Marburg Haemorrhagic Fever

Key Messages:

Marburg virus disease(MVD) is a severe, often fatal illness in humans.

Marburg virus is transmitted to people from fruit bats and by human- human contact with

    blood, secretions and contaminated items associated with symptomatic(sick) persons.

Risk of infection can be mitigated by avoiding contact with blood, secretions and contaminated items

   associated with sick persons. It is vitally important to practice careful personal hygiene-especially

   hand hygiene- with an alcohol-based hand rub solution (hand sanitizer) or soap and water to reduce

   the risk of infection from hazardous contact.                                 

As from 17th October 2017, there has been an active ongoing outbreak of Marburg virus

    Disease in Kweene, Kapchorwa district, Eastern Uganda with 3 cases already identified.

    Due to human travel (including cross- border travel), multiple contacts are currently being traced

    within Uganda and in the western parts of Kenya around Mt. Elgon, West Pokot and Kitale areas.

WHO does not recommend travel restriction to affected areas, however travelers to the

    affected areas should exercise precaution and avoid contact with fruit eating bats typically

    found in the mines and caves frequently visited by tourists.

UN personnel intending to travel to the affected area should consult a health provider at a

    UN clinic at least 2 weeks before travel for risk assessment and advice. Gloves, Masks and

    other personal protective devices should be used by any travelers who may come into

    contact with fruit bats in the mines and caves of the affected areas.    

Background

Marburg virus disease (MVD), formerly known as Marburg hemorrhagic fever, is a severe, often fatal illness in humans.

Marburg virus is the causative agent of Marburg virus disease (MVD) which is associated with case fatality of up to 90%                        

Fruit bats of the Pteropodidae family, are known to be natural hosts of Marburg virus. The Marburg virus is transmitted to people from fruit bats and spreads among humans through human-to-human transmission. Human-to-human transmission involves direct contact (broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people. The virus also spreads through contact with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Airborne transmission has not been documented.

Outbreaks

Marburg hemorrhagic fever was initially detected in 1967 after simultaneous outbreaks in Marburg and Frankfurt in Germany; and in Belgrade, Serbia. These initial outbreaks were associated with laboratory work on African green monkeys. Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic Republic of the Congo, Kenya, South Africa (in a person with recent travel history to Zimbabwe) and Uganda.

Uganda has had recent outbreaks in 2007.2008,2012 and 2014.The Ugandan Ministry of Health notified WHO of a confirmed outbreak of Marburg virus disease in Kween district, Eastern Uganda on 17th October 2017.The Uganda Ministry of Health officially declared an outbreak in 19th October 2017.

The outbreak was confirmed by WHO on 2Oth October 2017.The affected district is in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The mount Elgon caves are a major tourist attraction with large colonies of cave-dwelling fruit bats known to transmit Marburg virus. The proximity of the affected area to the Kenyan border and cross-border movement raises the potential of Marburg virus transmission to Kenya through cross-border spread.

As of 3 November 2017, the three cases that have been previously reported (two confirmed and one probable case, the latter being the index case) have died, thus, resulting in an overall case-fatality rate of 100%. The cases were epidemiologically linked and come from one family.

The second confirmed case travelled to Kenya, prior to his death. Contact tracing and active case search is ongoing in Kween in Kapchorwa district in Uganda, as well as in Kitale district and West Pokot in Kenya. One close contact of the second confirmed case has been reported to have travelled to Kampala. The Kampala City Authority has sent a team to the village she is reported to be visiting to trace this contact and continue 21 days’ follow-up.

Risks to travelers

The risk of a traveler becoming infected with Marburg virus during a visit to the affected areas and developing disease after returning is extremely low, even if the visit included travel to areas where primary cases have been reported. This is because transmission requires direct contact with blood, secretions, other body fluid or tissues of infected persons, or with infected dead bodies or animals, all unlikely exposures for the average traveler. Travelers are strongly advised to avoid all such contacts.

In general, the risk of infection during the travel can be reduced using basic infection control measures.

Travelers who are deployed as Health-care workers can also be infected while treating patients with suspected or confirmed MVD.They are therefore expected to take standard personal protective precautions to limit risk of infection.

Public Health response

  • The Ugandan Ministry of Health continues to proactively respond to the outbreak with support from WHO and partners.
  • Contact tracing is ongoing, as well as active case search in health facilities and at community level. Reported deaths are also investigated for Marburg before burial and suspicious deaths accorded safe and dignified burials.
  • An isolation and treatment unit was set-up in Kapchorwa with logistical support from WHO, UNICEF, and MSF. A complete triage protocol has been implemented.
  • Social mobilization and risk communication are ongoing. With the support from Red Cross volunteers, UNICEF and WHO communication experts, over 4,000 community members have received information on MVD.
  • Psychosocial support specialists have been deployed to Kween and counselling sessions are being conducted for family members of the deceased Marburg cases, health workers, and other community members.
  • Guided tours of the Marburg treatment units in Kapchorwa and Kween were organized in order to dispel fear of the treatment center and rumours of wrong practices by healthcare workers that cause death of admitted patients.
  • A cross-border meeting between Uganda and Kenya health authorities was held on 7th November 2017 in Kapchorwa, and cross-border surveillance activities are ongoing.
  • Kenya Marburg virus disease outbreak contingency plan and the public health EOC have been activated and preparedness measures have started.The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies is a challenge for the response.
  • 2000 Personal Protective Equipment sets have been dispatched by WHO and shipped to Trans Nzoia County, Kenya.
  • Blood specimens were collected and have been dispatched to Nairobi’s KEMRI Laboratory
  • A temporary treatment center (Kaisangat Health center) has been identified and the Kenya Red Cross Society is recruiting and re-orienting nurses to manage the MVD treatment centre.
  • UNICEF is assisting with communication activities, and community engagement.
  • MSF-France has deployed to support setting up of treatment centres in Uganda (Kapchorwa and Kaproron) and Kenya (Kaisangat).

