H5N1

Marburg virus disease - Equatorial Guinea and the United Republic of Tanzania

A WHO disease outbreak news report: Marburg virus disease - Equatorial Guinea and the United Republic of Tanzania. Excerpt:

Situation at a glance   

Equatorial Guinea and the United Republic of Tanzania have been responding to separate outbreaks of Marburg virus disease (MVD) since early February and late March 2023, respectively.   

In Equatorial Guinea, from 13 February to 1 May 2023, 17 laboratory-confirmed MVD cases and 23 probable cases have been reported. The last confirmed case was reported on 20 April. Among the laboratory-confirmed cases, there are 12 deaths (Case Fatality Ratio (CFR) 75%).For one confirmed case, the outcome is unknown. Among the confirmed cases, four have recovered. All of the probable cases are dead. The most affected district is Bata in Litoral province, with 11 laboratory-confirmed MVD cases reported.   

In the United Republic of Tanzania, between 16 March to 30 April 2023, a cumulative total of nine cases including eight laboratory-confirmed cases and one probable case have been reported. The last confirmed case was reported on 11 April 2023. A total of six deaths (CFR 66.7%) have been reported, including one probable case and five among the confirmed cases. Among the confirmed cases, three have recovered. All cases have been reported from Bukoba district, Kagera region.   

Health authorities in both countries have shown strong political commitment. In recent weeks they have further strengthened critical response functions, such as disease surveillance, including at points of entry; laboratory activities; clinical case management; infection prevention and control; risk communication and community engagement; and operations support and logistics with support of WHO and partners.  

WHO continues to monitor the situation in these two countries closely and to support the responses.

WHO DON: Marburg virus disease - Equatorial Guinea

WHO has published Marburg virus disease - Equatorial Guinea. Excerpt:

Situation at a glance  

Since the last Disease Outbreak News on this event was published on 22 March 2023 (with data as of 21 March 2023), six additional laboratory-confirmed cases of Marburg virus disease (MVD) have been reported in Equatorial Guinea. This brings the total to 15 laboratory-confirmed and 23 probable cases since the declaration of the outbreak on 13 February 2023. Among the laboratory confirmed there are 11 deaths (Case Fatality Ratio 78.6%; for one confirmed case the outcome is unknown), and all probable cases are dead. The most affected district is Bata in Litoral province, with nine laboratory-confirmed MVD cases reported.  

WHO is supporting the Ministry of Health by strengthening different response pillars, including but not limited to surveillance, including at points of entry; laboratory; case management; infection prevention and control; risk communication and community engagement.  

MVD is a disease with high mortality that causes haemorrhagic fever, and is among the diseases that require assessment under the International Health Regulations.  

On 30 March 2023, WHO assessed the public health risk posed by this outbreak as very high at the national level, high at sub-regional level, moderate at the regional level and low at the global level.  

WHO advises against restrictions to international travel and/or trade in Equatorial Guinea.  

Description of the situation  

On 13 February 2023, the Ministry of Health and Social Welfare of Equatorial Guinea declared an outbreak of Marburg virus disease (MVD) after suspected viral hemorrhagic fever deaths were reported between 7 January and 7 February 2023, and a case tested positive on 12 February for Marburg virus by real-time polymerase chain reaction (RT-PCR) at the Institute Pasteur in Dakar, Senegal.  

Since the last Disease Outbreak News on this event (22 March 2023) and as of 11 April 2023, six additional laboratory-confirmed cases of MVD were reported in Equatorial Guinea, bringing the total of cases in the outbreak to 15 laboratory-confirmed. Additionally, 23 probable cases have been reported since the start of the outbreak. Eleven deaths were recorded among laboratory-confirmed cases (Case Fatality Ratio (CFR) among confirmed cases 78.6%), and all probable cases are dead; for one confirmed case the outcome is unknown. Four laboratory-confirmed cases (26.6%) were reported among healthcare workers, of whom two died. Among the confirmed cases, three have recovered.  

Among MVD laboratory-confirmed cases with age and sex information (n = 13), the majority occurred among females (9/14; 64.3%), while the most affected age group is 40-49 years (6/14; 42.8%), followed by the age groups 10-19 and 30-39 (three cases each).  

