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        Marburg Virus Disease
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    Clinical Overview Training for Non-U.S. Healthcare Facilities View All
October 30, 2024
  Viral Hemorrhagic Fevers
January 30, 2025
  Clinical Overview of Marburg Virus Disease
          Key points
            * Marburg virus disease (MVD) is a severe viral hemorrhagic fever and is rare in the United States.
            * MVD can be confused with other more common infectious diseases, such as malaria.
            * Do not delay testing for other more likely medical conditions when assessing for MVD.
            * It is essential you correctly and consistently wear proper personal protective equipment (PPE) and take infection control measures while assessing a patient for suspect MVD.
            * Notify your health department if you suspect a patient may have MVD.
        Overview
        Marburg virus disease is a rare, severe viral hemorrhagic fever that affects both people and other primates. The disease can lead to serious illness or death. Symptoms can appear suddenly and may include fever, rash, and severe bleeding.
          MVD basics‎
          MVD basics
              Read more about Marburg basics, like transmission and risk factors.
                About Marburg
        Cause
        MVD is caused by infection with one of two orthomarburgviruses, Marburg virus or Ravn virus.
        Exposure risks
        Family members and healthcare workers caring for patients infected with an orthomarburgvirus who have not used proper infection prevention and control measures are at a higher risk of becoming infected.
        Certain occupations, such as veterinarians and laboratory or quarantine facility workers who handle non-human primates recently imported from Africa, may also be at increased risk of exposure to orthomarburgviruses.
        Exposure risk can be higher for people in contact with infected non-human primates, travelers visiting enzootic regions in Africa who have contact with Egyptian rousette fruit bats (Rousettus aegyptiacus), which spread the virus, or enter caves or mines inhabited by these bats.
          Nosocomial transmission is a risk in clinical settings.‎
          Nosocomial transmission is a risk in clinical settings.
              Proper PPE and infection control procedures are vital to containing the spread of cases or outbreaks.
                Guidance for Personal Protective Equipment (PPE)
        Incubation period
        The incubation period for orthomarburgviruses ranges from 2-21 days from exposure.
        Mortality rates
        MVD has a high mortality rate of 20%–90%, depending on the virus strain and the level of case management. With early intensive supportive care and fluid replacement, mortality rates might be lower.
        Clinical features
        Early stage of disease
        Patients with MVD generally have an abrupt onset of fever and symptoms typically 8 to 10 days after exposure. However, fever is not universally exhibited by all patients with MVD. Initial signs and symptoms are nonspecific and may include elevated body temperature or subjective fever, chills, myalgia, and fatigue. These are known as "dry" symptoms.
        Malaria is the most common cause of acute undifferentiated fever after travel to sub-Saharan Africa and some other tropical areas. If applicable, follow Clinical Guidance: Malaria Diagnosis & Treatment in the U.S., as diagnostics should be done promptly and treatment instituted immediately. Typhoid fever, meningococcemia, and other bacterial infections, like pneumonia, also have similar nonspecific symptoms and can be confused with MVD.
          Keep Reading: Guidance for Malaria Diagnosis in Patients with Suspected Orthoebolavirus or Orthomarburgvirus Infection in the United States
        Mid-late stage of disease
        Four to five days after symptom onset, patients can progress to gastrointestinal symptoms, or "wet" symptoms. "Wet" symptoms can include severe watery diarrhea, nausea, vomiting, and abdominal pain. Other symptoms, such as chest pain, shortness of breath, headache, or confusion, may develop. Patients often have eye irritation and redness. Hiccups have been reported. Seizures may occur, and cerebral edema has been reported.
        Bleeding is not universally present. However, it can manifest later in the course of disease as petechiae, ecchymosis or oozing from venipuncture sites, mucosal hemorrhage, or blood in stool or vomitus.
        Patients may develop a mixture of flat and raised lesions on the skin, which are red in color, by days 5 to 7, usually involving the neck, trunk, and arms, that can peel or flake off.
        Pregnant people may experience spontaneous miscarriages.
        Pregnant women may experience spontaneous miscarriages.
