Marburg hits Europe once again

Marburg is a filovirus; a cousin of Ebola. Both cause hemorrhagic fever; both have been recently discovered in fruit bats; both have hit Africa in a small number of human outbreaks. Both also remain largely mysterious; we know very little about their ecology in the wild; how frequently they really infect humans (and other animal species; Ebola especially has taken a toll on great apes); and their mode of transmission from their wild reservoir to primate hosts. These enormous gaps in our knowledge remain despite recently passing the 40-year mark since the discovery of filoviruses in a lab in Marburg, Germany. Now it seems the Marburg virus has re-surfaced in Europe, in a Dutch tourist who recently traveled to Uganda. More after the jump…

European officials today reported a rare case of the often-deadly Marburg hemorrhagic fever on European soil, in a Dutch woman who recently was exposed to bats while visiting caves in Uganda.

Dutch authorities informed the European Union and the World Health Organization of the case today, according to a statement from the European Centre for Disease Prevention and Control (ECDC). The patient is a 40-year-old woman who had recently returned from a vacation in Uganda.

“The travel included a visit to two caves in the Maramagambo forest (between Queen Elizabeth Park and Kebale), where she was exposed to fruit bats,” the ECDC said. The patient was at Leiden University Medical Centre; her condition was not disclosed.

In Africa, hospitals frequently act as amplifiers for filovirus outbreaks, due to lack of basic barrier nursing procedures and limited basic resources (gloves, gowns, syringes and needles, even running water can all be scarce). Human to human transmission typically occurs due to direct contact with the patient’s blood and other body fluids, and filoviruses typically aren’t thought to be effectively spread via the air. (A possible exception is the Reston strain of Ebola, where airborne transmission has been postulated). In the Netherlands, that shouldn’t be an issue, though they are monitoring individuals who have been in close contact with the case:

“ECDC’s initial assessment is that the threat to public health is limited and mainly focused on the people who have been in close contact with the patient after the onset of her symptoms,” the agency said. “People intending to travel to Uganda should be aware there may be a risk related to visiting caves in the Maramagambo forest.”

They don’t say when or how the patient returned from Uganda to the Netherlands, or how her onset of symptoms correlated with her trip; and as noted, her condition wasn’t disclosed so it’s not known how serious her infection is. However, typical case fatality rates of 80-90% have been reported in African outbreaks; the initial German outbreak, though, had only 7 deaths from 31 infections; whether the difference is due to different virulence potentials of the strains, genetic susceptibility of the patients, nursing and treatment procedures, or a combination of all three also is currently unknown.

[UPDATE]: more news, including a report of the patient’s death and additional timeline, from this AP story:

Dutch woman has died from Marburg fever, a highly contagious Ebola-like virus she is thought to have caught from bats while touring caves in Uganda, hospital officials said Friday.

To avoid an outbreak of the rare disease, health authorities said they have been in touch with everyone known to have had contact with the 40-year-old woman since she returned to the Netherlands at the end of June.

Her symptoms began a few days after she returned to the Netherlands and she was admitted to a regional hospital July 5. Two days later she was transferred to Leiden with liver failure and severe hemorrhaging.

WHO said the woman had traveled in the African country for three weeks last month. She is likely to have contracted the disease from contact with at least one fruit bat when she visited the “python cave” in the Maramagambo Forest on June 19.

And in addition, the WHO is warning people to avoid caves in the area and avoid contact with bats and non-human primates in the area:

Health experts fear bats in caves and mines in western Uganda are a reservoir for the Marburg virus, a cousin of Ebola.

People who were in close contact with the victim, who visited two caves during a three-week trip to Uganda that ended on June 28, have been monitored daily but none have shown any symptoms, WHO spokesman Gregory Hartl said.

“It is an isolated case of imported Marburg. People should not think about amending their travel plans to Uganda but should not go into caves with bats,” he said.

In a statement, Uganda’s Health Ministry advised people entering caves or mines in the western district of Kamwenge to take “maximum precaution not to get into close contact with the bats and non-human primates in the nearby forests”.

Comments

  1. #1 John
    July 11, 2008

    Marburg is a kind of ebola, not a cousin of ebola. Ebola is a family of virions, including Ebola Marburg, Ebola Zaire (the one you think is called Ebola), Ebola Sudan, Ebola Reston and so on. They’re named for where they’re discovered; Marburg is a city in Germany.

    Please do some research next time.

  2. #2 Mel
    July 11, 2008

    John, it seems you are the one that should do some research. Marburgvirus and Ebolavirus belong to the same family and thus Tara is correct to describe them as cousins. Marburg is not a species of Ebolavirus as you describe.

  3. #3 BioinfoTools
    July 11, 2008

    John,

    Firstly, in my experience in science, it is more usual to politely point alternative information out without adding what, to me at least, are unecessary retorts. Its a variation on the old “don’t attack the person” theme. You’ll be better respected for it in my experience, too. Just a thought.

