Ghana has officially declared it state of health alert following the first Marburg outbreak (MVD)a deadly virus that is spreading in Africa and which – according to experts – is as dangerous and contagious as Ebola.
Marburg outbreak in Africa: the alert is triggered
Two men, one 26 and the other 51, died in Africa after testing positive for Marburg. It is a pathogen that belongs to the same family as the viruses that cause Ebola and which, likewise, develops in patients in the form of hemorrhagic fever.
The first outbreak was confirmed in Ghana, followed by two deaths – on 27 and 28 June – confirmed on Sunday 17 July by the World Health Organization. In its press release, WHO specified that the probability of death in the two patients they ranged from 24% to 88%, both because of the strain of the virus they had developed – particularly aggressive – and because of the (limited) treatments they had access to.
According to Matshidiso Moeti, WHO Regional Director for the Africa Section, the Marburg virus can “easily get out of hand“ without immediate containment but, both in the weeks before and after, “the health authorities (in Ghana, ed) responded quickly, obtaining an advantage in preparing for a possible outbreak”.
In fact, as reported by the Ghana Health Service, the 98 people who have had contact with MVD positive patients are currently monitored, after being placed in quarantine. The goal, of course, is to contain further spread of the virus.
Symptoms of the Marburg virus: how MVD manifests itself in patients
There is no vaccine or cure for the Marburg virus, the treatments used so far – such as rehydration with oral or intravenous fluids – can only increase the chances of survival. In fact, the supportive therapy aims to accompany the patient until the virus is spontaneously eradicated.
What we do know is that it is a zoonotic disease, so it can be transmitted from animals to humans, so the chances of death are up to 88%. The human-to-human transmissionon the other hand, it can occur through body fluids (between people), but also if one comes into contact with infected surfaces and materials, while the period of incubation can vary from 2 to 21 days.
In the two patients who died in Ghana, according to the WHO, the virus manifested itself with the most common ailments, namely diarrhea, fever, nausea and vomiting. THE symptoms of the Marburg virus include:
- fever;
- bloody diarrhea;
- bleeding from the gums, skin, or eyes;
- urine sanguinolente.
Previous Marburg outbreaks have been observed elsewhere in Africa, according to the World Health Organization, specifically in Guinea, Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.
The clinical course, according to the European Center for Disease Prevention and Control, can be divided into three stages:
- the first generalized phase (from 1 to 4 days);
- the early stage (from 5 to 13 days);
- the last late or convalescent phase (more than 13 days).
Survivors rarely developed more severe symptoms of the disease and in many cases never reached the late stage. Those who are not dead, therefore, have not actually seen their clinical condition worsen until the last stage.
In initial phase the way in which the MVD virus manifests itself is abrupt, with nonspecific symptoms similar to the flu but much more aggressive such as: high fever (usually 39–40 ° C), severe headache, chills, myalgia, prostration and malaise. In addition, 50-75% of patients reckon with rapid debilitation, characterized by gastrointestinal disturbances such as anorexia, abdominal pain, severe nausea, vomiting and diarrhea, within 2-5 days.
The intensity of the disease increases on days 5-7, with a maculopapular rash and symptoms of hemorrhagic fever, such as petechiae, mucosal and gastrointestinal bleeding, and bleeding from venipuncture sites. Neurological symptoms (disorientation, agitation, convulsions and coma) can manifest themselves in the later stages. Joint pain, uveitis, orchitis, recurrent hepatitis, pericarditis and mental dysfunction have been documented instead as complications during convalescencewhich can be slow.
MVD outbreak: what are the risks for public health (and for Italy)?
As reported in ECDC guidelinesper keep the MVD epidemic under control direct human-to-human transmission must be stopped. A bit like we learned with the management of Covid (by the way, here the latest news on the virus in Italy), the best way to block the spread is early diagnosis and rapid systematic isolation of cases, with timely contact tracing. and close monitoring of those at risk, as well as adequate personal protection, safe burials, and better community awareness of infection risk factors.
Isolation of infected patients, combined with adequate prevention and control measures of infections, has already been shown to effectively stop the spread in previous outbreaks.
As with Sars-Cov-2, all people working in the area of isolationlaunder potentially infected linen, disinfect objects or houses or come into contact with patients, must wear personal protective equipment (staying on the subject of masks, here how the rules have changed).
As soon as the diagnosis of MVD is suspectedpatients must be separated in a single room with separate bathroom according to the VHF protocol (available here) and all necessary safety measures and anti-contagion rules must be respected.
Under the heading “viral haemorrhagic fevers” (VHF) a number of diseases are included, with differences in virus type, geographic distribution, incidence, reservoir, mode of transmission and clinical symptoms. The common denominator is the possible emergence of a disease with general bleeding, often leading to death, but another common feature is the potential risk for close contacts and for healthcare and laboratory personnel.
Fortunately, most of these viruses are not easily transmitted (with the exception of the yellow fever virus and the Dengue virus which are spread through infected mosquitoes). To date, the African health authorities and the WHO have made it known that they have responded promptly to the spread of the virus in Ghana, taking steps to isolate both confirmed and suspected cases as much as possible, so as to be able to circumscribe the outbreak and contain it.