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Infection in health workers (HWs) has characterized outbreaks of Ebola virus disease (EVD) and Marburg virus disease (MVD). We conducted a systematic review to investigate infection and mortality rates and common exposure risks in HWs in EVD and MVD outbreaks. We searched the EMBASE and PubMed databases to identify articles posted before 27 December 2017, with no language restrictions. Data on the number, frequency, and mortality of HW infection and exposure risks were extracted. Ninety-four articles related to 22 outbreaks were included. HW infections composed 2%-100% of cases in EVD and 5%-50% of cases in MVD outbreaks. Among exposed HWs, 0.6%-92% developed EVD, and 1%-10% developed MVD. HW infection rates were consistent through outbreaks. The most common exposure risk situations were inadequate personal protective equipment and exposure to patients with unrecognized EVD/MVD. Similar risks were reported in past EVD/MVD outbreaks and in the recent outbreak in West Africa. Many outbreaks reported high proportions of infected HWs. Similar HW infection rates and exposure risk factors in both past and recent EVD and MVD outbreaks emphasize the need to improve the implementation of appropriate infection control measures consistently across all healthcare settings.

In February 2023, the government of Equatorial Guinea declared an outbreak of Marburg virus disease. We describe the response structure and epidemiologic characteristics, including case-patient demographics, clinical manifestations, risk factors, and the serial interval and timing of symptom onset, treatment seeking, and recovery or death. We identified 16 laboratory-confirmed and 23 probable cases of Marburg virus disease in 5 districts and noted several unlinked chains of transmission and a case-fatality ratio of 90% (35/39 cases). Transmission was concentrated in family clusters and healthcare settings. The median serial interval was 18.5 days; most transmission occurred during late-stage disease. Rapid isolation of symptomatic case-patients is critical in preventing transmission and improving patient outcomes; community engagement and surveillance strengthening should be prioritized in emerging outbreaks. Further analysis of this outbreak and a One Health surveillance approach can help prevent and prepare for future potential spillover events.

Marburg virus disease (MVD) is a highly virulent viral hemorrhagic fever with reported case fatality rates of up to 90%. It is part of the same family as the Ebola virus ( ). MVD, originally identified in 1967 in the context of outbreaks associated with African green monkeys, has been reported sporadically in Africa. Recent outbreaks, including those in Equatorial Guinea and Rwanda, underscore the need for robust preparedness systems and global response. This narrative review focuses on the pathogenesis, clinical manifestations, diagnostic challenges and treatment strategies regarding MVD. It also stresses the need for better surveillance, diagnostic capabilities and vaccines to help prepare for future outbreaks. A comprehensive review of clinical data, epidemiological trends, and diagnostic developments was performed by searching relevant literature in , and . The relevant data were extracted from studies on MVD and presented as a narrative review. MVD primarily affects immune and endothelial cells, resulting in a consequent cytokine storm, coagulopathy, and multi‑organ failure. Early symptoms such as fever, headache and myalgia are nonspecific and can delay diagnosis, as they mimic other infections. Monoclonal antibodies and newer antiviral agents are presently being evaluated for the management of MVD. MVD leads to significant morbidity and mortality, and the high fatality rate, along with the absence of targeted therapies, represents a serious global health threat. Collectively, the establishment of infrastructure for diagnostics, global collaboration, and advanced vaccine development will help bolster the response to MVD outbreaks and thus shorten periods of spiking mortality.

The 2023 Marburg virus disease outbreaks in Equatorial Guinea and Tanzania highlighted the importance of better understanding this lethal pathogen. We did a systematic review (PROSPERO CRD42023393345) of peer-reviewed articles reporting historical outbreaks, modelling studies, and epidemiological parameters focused on Marburg virus disease. We searched PubMed and Web of Science from database inception to March 31, 2023. Two reviewers evaluated all titles and abstracts with consensus-based decision making. To ensure agreement, 13 (31%) of 42 studies were double-extracted and a custom-designed quality assessment questionnaire was used for risk of bias assessment. We present detailed information on 478 reported cases and 385 deaths from Marburg virus disease. Analysis of historical outbreaks and seroprevalence estimates suggests the possibility of undetected Marburg virus disease outbreaks, asymptomatic transmission, or cross-reactivity with other pathogens, or a combination of these. Only one study presented a mathematical model of Marburg virus transmission. We estimate an unadjusted, pooled total random effect case fatality ratio of 61·9% (95% CI 38·8–80·6; I2=93%). We identify epidemiological parameters relating to transmission and natural history, for which there are few estimates. This systematic review and the accompanying database provide a comprehensive overview of Marburg virus disease epidemiology and identify key knowledge gaps, contributing crucial information for mathematical models to support future Marburg virus disease epidemic responses.

Five cases of confirmed Marburg virus disease in Equatorial Guinea are described.

