Health alarms have been raised across Europe after two suspected cases of Marburg virus emerged in Hamburg, Germany. On October 2, two passengers arrived by high-speed train at the city’s central station, a 20 year old medical student and his girlfriendwere hospitalized after experiencing symptoms similar to the virus, such as high fever and general malaise.
Both had come from Rwanda, countries experiencing an active outbreak of the diseasewith 29 confirmed cases and 11 deaths since the end of September.
The Marburg virus, from the same family as Ebola, is very contagious and can cause hemorrhagic fever, organ failure and a mortality rate of up to 88% depending on the strain. Transmission occurs primarily through direct contact with bodily fluids of infected people or contaminated surfaces. There are currently no approved treatments or vaccines for the disease.
German authorities have isolated the patients and are closely monitoring passengers who shared the train with them as a preventative measure. The two people hospitalized include to one who worked in a hospital in Rwanda, deepening concerns about the possible spread of the virus in Europe.
This virus was first identified in Germany in 1967 and has sporadically affected the European continent, but it continues to pose a considerable threat due to to its great lethality and rapid propagation capacity. These characteristics require strict monitoring by European health authorities to prevent possible epidemics and control their expansion.
Marburg virus
The mortality rate for Marburg virus disease (MVD), which causes the virus of that name, is as high as 88%, but could be much lower if patients were properly treated. VMD was first identified in 1967, after simultaneous outbreaks in Marburg and Frankfurt (Germany) and Belgrade (Serbia).
Although Marburg and Ebola viruses are different viruses, they both belong to the Filoviridae family. and cause diseases with similar clinical characteristics. Both are rare, but mortality rates from their outbreaks can be high.
Two large epidemics occurring simultaneously in Marburg and Frankfurt (Germany) and in Belgrade (Serbia) in 1967 made it possible to identify the disease for the first time. These outbreaks were associated with laboratory work carried out on African green monkeys (Cercopithecus aethiops) imported from Uganda. Subsequently, outbreaks and sporadic cases were reported in Angola, Kenya, Democratic Republic of Congo, South Africa (in a person who recently traveled to Zimbabwe) and Uganda. In 2008, two independent cases were reported in travelers who visited a cave inhabited by colonies of Rousettus bats in Uganda.
Transmission
Initially, human EVM infection is caused by prolonged stay in mines or caves inhabited by colonies of Rousettus bats.
Transmission between people occurs through cDirect contact of damaged skin or mucous membranes with blood, secretions, organs or other bodily fluids of infected persons, as well as with surfaces and materials contaminated with these fluids, such as personal clothing or bedding.
Symptoms of EVD
The incubation period (i.e. the interval between infection and the appearance of symptoms) varies between 2 and 21 days.
EVD begins suddenly, with high fever, severe headache and discomfort, and frequent muscle pain. On the third day, severe watery diarrhea, abdominal pain and cramps, nausea and vomiting may appear. Diarrhea may persist for a week. In this phase, patients were described as having a “ghostly appearance” due to their sunken eyes, lack of facial expression, and extreme lethargy.
Many patients experience severe hemorrhagic manifestations within 5 to 7 days, and fatal cases usually present with some form of hemorrhage, often in multiple organs. The presence of fresh blood in vomit and stools is often accompanied by nosebleeds.gums and vagina. Spontaneous bleeding at venipuncture sites where fluids are administered or blood samples are collected can be particularly problematic. During the severe phase of the disease, patients constantly have high fever. Involvement of the central nervous system can cause confusion, irritability and aggression. 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 significant blood loss and shock.