Five districts (Bata, Ebebiyin, Evinayong, Nsok Nsomo and Nsork) in four provinces (Centro Sur, Kie Ntem, Litoral and Wele-Nzas) have been affected by the outbreak (Figure  2), with Bata district reporting the majority of confirmed cases (n = 9) and deaths (n = 6), and Ebebiyin district, where the outbreak was first detected, reporting the majority of probable cases,(n = 11) (Table 1). 

In the last 21 days (from 22 March 2023 to 11 April 2023), five confirmed cases were reported from Bata (n = 4) and Nsork (n = 1) districts (Figure 3). Among the four cases reported from Bata district, three cases have an epidemiological link either through a family cluster or through health care setting. The fourth and most recent case was reported on 7 April; an investigation of this case is ongoing to establish transmission chains and ensure appropriate identification of all contacts.  

Since the last Disease Outbreak News on this event, one new district, Nsork in Wele-Nzas province, has been affected by the outbreak, reporting one confirmed case, linked to a known case from another district that previously reported confirmed cases.  

Since the start of the outbreak and as of 10 April 2023, a total of 1322 contacts have been listed, with an average follow-up rate around 80-90%.

Kirundo-Muyinga: A mysterious disease with symptoms resembling those of the Ebola virus appears

Via SOS Médias Burundi, a March 27 report: Kirundo-Muyinga: a mysterious disease with symptoms resembling those of the Ebola virus appears. The Google translation:

An as yet unidentified disease killed three people in three days in the commune of Gitobe in the province of Kirundo and in the commune of Butihinda in the province of Muyinga (north-eastern Burundi). 

Symptoms developed by patients suffering from this disease resemble those of Ebola hemorrhagic virus or Marburg virus disease. In the case of Kirundo, the governor and the provincial doctor are waiting for the results of samples taken by specialists from the INSP (National Institute of Public Health) to decide.  

The ministry in charge of health has already confirmed for that of Muyinga that it is neither the Marburg virus disease nor Ebola. (SOS Media Burundi) This disease, not yet identified but having signs similar to those of Ebola, has just claimed the lives of two people in the commune of Gitobe. Both people died within 24 hours of showing the signs. All the patients come from the same Migwa hill, in the Baziro area.  

According to witnesses on the spot, "the symptoms include abdominal pain, nasal bleeding which increases after death, acute headaches, high fever, vomiting and dizziness". This disease kills very quickly, noted a nurse interviewed by SOS Media Burundi.  

“It's a disease that kills quickly. Within 24 hours, the infected person dies. It's terrible, we are all waiting for death," said a panicked nurse from the Migwa health center in the Gashoho health district in Muyinga province where patients were sent, including two women who died there.

When the population of Baziro wanted to bring the third person there, the population of Migwa blocked the entrances, fearing the spread of the disease. For the moment no one can leave the area of ​​Baziro which, it seems, has been confined. 

Samples were taken by the INSP to identify which disease it is.  

But until now the disease is not yet detected, according to doctors.  

In the morning of Friday, the governor of Kirundo, Albert Hatungimana, accompanied by the provincial doctor, carried out a raid in the commune of Gitobe, but they made no forecast.  

"We are awaiting the results of the swabs," a member of the governor's cabinet said.  

The population is worried because, she says, "So far no real prevention strategy against this disease has been communicated".  

“Apart from washing your hands and avoiding greeting each other, there are no strict measures, which can promote contamination,” residents insisted.  

Note that at Kirundo hospital, the first case was also admitted on Friday evening. In the commune of Ntega (same province), people with the same symptoms were reported on the same Friday evening.  

The population of the urban center of Kirundo lives in panic fear. She asks the government to declare the epidemic so that there is a rapid intervention.  

Another case was recorded in Giteranyi commune, Muyinga province (neighboring Kirundo). A student from Kobero Basic School not far from the border with Tanzania, died of this disease last Thursday.  

