Marburg virus disease outbreak in Kween District Uganda, 2017: Epidemiological and laboratory findings

Abstract

Introduction 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. Methods 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. Results 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. Conclusion 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.

Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa

“…arburg virus (MARV), a close relative of the betterknown Ebola virus (EBOV), is the founding member of the family Filoviridae 1,2 and is known to cause sporadic outbreaks of severe, often fatal disease in humans. There have been 12 known Marburg virus disease (MVD) outbreaks, most recently in 2017 in Uganda 3,4 . The largest MVD outbreak on record occurred in Uige, Angola, in 2005, with 227 deaths out of 252 known cases 5 .…”

Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016–2018

“…First, there is evidence that Viral Haemorrhagic Disease epidemics that were previously rare have recently caused devastating epidemics in the region [26,27]. For instance, Ebola and Marburg Virus Diseases (MVD), previously known to be rare, have recently caused major epidemics in Liberia, Guinea and Sierra Leone (2013-2016) [28][29][30][31], in Uganda (2017 and 2018) [32,33], and in the Democratic Republic of the Congo (2018 and 2019) [34][35][36][37]. A 2016 comprehensive regional risk assessment and mapping for all epidemics reported in Africa between 1970 and 2016 revealed that the epicentres for the Ebola virus disease and Marburg virus disease epidemics were mainly in East and Central Africa, except for the West Africa Ebola virus disease epidemic [1]).…”

Filovirus Disease Outbreaks: A Chronological Overview

“…Epidemiological investigations revealed that the outbreak occurred within a single family; three out of a total of four infected persons died of the disease. 56 Due to rapid case detection and the presence of trained national and district response teams, the outbreak was contained within a month. The index case was found to be a herdsman who hunts game in a sub-county where there are caves harboring large populations of Egyptian fruit bats.…”