid=21987753 |last16=Amman |first16=B. |last17=Manning |first17=C. |last18=Towner |first18=J. |last19=Nichol |first19=S. T. |last20=Rollin |first20=P. E.}}</ref>

=== 2008 cases === On July 10, 2008, the [[Netherlands National Institute for Public Health and the Environment]] reported that a 41-year-old Dutch woman, who had visited Python Cave in [[Maramagambo Forest]] during her holiday in [[Uganda]], had MVD due to MARV infection, and had been admitted to a hospital in the [[Netherlands]]. The woman died under treatment in the [[Leiden University Medical Centre]] in [[Leiden]] on July 11. The Ugandan Ministry of Health closed the cave after this case.<ref name="Timen2009">{{Cite journal |last1=Timen |first1=A. |author-link1=Aura Timen |last2=Koopmans |first2=M. P. |last3=Vossen |first3=A. C. |last4=Van Doornum |first4=G. J. |last5=Günther |first5=S. |last6=Van Den Berkmortel |first6=F. |last7=Verduin |first7=K. M. |last8=Dittrich |first8=S. |last9=Emmerich |first9=P. |last10=Osterhaus |first10=A. D. M. E. |last11=Van Dissel |first11=J. T. |last12=Coutinho |first12=R. A. |year=2009 |title=Response to Imported Case of Marburg Hemorrhagic Fever, the Netherlands |journal=Emerging Infectious Diseases |volume=15 |issue=8 |pages=1171–1175 |doi=10.3201/eid1508.090015 |pmc=2815969 |pmid=19751577}}</ref> On January 9 of that year an infectious diseases physician notified the Colorado Department of Public Health and the Environment that a 44-year-old American woman who had returned from [[Uganda]] had been hospitalized with a [[fever of unknown origin]]. At the time, serologic testing was negative for [[viral hemorrhagic fever]]. She was discharged on January 19, 2008. After the death of the Dutch patient and the discovery that the American woman had visited Python Cave, further testing confirmed the patient demonstrated MARV [[antibodies]] and [[RNA]].<ref name="CDC2009">{{Cite journal |last=Centers for Disease Control and Prevention (CDC) |year=2009 |title=Imported case of Marburg hemorrhagic fever - Colorado, 2008 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=58 |issue=49 |pages=1377–1381 |pmid=20019654}}</ref>

=== 2017 Uganda outbreak === [[File:Kween District in Uganda.svg|thumb|200px|Kween District in Uganda]] {{Main|2017 Uganda Marburg virus outbreak}} In October 2017 an outbreak of Marburg virus disease was detected in [[Kween District]], Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to [[Kenya]] before the death. A close contact of the second confirmed case traveled to [[Kampala]]. It is reported that several hundred people may have been exposed to infection.<ref name="who2017">{{Cite web |date=7 November 2017 |title=Marburg virus disease – Uganda and Kenya |url=https://www.who.int/csr/don/7-november-2017-marburg/en/ |archive-url=https://web.archive.org/web/20171109232727/http://www.who.int/csr/don/7-november-2017-marburg/en/ |archive-date=November 9, 2017 |access-date=2017-12-04 |publisher=WHO}}</ref><ref name="newsweek2017">{{Cite news |last=Dana Dovey |date=18 November 2017 |title=WHAT IS MARBURG? THIS VIRUS CAUSES VICTIMS TO BLEED FROM EVERY ORIFICE AND DIE |url=http://www.newsweek.com/marburg-virus-ebola-virus-hemorrhagic-disease-715714 |url-status=live |archive-url=https://web.archive.org/web/20180704160554/http://www.newsweek.com/marburg-virus-ebola-virus-hemorrhagic-disease-715714 |archive-date=2018-07-04 |access-date=2017-12-04 |work=Newsweek}}</ref>

