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”.