Recent report of novel Marburg virus disease (MVD) outbreak across the world

Highlights The Marburg virus (MARV), a member of the Filovirus family of RNA viruses, causes a severe haemorrhagic fever. Equatorial Guinea reported on February 7, 2023, the deaths of a number of individuals with suspected haemorrhagic fever. Since the epidemic began, there have been 40 confirmed Marburg virus disease (MVD) cases, with 35 fatalities. Effective vaccines, drugs and treatments are not presently available for MVD. Remdesivir and favipiravir, both of which were first studied for Ebola virus disease (EVD), may be studied for MVD or used under compassionate use/expanded access if authorized by the FDA. Dear Editor, The Marburg virus (MARV), a member of the Filovirus family of RNA viruses, causes a severe haemorrhagic fever known as Marburg virus disease (MVD), which can be lethal with case-fatality ratio (CFR) of up to 88% in both humans and non-human primates1. According to the most recent reports, Equatorial Guinea has been infected with an unknown, fatal haemorrhagic fever; as a consequence, neighbouring Cameroon has restricted border crossings in an attempt to control the disease2. On February 13, 2023, young males and females, both 16 years old, with no known exposure to Equatorial Guinea’s endemic areas, were screened for the virus. A total of 42 persons who had contact with the two children were identified, and more investigations are underway3. The Kié-Ntem area of north-western Equatorial Guinea, which shares borders with Cameroon and Gabon, is now experiencing an outbreak. Since the first case was recorded in early January 2023, there have been a total of 25 suspected cases, 9 of which have resulted in death4. Equatorial Guinea reported on February 7, 2023, the deaths of a number of individuals with suspected haemorrhagic fever, and subsequently, one sample tested positive for MARV by real-time polymerase chain reaction (RT-PCR). The cumulative number of cases was nine on February 21, 2023, including one confirmed case, four probable cases and four suspected cases with the death of all the cases, while over 200 people have been quarantined in Equatorial Guinea. Contact tracing is being followed up. Risk assessment posed by this most recent and first MVD outbreak in Equatorial Guinea seems to be high at the national level, moderate at the regional level and low at the global level5. Since the epidemic began, there have been 40 confirmed MVD cases, with 35 fatalities. If no further cases emerge, the epidemic will be declared finished on June 1, 2023, 42 days after the last known person was discharged from the hospital6. Spain also has a suspected MVD case; however, the 34-year-old male who had visited Equatorial Guinea tested negative for MARV7. Many patients have severe haemorrhagic symptoms between days 5 and 7, and in fatal instances, bleeding is almost always present, often from numerous places of the body. Fever is common in severe cases. Damaged brains may cause unreasonable or violent behaviour. At this late stage, orchitis (testicular inflammation) is unusual (15 days). Clinically, MVD may be difficult to differentiate from other infectious diseases and viral haemorrhagic fevers. To establish that symptoms are caused by MVD, antigen capture ELISA (enzyme-linked immunosorbent assay), serum neutralisation test, RT-PCR assay, and virus isolation by cell culture are conducted8. Due to the high potential for this infectious disease transmission, testing on non-inactivated patient samples in the lab requires the highest levels of biological containment facilities (BSL-4 laboratories). Effective vaccines, drugs and treatments are not presently available against MVD. Survival rates may be improved, however, by supportive therapy by administering fluids orally or intravenously and treating associated symptoms. Remdesivir and favipiravir, both of which were first studied for Ebola virus disease (EVD), may be studied for MVD or used under compassionate use/expanded access if authorized by the FDA. In May 2020, the EMA – European Medicines Agency approved both Zabdeno (Ad26.ZEBOV) and Mvabea (MVA-BN-Filo) as preventatives against EVD. Genetic engineering was used to produce four proteins from the Zaire ebolavirus and three other related viruses, resulting in Vaccinia Ankara Bavarian Nordic (MVA) (Filoviridae)4. Considering the recent three MVD outbreaks during 2021–2023 in Guinea (2021), Ghana (2022) and presently in Equatorial Guinea (2023), along with past outbreaks and being a highly contagious and deadly disease, there is an urgent need to strengthen laboratory facilities, early diagnosis, enhancing surveillance and monitoring, and follow timely contact tracing2. Besides a better understanding of this disease, developing efficacious vaccines, drugs and therapies are of utmost importance. Additionally, in-depth disease investigations, case management studies, adopting adequate infection prevention and control measures, risk communication, community engagement and enhancing awareness, and implementation of one health approach more effectively are all very crucial to counteract MARV transmission and spread before it could pose dangers of global public health concerns amid the ongoing Monkeypox global health emergency and COVID-19 pandemic9. Ethical approval Ethics approval was not required for this Correspondence article. Consent Informed consent was not required for this Correspondence article. Sources of funding No funding. Author contribution R.A.: conceptualization, data curation, writing – original draft preparation, reviewing, and editing; S.C. and G.S.: data curation, writing – original draft preparation, reviewing, and editing; K.D., R.D., S.A.A., and T.B.E.: writing – reviewing and editing, visualization, and supervision. Conflicts of interest disclosure There are no conflicts of interest. Research registration unique identifying number (UIN) Not applicable for this Correspondence article. Guarantor Talha Bin Emran, PhD, Associate Professor, Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh; Tel: +88 030 3356193, fax: +88 031 2550224, Cell: +88 01819942214; https://orcid.org/0000-0003-3188-2272; E-mail: [email protected]. Provenance and peer review Not commissioned, internally peer-reviewed. Data availability statement Not applicable to this article.