Marburg virus disease: Emerging threat, pathogenesis, and global public health strategies

Table 1 Comparative overview of Marburg virus and Ebola virus

Feature	MARV	Ebola virus
Virus family	Filoviridae	Filoviridae
First identified outbreak	1967: Marburg and Frankfurt, Germany, and Belgrade, Serbia	1976: Yambuku, Democratic Republic of the Congo, and Nzara, Sudan
Origin of outbreaks	African green monkeys imported from Uganda	Suspected zoonotic transmission, with bats as reservoirs and transmission to humans or other primates
Reservoir hosts	Egyptian fruit bat (Rousettus aegyptiacus) suspected	Fruit bats (Pteropodidae family), particularly Eidolon helvum
Case fatality rate (%)	24%-90%, depending on outbreak and case management	25%-90%, depending on outbreak and case management
Geographic distribution	Primarily sub-Saharan Africa	Primarily sub-Saharan Africa
Symptoms	Hemorrhagic fever, severe malaise, high fever, vomiting, diarrhea, organ dysfunction	Similarto MARV: Hemorrhagic fever, malaise, vomiting, diarrhea, multi-organ failure
Transmission	Direct contact with bodily fluids (e.g., blood, saliva, urine) of infected persons or animals	Direct contact with bodily fluids of infected persons or animals, contaminated surfaces
Laboratory diagnosis	PCR, ELISA, virus isolation	PCR, ELISA, virus isolation
Vaccines	No approved vaccine (research ongoing)	Approved vaccines available (e.g., rVSV-ZEBOV for Zaire strain)
Notable outbreaks	Angola (2004-2005), Democratic Republic of the Congo (1998-2000)	West Africa (2014-2016), Democratic Republic of the Congo (multiple outbreaks)

ELISA: Enzyme-linked immunosorbent assay; MARV: Marburg virus; PCR: Polymerase chain reaction.

Table 2 Timeline of significant epidemics caused by the Marburg virus

Year	Location	Cases	Deaths	Case fatality rate (%)	Notable features
1967	Marburg and Frankfurt, Germany; Belgrade, Serbia	29	7	24%	First recognized outbreak due to laboratory exposure
1967	Yugoslavia	2	0	0%	-
1975	South Africa	3	1	33%	-
1980	Kenya	2	1	50%	-
1987	Kenya	1	1	100%	-
1998-2000	Durba, Democratic Republic of the Congo	154	128	83%	Outbreak among gold miners
2004-2005	Uige Province, Angola	374	329	88%	Largest recorded outbreak
2007	Uganda	4	2	50%	-
2008	Netherland, United States of America	2	1	50%	-
2012	Ibanda, Uganda, and neighboring districts	15	4	27%	Spread across multiple districts
2014	Uganda	1	1	100%	-
2017	Kween District, Uganda	3	3	100%	Family cluster of cases
2021	Gueckedou, Guinea	1	1	100%	First reported case in West Africa
2022	Ashanti Region, Ghana	3	2	67%	Limited outbreak in West Africa
2023	Equatorial Guinea Equatorial Guinea	40	35	88%	Ongoing, affecting multiple provinces
2023	Kagera Region, Tanzania	9	6	67%	First Marburg virus disease outbreak in Tanzania

