Marburg Virus Infection
Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford; Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Associate Editor for Infectious Disease Alert
In 1967, in Marburg, a medieval university town north of Frankfurt, Germany, on the Lahn River, several employees of a Behringwerke AG, a manufacturer of vaccines, were hospitalized at the University Medical Clinic with a severe influenza-like illness.1
Each had had contact with African green monkeys (vervets), a source of kidney cells for polio vaccine production, which had recently been imported from Uganda. More than a dozen additional patients were subsequently admitted with similar symptoms, and a physician and a nurse at the hospital also became ill. At the same time, similar cases were being seen in Frankfurt and in Belgrade in individuals who had also been exposed to monkeys from Uganda. Many of the 31 total cases developed evidence of hemorrhage, and 7 died.
Dr. Gustav Martini in Marburg collected samples from some of the patients and, with his colleagues, visualized a virus that had grown in tissue culture with a novel filament-like appearance. This was the first sighting of a filovirus, and it was named after the city in which it was discovered.
Before 2004, only 3 subsequent outbreaks of Marburg virus infection were identified, with the only sizable event occurring in 1998-2000 in Congo, when 123 of 149 cases were fatal.2,3 However, an outbreak emerged in October, 2004, in northwestern Angola. That outbreak has continued and, as of April 7, 2005, has affected 205 individuals, 180 (88%) of whom have died. Among the fatalities, are 14 health care workers. Approximately three-fourths of cases occurred in children less than 5 years of age. While the epicenter is in Uige Province, 6 additional provinces have been affected.
The panic in affected areas has led to attacks on mobile surveillance teams who were forced to temporarily suspend operations in 1 area on April 7th. Residents were refusing to allow relatives to be taken to hospital, and it appears their decision may have been correct. The New York Times reported on April 9th that Médecins Sans Frontières has requested that the Angolan government shutter the regional hospital in Uige, as well as possibly 2 other hospitals, because they believe it is the hospital that is "feeding the infection."
The only other known filovirus is ebola, which causes a clinically indistinguishable disease. Marburg, like ebola, is a zoonosis, but its natural reservoir remains undetermined, although some evidence points to bats. Human-to-human transmission probably results from contact with body fluids.
While Marburg virus infection is a fearsome disease, it is important to put it into proper perspective. As is stated on the web site of the US embassy in Luanda, "More people die from malaria in 1 day in Angola than have died from hemorrhagic fever in the 6 months since the first Marburg case in occurred in Uige province".4
References
- Peters CJ, Olshaker MIn, Virus Hunter: Thirty Years of Battling Hot Viruses Around the World. Anchor Press. 1998;216-218.
- www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/filoviruses.htm - top
- www.who.int/csr/don/2005_04_08a/en/
- usembassy.state.gov/angola/wwwhfactsaboutmarburg.html
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