The World Health Organization (WHO) on 17 July 2022 declared Marburg virus disease (MVD) outbreak following confirmation of two cases from the Ashanti region in Ghana. After the initial discovery in Guinea in 2021, this infectious disease with serious consequences has now been found twice in West Africa. The Marburg virus was discovered in 1967, following outbreaks in two German cities (Marburg and Frankfurt) and Belgrade, Serbia’s capital. Since then, there has been reported outbreaks in South, East and more recently West Africa.

So far, Nigeria has not reported any case of Marburg virus disease however, because of her proximity with Ghana and high influx of cross border travel, there is a moderate risk of importation of the disease with potential impact on the Nigerian population. Thus, there is a need for enhanced surveillance and vigilance especially at the points of entry.

About Marburg virus disease

Marburg virus disease is a rare, zoonotic disease (primarily transmitted from animals to humans) caused by the Marburg virus, a viral haemorrhagic fever belonging to Filoviridae family with Ebola virus, a similar disease. Outbreaks has been reported in several African countries. The most recent outbreaks have been in the West African countries of Guinea (2021) and now Ghana (2022).

Transmission of the virus to humans occur through contact with infected animals and humans and from viral-contaminated environment/materials. The natural animal reservoir/host are fruits bats. The initial symptoms of the disease include high fever, malaise, headache, chills which may be accompanied by a rash, most prominent on the chest, back and abdomen, sorethroat, nausea/vomiting and abdominal pain by the fifth day of illness. Severity of illness may be worsened by the appearance of watery diarrhoea, jaundice, severe weight loss, bleeding from multiple areas, delirium, shock, massive haemorrhage and multiorgan dysfunction/failure. Death typically occurs between 8 and 9 days after the onset of symptoms. The case fatality rate for MVD ranges from 24 to 88 percent. There are currently no available treatments or vaccines for MVD. The treatment of infected patients is symptomatic and supportive. Early detection and treatment produce superior outcomes.

Advisory for healthcare workers and healthcare facilities

Healthcare workers (HCW) are at risk of MVD during care of patients, especially if recommended infection prevention and control practices are not observed. The NIDS enjoins HCW and health facilities to: (i) Review institutional preparedness to care for suspected MVD patients. (ii)Train hospital staff on recognition, isolation and other aspects of infection prevention and control-relating to MVD (iii.) Train and designate staff who can provide care to patients with suspected or confirmed MVD. (iv) Observe strict contact and droplet precautions during care of patients with suspected or confirmed MVD. (v) Establish protocols for referral, and reporting cases to the designated Federal, State and/or Local Government Area Public Health Departments immediately, or directly call NCDC toll free line on 6232.

Advisory for the general public

MVD presents with a symptomatic illness in majority of infected individuals. The public is advised not to spread fear, misinformation, and misconceptions about MVD, and to always seek accurate and updated information about MVD from established sources such as the publications from the various Ministries of health, NCDC, and World Health Organization, among others. They should avoid non-essential travels to locations where an outbreak has been reported and contact with the animal reservoir. Members of the public should take responsibility for their health, practice good personal hygiene, especially regular washing of hands with soap and water or use of alcohol-based hand sanitizers as necessary, and immediately report to the nearest hospital for appropriate diagnosis should they develop any fever and bleeding from any orifice. Male survivors of MVD are advised to practice safer sexual activities for 1 year from the onset of symptoms or until their semen test negative twice for the virus. Consequently, the public is advised to always seek advice from certified health workers and hospitals should they have any concerns about MVD.

Advisory for States and Federal Governments
Federal and state Governments are advised to heighten awareness creation, and risk communication relating to Marburg virus disease, and to invest in Marburg virus-related surveillance, diagnostic and research. The Federal Government through the NCDC, National Primary Healthcare Development Agency, NAFDAC, and other related agencies, should explore procurements of Marburg virus disease related therapeutics and vaccines for Clinical trials or Emergence Use Authorization in Nigeria, as necessary.
National and international health authorities and stakeholders should consider access, equity and cost in the development and deployment of the various medical countermeasures for Marburg virus disease prevention and control.

About the NIDS
The Nigerian Infectious Diseases Society (NIDS) is a multi-disciplinary professional society established to advance the prevention and control of infectious diseases in Nigeria. We are actively involved in advocacy, education, training, research, and partnerships to expand the understanding and the prevention and control of infectious and communicable diseases in Nigeria.
More on the NIDS:

Prof. Dimie Ogoina                                                                                         Dr. Iorhen E. Akase
President, NIDS                                                                                              Chairman, Epidemic Response Committee, NIDS