Marburg Disease Outbreaks

Marburg Virus Disease Outbreaks

Marburg virus is a Filovirus disease (MVD) that causes a severe and often fatal (up to 88%) viral hemorrhagic fever (VHF) infection. MVD was observed for the first time in 1967 during an outbreak in Marburg a der Lahn and Frankfurt am Main, West Germany. Twenty-nine people developed clinical signs, and seven eventually died. Before developing the disease, all primary MVD cases directly interacted with grivets imported from Uganda or with grivet-derived tissues. 

A systematic review published by The Lancet in November 2023 and the accompanying database provide a comprehensive overview of Marburg virus disease epidemiology and identify critical knowledge gaps. Research presented detailed information on 478 reported cases and 385 deaths from Marburg virus disease-estimate, an unadjusted, pooled total random effect case fatality ratio of 61.9% (95% CI 38·8–80·6; I2=93%).

Marburg Outbreaks

As of December 20, 2024, Angola, DR Congo, Equatorial Guinea, Cameroon, Ghana, Guinea, Kenya, Serbia, South Africa, Tanzania, Yugoslavia, Uganda, and Rwanda have confirmed MVD cases. The U.S. Centers for Disease Control and Prevention (CDC) published a Level 3 - Practice Enhanced Precautions regarding the Republic of Rwanda's MVD outbreak on October 7, 2024. The CDC has previously issued Travel Health Advisories focused on various MVD outbreaks and published the History of Marburg Outbreaks, a chronological list of known cases.

Burundi Marburg Risk

The Republic of Burundi authorities confirmed via Twitter on March 28, 2023, the death of a third person following a mysterious illness that broke out in the northwest area. Local authorities have been ordered to prevent passengers from neighboring Tanzania from spreading Marburg disease.

Cameroon Marburg Risk

On February 14, 2023, the Cameroon Regional Health Ministry reported two suspected MVD cases in the Olamze Commune. Cameroon previously restricted movement along the Equatorial Guinea border and restricted the movement of populations at the border. It also activated the incident management system throughout the region.

Equatorial Guinea Marburg Outbreak

The Republic of Equatorial Guinea (EG) confirmed its first-ever outbreak of MVD on February 13, 2023. The index case died in early January 2023. This outbreak was declared over on June 8, 2023. Since the outbreak declaration, 17 laboratory-confirmed cases of MVD and 12 deaths have been recorded (CFR 75%). The city of Bata in Litoral province is the most affected district, with nine laboratory-confirmed MVD cases reported. The U.S. Embassy in EG implemented a temporary policy under which official travel to the mainland region (Bata) by Embassy employees is only permitted for mission-critical needs, such as support for the MVD response.

Separately, the U.S. CDC updated its Level 2 travel alert regarding EG's MVD outbreak on May 12, 2023, stating, 'Reconsider non-essential travel to mainland Equatorial Guinea.' The U.K. says health professionals should remain alert for travelers returning from MVD-affected areas who develop symptoms compatible with MVD. Guidance and information about high-consequence infectious disease and its management in England, as well as further information and advice about Marburg fever, are available from the U.K. Health Security Agency.

Europe Marburg Risk

The European Centre for Disease Prevention and Control (ECDC) reported on March 25, 2023, that the likelihood of exposure and infection for EU/EEA citizens traveling or residing in the affected areas in Equatorial Guinea is currently very low. The most likely route of introduction of MVD into Europe would be via infected travelers. Should a case be imported, the likelihood of the spread of MVD within Europe is considered to be very low, says the ECDC.

Gabon Marburg Risk

The WHO Director-General stated on February 15, 2023, that the Gabonese Republic is preparing to rapidly detect, isolate, and care for suspected MVD cases. More than 163 people have crossed the borders between Equatorial Guinea, Cameroon, and Gabon.

Germany Marburg Virus Event

Marburg virus disease was first detected in 1967 after outbreaks in Marburg, Frankfurt, Germany, and Serbia. The outbreak was associated with laboratory work using African green monkeys imported from Uganda.

Nigeria Marburg Risk

The Nigeria Centre for Disease Control and Prevention confirmed in late February 2023 that there is a moderate risk of importing the Marburg virus into the country. 

Rwanda Marburg Outbreak

On December 20, 2024, the WHO announced the Marburg Virus Disease outbreak was declared as no new cases were reported over the last 42 days after the last patient tested negative for the virus twice. The third WHO Disease Outbreak News on Marburg virus disease in Rwanda was published on November 1, 2024. As of 31 October 2024, there were 66 confirmed cases, including 15 deaths (CFR: 23%). Sabin confirmed that over 1,700 experimental vaccines had already been delivered to Rwanda during the 2024 outbreak. On September 27, 2024, the Rwanda Ministry of Health reported its first Marburg disease outbreak. 

Tanzania Marburg Outbreak

In March 2023, an MVD outbreak was declared in the Kagera region, Northwestern Tanzania. On March 27, 2023, the U.S. CDC issued a Watch—Level 1 Practice Usual Precautions, stating that Tanzania had confirmed an MVD outbreak. To ensure that health systems fully recover from the effects of the outbreak and stay alert against future outbreaks, the WHO has developed the 90-day Post MVD Recovery Operational Plan and is also supporting the Ministry of Health in developing the National 90-day Post MVD Recovery Plan. 

Uganda Marburg Risk

Screening of travelers commenced at Kikagate Point of Entry in Isingiro District on March 27, 2023.

Marburg Virus Testing

Testing for Marburg virus and other causes of viral hemorrhagic fevers is available at CDC (Atlanta, Georgia) and within the Laboratory Response Network (LRN). As of April 2023, 32 geographically diverse LRN laboratories and 8 Regional Emerging Special Pathogen Treatment Centers can test using the Biofire FilmArray NGDS Warrior Panel. In addition, several more LRN laboratories are working toward building testing capability. On February 27, 2024, the WHO updated its Marburg infection prevention and control guidelines. The key recommendations are summarized in The BMJ.

Marburg Disease Vaccine Candidates

As of December 2024, the African CDC, the U.S. FDA, and the European Medicines Agency (EMA) have not approved any Marburg vaccine candidate.