    Secondly, a few minutes research contradicts your comment. I’m not a virologist, nor a taxonomist, and a few minutes can hardly be definitive (!), but the NCBI Taxonomy database, shows Marburgvirus as a cousin to the ebola-like viruses, i.e. as separate branches within Filoviridae (see the NCBI Taxonomy database for filoviridae).

    Likewise a few research papers I look at, like this one classify them separately, e.g.:

    The filoviruses, Ebola (EBOV) and Marburg (MARV), cause a lethal hemorrhagic fever.

    and

    The family Filoviridae consists of two genera called ebolavirus (EBOV) and marburgvirus (MARV)

    To be fair, bacterial and virial taxonomy appears to be awkward, no doubt partly because the species concept doesn’t apply to them in the way that it does for, say, mammals. A purely hierarchial taxonomy for viruses and bacteria has always struck me as an uncomfortable fit for some purposes. (Please do note the for some purposes: the purpose a taxonomy is being used for and how its constructed matter, etc.) I wouldn’t be at all surprised to find alternative taxonomies for these viruses. The NCBI taxonomy will be based on molecular phylogeny, not infectious properties, morphology (or whatever else it is that viral taxonomists use!): taxonomies built using this information might be different.

    PS: Small nitpick: its usually worded “a family of viruses“: ‘virion’ refers to a stage of the viral life cycle, rather than the organism per se.

    PPS: I should be clear that I’m not try to “defend” Tara: I’ve little doubt she knows this area better than I do!

  4. #4 BioinfoTools
    July 11, 2008

    My previous post crossed with Mel’s. (Who was much, much more concise than me!)

  5. #5 Tara C. Smith
    July 11, 2008

    Wow John, hostility. As others have pointed out, Ebola and Marburg are indeed separate genera of filoviruses. As far as research, searching this site will bring up a number of posts on Ebola and Marburg; it’s easy enough to see that I follow developments on these viruses pretty closely. Indeed, I’ve noted before that Ebola is one of my favorite pathogens, interviewed field workers and even written a book on the topic. So, yeah, you could probably say I’ve researched it just a wee bit…

  6. #6 gary
    July 12, 2008

    I went to the Amazon link and noticed there are no reviews for your book. Maybe since John knows so much about viruses, he should go over there and review it.

  7. #7 Poodle Stomper
    July 13, 2008

    Wow, I didn’t know you had written a book on this. I have always been interested in Ebola but never got around to reading much on them. I ordered the book from Amazon and I’m sure I won’t be disappointed.

  8. #8 Tara C. Smith
    July 13, 2008

    Well, it’s a bit out of date now (I submitted the manuscript in 2005), so just keep that in mind. I’m doing an update (and actually revising a good half of it because the publisher asked to do a combined Ebola/Marburg edition), but that won’t be out until late 2009.

  9. #9 John
    July 13, 2008

    Try to stick to what you actually said. X and Y are part of class A. You said X was a cousin of A. Now you’re saying X is a cousin of Y.

    Yes, Marburg and Zaire are “cousins” of a sort. What you actually said, however, was that Marburg and Ebola are cousins. That’s quite different.

    Incidentally, no, that’s not hostility. It’s disgust at sloppy writing. That you needed to try to convert your rebuke by way of Auto Ad Verecundiam, and in so doing to make a buck, just

    Oh, and don’t try to pick apart the use of the fallacies. That’s an insult, not a well meaning mistake. You wanted hostility; now you’ve got it. See the difference?

    (And yet, I expect a “no”…)

    —–

    “Firstly, in my experience in science, it is more usual to politely point alternative information out without adding what, to me at least, are unecessary retorts.”

    Welcome to the internet.

    Notice that the title is “scienceblogs”. If the rules of science applied, this article would have been peer edited, as would have the resulting retorts; as such the category error, as well as its blind thumping in retort, would never have made it past the editors.

    As that is clearly not the case, the rules of blogs apply, and inbetween my vitriol I should be attempting to sell you a cream that will enlarge your ipod by three inches.

    Thanks for playing. By the way, “peer review” on the internet means people making fun of you for not being able to follow the last set of valid criticisms levied in the attempt to refute them.

    Bravo, you set of Einsteins. Take a vitamin before you try IRC; you’re just not ready.

  10. #10 Tara C. Smith
    July 13, 2008

    Zaire is a subtype of Ebola, along with Reston, Ivory Coast, Sudan, and the as-yet-unnamed type I mentioned here. Marburg is not; it’s a separate genera of virus, which has its own subtypes. Both are within the family of filoviruses, hence “cousins.” I don’t know how to say this any more clearly, and this is also how it appears in the published literature. See for example this review:

    Genetic and antigenic characterization of Ebola virus (EBOV) isolates during human outbreaks has led to the identification of four subtypes–Ebola Sudan, E. Zaire, E. Ivory Coast and E. Reston.

    Note the absence of “Ebola Marburg.” Also check out this Marburg review, which again separates the two genera.

