Marburg virus disease

Overview

Marburg Virus Disease (MVD), formerly known as Marburg haemorrhagic fever, is a rare but severe zoonotic disease. It is a rapidly progressive febrile illness that leads to haemorrhagic shock and death in a large proportion of cases.

Disease epidemiology

MVD was initially detected in 1967 when two simultaneous outbreaks occurred in Germany and Serbia, arising from laboratory researchers who were inadvertently exposed to the virus after performing necropsies on infected non-human primates that were imported from Africa for use in vaccine production. Since then, there have been several MVD outbreaks, all of which occurred in Central and East Africa. Autochthonous cases were detected in Angola, the Democratic Republic of the Congo, Ethiopia, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, Tanzania and Uganda. The largest MVD outbreak to date involved more than 370 confirmed cases in Angola in 2004 and was centred on a paediatric ward where the infection apparently spread through contaminated transfusion equipment. There were also reports on sporadic cases of international travellers developing MVD after visiting caves colonised by Rousettus fruit bats in Uganda.

The case fatality rates (CFR) have varied from 23% to 90% in past MVD outbreaks.

On 2 July 2026, the World Health Organisation (WHO) reported one laboratory-confirmed case of MVD in Kyegegwa district in western Uganda. This is the fifth outbreak of MVD in Uganda since 2007, with the last outbreak occurring in 2017 involving a family cluster of three fatal cases in eastern Uganda.

Pathogen(s)

Marburg virus (MARV) and Ravn virus (RAVV) are the two viruses under Orthomarburgvirus marburgense that cause MVD. Similar to Ebola viruses, both viruses are part of the Filoviridae family.

Fruit bats (Rousettus aegyptiacus) native to Africa are considered the natural hosts.

Transmission

Transmission can occur through:

• Contact with infectious body fluids (blood, urine, vomitus, faeces, secretions, semen, breast milk) and/or organs of infected persons.

• Contact with infected animals or their tissues.

• Contact with contaminated surfaces or materials (e.g., needles and contaminated medical equipment).

Healthcare-associated transmission may occur during patient care, specimen collection, handling or laboratory processing, particularly through needlestick injuries, exposure to infectious blood or body fluids, improper cleaning or disinfection of medical equipment, reuse of needles, or contact with contaminated medical supplies. Appropriate infection prevention and control measures and laboratory biosafety precautions are essential to minimise these risks.

Incubation period: Typically 5 to 10 days; range is 2 to 21 days.

Infectious period: Infected individuals are not contagious during the incubation period.  They become infectious when they begin to develop symptoms, and remain infectious as long as their blood and body fluids (including semen) contain the virus.

Clinical features

Presentation of MVD is similar to the Ebola Virus Disease. Early symptoms such as fever, headache, sore throat, myalgia, joint pain, and malaise can be varied and non-specific. Progression to maculopapular rash, abdominal pain, nausea, vomiting, diarrhoea, gum bleeding and gastrointestinal bleeding should alert the clinician to MVD. In the late phase of the disease, patients may experience orchitis and central nervous system (CNS) manifestations of confusion, agitation, seizures or coma.

Risk factors

Risk factors include:

• Relevant travel to affected countries or regions with ongoing Marburg Virus Disease outbreak.

• Contact with confirmed or suspected cases, or their blood and body fluids.

• Contact with infected animals or animal products, including preparation or consumption of bushmeat.

• Contact with contaminated surfaces or materials (e.g., needles and contaminated medical equipment).

Diagnosis

Diagnosis in acute infection is by detection of MARV by polymerase chain reaction (PCR) in blood specimens. Diagnostic tests for MVD should be performed only after discussion with MOH. Laboratory investigations at the primary care level should not be performed.

Sample can be sent to NPHL for diagnosis. NPHL will provide laboratory support and guidelines for testing, including protocols for specimen transport, testing and reporting.

Treatment and management

To date, there are no antiviral treatments for MVD. Vaccines and treatments developed against Ebola virus disease are ineffective against MVD.

In the absence of proven antivirals, supportive care remains the mainstay of treatment for MVD. This includes maintaining adequate hydration, symptomatic management (anti-emetics, analgesics), managing electrolyte imbalances, oxygen supplementation and managing shock through active management of fluid status, blood product support, and inotropes as needed. Treatment of secondary infections or any suspected co-infections based on clinical features and travel history pending laboratory confirmation (e.g. malaria, bacterial sepsis etc) is also important.  

Precaution, prevention, and control

General advice

All cases with suspected MVD should wear a surgical mask at the earliest opportunity. Patients should be isolated in an Airborne Infection Isolation Room (AIIR), at a minimum, and managed under Strict Contact, Droplet and Airborne precautions. All personnel attending to these cases should don the following PPE:

• Disposable fluid-resistant hood to cover the head and neck areas (staff with long hair may wish to use head cover prior to wearing hood);

• Disposable eye protection gear (e.g., disposable downward face shields secured at forehead or goggles);

• Inner and outer layers of disposable fluid-resistant (AAMI 4) gown (should extend at least until the ankle portion of the boot cover);

• Disposable 12-inch double nitrile or latex gloves certified for healthcare use (extended cuffs should reach up to mid forearm); and

• Disposable fluid resistant boot covers (should extend up to knee height).

Staff attending to suspect MVD case should be closely monitored (e.g. twice daily temperature monitoring), even if they wear the appropriate PPE. Unprotected exposure should be reported to CDA immediately. A log of all staff attending to the patient should be maintained.

Personnel with skin or mucosal exposure to body fluids from a suspect MVD case should immediately wash the affected skin surfaces with soap and water. Mucous membranes (e.g. conjunctiva) should be irrigated with copious amounts of water or eyewash solution.

Waste generated from patients should be double-bagged, sealed and disposed of as biohazardous waste by a licensed biohazard waste contractor. Environmental surfaces should be cleaned and disinfected using 5,000 ppm sodium hypochlorite. Disinfectants should be applied (not sprayed) before cleaning. Surfaces contaminated with blood, other body fluids, secretions, excretions or spills should be disinfected using 10,000 ppm sodium hypochlorite after the spill is removed using solidifiers or absorbent powder.

CDA will conduct contact tracing for contacts and take appropriate follow-up actions, such as quarantine, phone surveillance, or self-monitoring. Contacts may also be referred to NCID for assessment.

Vaccination

There are currently no vaccines to prevent Marburg virus infection.

Notification

MVD is an emerging infectious disease and is legally notifiable in Singapore. All suspected cases of MVD should be reported to CDA immediately and instructions will be provided on further management of these cases. CDA will arrange for transfer of suspected cases to the NCID on a case-by-case basis. All confirmed MVD cases will be managed at the HLIU in NCID.

Who should notify:

• Medical practitioners

• Laboratories

When to notify:

• On clinical suspicion

• On laboratory confirmation

How to notify:

• Please refer to the Infectious Disease Notification (opens in new tab) for more information.

Notification timeline:

• Immediately

Resources

Get MVD situation updates from the WHO (opens in new tab).