Marburg virus disease

Marburg virus disease (MVD) is a severe, often fatal illness caused by the Marburg virus. The virus causes severe viral haemorrhagic fever in humans characterized by fever, headache, back pain, muscle pain, abdominal pain, vomiting, confusion, diarrhoea, and bleeding at very late stages.

MVD was first identified in Marburg, Germany in 1967. Since then, there have been a limited number of outbreaks reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.

In 2023, two separate MVD outbreaks have been reported in two countries, Equatorial Guinea and the United Republic of Tanzania.

While rare, MVD remains a severe public health threat due to its high mortality rate and the lack of an effective antiviral treatment or vaccine.  

Read more: Fact sheet on marburg virus disease

People are initially infected with Marburg virus when they come in close contact with Rousettus bats, a type of fruit bat, that can carry the Marburg virus, and are often found in mines or caves.  

Between humans, the virus is mainly transmitted through contact with the body fluids of infected people. It can spread through direct contact with body fluids (blood, faeces, vomit, saliva, urine, sweat, breast milk, semen, pregnancy fluids) of infected people or people who died from the disease, or from contact with surfaces or materials contaminated with these body fluids. The disease does not spread through the air.

The virus often spreads to a family member or a local health worker who has cared for someone ill or who has died from MVD without proper protective equipment.  

People remain infectious as long as their blood contains the virus. This means patients must continue treatment at a dedicated health facility and wait for the laboratory test to confirm when they may safely return home.   

Early symptoms

Early symptoms of MVD can arise quickly after infection and may include high fever, chills, severe headache and severe tiredness. Muscle aches and pains are also common early symptoms.

Symptoms become increasingly severe and can include nausea, vomiting, stomach and or chest pain, rash and diarrhoea which can last around a week.  

Late symptoms

In later stages of the disease, bleeding from various sites such as the gums, nose and anus can occur. Patients can suffer shock, delirium and organ failure.

The most reported MVD symptoms include:

• fever
• back pain
• muscle pain
• stomach-ache
• loss of appetite
• vomiting
• lethargy
• rash
• difficulty in swallowing
• headache
• diarrhoea
• hiccup
• difficulty breathing.

The interval from infection to onset of symptoms varies from 2 to 21 days. Some patients will experience bleeding between 5 and 7 days, and fatal cases usually have some form of bleeding, often from multiple areas. Blood in vomit and/or faeces is often accompanied by bleeding from the nose, gums, and vagina.

Death can occur rapidly, and is usually caused by viral sepsis, multi-organ failure and bleeding.

Marburg and Ebola diseases are both similar, rare diseases, although caused by different viruses. They are both members of the filovirus family and have the capacity to cause outbreaks with high fatality rates.  

Read more about EVD: Ebola Virus Disease

It can be difficult to distinguish between MVD and other infectious diseases such as Ebola, malaria, typhoid fever and dengue fever due to the similarity of many symptoms. Only a test done in a laboratory, using blood, tissue, or other body fluid samples, can confirm the disease.

If you or a loved one has MVD-like symptoms, reach out to a local health provider for up-to-date and accurate advice.

If you or a loved one tests positive for MVD, early care at a designated treatment centre is essential and can improve the chance of survival. 

There is no specific treatment for MVD. However, to maximize the chances of recovery and for the safety of others, all patients should receive care and remain at a designated treatment centre until cleared to leave by the centre staff. You should not be treated at home.

If you or a loved one tests negative for MVD but still has symptoms, remain vigilant until symptoms have disappeared and until you have been cleared by your health care provider. 

Follow your health care providers’ advice because further laboratory analysis may be required if you test negative for the Marburg virus but still have symptoms. 

The best way to prevent MVD is to avoid contact with infected individuals or animals and to practice good hygiene and follow other preventive measures recommended by your local government or health authority.

If you live in or are travelling to an area where MVD has been reported, even if you do not have symptoms and you are not a contact, follow all recommended local preventive measures such as: 

• seeking care if you have MVD symptoms:
• washing your hands regularly with soap or with alcohol-based hand rub solution;
• avoiding contact with body fluids of people with MVD symptoms and the body of someone who died with symptoms of MVD;
• stopping at official check points and adhering to any preventive measures in place;
• agreeing to temperature screening; and

• completing health declaration forms when available at public entry points (e.g. hospitals, markets, churches, sports places, public offices, banks, airports, seaports and land borders)

If you have been in contact with someone who has fallen ill with MVD or if you experience similar symptoms, you may be at risk of developing the disease, especially if you have been:

• in close contact with a MVD patient (while sick or dead) such as living or staying in the same household or room;
• admitted to a health facility where there was a MVD patient; and/or
• sharing objects or touching the same surfaces that may have been contaminated by body fluids of an MVD patient.