=== 2021 Guinean cases === {{Main|2021 Guinea Marburg virus disease outbreak}}

In August 2021, two months after the re-emergent Ebola epidemic in the [[Guéckédou]] prefecture was declared over, a case of the Marburg disease was confirmed by health authorities through laboratory analysis.<ref name="mvdwho" /> Other potential case of the disease in a contact awaits official results. This was the first case of the Marburg hemorrhagic fever confirmed to happen in West Africa. The case of Marburg also has been identified in [[Guéckédou Prefecture|Guéckédou]].<ref name="reuters" /> During the outbreak, a total of one confirmed case, who died ([[Case fatality rate|CFR]]=100%), and 173 contacts were identified, including 14 high-risk contacts based on exposure.<ref name=":0">{{Cite web |title=Marburg virus disease - Guinea |url=https://www.who.int/emergencies/disease-outbreak-news/item/marburg-virus-disease---guinea |url-status=live |archive-url=https://web.archive.org/web/20221128214025/https://www.who.int/emergencies/disease-outbreak-news/item/marburg-virus-disease---guinea |archive-date=2022-11-28 |access-date=2022-11-29 |website=www.who.int |language=en}}</ref> Among them, 172 were followed for a period of 21 days, of which none developed symptoms. One high-risk contact was lost to follow up.<ref name=":0" /> Sequencing of an isolate from the Guinean patient showed that this outbreak was caused by the Angola-like Marburg virus.<ref>{{Cite journal |last1=Koundouno |first1=Fara R. |last2=Kafetzopoulou |first2=Liana E. |last3=Faye |first3=Martin |last4=Renevey |first4=Annick |last5=Soropogui |first5=Barrè |last6=Ifono |first6=Kékoura |last7=Nelson |first7=Emily V. |last8=Kamano |first8=Aly A. |last9=Tolno |first9=Charles |last10=Annibaldis |first10=Giuditta |last11=Millimono |first11=Saa L. |last12=Camara |first12=Jacob |last13=Kourouma |first13=Karifa |last14=Doré |first14=Ahmadou |last15=Millimouno |first15=Tamba E. |date=2022-06-30 |title=Detection of Marburg Virus Disease in Guinea |journal=New England Journal of Medicine |language=en |volume=386 |issue=26 |pages=2528–2530 |doi=10.1056/NEJMc2120183 |issn=0028-4793 |pmc=7613962 |pmid=35767445 |s2cid=250114159}}</ref> A colony of [[Egyptian fruit bat|Egyptian rousettus bats]] ([[Natural reservoir|reservoir host]] of [[Marburg virus]]) was found in close proximity (4.5&nbsp;km) to the village, where the Marburg virus disease outbreak emerged in 2021.<ref name=":1">{{Cite bioRxiv |biorxiv=10.1101/2022.11.03.514981v1 |first1=Marat |last1=Makenov |first2=Sanaba |last2=Boumbaly |title=Investigating the Zoonotic Origin of the Marburg Virus Outbreak in Guinea in 2021 |date=2022-11-04 |language=en |last3=Tolno |first3=Faya Raphael |last4=Sacko |first4=Nouminy |last5=N'Fatoma |first5=Leno Tamba |last6=Mansare |first6=Oumar |last7=Kolie |first7=Bonaventure |last8=Stukolova |first8=Olga |last9=Morozkin |first9=Evgeny |last10=Kholodilov |first10=Ivan |last11=Zhurenkova |first11=Olga |last12=Fyodorova |first12=Marina |last13=Akimkin |first13=Vasily |last14=Popova |first14=Anna |last15=Conde |first15=Namoudou}}</ref> Two sampled fruit bats from this colony were PCR-positive on the Marburg virus.<ref name=":1" />

=== 2022 Ghanaian cases === {{Main|2022 Ghana Marburg virus disease outbreak}}

In July 2022, preliminary analysis of samples taken from two patients – both deceased – in [[Ghana]] indicated the cases were positive for Marburg. However, per standard procedure, the samples were sent to the [[Pasteur Institute of Dakar]] for confirmation.<ref>{{Cite web |date=7 July 2022 |title=Ghana reports first-ever suspected cases of Marburg virus disease |url=https://www.afro.who.int/countries/ghana/news/ghana-reports-first-ever-suspected-cases-marburg-virus-disease |url-status=live |archive-url=https://web.archive.org/web/20220707232508/https://www.afro.who.int/countries/ghana/news/ghana-reports-first-ever-suspected-cases-marburg-virus-disease |archive-date=7 July 2022 |access-date=7 July 2022 |website=[[World Health Organization]]}}</ref> On 17 July 2022 the two cases were confirmed by Ghana,<ref>{{Cite news |date=2022-07-18 |title=Ghana confirms its first outbreak of highly infectious Marburg virus |url=https://www.reuters.com/world/africa/ghana-confirms-two-cases-highly-infectious-marburg-virus-2022-07-17/ |url-status=live |archive-url=https://web.archive.org/web/20220718122312/https://www.reuters.com/world/africa/ghana-confirms-two-cases-highly-infectious-marburg-virus-2022-07-17/ |archive-date=2022-07-18 |access-date=2022-07-18 |work=Reuters |language=en}}</ref> which caused the country to declare a Marburg virus disease outbreak.<ref>{{Cite news |date=2022-07-18 |title=Ghana Declares First Marburg Virus Disease Outbreak |url=https://www.bloomberg.com/news/articles/2022-07-18/ghana-declares-first-marburg-virus-disease-outbreak |access-date=2022-07-18 |work=Bloomberg.com |language=en}}</ref> An additional case was identified, bringing the total to three.<ref>{{Cite tweet |number=1552740941710200832 |user=_GHSofficial |title=Update on Marburg Virus Disease Outbreak in Ghana |author=Ghana Health Service |access-date=22 January 2025}}</ref>

