Ghana has declared an outbreak of Marburg disease, a zoonotic virus in the same family as Ebola, after two suspected cases were confirmed.
The Pasteur Institute in Dakar (Senegal), which collaborates with the World Health Organization (WHO), received samples from the two patients and corroborated the results by another laboratory in Ghana. The patients, two unrelated men aged 26 and 51, presented with diarrhoea, fever, nausea and vomiting and died shortly after hospital admission.
More than 90 contacts, including health workers and community members, have been identified and are being monitored.
“The health authorities have responded quickly, anticipating the preparation of a possible outbreak. This is good because, without immediate and decisive action, Marburg can easily get out of hand“said Dr. Matshidiso Moeti, WHO regional director for Africa.
The UN agency has deployed experts, including personal protective equipment, to bolster surveillance, testing, contact tracing and alerting communities. In addition, another team will be deployed in the coming days to be in charge of coordination, risk assessment and infection prevention measures.
Marburg is a highly infectious viral hemorrhagic fever from the same family as the Ebola virus. It is only the second time that this zoonotic disease has been detected in West Africa. Previous outbreaks and sporadic cases of Marburg have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa, and Uganda. The WHO has contacted neighboring high-risk countries and they are on alert.
direct contact infections
the marburg transmitted to people through fruit bats and, like Ebola, it spreads between humans through direct contact with the blood (through wounds or mucous membranes), secretions, organs, or other body fluids of infected persons, and with surfaces and materials (eg, bedding, clothing) contaminated with these fluids.
Healthcare personnel can become infected when treating Marburg patients if infection control precautions are not strictly practiced.
Burial ceremonies involving direct contact with the body of the deceased may also contribute to Marburg transmission.
People remain infectious as long as their blood contains the virus.
The incubation period (interval from infection to onset of symptoms) ranges from two to 21 days.
The disease caused begins abruptly, with high fever, severe headache and general malaise. Muscle aches are a common feature. Severe watery diarrhoea, abdominal pain and cramps, nausea and vomiting may begin on the third day.
In this phase, it has been described that patients have a “ghost appearance” due to sunken eyes, facial expressionlessness, and extreme lethargy.
Many patients have severe bleeding manifestations within 5 to 7 days, and fatal cases usually have some form of bleeding, often in multiple organs. The presence of fresh blood in vomit and feces is often accompanied by bleeding from the nose, gums, and vagina. Spontaneous bleeding at venipuncture sites where fluids are given or blood samples are drawn can be especially troublesome. During the severe phase of the disease, patients have a persistently high fever. Central nervous system involvement can produce confusion, irritability, and aggressiveness. Occasional cases of orchitis (inflammation of one or both testicles) have also been described in the late phase of the disease (15 days after onset).
In fatal cases, death usually occurs 8 to 9 days after the onset of symptoms and is usually preceded by extensive blood loss and shock.
There is no treatment or vaccines
Though there are no vaccines or approved antiviral treatments to treat the virus, care -rehydration with oral or intravenous fluids- and the treatment of specific symptoms improve survival. Various potential treatments are being evaluated, including blood products, immune and drug therapies, as well as candidate vaccines with phase 1 data.
From a clinical point of view, it can difficult to distinguish Marburg from other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis and other viral hemorrhagic fevers. Laboratory diagnostic methods such as PCR and antigen tests are used to confirm that the cause of the symptoms is the Marburg virus.
The handling of patient samples exposes a very high risk and the analyzes of non-inactivated samples must be carried out under conditions of maximum biocontainment. All biological samples for national or international transport must be packaged using the triple packaging system.
Prevention and control
To successfully control outbreaks, several measures related to treatment, infection prevention and control, surveillance and contact tracing, quality of laboratory services, safety of burials and social mobilization must be applied. . The participation of the population is essential to control outbreaks.
Public health messages aimed at reducing risk should focus on several issues:
- Reducing the risk of fruit bat-to-human transmission through prolonged exposure in mines or caves inhabited by colonies of these animals. During outbreaks, all animal products (blood and meat) should be thoroughly cooked.
- Close physical contact with infected patients should be avoided. by the Marburg virus. People caring for patients at home should wear gloves and other appropriate personal protective clothing and wash their hands regularly. It is also necessary to wash your hands after visiting hospitalized patients or caring for patients at home.
- affected communities they must do everything possible to duly inform the population about the nature of the disease and the necessary measures to contain the outbreaks.
- The burial of the corpses must be quick, dignified and safe, and people who may have been in contact with an infected person must be identified and followed up for 21 days, separating healthy and sick people so as not to increase the spread.
- Reducing the risk of sexual transmission. Based on the results of ongoing research, WHO recommends that convalescent men take no risks and use protective measures during sexual intercourse, as well as good hygiene for 12 months after the onset of symptoms or until semen tests twice negative for Marburg virus.
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