From Ebola to Marburg, it is a season of deadly viruses

With West Africa, and indeed the rest of the world, still reeling from the deaths brought about by the Ebola virus, the recent death of a Ugandan hospital technician of another deadly viral disease, Marburg Haemorrhagic Fever (MHF), has brought fresh fears.
Uganda’s Ministry of Health disclosed that a total of 99 people who had been in contact with the victim had been moved to quarantine. These contacts are being monitored for signs and symptoms of the disease after tests confirmed that the 30-year-old man who worked as a radiographer in a Kampala hospital died of the disease. The man was said to have had a headache, abdominal pains, diarrhoea and vomited blood before he died.

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Marburg virus was first identified in 1967, after simultaneous outbreaks in Marburg (from which the disease takes its name) and Frankfurt both in Germany, Belgrade, Serbia and Yugoslavia. It was later traced back to monkeys imported from Uganda for laboratory work. Since then, the virus has appeared sporadically, with just a dozen outbreaks on record. The most recent outbreak, also in Uganda, in 2012, killed four out of 15 patients, according to the United States of America’s Centers for Disease Control and Prevention.
The Marburg virus is similar to the Ebola virus in many ways than one. They both cause illnesses marked by severe bleeding (haemorrhage), organ failure and, in many cases, death. The Marburg virus is a genetically unique zoonotic (transmissible from animal to man) RNA virus of the filovirus family. The five species of Ebola virus are the only other known members of the filovirus family. The reservoir host of Marburg virus is the African fruit bat which, when infected with the virus, do not to show obvious signs of illness.
Although, it is not clearly known of how the Marburg virus first got transmitted from its animal host to humans, it was discovered that in the two cases in Uganda in 2008, unprotected contact with infected bat faeces or aerosols were the most likely routes of infection. In some other outbreaks, persons who have handled infected non-human primates or have come in direct contact with their fluids or cell cultures have become infected. As soon as infection occurs, it leads to contracting the deadly Marburg Haemorrhagic Fever which has a high mortality.
Human-to-human transmission occurs within communities through cultural practices, under-protected family care settings and under-protected health care staff. Just like the Ebola virus, close contact with the blood, secretions or other bodily fluids of infected persons, burial ceremonies where mourners have direct contact with the body of the deceased and  close contact without the use of correct infection control precautions by health workers can play a significant role in the transmission of the Marburg virus. Transmission can also occur through infected semen for up to seven weeks after clinical recovery. Transmission has not been established to be air borne or by insect bites. According to the World Health Organisation, case fatality rates in Marburg Haemorrhagic Fever outbreaks have ranged from 24 per cent to 88 per cent.
The incubation period (period from infection to beginning of symptoms appearing) varies from two to 21 days.
The World Health Organisation states that symptoms of Marburg haemorrhagic fever begin abruptly with high fever, severe headache, muscle aches and pains as well as severe general feeling of unwellness. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting usually begin on the third day. The diarrhoea can persist for a week. The looks of patients at this phase also change drastically as it has been reported that they show “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy. Sometimes, a non-itchy rash may be noted in patients between two and seven days after onset of symptoms.
As the name implies, there is haemorrhaging (bleeding) at some point. Many patients develop severe haemorrhagic manifestations between five and seven days, and fatal cases usually have some form of bleeding, often from multiple areas. Fresh blood in vomitus and faeces is often accompanied by bleeding from the nose, ears, vagina and other orifices. Spontaneous bleeding also occurs at sites where intravenous access is obtained to give fluids or obtain blood samples. During the severe phase of illness, patients have sustained high fever and there is an involvement of the central nervous system which can result in confusion, irritability, and aggression
Death occurs most often between eight and nine days after the onset of these symptoms and is usually preceded by severe blood loss and shock.
Unfortunately, it neither has any vaccine or specific treatment at the moment. Treatment includes intensive supportive care, as patients are frequently in need of intravenous fluids or oral rehydration with solutions containing electrolytes.
Over the years, there have been several attempts at creating a vaccine and these are being tested but it could be several years before any are available.
With the recorded death in Uganda, the fear of a possible spread within and outside the country is palpable. However, Uganda, which is no stranger to haemorrhagic fevers such as Ebola and Marburg and has lived with outbreaks of these deadly diseases for decades including an outbreak of Ebola in 2000 that killed at least 224 people over several weeks, seems confident of containing the spread of the virus. Ugandan health officials have tried to assuage the mounting fears  of a spread by stating that they can contain an outbreak by drawing on their past experience in fighting Ebola and the Marburg haemorrhagic fever.
Prevention
Measures for prevention of secondary transmission of Marburg virus are similar to those used for other haemorrhagic fevers such as Ebola.
Worst Ebola outbreak on record tests global response
International agencies and governments are fighting to contain the world’s worst Ebola epidemic since the disease was identified in 1976.
The virus, which causes fever and bleeding, has killed nearly 4,000 people.
Here is a timeline of the outbreak in 2014 as compiled by Reuters:
March 22: Guinea confirms a previously unidentified haemorrhagic fever, which killed over 50 people in its southeastern Forest Region, is Ebola. Cases are also reported in the capital.
March 30: Liberia reports two Ebola cases; suspected cases reported in Sierra Leone.
April 1: Medical charity, Medecins Sans Frontieres (MSF), warns the epidemic’s spread is “unprecedented.” But a World Health Organisation (WHO) spokesman calls it “relatively small still.”
April 4: A mob attacks an Ebola treatment centre in southeastern Guinea. Healthcare workers in Guinea, Sierra Leone and Liberia face growing hostility from fearful, suspicious local people.
May 26: WHO confirms first Ebola deaths in Sierra Leone.
June 17: Liberia says Ebola has reached its capital, Monrovia.