Tanzania declared a Marburg virus epidemic on March 21. A cousin of Ebola, this “filovirus” causes high fevers accompanied by virulent haemorrhages. So far, there is no vaccine or antiviral treatment for this disease, which can also attack primates. It is suspected that it is the Marburg virus which has spread in the Burundian provinces bordering Tanzania, the epidemic having been detected in the Kagera region in the north-west of Tanzania not far from Burundi and Rwanda .

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.

WHO: Ghana reports first-ever suspected cases of Marburg virus disease

Via WHO AFRO:Ghana reports first-ever suspected cases of Marburg virus disease. The news release and then a comment:

Accra – Ghana has announced the preliminary finding of two cases of Marburg virus disease and if confirmed these would the first such infections recorded in the country. Marburg is a highly infectious viral haemorrhagic fever in the same family as the more well-known Ebola virus disease.   

Preliminary analysis of samples taken from two patients by the country’s Noguchi Memorial Institute for Medical Research indicated the cases were positive for Marburg. However, per the standard procedure, the samples have been sent to the Institut Pasteur in Senegal, a World Health Organization (WHO) Collaborating Centre for confirmation. The two patients from the southern Ashanti region – both deceased and unrelated – showed symptoms including diarrhoea, fever, nausea and vomiting. They had been taken to a district hospital in Ashanti region.   

Preparations for a possible outbreak response are being set up swiftly as further investigations are underway.  

“The health authorities are on the ground investigating the situation and preparing for a possible outbreak response. We are working closely with the country to ramp up detection, track contacts, be ready to control the spread of the virus,” said Dr Francis Kasolo, World Health Organization (WHO) Representative in Ghana.  

WHO is deploying experts to support Ghana’s health authorities by bolstering disease surveillance, testing, tracing contacts, preparing to treat patients and working with communities to alert and educate them about the risks and dangers of the disease and to collaborate with the emergency response teams.  

If confirmed, the cases in Ghana would mark the second time Marburg has been detected in West Africa. Guinea confirmed a single case in an outbreak that was declared over on 16 September 2021, five weeks after the initial case was detected.  

Previous outbreaks and sporadic cases of Marburg in Africa have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.  

Marburg is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Many patients develop severe haemorrhagic signs within seven days. Case fatality rates have varied from 24% to 88% in past outbreaks depending on virus strain and case management.  

Although there are no vaccines or antiviral treatments approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival. A range of potential treatments, including blood products, immune therapies and drug therapies, are being evaluated.

When I hear of an outbreak like this, I go straight to the affected country's media and ministry of health. Too often, I find the media have nothing on the story (or the websites aren't accessible) and neither does the ministry. It was a big problem early in the West African Ebola outbreak, though the media and most of the health ministries finally began to provide prompt, reliable information.

I hope this Marburg outbreak will be brief, but also that it will push the Ghanaian government to pay more attention to health communication in general—and to its online communication in particular.

West Africa COVID-19 deaths surge amid Ebola and other outbreaks

A news release from WHO AFRO: West Africa COVID-19 deaths surge amid Ebola and other outbreaks. Excerpt:

Brazzaville, 20 August 2021 – West Africa has recorded its highest number of COVID-19 deaths since the pandemic began as several countries grapple with outbreaks of cholera, Ebola Virus Disease and Marburg Virus Disease that threaten to further strain the already stretched emergency response capacity in the region. 

COVID-19 fatalities in West Africa over the past four weeks increased by 193% from 348 in the previous four weeks to 1018 in the week ending on 15 August. Although the case fatality ratio, or the proportion of people diagnosed with the disease who have died, stands at 1.4%—below the continental average of 2.5%—it is higher than the previous two waves in the sub-region, a sign that health systems are feeling the strain of a heavy caseload. While new cases in West Africa have dropped this week, they were surging for eight consecutive weeks. 

Overall Africa recorded over 244 000 new cases in the week ending on 15 August, an 11% drop from the week before and a second straight week of declining cases. However, nine out of 23 countries experiencing a resurgence are in West Africa. Cote d’Ivoire, Guinea and Nigeria are experiencing a surge in cases and all three countries are tackling other outbreaks. 