=== 2023 Equatorial Guinea outbreak === {{Main|2023 Equatorial Guinea Marburg virus disease outbreak}}

A disease outbreak was first reported in [[Equatorial Guinea]] on 7 February 2023, and on 13 February 2023, it was identified as being Marburg virus disease. It was the first time the disease was detected in the country.<ref>{{Cite web |date=13 February 2023 |title=Equatorial Guinea confirms first-ever Marburg virus disease outbreak |url=https://www.afro.who.int/countries/equatorial-guinea/news/equatorial-guinea-confirms-first-ever-marburg-virus-disease-outbreak |url-status=live |archive-url=https://web.archive.org/web/20230213183549/https://www.afro.who.int/countries/equatorial-guinea/news/equatorial-guinea-confirms-first-ever-marburg-virus-disease-outbreak |archive-date=13 February 2023 |access-date=13 February 2023 |website=[[World Health Organization]]}}</ref> Neighbouring [[Cameroon]] detected two suspected cases of Marburg virus disease on 13 February 2023,<ref>{{Cite web |title=Cameroon detects two suspected cases of Marburg virus near Eq. Guinea |url=https://www.reuters.com/world/africa/who-increasing-health-surveillance-after-equatorial-guinea-finds-marburg-virus-2023-02-14/ |url-status=live |archive-url=https://web.archive.org/web/20230221132513/https://www.reuters.com/world/africa/who-increasing-health-surveillance-after-equatorial-guinea-finds-marburg-virus-2023-02-14/ |archive-date=2023-02-21 |access-date=14 February 2023 |website=[[Reuters]]}}</ref> but they were later ruled out.<ref>{{Cite web |title=&#124; By Ministère de la Santé Publique du Cameroun &#124; Facebook |url=https://www.facebook.com/MINSANTE.PageOfficielle/videos/c4534e7c/757499088848735/ |url-status=live |archive-url=https://web.archive.org/web/20230228190904/https://www.facebook.com/MINSANTE.PageOfficielle/videos/c4534e7c/757499088848735/ |archive-date=2023-02-28 |access-date=2023-02-28 |website=www.facebook.com}}</ref> On 25 February, a suspected case of Marburg was reported in the Spanish city of [[Valencia]],<ref name="Spain">{{Cite web |date=25 February 2023 |title=Aislado un paciente en Valencia por sospechas de que padezca la grave fiebre de Marburgo |url=https://elpais.com/espana/comunidad-valenciana/2023-02-25/aislado-un-paciente-en-valencia-por-sospechas-de-que-padezca-la-grave-fiebre-de-marburgo.html |url-status=live |archive-url=https://web.archive.org/web/20230225073702/https://elpais.com/espana/comunidad-valenciana/2023-02-25/aislado-un-paciente-en-valencia-por-sospechas-de-que-padezca-la-grave-fiebre-de-marburgo.html |archive-date=2023-02-25 |access-date=25 February 2023 |website=[[El País]]}}</ref> however this case was subsequently discounted.<ref>{{Cite web |title=Spain says patient does not have Marburg disease |url=https://www.reuters.com/world/europe/spanish-authorities-detect-first-suspected-case-marburg-disease-2023-02-25/ |url-status=live |archive-url=https://web.archive.org/web/20230227191716/https://www.reuters.com/world/europe/spanish-authorities-detect-first-suspected-case-marburg-disease-2023-02-25/ |archive-date=2023-02-27 |access-date=28 February 2023 |website=[[Reuters]]}}</ref> As of 4 April 2023, there were 14 confirmed cases and 28 suspected cases, including ten confirmed deaths from the disease in Equatorial Guinea.<ref name="BNO">{{Cite web |date=13 February 2023 |title=Equatorial Guinea declares outbreak of Ebola-like Marburg virus |url=https://bnonews.com/index.php/2023/02/equatorial-guinea-declares-outbreak-of-ebola-like-marburg-virus/ |url-status=live |archive-url=https://web.archive.org/web/20230220120932/https://bnonews.com/index.php/2023/02/equatorial-guinea-declares-outbreak-of-ebola-like-marburg-virus/ |archive-date=20 February 2023 |access-date=13 February 2023 |publisher=[[BNO News]]}}</ref><ref name="cidrap1" /> On 8 June 2023, the [[World Health Organization]] declared the outbreak over.<ref>{{Cite web |date=8 June 2023 |title=WHO declares end to Marburg virus outbreak in Equatorial Guinea |url=https://www.france24.com/en/africa/20230608-who-declares-end-to-marburg-virus-outbreak-in-equatorial-guinea |url-status=live |archive-url=https://web.archive.org/web/20231106034119/https://www.france24.com/en/africa/20230608-who-declares-end-to-marburg-virus-outbreak-in-equatorial-guinea |archive-date=6 November 2023 |access-date=19 June 2023 |website=[[France 24]]}}</ref> In total, 17 laboratory-confirmed cases and 12 deaths were recorded. All the 23 probable cases reportedly died. Four patients recovered from the virus and have been enrolled in a survivors programme to receive psychosocial and other post-recovery support.<ref>{{Cite web |date=2023-06-08 |title=Marburg Virus Disease outbreak in Equatorial Guinea ends |url=https://www.afro.who.int/countries/equatorial-guinea/news/marburg-virus-disease-outbreak-equatorial-guinea-ends |url-status=live |archive-url=https://web.archive.org/web/20230801060026/https://www.afro.who.int/countries/equatorial-guinea/news/marburg-virus-disease-outbreak-equatorial-guinea-ends |archive-date=2023-08-01 |access-date=2023-07-05 |website=WHO {{!}} Regional Office for Africa |language=en}}</ref>