June 23: With deaths above 350, making the West African outbreak the worst Ebola epidemic on record, MSF says it is “out of control” and calls for massive resources.
July 25: Nigeria, Africa’s biggest economy, confirms its first Ebola case, a man who died in Lagos after traveling from Monrovia.
July 29: Dr. Sheik Umar Khan, who was leading Sierra Leone’s fight against the epidemic, dies of Ebola.
July 30: Liberia shuts schools and quarantines the worst-affected communities, using troops for enforcement.
August 2: A US missionary physician infected with Ebola in Liberia is flown to Atlanta in the United States for treatment.
August 5: A second US missionary infected with Ebola is flown from Liberia to Atlanta for treatment.
August 8: WHO declares Ebola “international public health emergency.”
August 12: WHO says death toll has topped 1,000, approves use of unproven drugs or vaccines. A Spanish priest with Ebola dies in a Madrid hospital.
August 15: MSF says the epidemic will take about six months to control.
August 20: Security forces in Monrovia fire shots, tear gas to disperse crowd trying to break out of quarantine, killing a teenager.
August 21: The two US missionary aid workers treated in Atlanta are released from the hospital free of the virus.
August 24: Democratic Republic of Congo declares Ebola outbreak, apparently separate from larger epidemic. An infected British medical worker is flown home from Sierra Leone for treatment.
August 28: WHO puts death toll at above 1,550, warns outbreak could infect more than 20,000.
August 29: Senegal reports first confirmed Ebola case.
September 2: MSF President, Joanne Liu, tells UN members the world is “losing the battle” to contain Ebola, slams “a global coalition of inaction.”
September 3: Epidemic’s pace accelerates; deaths top 1,900. Officials say there were close to 400 deaths in the past week.
A third U.S. missionary doctor infected with Ebola is flown from Liberia for treatment in Omaha, Nebraska.
September 5: Latest WHO tally: More than 2,100 dead out of about 4,000 people thought to have been infected.
September 7: President Barack Obama says in an interview the United States needs to do more to help control Ebola to prevent it from becoming a global crisis.
September 8: Britain says it will send military and humanitarian experts to Sierra Leone to set up a treatment centre; United States says it will send 25-bed military field hospital to Liberia to care for health workers. A fourth Ebola patient was flown to the United States for treatment in Atlanta.
September 9: New WHO tally: At least 2,296 dead out of 4,293 cases recorded in five countries.
September 13: Liberian President, Ellen Johnson Sirleaf, appeals to US president, Barack Obama, for urgent aid in tackling Ebola.
September 16: The United States promises to send 3,000 military engineers and medical personnel to West Africa to build clinics and train healthcare workers.
September 17: MSF says a French nurse volunteering for the medical charity in Liberia has Ebola.
September 18: New WHO tally: 2,630 dead out of 5,357 believed infected.
The United Nations says a special mission to combat Ebola will deploy staff in Liberia, Guinea and Sierra Leone. UN Security Council adopts US-drafted resolution calling for lifting of travel and border restrictions.
French President, Francois Hollande, says a military hospital will be set up in Guinea.
September 19 - Streets in Sierra Leone’s capital, Freetown, are deserted as the country imposes a three-day lockdown to try to halt Ebola’s spread.
Sept. 20 - Liberian national, Thomas Eric Duncan, flies from Liberia to Dallas via Brussels and Washington after reportedly trying to help a woman with Ebola in his home country.
September 22 - WHO says the outbreak has been largely contained in Senegal and Nigeria but says Ebola has killed more than 2,811 people in West Africa.
September 23 - The CDC estimates between 550,000 and 1.4 million people in West Africa may be infected with Ebola by January.
September 25 - At a meeting on the sidelines of the UN General Assembly, Obama calls on more countries to help fight Ebola, saying hundreds of thousands of lives are at stake.
Duncan goes to a Dallas hospital complaining of fever and abdominal pain. He is sent back to the apartment where he is staying, with antibiotics, despite telling a nurse he has traveled from West Africa.
September 26 - New WHO tally: 3,091 dead out of 6,574 probable, suspected and confirmed cases.
Cuba says it will send nearly 300 doctors and nurses to West Africa, to join 165 healthcare workers slated to arrive in early October.
September 28 - Duncan’s condition worsens, and he is taken to the Dallas hospital by ambulance.
September 30 - CDC confirms Duncan has Ebola, making his first case diagnosed in the United States.
October 1 - WHO updates West Africa death toll to 3,338 dead out of 7,178 cases.
October 2 - Britain pleads for international help to fight epidemic at “Defeating Ebola” conference in London.
NBC News says an American freelance television cameraman working for the network, Ashoka Mukpo, has tested positive for Ebola and will be flown back to the United States for treatment.
October 3 - New WHO tally: 3,439 dead out of 7,492 suspected, probable and confirmed cases in West Africa and in the United States, which has one of the cases.
A Ugandan doctor suffering from the disease arrives in Frankfurt, Germany, from Sierra Leone for treatment at a hospital there.
October 4 - The volunteer nurse in Liberia who was the first French national to contract the virus leaves a hospital outside Paris after being successfully treated for the disease.
Duncan’s condition worsens from serious to critical.
October 6 - A Spanish nurse who treated the Spanish priest who was repatriated to Madrid with Ebola has also been infected, according to health officials in Spain.
Freelance TV cameraman Mukpo, 33, lands in Omaha in a private plane and is taken to the Nebraska Medical Center.
October 8 - Duncan dies in Dallas hospital.
WHO raises Ebola toll to 3,879 dead out of 8,033 cases and says there is no evidence the epidemic is being brought under control in West Africa.
US government orders five major airports to screen passengers from West Africa for fever, in an effort to bolster defenses against the spread of Ebola.