When a man in Temessadou M’Boket – a village in the densely forested southern Guinea region – died in early August 2021 after suffering fever, headache and haemorrhage, a medical team was quickly dispatched, and within hours of his death, laboratory analysis revealed that he had been ill with Marburg, a viral disease in the same family as Ebola.
This was Guinea’s and West Africa’s first case of Marburg virus disease. The quick detection is credited to a build-up of outbreak response expertise since the 2014–2016 West Africa Ebola crisis. Over the years, Guinea and its neighbouring countries have chalked up crucial know-how in disease surveillance, testing, treatment, vaccination, tracing of contacts and community outreach with support from World Health Organization (WHO) and partner organizations.
Thanks to a decentralized system, the Marburg virus was first detected by a field laboratory in Gueckedou town in the south of Guinea and confirmed by the national laboratory in the capital Conakry as well as the Institut Pasteur reference laboratory in Senegal. Guinea declared having confirmed a case of Marburg virus disease on 9 August 2021.
Training of health workers in the surveillance of outbreak-potential diseases also proved critical. Fassara Diawara, the head of a local clinic in southern Guinea, says that the timely detection of Marburg was possible due to health workers’ alertness to the warning signs of outbreak-prone diseases. Once we were notified “we quickly informed the prefectural health authorities so that they could come and collect samples,” he says of the patient who tested positive for Marburg posthumously.
Dr Mamadou Kourouma, a WHO field coordinator in Guinea, explains that quickly deploying experts on the ground even as further analyses are carried out following the detection of an outbreak-potential disease is vital to boosting response and epidemiological knowledge. He notes that soon after being alerted to a possible case of Marburg, a WHO support team was sent to the field. “The objective was to evaluate the risk level as well as the [capacity of] health facilities in the region to step up disease surveillance,” says Dr Kourouma.
In Temessadou M’Boket, a WHO team was also deployed to ensure safe burials, disinfect the health centre where the patient had sought treatment and identify, isolate and monitor the deceased’s contacts. More than 90 health workers were then rapidly trained in the standard precautions on outbreak-potential disease such as Marburg, and the patient triage and isolation system in Gueckedou hospital and local health centres in the region reinforced.
Marburg is viral haemorrhagic disease transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Many patients develop severe haemorrhagic signs within seven days. Case fatality rates have varied from 24% to 88% in past outbreaks depending on virus strain and case management.
Although there are no vaccines or antiviral treatments approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival. A range of potential treatments, including blood products, immune therapies and drug therapies, are being evaluated.
Previous outbreaks in Africa have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda.
In Guinea, to enhance community collaboration in the Marburg response, the national health authorities and WHO teams have been educating the public on the symptoms of the disease, preventive measures, the importance of seeking treatment immediately and other response measures.
“We will continue to reinforce community surveillance in [Guinea’s] forest region as well as the capacity of health workers in the facilities,” says Dr Kourouma of WHO.
No new cases have been reported since the virus was confirmed and a 42-day countdown to declaring the end of the outbreak began on 26 August. However, responding to Marburg, maintaining surveillance after the end of the February–June 2021 Ebola outbreak as well as tackling the COVID-19 pandemic is a tough task, says Dr Kourouma.
“Gueckedou has not been spared from COVID-19 and many health workers have been mobilized to respond to the pandemic, Ebola and Marburg. This is a complex but not an impossible task.”