Once you have been identified as a contact of someone with MVD symptoms, you will be monitored (as a contact) by the health authorities for 21 days after exposure. Health authorities will come to visit you twice a day to check on your health.

If you have been identified as a contact:

• accept a visit by representatives of health authorities twice a day to monitor your health;
• provide them with accurate information, answering all questions as accurately as you can;
• avoid travelling unless travel has been approved by your local health authority; and
• report any symptoms immediately to your local health authority. 

If you have no symptoms 21 days after exposure, your health will no longer be monitored.

If symptoms develop while being monitored by the health authorities, you will be advised to take a laboratory test. The test results will guide the health professional on whether you should immediately be admitted to a treatment centre or not for care.

Bodies of people who have died from MVD must be handled only by people wearing appropriate personal protective equipment and must be buried immediately. Never wash, kiss or touch the body of someone who is confirmed or suspected of having died of MVD.

If you are attending the burial, it is essential that you wash your hands with soap and water: 

• before and after the burial; and
• before and after eating and after touching any surfaces in the area where the burial took place.

Alcohol based hand rub solutions may be used if there is no visible soiling of hands (e.g. no blood or body fluids are visible on the hands). 

Any person showing symptoms of MVD before dying must be reported to local health authorities to assess and determine if a safe and dignified burial is required.

Local health authorities should provide guidance on how to mourn the loss of loved ones in safe and dignified ways.

There is currently no available treatment for MVD. This is why is it important for people showing Marburg-like symptoms to seek care early. Supportive care, including providing adequate hydration, pain management and treatment of symptoms as they arise under professional care remains the safest and most effective way to manage MVD. Treatment of co-infection such as malaria is also crucial for supportive care against MVD.  

Some candidate treatments have been prioritized by WHO for evaluation under randomized clinical trials.

Emergency use of unproven clinical interventions outside clinical trials: ethical considerations

Public health authorities, together with government partners, ensure that treatment centres are safe, equipped with appropriate materials and managed by skilled and trained professionals who can provide safe and adequate care to all patients with respect to their dignity and humanity.

Once at a hospital or treatment centre, health professionals and support personnel will provide you with whatever help is needed for your recovery. This includes room, toilets, safe water, medicines, food, and any assistance on how to manage contact with your loved ones. Seeking care early when you are sick will improve your chance of survival and limit the transmission of the disease to your loved ones.

Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola

When people recover from MVD, they need to be welcomed back into the community. 

To maintain the health and safety of survivors, they: 

• will need regular medical checks and care for possible remaining adverse effects such as eye problems and, muscular pain
• will need love, inclusion and re-integration so that they do not feel excluded from the community.    

If you are a man recovering from MVD, you will be advised to observe safe sex practices, including consistent use of condoms, until semen has been tested twice as negative for MVD.   

If you are a woman breastfeeding while sick with MVD you may be advised to refrain from breastfeeding your baby, and, in that case, health authorities will support you with adequate milk replacement. 

After recovering, comply with testing to know when you can resume breastfeeding safely. If you are pregnant at the time of MVD infection and have recovered with a viable pregnancy, seek and accept dedicated supportive care until after your baby is born.

There are no vaccines approved for MVD. However, there are some candidate vaccines currently under development.

The World Health Organization has identified MVD as a top priority disease for which a vaccine is urgently needed. 

WHO Technical Advisory Group – candidate vaccine prioritization.  Summary of the evaluations and recommendations on the four Marburg vaccines

Integrating Research into Outbreaks: How can we prepare for the next Marburg outbreak?

During MVD outbreaks, all animal products (blood and meat) should be safely managed, cleaned and cooked before consumption. It is important to correctly wash your hands before and after touching animals and related products. 

During field activities, work, research activities or tourist visits in mines, forests or caves inhabited by fruit bats, you should always wear long clothing, gloves and other appropriate protective coverings (including masks).