Marburg virus disease
What do health professionals need to know about Marburg virus disease?
Health professionals in Canada are advised to be vigilant for the recognition, reporting and prompt investigation of patients with symptoms of Marburg virus disease and other similar diseases that can cause viral haemorrhagic fevers.
Person-to-person transmission of the Marburg virus is primarily associated with direct contact with blood and body fluids, and people remain infectious as long as their blood contains the virus, including after death. Notably, infection may be transmitted through the semen of men who have recovered from Marburg virus disease. Health professionals caring for patients with suspected or confirmed Marburg virus disease should apply strict infection control precautions.
The decision for specimen collection and testing should rely on:
- the clinical status of the patient (compatible clinical presentation)
- the risk of exposure (epidemiological factors)
Mishandled specimens from patients under investigation for Marburg virus disease are a serious risk to all, including laboratory personnel. Before accepting samples and proceeding with testing, laboratories receiving specimens from patients under investigation for Marburg virus disease should consult the Biosafety Guidelines for Laboratories Handling Specimens from Patients Under Investigation for Ebola Disease.
Virus cultures for Marburg viruses should not be attempted outside of the biosafety level 4 containment laboratories at the National Microbiology Laboratory (NML).
For diagnostic or confirmatory services for Marburg viruses, liaise with the provincial public health laboratory of your jurisdiction. The provincial public health laboratory should coordinate with the NML Operations Centre Director at 1-866-262-8433. This number is staffed at all times.
The NML Operations Centre Director will:
- work with the requesting provincial or territorial jurisdiction to activate the Emergency Response Assistance Plan
- connect you with the appropriate subject matter expert if you require assistance with:
- sample requirements
- sample packaging
- sample shipping conditions
- the shipping process
Clarification or further information may be requested from the patient's clinician to optimize delivery of requested laboratory services.
Patients under investigation for Marburg virus disease should be reported immediately to local public health authorities. This is a requirement as per jurisdictional protocols in Canadian provinces and territories.
Provinces and territories are required to report cases to PHAC by contacting the Health Portfolio Operations Centre (HPOC) at 1-800-545-7661.
A case is said to be confirmed when the patient presents clinical signs of the disease, one of the epidemiological factors mentioned below (probable case) has occurred and is positive to a PCR test performed by the NML.
- A Marburg virus disease case can only be confirmed through laboratory testing at the Agency's NML.
A probable case is defined as one with clinical evidence of illness and a history within the three weeks before onset of fever of one of the following:
- travel in a specific area of a country where an outbreak of Marburg virus disease has recently occurred
- contact with a suspect, probable or confirmed case of Marburg virus disease
- direct contact with blood or other body fluid secretions or excretions of a person or animal with a confirmed or probable case of Marburg virus disease
- work in a laboratory or animal facility that handles haemorrhagic fever viruses
Clinical manifestations include severe acute viral illness consisting of sudden onset of fever, malaise, myalgia, headache, conjunctival injection, pharyngitis, vomiting and diarrhea that can be bloody.
It is often accompanied by a maculopapular or petechial rash that may progress to purpura. Haemorrhage (such as hematemesis, bleeding from injection sites, gastrointestinal bleeding) may occur around 5-7 days after initial symptom development, however, it is not present in all cases. Dehydration and significant wasting occur as the disease progresses.
In severe cases, leucopenia, thrombocytopenia, hepatic, renal and central nervous system involvement, or shock with multi-organ dysfunction, and death may occur.
There is no specific treatment or vaccine for Marburg virus disease.
Patients are treated for their symptoms. Treatment options include:
- supportive care in an intensive care unit
- maintenance of fluid levels and electrolytes
- maintenance of oxygen status and blood pressure
- replacement of lost body fluids, blood and/or clotting factors
- strict isolation to prevent the infection from spreading
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