West Africa health systems are even more fragile than those in other sub-regions. A World Health Organization (WHO) assessment of the functionality of health systems in West Africa found that they were 21% lower than in Southern Africa, 

“We are particularly concerned about West Africa and we can expect the pressure of COVID-19 to hit health services harder and faster,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “In addition to the strain of COVID-19, comes Ebola and other outbreaks. Fighting multiple outbreaks is a complex challenge.” 

COVID-19 vaccines deliveries 

West Africa has to date received around 29 million vaccine doses—almost the same amount as East and Southern Africa. However, the rollout has been slow, with 38% of the doses administered compared with 76% in East and Southern Africa and 95% in North Africa. West Africa has delivered 2.4 doses per 100 people. In East and Southern Africa, the figure stands at 4.8 doses per 100 people. 

Vaccine shipments to Africa have picked up with the COVAX Facility delivering almost 10 million doses to Africa so far in August, that is nine times what was delivered in the same period in July. The African Union has so far delivered 1.5 million doses to nine countries. Since June, the number of doses administered per 100 people in sub-Saharan Africa has almost tripled from 1.2 per 100 people to 3.4 per 100 people. 

“While COVID-19 vaccine shipments seem to be taking off, Africa is encountering headwinds. Moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa. As some richer countries hoard vaccines, they make a mockery of vaccine equity,” said Dr Moeti.

Canadian-made Ebola vaccine could have saved more lives if research was funded earlier, microbiologist says

Via CBC Radio: Canadian-made Ebola vaccine could have saved more lives if research was funded earlier, microbiologist says. Excerpt:

In 2005, microbiologist Steven Jones was part of a medical team in Angola, which was in the midst of an outbreak of Marburg, Ebola's sister virus. 

The team had samples of an experimental vaccine, developed by Jones and researchers in Winnipeg to treat Ebola and Marburg, with them. But clinical tests weren't yet complete, so they couldn't use it on infected patients, even though preliminary research had shown it to be effective as early as 2003, Jones says. 

That restriction sparked a tense confrontation with a military doctor. 

"He begged us to use it and we had to tell him no. And it was an extremely difficult conversation, because nothing else had been working," Jones, associate provost of health at the University of Saskatchewan Health Sciences, told The Current's guest host Matt Galloway.  

The vaccine, also known as VSV-ZEBOV, is currently being used to combat an Ebola outbreak in Congo, which has killed at least 1,900 people in the last year. But Jones believes it could have been used to save more lives if governments and pharmaceutical companies committed to greater funding and support years earlier. 

The 2005 Marburg outbreak in Angola killed 329 people, with a nearly 90 per cent case fatality rate of those infected. Jones believes that if he were able to use the vials of the vaccine they had on hand, they might have saved "at least half" of the lives lost. 

A long regulatory process 

But he recognizes the need for meticulous testing and research to ensure a new vaccine is proven safe to use on humans. 

That process, however, takes a lot of money and the political will to keep that money flowing, he says, adding it has been coined the "valley of death: where bright ideas go to die." 

Jones and his team requested $6 million from Canada's CBRNE Research and Technology Initiative (CIRT) to develop vaccines for Marburg and Ebola, but only received $2 million in 2006, specifically for the Ebola vaccine. It wouldn't last through the series of required clinical trials. 

"We were not funded to do the clinical trials, because those start to get more expensive," he said. "At the time, I thought the decision was wrong. I still think the decision was wrong, but I understand why it was made."

Uganda: Strange disease kills two in Kagadi

Thanks to Viki Hansen-Landis for alerting me to this report in allAfrica.com, reprinted from the Daily Monitor in Kampala: Uganda: Strange Disease Kills Two in Kagadi. Excerpt and then a comment:

Kagadi — Two children have died of a strange disease which presented symptoms similar to those of the Ebola virus.  

The victims of the strange disease are 10-year-old Jovia Natukunda and David Niwagaba who was nine months old.  

They were children of Mr Valence Byaruhanga, a resident of Kikonda village in Kiryanga Sub-county, Kagadi District. They died on Thursday. 

