11 July 2008

Marburg haemorrhagic fever in a traveller to Uganda

On 10 July 2008, a case of Marburg haemorrhagic fever was reported in a 40 year old Dutch traveller [1-3]. The woman travelled to Uganda as a tourist between 5 and 28 June 2008, visiting two caves during her trip. No bats were seen at the first cave (in Fort Portal, visited on 16 June), however direct exposure to bats was reported in the second cave, “python cave” in Maramagombo forest (between Queen Elizabeth Park and Kebale) visited on 19 June. It is thought that this cave harbours species of bats which in other locations in sub-Saharan Africa have been found to carry filoviruses, the group of viruses to which Marburg belongs [3]. The woman had travelled to the caves as part of a tour; two other travellers from the tour group also visited the cave at the same time. None of the other travellers in the tour group have developed symptoms to date.

On 2 July 2008, four days after returning to the Netherlands, she began to develop symptoms (fever and chills). She was hospitalised on 5 July, and on 7 July, rapid clinical deterioration with liver failure and severe haemorrhaging occurred. She died on 11 July [2]. Laboratory tests have confirmed that the infection is due to Marburg virus.

Advice to travellers

Marburg haemorrhagic fever is a severe disease caused by a virus of the Filoviridae family. Marburg has previously been reported in Kenya, Uganda, Angola and the Democratic Republic of Congo. It is highly transmissible by direct contact with blood, secretions, organs or other bodily fluids of dead or living infected persons. Transmission can also occur by contact with infected animals (certain species of monkeys and bats). Marburg virus causes an acute febrile illness accompanied by severe haemorrhagic manifestations. The disease presents with the sudden onset of fever, headache, joint and muscle aches, and weakness. As infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion, and haemorrhage can all occur. This can lead to multi-organ failure, shock, and death in severe cases.

The likelihood of travellers contracting Marburg is low unless there has been direct contact with the blood or body fluids of infected persons, or with objects, such as needles, that have been contaminated with body fluids.

Travellers to Uganda should be aware of the apparent risk of contracting Marburg when visiting caves in the Maramagombo forest. Travellers are advised to avoid entering either of the caves included in this tour as well as other caves in Uganda where bats are present.

Travellers who have been potentially exposed to Marburg virus should seek medical attention immediately if they experience any of the above symptoms within the first 21 days of return to the UK or 21 days after exposure.

United Kingdom guidance on the management and control of viral haemorrhagic fevers (VHF) has been written by the Advisory Committee on Dangerous Pathogens: http://www.hpa.org.uk/webw/HPAweb&Page&HP

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Guidance for healthcare workers who will be working with VHF patients in African healthcare settings, has been written by the CDC in conjunction with WHO: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm.

References

1. European Centre for Disease Control threat assessment in response to Early Warning and Response System posted by the Netherlands on Thursday, 10 July 2008.

2. European Centre for Disease Control. Imported Marburg case reported in the Netherlands. 10 July 2008. [Accessed 10 July 2008]. Available at: http://ecdc.europa.eu/index.html

3. World Health Organization. Case of Marburg haemorrhagic fever imported into the Netherlands from Uganda. 10 July 2008. [Accessed 11 July 2008]. Available at: http://www.who.int/csr/don/2008_07_10/en/index.html