Marburg virus disease

Primary reference(s)

WHO, 2025. Marburg virus disease. World Health Organization. Accessed 29 May 2025.

Annotations

Key relevant UN convention / multilateral treaty

International Health Regulations (2005), 3rd ed. (WHO, 2016).

Drivers

Human infection with Marburg virus disease initially results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Once an individual is infected with the virus, Marburg can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids (WHO, 2025).

Health-care workers are most at risk of being infected while treating patients with suspected or confirmed MVD. This has occurred through close contact with patients when infection control precautions are not strictly practised. Transmission via contaminated injection equipment or through needle-stick injuries is associated with more severe disease, rapid deterioration, and, possibly, a higher fatality rate. Burial ceremonies that involve direct contact with the body of the deceased can also contribute to the transmission of Marburg (WHO, 2025).

Impacts

Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Muscle aches and pains are a common feature. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. The appearance of patients at this phase has been described as showing “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy. Many patients develop severe haemorrhagic manifestations between 5 and 7 days, and fatal cases usually have some form of bleeding. During the severe phase of illness, patients have sustained high fevers. Involvement of the central nervous system can result in confusion, irritability, and aggression. Orchitis (inflammation of one or both testicles) has been reported occasionally in the late phase of the disease (15 days). In fatal cases, death occurs most often between 8 and 9 days after symptom onset. The average MVD case fatality rate is around 50%. Case fatality rates have varied from 24% to 88% in past outbreaks depending on virus strain and case management (WHO, 2025). 

People remain infectious as long as their blood contains the virus. Relapse-symptomatic illness in the absence of re-infection in someone who has recovered from MVD is a rare event but has been documented. The reasons for this phenomenon are not yet fully understood. Marburg virus is known to persist in immune-privileged sites in some people who have recovered from Marburg virus disease. These sites include the testicles and the inside of the eye. The virus persists in the placenta, amniotic fluid and foetus in women who have been infected while pregnant and may persist in the breast milk of women infected while breastfeeding. Marburg virus transmission via infected semen has been documented up to seven weeks after clinical recovery. After obtention of two consecutive negative test results, MVD survivors can safely resume normal sexual practices with a minimized risk of Marburg virus transmission. In the absence of a semen testing programme, male survivors should follow safer sex practices for 12 months (WHO, 2025).

Multi-hazard context

As an example of the multihazard context, Rwanda reported its first MVD outbreak. As of 9 October 2024, 58 cases, including 13 deaths, were reported in the country. According to limited available information, the majority were healthcare workers. Cases were reported from eight of Rwanda’s 30 districts. In response to this outbreak, the Rwandan Ministry of Health implemented measures such as restrictions on hospital visits and attendance at funerals, measures for educational settings, places of worship, and meetings, as well as a travel advice. Routine temperature checks were conducted at points of entry and exit screening was implemented at Kigali airport. Vaccination of healthcare workers with an investigative vaccine was also being implemented (ECDC, 2024b).

Risk Management

Good outbreak control relies on using a range of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe and dignified burials, and social mobilization (WHO, 2025). 

As an example, Rwanda reported its first MVD outbreak. As of 9 October 2024, 58 cases, including 13 deaths, were reported in the country. According to limited available information, the majority were healthcare workers. Cases were reported from eight of Rwanda’s 30 districts. In response to this outbreak, the Rwandan Ministry of Health implemented measures such as restrictions on hospital visits and attendance at funerals, measures for educational settings, places of worship, and meetings, as well as travel advice. Routine temperature checks were conducted at points of entry and exit screening was implemented at Kigali airport. Vaccination of healthcare workers with an investigative vaccine was also being implemented (ECDC, 2024). 

Community engagement is key to successfully controlling any outbreaks. Outbreak control relies on using a range of interventions, such as case management, surveillance and contact tracing, good laboratory service, infection prevention and control in health facilities, safe and dignified burials and social mobilization. Raising awareness of risk factors for MVD and protective measures that individuals can take is an effective way to reduce human transmission (WHO, 2025). Risk reduction messaging should focus on several factors: 

• Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bat colonies. People visiting or working in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks). During outbreaks all animal products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with MVD patients should be avoided. Patients suspected or confirmed for MVD should be isolated in a designated treatment centre for early care and to avoid transmission at home.
• Communities affected by MVD should make efforts to ensure that the population is well informed, both about the nature of the disease itself and about necessary outbreak containment measures.
• Outbreak containment measures include safe and dignified burial of the deceased, identifying people who may have been in contact with someone infected with MVD and monitoring their health for 21 days, separating the healthy from the sick to prevent further spread and providing care to the confirmed patient and maintaining good hygiene and a clean environment need to be observed (WHO, 2025). 

Healthcare workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe and dignified burial practices. Healthcare workers caring for patients with suspected or confirmed MVD should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Marburg virus infection should be handled by trained staff and processed in suitably equipped laboratories (WHO, 2025). 

All survivors, their partners and families should be shown respect, dignity and compassion. WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Marburg virus. MVD survivors might suffer from both clinical and psychological sequelae. WHO encourages affected countries to consider the establishment of a survivor care programme to alleviate sequelae, support community reintegration and offer counselling and biological testing. Marburg virus is known to persist in immune-privileged sites in some people who have recovered. These sites include the testicles and the inside of the eye. Extrapolating from data on other filoviruses, the virus may persist in the placenta, amniotic fluid and foetus of women infected while pregnant and the breast milk of women infected while breastfeeding. Relapse-symptomatic illness in the absence of re-infection in someone who has recovered from MVD is a rare event but has been documented. The reasons for this phenomenon are not yet fully understood. Marburg virus transmission via infected semen has been documented up to seven weeks after clinical recovery (WHO, 2025). To mitigate the risk of potential transmission via exposure to infected semen, a semen testing programme should be implemented to: 

• offer counselling to male MVD survivors and their sexual partners, as needed, to inform them of potential risks and support them in adhering to safer sex practices (including condom provision and good hand and personal hygiene); and
• offer monthly semen testing until the obtention of two consecutive negative test results. 

After obtention of two consecutive negative test results, MVD survivors can safely resume normal sexual practices with a minimized risk of Marburg virus transmission. In the absence of a semen testing programme, male survivors should follow safer sex practices for 12 months (WHO, 2025). 

WHO aims to prevent MVD outbreaks by maintaining surveillance for MVD disease and supporting at-risk countries to develop preparedness plans. The following document provides overall guidance for control of Ebola and Marburg disease outbreaks: When an outbreak is detected WHO responds by supporting surveillance, community engagement, case management, laboratory services, infection prevention and control, logistical support and training and assistance with safe burial practices. 

Monitoring

The section and the table below offer an overview of monitoring for Marburg Virus Disease. This information can be used for forecasting within a national early warning system (EWS). Since EWS capacities and processes differ across countries, the most current and specific information regarding EWS should be obtained from the appropriate national or regional agency/authority responsible for disaster management.