Overview
Marburg Virus Disease (MVD) is a rare and severe hemorrhagic illness caused by the Marburg virus. MVD occurs in sub-Saharan Africa. It affects people and nonhuman primates, such as monkeys. Between 20-90 percent of people with the disease will die.
On December 20, 2024, the Government of Rwanda declared the outbreak of Marburg Virus Disease over following the recovery of the last patient 42 days ago. There were no cases of MVD in Virginia or the United States.
For more information on this outbreak, see the outbreak section below.
Frequently Asked Questions
Marburg Virus Disease (MVD) is a rare and severe hemorrhagic illness caused by the Marburg virus. MVD occurs in sub-Saharan Africa. It affects people and nonhuman primates, such as monkeys. Between 20-90 percent of people with the disease will die.
Currently, there are no cases of Marburg in Virginia or the United States. The risk of infection with this virus in the United States is low.
MVD symptoms start 2-21 days after exposure to the virus. Early symptoms include:
- Fever
- Chills
- Headache
- Muscle aches
- Rash with both flat and raised bumps, often on the torso
- Chest pain
- Sore throat
- Nausea, vomiting, and diarrhea
As the disease advances, symptoms can become more severe, including liver failure, delirium, shock, bleeding (hemorrhage), and multi-organ dysfunction.
MVD occurs in sub-Saharan Africa. People become infected when they come into close contact with Egyptian rousette bats that are often found in mines or caves.
MVD can then spread from person to person through direct contact with blood or body fluids. Body fluids that can spread MVD include urine, feces, saliva, sweat, vomit, breast milk, and semen. Only body fluids or items contaminated with the body fluids of a person who is sick with or has died from MVD can spread the virus. For example, medical equipment, needles, and syringes that have been contaminated can spread the illness. The virus enters the body through broken skin or through the eyes, nose, or mouth.
The risk of infection with this virus in the United States is low.
- Follow travel recommendations when traveling to areas where Marburg virus is found.
- Travel alerts and recommendations can be found on the CDC Traveler’s Health webpage.
- Avoid contact with blood and body fluids of people who are sick.
- Avoid contact with semen from a person who recovered from Marburg until testing shows that the virus is gone from their semen.
- Do not handle items that may have come in contact with an infected person's body fluids.
- Avoid contact with Egyptian rousette bats and non-human primates if in areas where Marburg virus is found.
- There is currently no FDA-approved vaccine for MVD. However, the U.S. Administration for Strategic Preparedness and Response (ASPR) has distributed a candidate MVD vaccine for use in people at high risk of MVD (e.g., healthcare workers, contacts of people with MVD) during the 2024 Marburg outbreak in Rwanda. The same candidate vaccine from the Sabin Vaccine Institute is also being studied in a clinical trial in Uganda and Kenya
Currently, there are no licensed treatments specific for MVD. Treatment is limited to supportive care such as rest, fluids, managing oxygen status and blood pressure, and treating secondary infections.
2024 Outbreak in Rwanda
- On September 30, CDC announced that the Republic of Rwanda confirmed its first outbreak of MVD and issued a travel notice (Level 2, Practice Enhanced Precautions).
- On October 3, CDC issued a HAN Health Advisory to summarize CDC’s recommendations for public health departments, healthcare workers returning from work in Rwanda, and clinicians.
- On October 7, CDC raised the travel notice to all of Rwanda. This means that people should avoid nonessential travel to the country of Rwanda.
- On October 16, all U.S.-bound travelers who have been in Rwanda in the past 21 days are being routed to one of three airports for enhanced screening: Washington-Dulles International Airport (IAD), JFK International Airport in New York City (JFK), or Chicago O’Hare International Airport (ORD). VDH staff will assess travelers arriving in Virginia who were in Rwanda and might have been exposed to MVD in the previous 21 days. These travelers will be monitored for symptoms of MVD.
- On November 9, WHO announced the start of a 42-day countdown to declare the end of the outbreak. This happened after the last patient tested negative for MVD.
- On December 5, the U.S. Government stopped redirecting airline travelers from Rwanda to select U.S. airports.
- On December 20, the outbreak was declared over. No cases were reported in the United States.
- VDH is raising awareness of this outbreak by sharing information with the public and healthcare providers and training VDH staff.
- Issued a Clinician Letter for healthcare providers.