Symptoms

The incubation period (interval from infection to onset of symptoms) varies from 2 to 21 days. People are not infective during the incubation period, but become infective with the onset of symptoms.

Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise.

Other common symptoms associated with Marburg Virus infection include:

● Muscle aches and pains.

● Severe watery diarrhea

● Abdominal pain and cramping

● Nausea and vomiting.

● Severe hemorrhage after 5-7 days (Blood in vomit, stool, gums, vagina)

The disease can progress rapidly with complications leading to death.

Treatment and vaccines

There is no proven treatment available for MVD yet. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.

Recommendations to all UN personnel

Based on the information available, the WHO does not recommend the application of any travel or trade restrictions to Uganda or to the affected area. Travelers to the Mount Elgon area are advised to avoid exposure to bat caves and contact with non-human primates.

UN personnel intending to travel to the affected area should consult a health provider at their UN clinic at least 2 weeks before the date of travel. The health provider will conduct a health risk assessment and provide up to date guidance and health information aimed at limiting the risk of infection, ensuring self-monitoring and access to early treatment in the event of suspected risk exposure. If you fall ill during or after your travel to a Marburg affected area, do not leave home; minimize your contact with others and promptly contact the UN Clinic at your duty station by phone or email.

If you have symptoms while in Uganda, do not leave home/Office Call the UN clinic without delay on below contacts:

Mobile: +256772289164  OR Office: +256312320115/1 

The following general guidelines should be observed:

1.Avoid all contact with blood, body fluids and tissues of wild animals or sick people even after their death. The following animals may be a source of infection to humans: chimpanzees, gorillas, monkeys, forest antelope, porcupines, duikers, and fruit bats found ill or dead in forests. Avoid handling or eating any of the above animals.

2. Do not handle items that may have been in contact with an infected person.

3. Simply being in proximity to a healthy-looking person (for example, in a public transport conveyance) does not constitute a risk.

4. Practise careful hygiene, especially hand hygiene with an alcohol-based hand rub solution (hand sanitizer), if available, and with soap and water when hands are visibly soiled. Practise hand hygiene especially before touching eyes, nose or mouth, and after using the toilet or touching objects at high risk of being contaminated.

5. If you stayed in the areas where Marburg cases have been recently reported seek immediate medical attention if you feel ill (fever, headache, achiness, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes). Early treatment improves the chance of recovery.

6. If you suspect you may have Marburg, it is advisable that you don’t report to work, contact your supervisor and health authorities by phone or email at the earliest opportunity and NOT physically present yourself to a clinic, since not all health facilities have the capacity to manage the disease.

7. There are specific designated health facilities that are equipped to handle Marburg cases and your contacting the UN clinic will enable you get the correct advice (Please see list of contact persons in each location in the appendix below).

8. Carry a first Aid kit and sufficient supply of your regular medication for the duration of your mission. The first aid kit can also be provided from your UN Clinic at the duty station before departure.

 

Sourced from:

1.WHO Marburg fact sheet October 2017

http://www.who.int/mediacentre/factsheets/fs_marburg/en/

2.WHO Disease Outbreak News November 7th 2017

http://www.who.int/csr/don/7-november-2017-marburg/en/

3.WFP Interim guidance on Marburg viral disease,2017

 

APPENDIX 

Health Facility Contacts for Marburg Virus Disease Cases

In UGANDA

UN clinic physician: Dr. Simon Emuron

Mobile: +256772289164

Office: +256312320115/1

Email: simon.emuron@undp.org

 

2. Moroto: Matany Hospital

Dr. John Bosco Nsubuga

Email: ms@matanyhospital.org

Mobile: 0782030308

Bro. Gunther Mahridi

Email: ceo@matanyhospitial.org

Moroto Referral Hospital

 

3. Kotido: Kanawat Missionary Hospital

Sr. Rosario Marinho

Email: kanawathc@gmail.com

Phone: 0392002600

Calvary Health and Laboratory Services

Vincent, Clinical Officer

Dr. Emmanuel Oumo (also affiliated with Kotido Health Center 4)

Mobile: 0789564203

0758875830

 

5. Kaabong: Kaabong District Hospital

Dr. Atim Dansan

Email: oatimdansan@gmail.com

oatimdansan@yahoo.com

Mobile: 0779609740/0778930820

 

6. Nakapiripirit: Amudat Health Center 4

Dr. Patrick Sagaki

Email: drsagaki@yahoo.com

Mobile: +256772316596

+256752316590

Tokora Health Center 4

 

7. Mbale: Mt. Elgon Hospital

Babra Nabuyaka

Email: creditmanager@meh-mbale.com

Mobile: 0789488206

Mbale Referral Hospital

 

In Nairobi

Duty Nurse(24hrs)

UNON JMS Clinic, GIGIRI

Tel: 0724 255 378

Email: medical.evacuation@un.org