Tanzania declared a Marburg Virus Disease (MVD) outbreak on March 21, 2023, reporting nine cases and six deaths (case fatality rate (CFR) 66.7%). Detection began when a Community Health Worker (CHW) reported unexplained illness via the electronic EBS (e-EBS) system, triggering a national outbreak response. This study documents the Early Warning, Alert and Response (EWAR) interventions carried out during the MVD outbreak response in the Kagera region to identify strengths and bottlenecks for strengthening future outbreak preparedness and response efforts. We documented EWAR interventions using retrospective surveillance document review. MVD outbreak detection and reporting timeliness were compared with Tanzania's EBS indicators and the 7-1-7 target. Surveillance interventions included additional staff deployment, equipment addition, and tool adoption. Community sensitization efforts utilized Swahili-translated informational cards to facilitate early detection and reporting of signals through multiple channels, including the 199-hotline number, EBS desk numbers and via e-EBS and verified using the standard case definition (SCD). Signals were compiled in Microsoft Excel, where descriptive analysis using frequencies to show trends was conducted. Suspected MVD cases were sent for laboratory confirmation. On March 15, 2023, a CHW reported a signal in the e-EBS system within 24 hours. However, a community member and HCWs missed unusual signs of the MVD index case. Five additional members were deployed to support data management using the equipment provided, including three laptops, ten smartphones, and adapted tools. A total of 6,260 informational cards were distributed during community sensitization; 176 MVD signals were reported, where 48 (27.3%) met the SCD, and 37 were sent for laboratory confirmation, of which 2.7% tested positive for the virus. Most signals, 107 (60.8%), were reported in April. The government should adopt the 7-1-7 target and strengthen community and health facility EBS through ongoing mentorship for EWAR.

The filoviruses Marburg and Ebola cause severe hemorrhagic fever (HF) in humans. Beginning with the 1967 Marburg outbreak, 30 epidemics, isolated cases, and accidental laboratory infections have been described in the medical literature. We reviewed those reports to determine the basic clinical and laboratory features of filoviral HF. The most detailed information was found in descriptions of patients treated in industrialized countries; except for the 2000 outbreak of Ebola Sudan HF in Uganda, reports of epidemics in central Africa provided little controlled or objective clinical data. Other than the case fatality rate, there were no clear differences in the features of the various filovirus infections. This compilation will be of value to medical workers responding to epidemics and to investigators attempting to develop animal models of filoviral HF. By identifying key unanswered questions and gaps in clinical data, it will help guide clinical research in future outbreaks.

In March 2023, a Marburg Virus Disease (MVD) outbreak was declared in Kagera region, Northwestern Tanzania. This was the first MVD outbreak in the country. We describe the epidemiological characteristics of MVD cases and contacts. The Ministry of Health activated an outbreak response team. Outbreak investigation methods were applied to cases identified through MVD standard case definitions and confirmed through reverse-transcriptase polymerase chain reaction (RT PCR). All identified case contacts were added into the contact listing form and followed up in-person daily for any signs or symptoms for 21 days. Data collected from various forms was managed and analyzed using Excel and QGIS software for mapping. A total of nine MVD cases were reported with eight laboratory-confirmed and one probable. Two of the reported cases were frontline healthcare workers and seven were family related members. Cases were children and adults between 1-59 years of age with a median age of 34 years. Six were males. Six cases died equivalent to a case fatality rate (CFR) of 66.7%. A total of 212 individuals were identified as contacts and two (2) became cases. The outbreak was localized in two geo-administrative wards (Maruku and Kanyangereko) of Bukoba District Council. Transmission during this outbreak occurred among family members and healthcare workers who provided care to the cases. The delay in detection aggravated the spread and possibly the consequent fatality but once confirmed the swift response stemmed further transmission containing the disease at the epicenter wards. The outbreak lasted for 72 days but as the origin is still unknown, further research is required to explore the source of this outbreak.

Filoviruses such as Ebola virus continue to pose a substantial health risk to humans. Advances in the sequencing and functional characterization of both pathogen and host genomes have provided a wealth of knowledge to clinicians, epidemiologists and public health responders during outbreaks of high-consequence viral disease. Here, we describe how genomics has been historically used to investigate Ebola virus disease outbreaks and how new technologies allow for rapid, large-scale data generation at the point of care. We highlight how genomics extends beyond consensus-level sequencing of the virus to include intra-host viral transcriptomics and the characterization of host responses in acute and persistently infected patients. Similar genomics techniques can also be applied to the characterization of non-human primate animal models and to known natural reservoirs of filoviruses, and metagenomic sequencing can be the key to the discovery of novel filoviruses. Finally, we outline the importance of reverse genetics systems that can swiftly characterize filoviruses as soon as their genome sequences are available.Filoviruses such as Ebola virus pose a substantial health risk to humans. Advances in genomic technologies have enabled the rapid, large-scale generation of virus sequence data at the location of disease outbreaks and thus the use of reverse functional genomics to swiftly characterize the threat of, and treatment for, filovirus disease.

In October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations. A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus. Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda. This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.