        Patients with fatal disease usually develop more severe clinical signs early during infection and die typically between days 6 and 16 of complications, including multiorgan failure and septic shock. In nonfatal cases, patients may have fever for several days and improve, typically around day 6. Patients who survive can have a prolonged convalescence.
        Prevention
        There is no Food and Drug Administration (FDA)-approved vaccine for MVD. However, trials with an investigational vaccine are underway in Rwanda via the Ministry of Health, with a focus on healthcare workers.
          Nosocomial transmission is a risk in clinical settings.‎
          Nosocomial transmission is a risk in clinical settings.
              Proper PPE and infection prevention and control procedures are vital to preventing Marburg virus spread in healthcare settings.
                Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF)
        Screening
        Evaluate the patient
        Early consideration of MVD in the differential diagnosis of a patient with consistent clinical and epidemiological factors is essential for providing appropriate and prompt patient care and preventing further transmission of the infection. It is important to systematically assess patients through a screening process and treat infections as soon as they are discovered.
                Clinical Screening and Diagnosis for VHFs
                Guidelines for screening patients for VHFs
              May 9, 2024
                Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease
                Guide for evaluating an ill person for a VHF or other high-consequence disease
              May 13, 2024
                Viral Hemorrhagic Fever (VHF) 2022 Case Definition
                General Approach to the Returned Traveler CDC Yellow Book 2024
        Notify your health department
        Healthcare providers with concerns about MVD infection in a patient should contact their jurisdictional health department immediately via the 24-hour Epi-On-Call contact list and follow jurisdictional protocols for patient assessment.
        Clinical teams should coordinate with public health officials and CDC to assess the risk of MVD based on the clinical presentation and epidemiologic risk factors. This will help determine if testing is needed and what other causes of illness should be considered (e.g., malaria). This coordination can ensure proper patient care and appropriate precautions are taken to help prevent potential spread within the healthcare setting. Timely identification of other more likely pathogens and access to routine laboratory testing, such as blood counts and chemistries, are essential for providing appropriate patient care.
          Spotlight‎
          Spotlight
              CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations on MVD by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB's on-call epidemiologist.
                Guidance on Performing Routine Diagnostic Testing for Patients with Suspected VHFs or Other High-Consequence Disease
                Healthcare providers and laboratory workers can learn how to safely perform clinical tests for patie...
              May 14, 2024
                VHF Specimen Collection
                Healthcare professionals can learn how to collect VHF specimens
              Apr. 24, 2024
                VHF Clinical Specimen Packaging and Shipping
                Health professionals can learn how to package & ship samples for VHF testing.
              May 10, 2024
        Treatment
        There is no specific treatment for MVD. Supportive hospital therapy should be utilized, which includes:
          * Balancing the patient's fluids and electrolytes
          * Maintaining oxygen status and blood pressure
          * Replacing lost blood and clotting factors
          * Treatment for any complicating infections
        Long-term effects
        MVD is fatal in up to 90% of patients infected with the virus. There are little data on the persistence of orthomarburgviruses in survivors of MVD; however, since orthoebolaviruses and orthomarburgviruses are in the same virus family (Filoviridae), it can be assumed that orthomarburgviruses can persist in the same "immunologically privileged sites" as orthoebolaviruses: the testes, aqueous humor, placenta, and central nervous system.
          Keep Reading: Caring for Ebola Disease Survivors in the U.S.
        Resources
                Training: Infection Prevention and Control for Marburg Virus Disease in Non-U.S. Healthcare Settings
                Infection prevention & control training for healthcare workers & facility managers in non-U.S. setti...
              May 17, 2024
                Marburg Resources
                List of printable fact sheets on Marburg virus disease.
              Apr. 30, 2024
                Viral Hemorrhagic Fevers (VHFs) for Health Care Providers
                Viral hemorrhagic fevers are rare, but serious viral diseases. Learn how to care for patients and co...
              Oct. 3, 2024
                Viral Hemorrhagic Fever (VHF) 2022 Case Definition
        On This Page
            * Overview
            * Cause
            * Exposure risks
            * Incubation period
            * Mortality rates
            * Clinical features
            * Prevention
            * Screening
            * Treatment
            * Long-term effects
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