CDC Alerts Docs to Watch for Potential Imported Marburg Cases

While there have been no confirmed cases of Marburg virus disease (MVD) outside Equatorial Guinea and Tanzania, clinicians and public health experts should be aware of the potential for imported cases, the CDC said.

In a Health Alert Network advisory, the agency said that it is important for clinicians to assess patients for the possibility of viral hemorrhagic fevers -- including MVD or Ebola -- through a triage and evaluation process that includes a detailed travel history.

"Early identification of MVD or other viral hemorrhagic fevers is important for providing appropriate and prompt patient care and preventing the spread of infection," the CDC stated. "Recent presence in Equatorial Guinea or Tanzania should not be a reason to defer routine laboratory testing or other measures necessary for standard patient care."

The agency did note that there is no evidence to suggest that current outbreaks of MVD in Equatorial Guinea and Tanzania are related, and that most experts agree the two situations represent independent animal-to-human spillover events.

As of April 5, a total of 14 lab-confirmed cases of MVD have been identified in Equatorial Guinea, with 10 of those fatal, according to the CDC. Eight lab-confirmed cases of MVD have been reported in Tanzania as of the same date. And five were fatal.

The current outbreaks do mark the first time Marburg virus has been identified in either country; the pathogen has been previously identified in neighboring nations, the CDC said. Additionally, its reservoir, the Egyptian fruit bat, is known to be present in both Equatorial Guinea and Tanzania.

Though rare, MVD is a highly fatal viral hemorrhagic fever, CDC officials said. An individual is not contagious until symptoms -- which may include fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding -- appear.

"Marburg virus is spread through contact (through broken skin or mucous membranes) with the blood or other body fluids (including urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, or semen) of a person who is sick with or has died from MVD, with the body fluids of infected animals, or with needles or other fomites that are contaminated with the virus," the CDC explained. "Marburg virus is not spread through airborne transmission."

There is currently no FDA-approved vaccine or treatment for MVD. Without early diagnosis and appropriate supportive care, MVD has a mortality rate of 23% to 90%.

As for what actions clinicians are advised to take, the CDC said that MVD should be included as a differential diagnosis for an ill patient with a history of a concerning exposure while in an affected area. If a patient is determined to meet criteria for Marburg virus testing, the patient is considered a suspected case of MVD and should be managed under isolation precautions until receiving a negative test result on a sample collected more than 72 hours after symptom onset, the agency said, adding that Marburg virus diagnostic testing should not be delayed while awaiting results of other testing.

Clinicians with concerns regarding a patient with suspected MVD should contact their jurisdictional health department immediately and follow protocols for patient assessment, the CDC added. "If a diagnosis of MVD is considered, jurisdictional officials will work with the CDC and the clinical team to coordinate care and testing for the patient and ensure appropriate precautions are taken to help prevent potential spread," the agency stated.

Hospitals are advised of infection prevention and control measures, including the use of personal protective equipment (PPE), care considerations, and the placement of patients in an isolated and private room with a private bathroom or covered bedside toilet.

And for public health departments, the CDC said that its Viral Special Pathogens Branch is available 24/7 for consultations about MVD or other viral hemorrhagic fevers by calling its Emergency Operations Center. Clinical laboratories can safely perform common diagnostic testing for individuals with suspected MVD, the agency added, by following the Standard Precautions for All Patient Care and Universal Precautions for Preventing Transmission of Bloodborne Infections.

In its alert, the CDC also cautioned the public, reiterating that MVD is serious and often deadly. The agency stated that there are ways to protect oneself and prevent spread when living or traveling to a region where Marburg virus is potentially present, or where an outbreak of MVD is occurring. That includes avoiding contact with blood and body fluids of people who are sick, funeral or burial practices that involve touching the body of a person who died from suspected or confirmed MVD, and contact with fruit bats and nonhuman primates.

After returning from an area experiencing an outbreak of MVD, individuals should monitor their health for 21 days, the CDC said, and should seek medical care immediately if they develop symptoms of the hemorrhagic fever.

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