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Marburg Hemorrhagic Fever: Epidemiologic Clues Emerge

Outbreaks could originate from zoonotic contact, perhaps with bats or their excrement, in mines or caves.

First described in 1967, Marburg hemorrhagic fever (MHF) is rare but deadly. Investigators recently described the clinical and molecular epidemiologic aspects of an MHF outbreak centered in Durba, a gold-mining village in northeastern Democratic Republic of the Congo.

From October 1998 through September 2000, 154 MHF cases were identified (48 virologically confirmed, 106 suspected). The mortality rate was 83%. Fifty-two percent of cases were in young adult male miners. Independent chains of infection appeared to begin in these young men: Only 27% of the affected miners had previous contact with someone with MHF, compared to 67% of the other affected individuals (e.g., housewives, infants, healthcare workers; P<0.001). Disease transmission was seasonal, beginning in October or November and peaking in January or February, with only short chains of human-to-human transmission. At least nine genetic lineages of Marburg virus circulated during the outbreak, supporting the idea that virus was introduced into the community multiple times. Ninety-four percent of the ill miners worked in an underground mine that was heavily contaminated with human and bat excrement. The outbreak ceased after the mine was flooded. Upon questioning, healthcare workers recalled small outbreaks of a similar illness among miners in recent years.

Comment: This report helps to unravel some of the mysteries of MHF. The findings suggest that the virus’s reservoir hosts reside in mines or caves. Ebola virus, a filovirus relative of Marburg, has recently been found in fruit bats. On-site diagnostic facilities and improved medical delivery systems would allow earlier diagnosis of MHF and better management of future outbreaks.

— Neil R. Blacklow, MD

Published in Journal Watch Infectious Diseases August 30, 2006

Citation(s):

Bausch DG et al. Marburg hemorrhagic fever associated with multiple genetic lineages of virus. N Engl J Med 2006 Aug 31; 355:909-19.

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