As we speak, the Facilities for Illness Management and Prevention (CDC) issued a Well being Alert Community (HAN) Well being Advisory to tell clinicians and public well being departments in america about two confirmed outbreaks of Marburg virus illness (MVD)—one in Equatorial Guinea and one in Tanzania.
At the moment, there isn’t any proof to recommend that these two outbreaks are associated; most specialists agree that these symbolize two impartial animal-to-human spillover occasions. So far, no confirmed instances of MVD associated to those outbreaks have been reported in america or different international locations exterior Equatorial Guinea and Tanzania.
Suggestions for Clinicians
At the moment, the danger of MVD in america is low; nonetheless, clinicians ought to pay attention to the potential for imported instances. It is very important systematically assess sufferers for the potential of viral hemorrhagic fevers (together with MVD or Ebola illness) via a triage and analysis course of, together with an in depth journey historical past. Early identification of MVD or different viral hemorrhagic fevers is vital for offering acceptable and immediate affected person care and stopping the unfold of an infection. Current presence in Equatorial Guinea or Tanzania shouldn’t be a motive to defer routine laboratory testing or different measures obligatory for normal affected person care.
MVD needs to be included as a differential analysis for an unwell particular person with a historical past of a regarding publicity whereas in a MVD affected space (eg, contact with a symptomatic particular person with suspected or confirmed MVD or an unknown sickness; attending/collaborating in a funeral; visiting or working in a healthcare facility; having contact with bats or non-human primates; working or spending time in a mine/cave) inside 21 days earlier than symptom onset and who’ve medical signs equivalent to fever, headache, muscle and joint ache, fatigue , lack of urge for food, gastrointestinal signs, or unexplained bleeding. Various diagnoses equivalent to malaria, COVID-19, influenza, or widespread causes of gastrointestinal and febrile diseases in a affected person with current worldwide journey needs to be thought of, evaluated, and managed appropriately. Moreover, sufferers with a Marburg virus an infection could current with concurrent infections (eg, co-infection with malaria) and the potential of a concurrent an infection needs to be thought of if a affected person has a medical and epidemiologic historical past appropriate with MVD.
If a affected person is decided to satisfy the standards for Marburg virus testing, the affected person is taken into account a suspected case of MVD and needs to be managed beneath isolation precautions till receiving a damaging Marburg virus check outcome on a pattern collected > 72 hours after symptom onset. Routine laboratory testing to observe the affected person’s medical standing and diagnostic testing for different potential causes of the affected person’s sickness needs to be pursued whereas Marburg virus testing is underway. Marburg virus diagnostic testing shouldn’t be delayed whereas awaiting outcomes of different diagnostic exams.
Clinicians with issues a few affected person with suspected MVD ought to contact their jurisdictional well being division instantly (by way of the 24-hour Epi On Name contact listing) and observe jurisdictional protocols for affected person evaluation. If a analysis of MVD is taken into account, jurisdictional officers will work with the CDC and the medical staff to coordinate care and testing for the affected person and guarantee acceptable precautions are taken to assist stop potential unfold.
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Clinicians caring for sufferers with deliberate journey to an MVD outbreak affected space can counsel their sufferers on methods to stop publicity throughout their travels. This consists of avoiding contact with blood and physique fluids (or supplies probably contaminated with blood and physique fluids) of people who find themselves sick; funeral or burial practices that contain touching the physique of somebody who died from suspected or confirmed MVD; or contact with fruit bats and nonhuman primates and areas recognized to be inhabited by fruit bats (equivalent to mines or caves).
Suggestions for Public Well being Departments
If a affected person with regarding medical and epidemiologic historical past for MVD is recognized in america, public well being departments ought to observe their established jurisdictional protocols relating to affected person evaluation to find out if testing for Marburg virus is warranted. Affected person administration, pattern referral, and Marburg virus testing needs to be coordinated by the jurisdictional well being officers, CDC, and the medical staff. CDC’s Viral Particular Pathogens Department (VSPB) is out there 24/7 for consultations about Marburg virus illness or different viral hemorrhagic fevers by calling the CDC Emergency Operations Heart at 770-488-7100 and requesting VSPB’s on-call epidemiologist or by e-mailing spather @cdc. gov.
Marburg virus illness is a uncommon however extremely deadly viral hemorrhagic fever attributable to two zoonotic viruses, Marburg virus and Ravn virus, which are intently associated to ebolaviruses throughout the household Filoviridae. In February and March 2023, two distinct outbreaks of Marburg virus have been reported in Equatorial Guinea and Tanzania. These outbreaks mark the primary time that the Marburg virus has been recognized in both Equatorial Guinea or Tanzania, though the virus has been beforehand recognized in neighboring international locations and the reservoir, the Egyptian fruit bat, is understood to be current in each international locations. Obtainable info means that these outbreaks could have originated individually in every nation. So far, there isn’t any proof that these two outbreaks are epidemiologically linked. Viral genetic sequencing from Tanzania is in course of; these outcomes, together with sequence information accessible from Equatorial Guinea, will additional inform whether or not the outbreaks emerged individually via distinct animal-to-human spillover occasions.