They were passing out blood from the mouth and the nose which symptoms are similar to those caused by the Ebola virus. 

Their death has caused fear among residents in a district that was hit by an outbreak of Ebola in 2012.  

The Kagadi Ebola Task Force led by the District Surveillance Officer, Mr Selevano Thembo, went to the area to investigate the matter. 

Wearing protective clothes, the team carried out the burial as one of the precautionary procedures in cases of suspected contagious diseases.  

"When people see blood coming out of their sick relatives, they tend to take it as a serious disease and our team went to investigate," Mr Thembo said. 

He said that they got blood samples from the bodies which will be taken to the Uganda Virus Research Institute for analysis. 

"Our district is at risk because of the outbreak of the Ebola disease in DR Congo," Mr Thembo said.  

Diseases which present with signs and symptoms similar to those of Ebola include Rift Valley Fever-RVF, Crimean Congo Haemorrhagic Fever-CCHF and Marburg fever. 

In 2018, Crimean Congo Haemorrhagic Fever outbreak was confirmed in neighbouring Kakumiro District in Nkooko Sub-county. It claimed one person.  

In late April, the Ministry of Health gave Shs146 million to Kagadi District for Ebola preparedness activities.

This is not just another health-scare story. The link in the text will take you to a report in 2012 about a real Ebola outbreak in Kagadi, and the town had a similar case less than a month ago. It's also useful to be reminded that Ebola's early symptoms mimic those of several other common diseases in the region—a major reason why relatively few suspected Ebola cases are confirmed. 

Ebola-like virus found in Chinese bats

Thanks to Tony Trehy for sending the link to this report in the South China Morning Post: Ebola-like virus found in Chinese bats. Excerpt:

A new Ebola-related bat-borne virus with the potential to infect humans and animals has been found by a team of Chinese and Singaporean scientists in southwestern China. 

The Mengla virus – discovered in a fruit bat caught in Mengla county, Yunnan province – is closely related to the Ebola and Marburg viruses which are capable of causing severe and often fatal bleeding and organ failure in humans, according to the scientists. 

Their study, published in the January edition of the online journal Nature Microbiology, confirmed that the new virus could infect cells from monkeys, hamsters, dogs and humans. 

The team, led by Shi Zhengli from the Chinese Academy of Sciences’ Institute of Virology in Wuhan and Wang Linfa from the Duke-NUS Medical School in Singapore, discovered that the new virus had several important functional similarities with the Ebola and Marburg viruses. 

The similarities, which include using the same molecular receptor to gain entry into cells and cause infection, put the new virus into the filovirus family, which is known for causing severe haemorrhagic fever in humans.  

“Studying the genetic diversity and geographic distribution of bat-borne filoviruses is very important for risk assessment and outbreak prevention, as this type of infectious disease can affect the general public without warning and with devastating consequences,” Wang said. 

At present, the Mengla virus has only been identified in populations of Rousettus bats in China, and further tests will be conducted to assess the risk of the virus spreading to other species.

Sierra Leone fruit bats infected with Ebola-like Marburg virus

Via Reuters: Sierra Leone fruit bats infected with Ebola-like Marburg virus. Excerpt:

Scientists in Sierra Leone have found live bats infected with Marburg virus, a deadly hemorrhagic fever similar to Ebola and so far undetected in West Africa, a U.S. government statement said on Thursday. 

The African fruit bat is the reservoir host of the virus, which has caused at least 12 outbreaks of hemorrhagic fever on the continent. 

Angola suffered the worst epidemic in 2005, when 90 percent of the 252 people infected in the southern African country died. The continent’s most recent outbreak killed three people in Uganda last year. 

In a statement on Thursday, the U.S. Centers for Disease Control and Prevention (CDC) said five Egyptian rousette fruit bats caught in Sierra Leone tested positive for the Marburg virus.  

No human cases of the fever have so far been reported, although the presence of infected bats — who do not show obvious signs of the disease — increases the risk of contracting the virus.  

“We have known for a long time that rousette bats, which carry Marburg virus in other parts of Africa, also live in West Africa. So it’s not surprising,” said CDC ecologist Jonathan Towner in the statement.