- While travelers from Rwanda were being redirected to IAD airport, VDH provided education to airline travelers who recently entered Virginia from Rwanda and monitored the health of travelers who might have been exposed to MVD while in Rwanda.
- VDH is updating plans, procedures, guidance, and resources for staff and partners who are conducting surveillance and traveler monitoring or who are preparing for a possible case.
- VDH is actively engaging with partners, including DCLS, hospitals designated to assess or treat patients with MVD or other special pathogen infections, VHHA, Dulles International Airport, and CDC.
- VDH has issued a Declaration of Marburg Virus Disease as a Communicable Disease of Public Health Threat for Virginia to help with issuing isolation or quarantine orders, if needed, to control MVD in Virginia.
Information for Healthcare Professionals
Most febrile patients presenting in U.S. healthcare facilities do not have MVD. But early symptoms of MVD are like other febrile illnesses, including malaria. Early consideration of MVD in the differential diagnosis is important. Systematically assess patients for the possibility of MVD through a triage and evaluation process.
- Get a thorough travel history for all acutely ill patients returning from an area with an active MVD outbreak.
- Look for epidemiologic risk factors in all travelers returning from areas with an active MVD outbreak. If an acutely ill patient has any of these risk factors, isolate them and begin immediate infection prevention and control measures. Important epidemiologic risk factors include:
- Having a percutaneous or mucus membrane exposure to blood or body fluids from someone with known or suspected MVD
- Having direct contact with a person (alive or deceased) with known or suspected MVD
- Living in the same household as someone with known or suspected MVD
- Being present in a Rwandan healthcare facility, including an out-patient facility or traditional healer
- If exposure criteria are met, ask about signs or symptoms compatible with MVD.
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- Take action if the patient evaluation indicates possible MVD.
- Identify. Clinicians should be prepared to promptly identify MVD cases and be familiar with appropriate screening questions and signs and symptoms.
- Isolate the patient in a single room with a private bathroom or covered, bedside commode.
- Adhere to infection prevention and control procedures to prevent transmission through direct or indirect contact, including wearing appropriate PPE and using dedicated equipment.
- Use only essential healthcare workers trained in their designated roles for patient care and keep a log of everyone who enters and leaves the patient’s room.
- Perform only necessary tests and procedures and avoid aerosol-generating procedures.
- Inform. Immediately notify your facility’s Infection Prevention and Control Program, other healthcare personnel, and the local health department of a suspected MVD case. Contact your local health department for consultation about testing for MVD.
- Initiate. Rapidly initiate stabilizing medical care. Utilize resources and guidance to provide advance training to medical staff about how to provide care for a patient with suspected MVD.
- If Marburg virus testing is approved by VDH and CDC, the provider should collect specimens for DCLS and DCLS will test the patient’s specimens. CDC will perform confirmatory testing, if needed.
- If a patient is determined to meet criteria for Marburg virus testing, the patient is considered a suspect case-patient and should be managed under isolation precautions until receiving a negative Marburg virus test result on a sample collected more than 72 hours after the patient first developed symptoms.
- Routine testing to monitor the patient’s clinical status and diagnostic testing for other potential causes of the patient’s illness should be pursued while Marburg virus testing is underway.
- If a hospital facility is unable to provide appropriate clinical care and laboratory diagnostic testing for a suspect case of Marburg disease, the patient should be transferred to a facility that is able to provide appropriate management until Marburg virus testing is completed.
- VDH Clinician Letter - Marburg Virus Disease Update
- VDH Office of Emergency Services information on Viral Hemorrhagic Fever
- VDH Marburg Virus Disease Preparedness for Frontline Facilities – webinar 11/12/2024
- DCLS Ebola and Marburg Testing and Shipping Instructions
- CDC Marburg Virus Disease for Healthcare Providers
- CDC Clinical Screening and Diagnosis for Viral Hemorrhagic Fevers (VHFs)
- CDC HAN Health Advisory: First Marburg Virus Disease Outbreak in the Republic of Rwanda
- CDC Interim Recommendations for Public Health Management of U.S.-based Healthcare Personnel Returning from Rwanda
- CDC Evaluating an Ill Person for a Special Pathogen
- CDC Guidance on Performing Routine Diagnostic Testing for Patients with Suspected VHFs or Other High-Consequence Disease
Contacts
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