=== 2023 Tanzania outbreak === {{Main|2023 Tanzania Marburg virus disease outbreak}}

A Marburg virus disease outbreak in [[Tanzania]] was first reported on 21 March 2023 by the Ministry of Health of Tanzania.<ref>{{Cite web |date=21 March 2023 |title=Tanzania confirms first-ever outbreak of Marburg Virus Disease |url=https://www.afro.who.int/countries/united-republic-of-tanzania/news/tanzania-confirms-first-ever-outbreak-marburg-virus-disease |url-status=live |archive-url=https://web.archive.org/web/20230419014154/https://www.afro.who.int/countries/united-republic-of-tanzania/news/tanzania-confirms-first-ever-outbreak-marburg-virus-disease |archive-date=2023-04-19 |access-date=2023-04-19 |website=WHO {{!}} Regional Office for Africa |language=en}}</ref> This was the first time that Tanzania had reported an outbreak of the disease. On 2 June 2023, Tanzania declared the outbreak over.<ref>{{Cite news |date=2 June 2023 |title=Tanzania declares end of Marburg viral outbreak |url=https://www.reuters.com/world/africa/tanzania-declares-end-marburg-viral-outbreak-2023-06-02/ |url-status=live |archive-url=https://web.archive.org/web/20230619071254/https://www.reuters.com/world/africa/tanzania-declares-end-marburg-viral-outbreak-2023-06-02/ |archive-date=19 June 2023 |access-date=19 June 2023 |work=[[Reuters]]}}</ref> There were 9 total infections, resulting in 6 total deaths.<ref name="tanz" /><ref name="tanz2" />

=== 2024 Rwanda outbreak === {{Further|Rwanda Marburg virus disease outbreak}} On September 27, 2024, an outbreak of the [[Marburg virus]] was confirmed in [[Rwanda]]. As of September 29, 2024, six deaths and twenty cases had been confirmed. The Rwandan Minister of Health, [[Sabin Nsanzimana]], confirmed that the infected were mostly healthcare workers and that [[contact tracing]] had been initiated in the country.<ref>{{Cite web |date=29 September 2024 |title=Marburg virus in Rwanda: Six killed |url=https://www.bbc.com/news/articles/c8el1ky2nd6o |url-status=live |archive-url=https://web.archive.org/web/20240929081953/https://www.bbc.com/news/articles/c8el1ky2nd6o |archive-date=2024-09-29 |access-date=2024-09-29 |website=www.bbc.com |language=en-GB}}</ref><ref>{{Cite news |title=Six people died of Marburg virus in Rwanda, health minister says |url=https://www.reuters.com/business/healthcare-pharmaceuticals/six-people-died-marburg-virus-rwanda-health-minister-says-2024-09-28/ |access-date=2024-09-29 |work=[[Reuters]]}}</ref>