Table 3 Different types of viral haemorrhagic fevers and causative agents

Family	Causative virus	Disease	Symptoms	Treatment
Arenaviridae	Lassa virus	Lassa fever	Fever, weakness, haemorrhage	Supportive care, ribavirin
Arenaviridae	Junin virus	Argentine haemorrhagic fever	Fever, malaise, haemorrhage	Supportive care
Arenaviridae	Chapare virus	Chapare hemorrhagic fever	fever, malaise, headache, vomiting and diarrhoea	Supportive care and early diagnosis
Arenaviridae	Guanarito virus	Venezuelan hemorrhagic fever	confusion, convulsions, coma, and bleeding from body orifices	No specific anti-viral treatment is available
Arenaviridae	Lujo virus	Lujo hemorrhagic fever	fever, headache, vomiting, diarrhea, arthralgia, myalgia	Supportive care
Arenaviridae	Lymphocytic choriomeningitis virus	Lymphocytic choriomeningitis	Fever (38.5 °C to 40 °C), malaise, myalgia, retro-orbital headache, photophobia, anorexia	Supportive care, ribavirin
Arenaviridae	Machupo virus	Bolivian hemorrhagic fever	Fever, malaise, fatigue headache, dizziness, myalgias, severe lower back pain	Supportive care
Arenaviridae	Sabia virus	Brazilian hemorrhagic fever	High fever, fatigue, maculopapular/petechial rash bleeding and haemorrhage	Supportive care, ribavirin antiviral drug
Bunyaviridae	Crimean-Congo haemorrhagic fever virus	Crimean-Congo haemorrhagic fever	Fever, myalgia, haemorrhage	Supportive care, ribavirin
Bunyaviridae	Hantan virus	Hantavirus pulmonary syndrome	Fever, muscle pain, pulmonary oedema	Supportive care
Bunyaviridae	Dobrava-Belgrade virus	Hemorrhagic fever with renal syndrome	Intense headache, back and abdominal pain, fever, chills, blurred vision	Supportive therapy, renal dialysis. Treatment with ribavirin
Bunyaviridae	Seoul virus	Hemorrhagic fever with renal syndrome	Intense headache, back and abdominal pain, fever, chills, blurred vision	Supportive therapy, renal dialysis. Treatment with ribavirin
Bunyaviridae	Puumalavirus	Hemorrhagic fever with renal syndrome	Intense headache, back and abdominal pain, fever, chills, blurred vision	Supportive therapy, renal dialysis. Treatment with ribavirin
Bunyaviridae	Rift Valley fever virus	Rift Valley fever	Transient fever, headache, severe muscle and joint pain, photophobia and anorexia	Drugs like Ibuprofen or Acetaminophen
Bunyaviridae	Saaremaa virus	Hemorrhagic fever with renal syndrome	Intense headache, back and abdominal pain, fever, chills, blurred vision	Supportive therapy, renal dialysis. Treatment with ribavirin
Bunyaviridae	Sin Nombre virus	Hantavirus pulmonary syndrome	Fever, muscle pain, pulmonary edema	Intubation and oxygen therapy, fluid replacement and use of medications to support blood pressure
Bunyaviridae	Severe fever and thrombocytopenia syndrome virus	Severe fever and thrombocytopenia syndrome	Fever, vomiting, diarrhoea, multiple organ failure, thrombocytopenia, leucopoenia elevated liver enzyme levels	Intravenous ribavirin
Bunyaviridae	Tula virus	Hemorrhagic fever with renal syndrome	Intense headache, back and abdominal pain, fever, chills, blurred vision	Supportive therapy, renal dialysis. Treatment with ribavirin
Filoviridae	Bundibugyo ebolavirus	EBOV disease	Fever, severe haemorrhage, organ failure	Supportive care, experimental treatments
Filoviridae	Marburg virus	Marburg haemorrhagic fever	Fever, severe haemorrhage, organ failure	Supportive care, experimental treatments
Filoviridae	Sudan ebolavirus	EBOV disease	Sudden onset of fever, fatigue, muscle pain, headaches, sore throat, vomiting, diarrhoea, rash, impaired kidney, liver functions	Monoclonal antibodies like Inmazeb, Ebanga
Filoviridae	Tai Forest ebolavirus	EBOV disease	Sudden onset of fever, fatigue, muscle pain, headaches, sore throat, vomiting, diarrhoea, rash, impaired kidney, liver	Monoclonal antibodies like Inmazeb, Ebanga
Filoviridae	EBOV	EBOV disease	Sudden onset of fever, fatigue, muscle pain, headaches, sore throat, vomiting, diarrhoea, rash, impaired kidney, liver functions	Monoclonal antibodies like Inmazeb, Ebanga
Flaviviridae	Dengue virus	Dengue fever	Fever, rash, haemorrhage	Supportive care, fluids
Flaviviridae	Kyasanur forest disease virus	Kyasanur forest disease	Sudden onset of chills, fever, and headache	Supportive treatment with maintenance of proper hydration and circulation by transfusion of IV fluids
Flaviviridae	Omsk hemorrhagic fever virus	Omsk hemorrhagic fever	Fever, headache, myalgia, cough, petechial rash or bruises	Supportive care
Flaviviridae	Yellow fever virus	Yellow fever	Fever, chills, headache, back pain, vomiting, fatigue	Rest, hydration and seek medical advice

EBOV: Ebola virus.

Table 4 Phases of Marburg virus with symptoms

Incubation Period (5–10 days)
Phase	Duration	Key symptoms	Outcome	Treatment
Generalization phase	Days 1–4	Fever (39–40 °C), headache, chills, myalgia, anorexia. Gastrointestinal symptoms like nausea, vomiting, diarrhoea	Supportive care may prevent progression	Galidesivir (BCX4430)
Early organ phase	Days 5–13	Hemorrhagic symptoms (petechiae, mucosal bleeding), maculopapular rash, fatigue, organ damage (kidney, liver)	Escalation in disease severity	Favipiravir (T-705), Obeldesivir
Late organ phase/convalescence phase	Days 13+	Recovery: Gradual resolution of symptoms. Fatality: Multiorgan failure, shock, dehydration	Recovery or death within 8–16 days	Remdesivir (GS-5734), AVI-7288

Table 5 Treatment and next steps

Vaccine/treatment	Type	Trial phase	Key findings	Next steps
cAd3-Marburg	Chimpanzee adenovirus vector	Phase 1	95% immune response in participants	Phase 2 trials pending
Mvabea (MVA-BN-Filo)	Modified Vaccinia Ankara	Phase 1	Safe, good immune response	Phase 2/3 trials planned
Marburg virus DNA plasmid vaccine	DNA-based vaccine	Phase 1	Early immune activation observed	Further studies required
Galidesivir	RNA polymerase inhibitor	Preclinical	Effective in animal models	Human trials needed
Remdesivir	Antiviral drug	Preclinical	Shows potential in vitro	Further evaluation required

Table 6 Prevention and control

Category	Key strategies
Case management	Early diagnosis, isolation of confirmed cases, and supportive care to reduce mortality
Surveillance and contact tracing	Identifying cases, monitoring close contacts for 21 days, and implementing quarantine if necessary
Infection control in healthcare settings	Strict hand hygiene, PPE usage, safe injection practices, and handling of biological specimens in high-containment labs
Community awareness and engagement	Educating populations on transmission risks, reducing stigma, and encouraging early healthcare-seeking behavior
Preventing Bat-to-human transmission	Avoiding caves/mines with fruit bat colonies, using protective gear for workers in high-risk areas
Preventing human-to-human transmission	Avoiding contact with bodily fluids of infected individuals, using protective measures for caregivers and healthcare workers
Safe burial practices	Implementing protocols for dignified but safe burials, avoiding direct contact with deceased bodies
Public health measures	Restricting travel to and from outbreak zones, ensuring preparedness plans, and maintaining emergency stockpiles of PPE and diagnostic kits

PPE: Personal protective equipment.