    Additionally, I don’t make any money from book sales. If anyone else wants a copy I’d be happy to send the word document (again with the disclaimer that it’s a few years out of date). It lacks a few elements of the book (fact boxes & pictures) but the basic text is there.

  11. #11 BioinfoTools
    July 13, 2008

    John,

    I suspect you misread the first sentence: it has a semicolon separating the two clauses, not a comma. A useful trick in this case is to replace the semicolon with an ‘and’ and see how it reads:

    Marburg is a filovirus and a cousin of Ebola.

    Its quite clear what is being said is that Marburg is a cousin of Ebola, not that filoviruses are cousins of Ebola. Perhaps we should express disgust at sloppy reading? ;-) Let us know.

    I’m wondering, though, if “haven’t a clue” is (part of) the reason behind your gaffe. Particularly given how you describe yourself in your blog title :-)

    (Excuse my poor typing in portions of my previous post.)

  12. #12 BioinfoTools
    July 13, 2008

    My posts are forever crossing others’…

    Tara: your offer of a copy of the text of book is very tempting! For now I’ll restrain myself to make sure I get through my work reading first. (One less temptation to procrastinate…!)

  13. #13 Fleming
    July 13, 2008

    Nobody on earth cares about the Marburg virus, nor fruit bats.

  14. #14 BioinfoTools
    July 13, 2008

    Fleming:

    Somehow I think if you, a relative, or someone you were in close contact with, were infected with Marburg virus, you’d suddenly be extremely interested in it! And fruit bats :-)

  15. #15 fleming
    July 13, 2008

    Bioinfotools,

    No. I am opposed to hype, fear-mongering and scaremongering by these ridculous virus hunters.

  16. #16 NM
    July 14, 2008

    BioinfoTools. Don’t feed trolls, ever.

  17. #17 Richard W. Crews
    July 16, 2008

    Would it be possible to make a weapon out of Marlburg/Ebola. NOT that I want to. Could you dice up and seal Ebola guy, then put him in a bomb designed to maim and injure? I know it’s a terrible idea (shame on me), but I can’t be the only one thinking that.

  18. #18 Zayıflama
    July 25, 2008

    I suspect you misread the first sentence: it has a semicolon separating the two clauses, not a comma. A useful trick in this case is to replace the semicolon with an ‘and’ and see how it reads:

  19. #19 Orjinal Tala
    July 25, 2008

    John, it seems you are the one that should do some research. Marburgvirus and Ebolavirus belong to the same family and thus Tara is correct to describe them as cousins. Marburg is not a species of Ebolavirus as you describe.

  20. I went to the Amazon link and noticed there are no reviews for your book. Maybe since John knows so much about viruses, he should go over there and review it.

  21. #21 Thomas Boteler
    July 25, 2008

    “More after the jump…” WTF? Why must people insist on using this trite, meaningless phrase? Don’t they know it immediately makes people hate them for using it? I’m pretty sure people know how to scroll down to see if the article continues. And when all that “jump” is is a double-spaced line… WFT!?

  22. #22 murison
    July 29, 2008

    Being a bit of a virus junkie ever since reading Laurie Garrett’s book, I naturally ran across Tara’s Ebola book a couple years ago at Amazon and bought a copy. It’s slim and introductory in nature, and I learned a few things. I was a bit disappointed that it didn’t have more technical meat to it, but that is more a comment on my state of education at the time and not on the book itself. It’s a decent introduction, which is the point. When the 2009 revision comes out, I’ll be ordering a copy.

  23. #23 Poodle Stomper
    July 30, 2008

    I just read Tara’s Ebola book this past week and while I agree it is introductory I also admit to knowing very little about Ebola so this was an excellent starting place for me. I found the book to be very informative and in my opinion a very good place for any Ebola-novice to start. It does leave one itching to know what the natural reservoir for this virus is, though. Hopefully soon…?

  24. #24 Tara C. Smith
    July 30, 2008

    Keep in mind that the series of books that’s a part of is geared toward upper-level high school kids–my editor trimmed out quite a bit of more “technical” stuff and I had to re-write portions to make it easier to read. So it’s certainly not for the practicing virologist…

    Regarding the reservoir, that will be one of the major updates, with the discovery of virus in fruit bats as I mention in the post above. Whether they’re ultimately “THE” reservoir remains unclear, but at least it’s a step in the right direction toward a better understanding of the ecology of filoviruses.

  25. #25 muhabbet
    March 25, 2009

    thanks..

  26. #26 v-pills
    September 12, 2009

    The NCBI taxonomy will be based on molecular phylogeny, not infectious properties, morphology (or whatever else it is that viral taxonomists use!): taxonomies built using this information might be different.

  27. #27 v-pills
    July 18, 2011

    Could you dice up and seal Ebola guy, then put him in a bomb designed to maim and injure? I know it’s a terrible idea (shame on me), but I can’t be the only one thinking that..

  28. #28 panax
    November 18, 2011

    I suspect you misread the first sentence: it has a semicolon separating the two clauses, not a comma.

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