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Uganda Marburg Update – 14/10/2014

In the heat of the media hype surrounding the Ebola outbreak it is possible that the Marburg outbreak in Uganda could be forgotten. Marburg is similar to Ebola although generally considered less lethal. On the 28th of September 2014 the first victim in Uganda died generating more than 100 contacts for surveillance. Updates from the region are spotty at best and often contradictory. The following update is based only on information with multiple sources.

  • Five Ugandans are in isolation with no confirmations that Marburg has spread.
  • Up to 149 contacts are being monitored for the virus.
  • The nurse responsible for treating the first patient has tested negative to date.
  • Kenya has placed health officials at key border points to monitor border crossings
  • A possible second outbreak is being investigated and two patients have been isolated
  • It is not clear how the index patients became infected. It is thought that previous outbreaks resulted from contact with Bat guano.
  • On the weekend several tweets indicated that a second Marburg death had occurred. The Ministry has claimed the suspected patient died of “liver failure”.
  • The World Health Organization has confirmed the outbreak and is monitoring the situation.
  • Reports that at least 8 people developed symptoms have been denied by the official Health Ministry.

Uganda has extensive experience in dealing with Marburg. They recently brought an outbreak under control in 2012 as well as on several occasions before that. The virus displays similar symptoms to Ebola with the largest outbreak recorded in Angola during 2004 and 2005 where 252 cases were confirmed.

Ebola and Marburg outbreaks have occurred across the region in the past resulting in well established protocols and procedures for dealing with contagious diseases. If no new cases are reported by the 20th of October it is likely that the outbreak will be declared over by mid November 2014.

Uganda – Marburg Outbreak

Marburg is a close relative of the Ebola virus with several similarities including a terrify fatality rate above 80%. State officials in Uganda announced yesterday a confirmed death related to the deadly virus in Kampala marking the first reported case since 2012 when the last outbreak occurred in the region.

The index case is a Health Care worker who developed symptoms last week. Samples sent for testing confirmed that Marburg was responsible. According to the Ugandan government at least 80 contacts have been identified and are being traced. The brother of the first case in 2014 has developed symptoms and has been placed in isolation while awaiting test results. No details are available surrounding the source of the transmission to the index case.

Marburg and Ebola are both Filoviridae and considered to be extremely lethal. The World Health Organization classifies any Filovirus as Bio-Safety Level 4. Marburg like Ebola typically causes viral hemorrhagic fever marked by the onset of headaches and fever before rapidly accelerating toward complete destruction of the host’s cellular system.

A key difference between Marburg and Ebola is the incubation time. Marburg has a typical incubation time of 2 weeks while Ebola has been documented to have an incubation time as long as 3 weeks. Marburg was first observed in 1967 when it infected 31 individuals across then West Germany and former Yugoslavia claiming 7 lives. The former Soviet Union famously experimented with Marburg (MARV) as a potential bio weapon.

The 2014 Ugandan outbreak is the 3rd active outbreak in 2014 attributed to a Filovirus, The Ebola outbreak in West Africa is not related to the outbreak in the Democratic Republic of Congo and therefore counts as separate epidemics.  At present no cause or reason for the increased number of outbreaks is known and can be considered mere coincidence.

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