== Research == Experimentally, recombinant [[Vesicular stomatitis virus|vesicular stomatitis Indiana virus]] (VSIV) expressing the glycoprotein of MARV has been used successfully in nonhuman primate models as post-exposure prophylaxis.<ref>{{Cite journal |last1=Daddario-Dicaprio |first1=K. M. |last2=Geisbert |first2=T. W. |last3=Ströher |first3=U. |last4=Geisbert |first4=J. B. |last5=Grolla |first5=A. |last6=Fritz |first6=E. A. |last7=Fernando |first7=L. |last8=Kagan |first8=E. |last9=Jahrling |first9=P. B. |last10=Hensley |first10=L. E. |last11=Jones |first11=S. M. |last12=Feldmann |first12=H. |year=2006 |title=Postexposure protection against Marburg haemorrhagic fever with recombinant vesicular stomatitis virus vectors in non-human primates: An efficacy assessment |url=https://apps.dtic.mil/sti/pdfs/ADA447898.pdf |url-status=live |journal=The Lancet |volume=367 |issue=9520 |pages=1399–1404 |doi=10.1016/S0140-6736(06)68546-2 |pmid=16650649 |s2cid=14039727 |archive-url=https://web.archive.org/web/20170927010820/http://www.dtic.mil/get-tr-doc/pdf?AD=ADA447898 |archive-date=2017-09-27 |access-date=2018-04-29}}</ref> A vaccine candidate has been effective in nonhuman primates.<ref>{{Cite journal |last1=Woolsey |first1=Courtney |last2=Cross |first2=Robert W. |last3=Agans |first3=Krystle N. |last4=Borisevich |first4=Viktoriya |last5=Deer |first5=Daniel J. |last6=Geisbert |first6=Joan B. |last7=Gerardi |first7=Cheryl |last8=Latham |first8=Theresa E. |last9=Fenton |first9=Karla A. |last10=Egan |first10=Michael A. |last11=Eldridge |first11=John H. |last12=Geisbert |first12=Thomas W. |last13=Mattasov |first13=Demetrius |year=2022 |title=A highly attenuated Vesiculovax vaccine rapidly protects nonhuman primates against lethal Marburg virus challenge |journal=PLOS Neglected Tropical Diseases |volume=16 |issue=5 |article-number=e0010433 |doi=10.1371/journal.pntd.0010433 |pmc=9182267 |pmid=35622847 |doi-access=free}}</ref> Experimental therapeutic regimens relying on [[antisense therapy|antisense technology]] have shown promise, with [[Morpholino|phosphorodiamidate morpholino oligomers]] (PMOs) targeting the MARV genome<ref>{{Cite journal |last1=Warren |first1=T. K. |last2=Warfield |first2=K. L. |last3=Wells |first3=J. |last4=Swenson |first4=D. L. |last5=Donner |first5=K. S. |last6=Van Tongeren |first6=S. A. |last7=Garza |first7=N. L. |last8=Dong |first8=L. |last9=Mourich |first9=D. V. |last10=Crumley |first10=S. |last11=Nichols |first11=D. K. |last12=Iversen |first12=P. L. |last13=Bavari |first13=S. |year=2010 |title=Advanced antisense therapies for postexposure protection against lethal filovirus infections |journal=Nature Medicine |volume=16 |issue=9 |pages=991–994 |doi=10.1038/nm.2202 |pmid=20729866 |s2cid=205387144}}</ref> New therapies from [[Sarepta Therapeutics|Sarepta]]<ref>{{Cite press release |title=Sarepta Therapeutics Announces Positive Safety Results from Phase I Clinical Study of Marburg Drug Candidate - Business Wire |date=2014-02-10 |url=http://www.businesswire.com/news/home/20140210005189/en/Sarepta-Therapeutics-Announces-Positive-Safety-Results-Phase |access-date=12 October 2014 |url-status=live |archive-url=https://web.archive.org/web/20180822113452/https://www.businesswire.com/news/home/20140210005189/en/Sarepta-Therapeutics-Announces-Positive-Safety-Results-Phase |archive-date=2018-08-22}}</ref> and Tekmira<ref>{{Cite web |date=2014-08-20 |title=Successful Marburg Virus Treatment Offers Hope for Ebola Patients |url=http://news.nationalgeographic.com/news/2014/08/140820-marburg-ebola-virus-treatment-monkey-africa/ |archive-url=https://web.archive.org/web/20140822032906/http://news.nationalgeographic.com/news/2014/08/140820-marburg-ebola-virus-treatment-monkey-africa/ |archive-date=August 22, 2014 |access-date=12 October 2014 |website=National Geographic}}</ref> have also been successfully used in humans as well as primates.

