The virus is currently spreading in the East African country. Eight people have died from the virus since Friday. There are a total of 27 confirmed cases of Marburg infection. It is not yet clear whether the medical student and his companion on board the train are actually carriers of the virus. The tests are still awaiting results. According to information gathered by Bild, the boy had flu-like symptoms since the previous day.
03 OTT –
A big scare yesterday at the central station in Hamburg, Germany. Platforms 7 and 8 remained closed for hours. They had assistants and full protective suits on duty and around 200 passengers on the train had to stay at their seats. A medical student from Hamburg (26 years old) and his Rwandan girlfriend may have been infected with the Marburg virus.
The virus is currently spreading in the East African country. Eight people have died from the virus since Friday. There are a total of 27 confirmed cases of Marburg infection. It is not yet clear whether the two passengers on board the train are actually carriers of the virus. The tests are still awaiting results.
According to information collected Bildthe student already felt sick when he was on board the train in Frankfurt. He is said to have felt flu-like symptoms a full day before arriving in Hamburg. The medical student and his girlfriend were transferred to Eppendorf University Hospital, which specializes in infectious diseases.
The student had previously arrived from Rwanda by plane. He then had contact with a patient who later tested positive for the Marburg virus.
What is Marburg virus? Marburg virus disease (MVD), formerly known as Marburg hemorrhagic fever, is a serious viral disease caused by the Marburg virus (MARV) which belongs to the same family as the Ebola virus, Filoviridae. Although Marburg and Ebola viruses are two separate viruses, they cause clinically very similar diseases and have similar case fatality rates. MVD affects humans and non-human primates.
The Marburg virus was first described in 1967 after two epidemics of hemorrhagic fever that occurred simultaneously in several laboratories in Frankfurt and Marburg (Germany), and in Belgrade, Serbia (then Yugoslavia). There were 31 infections and 7 deaths.
Since then, sporadic local outbreaks have been recorded over the years in various states in sub-Saharan Africa or among travelers returning from these countries. More details on the epidemiology are reported on the dedicated page.
Symptoms and clinical course. The incubation period usually lasts 5 to 10 days, but periods of 2 to 21 days have also been observed. The onset of the disease occurs suddenly with non-specific symptoms and signs such as high fever (39-40 °C), severe headache, chills, malaise and muscle pain. Three days after the onset, abdominal cramps and pain, nausea, vomiting and diarrhea may appear that last up to a week. From the fifth to the seventh day, a maculopapular rash may appear and the clinical picture may worsen with the appearance of hemorrhagic fever such as petechiae, mucosal and gastrointestinal hemorrhages, and bleeding from venous sampling sites. Afterwards, neurological signs and symptoms may also appear (disorientation, agitation, convulsions and a comatose state). Disseminated intravascular coagulation, lymphocytopenia, and thrombocytopenia may occur within a week of disease onset.
The fatality rate is about 50%, but it can vary (range 24-88%) based on the therapeutic management of the case and the viral strain. In fact, early treatment can significantly improve the chances of survival. In fatal cases, death occurs between 8 and 16 days from onset and is attributable to dehydration, internal bleeding and multiple organ failure.
Cross-addressing. Most outbreaks of Marburg virus disease are associated with human presence in bat-inhabited environments such as caves and mines, suggesting that the animal plays a central role in the transmission of the virus. In particular, in 2007 the isolation of the virus in bats of the species R. aegyptiacus gave evidence that this species is one of the main natural reservoirs. The maintenance dynamics of the virus in the reservoir population are not yet known and it is not clear how the transfer to humans occurs.
Person-to-person transmission occurs through direct contact (for example through broken skin or through the mucous membranes of the eyes, nose or mouth) with the blood or other body fluids (urine, saliva, faeces, vomit, semen) of an infected person or through contact indirectly with contaminated surfaces or objects such as clothing, sheets or medical equipment.
The risk of transmission is higher during the later stages of the disease, in the presence of vomiting, diarrhea or bleeding. The risk of transmission during the incubation period is small.
Regarding the persistence of Marburg virus in body fluids, data are limited. However, since this virus belongs to the same family as the one responsible for Ebola disease, it can be assumed that the persistence of the virus in body fluids may be similar. There is evidence that Marburg virus can persist in some body fluids, including semen, even after the acute phase of the disease.
In the environment, filoviruses can remain in liquids or on surfaces for many days. They are inactivated by gamma radiation, heated at 60°C for about an hour or boiled for 5 minutes. They are also sensitive to various disinfectants.
Other routes of infection are contact with infected animals, live or dead, or eating the flesh of wild animals.
Diagnosis. Clinical diagnosis of the disease can be difficult because many of the signs and symptoms of MVD are similar to those of other infectious diseases such as malaria, typhoid fever, dengue fever and other hemorrhagic fevers (Ebola and Lassa fever ).
To confirm the clinical suspicion, different laboratory investigations can be carried out depending on the stage of the disease.
Virus isolation is one of the most reliable methods but is not routinely used due to the limited number of advanced bioconservation laboratories capable of performing it.
Molecular tests (RT-PCR) have proven to be a valid, sensitive, specific and effective alternative for the diagnosis of MVD.
In the early stages of the disease, since there are high viral levels in the blood, a diagnosis can be made by looking for antigens.
Serological methods such as ELISA and IFA are very useful investigations for diagnosis. An IgM result for Marburg virus indicates recent infection and can be obtained as early as 2-4 days after the onset of symptoms. IgG is detected after 8-10 days and can persist up to 2 years after the disease. Although serology can be useful to confirm a case, it must be kept in mind that the absence of serological results does not allow to exclude the disease because it often happens that people infected with filovirus die before the development of a humoral immune response. Maximum care is essential when handling samples.
Prevention and treatment. In the case of an MVD outbreak, the main goal is to prevent person-to-person transmission. The main points of the strategy to control the spread of the virus are the early identification of cases and their rapid and systematic isolation, timely contact tracing, the use of adequate personal protective equipment, safe burial rituals and adequate communication to improve the population’s awareness of infection. risk factors and preventive measures. These strategies have proven effective in controlling previous outbreaks of Ebola and Marburg disease.
When traveling to sub-Saharan Africa, it is advisable to avoid environments such as caves or mines, where bats may be present.
There are currently no specific antiviral treatments or vaccines available to prevent MVD. Treatment consists of supportive therapy with maintenance of hydration and electrolytes, blood transfusions and oxygen therapy.
03 October 2024
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