== See also == * [[List of Ebola outbreaks#List of other Filoviridae outbreaks|List of other Filoviridae outbreaks]] * Use in the [[Soviet biological weapons program#Marburg virus|Soviet biological weapons program]]

== References == {{Reflist}}

== Further reading == {{Refbegin}} * {{Cite book |last=Klenk |first=Hans-Dieter |title=Marburg and Ebola Viruses. Current Topics in Microbiology and Immunology, vol. 235 |publisher=Springer-Verlag |year=1999 |isbn=978-3-540-64729-4 |location=Berlin, Germany}} * {{Cite book |last1=Klenk |first1=Hans-Dieter |title=Ebola and Marburg Viruses: Molecular and Cellular Biology |last2=Feldmann |first2=Heinz |publisher=Horizon Bioscience |year=2004 |isbn=978-0-9545232-3-7 |location=Wymondham, Norfolk, UK}} * {{Cite book |last=Kuhn |first=Jens H. |title=Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement, vol. 20 |publisher=SpringerWienNewYork |year=2008 |isbn=978-3-211-20670-6 |location=Vienna, Austria}} * {{Cite book |last1=Martini |first1=G. A. |title=Marburg Virus Disease |last2=Siegert |first2=R. |publisher=Springer-Verlag |year=1971 |isbn=978-0-387-05199-4 |location=Berlin, Germany}} * {{Cite book |last1=Ryabchikova |first1=Elena I. |title=Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy |last2=Price |first2=Barbara B. |publisher=Battelle Press |year=2004 |isbn=978-1-57477-131-2 |location=Columbus, Ohio, USA}} {{Refend}}

== External links == {{Commons|Marburg virus}} {{Scholia|topic}} * [http://www.expasy.org/viralzone/all_by_species/224.html ViralZone: Marburg virus] * [[Centers for Disease Control]], ''[https://web.archive.org/web/20050404234910/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm Infection Control for Viral Haemorrhagic Fevers In the African Health Care Setting]''. * Center for Disease Control, ''[https://web.archive.org/web/20050325072042/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg.htm Marburg Haemorrhagic Fever]''. * Center for Disease Control, ''[https://web.archive.org/web/20110920155118/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/marburgtable.htm Known Cases and Outbreaks of Marburg Haemorrhagic Fever]'' * {{ECDC|ebola_marburg_fevers/factsheet.aspx|Ebola and Marburg haemorrhagic fever|10 July 2008}} * [[World Health Organization]], ''[https://www.who.int/csr/disease/marburg/en/ Marburg Haemorrhagic Fever]''. * [http://www.ifrc.org/cgi/pdf_appeals.pl?/05/05me021.pdf#xml=http://www.ifrc.org/cgi/webinator/texis.exe/webinator/search/xml.txt?query=marburg&pr=english&order=r&cq=&id=4259e31f18 Red Cross PDF] * [http://www.viprbrc.org/brc/home.do?decorator=filoi Virus Pathogen Database and Analysis Resource (ViPR): Filoviridae] {{Medical resources | ICD11 = {{ICD11|1D60.1}} | ICD10 = {{ICD10|A|98|3|a|9}} | ICD9 = {{ICD9|078.89}} | DiseasesDB = 7835 | ICDO = | OMIM = | eMedicineSubj = ped | eMedicineTopic = 2406 | meshNumber = C02.782.417.560 }} {{Filoviridae}} {{Zoonotic viral diseases}} {{Authority control}}

[[Category:Animal viral diseases]] [[Category:Arthropod-borne viral fevers and viral haemorrhagic fevers]] [[Category:Biological agents]] [[Category:Hemorrhagic fevers]] [[Category:Tropical diseases]] [[Category:Virus-related cutaneous conditions]] [[Category:Zoonotic viral diseases]] [[Category:Marburg virus disease| ]]