Marburg virus disease

Marburg virus disease is similar to Ebola virus - an RNA virus and a member of the Filoviridae.

It can cause a severe and often fatal haemorrhagic fever called Marburg disease (MARD) which is clinically almost indistinguishable from Ebola virus disease.

Since the initial identification in 1967 during simultaneous outbreaks in Germany and Serbia, Marburg virus has caused recurrent epidemics predominantly in sub-Saharan Africa with fatality rates ranging from 24% to 90% as a result of differences in virus strains, healthcare infrastructure, and the quality of patient treatment (1):

• like Ebola virus, Marburg virus causes a viral hemorrhagic fever

Marburg virus is known to affect both humans and non-human primates:

• is generally accepted that Marburg virus is a zoonotic (animal borne) virus
  • fruit bats (Rousettus aegyptii) are considered to be the natural host of the virus
• monkeys are susceptible to Marburg virus infection but are not considered the reservoir hosts as they usually die rapidly once infected
• experimental infections have shown how pigs are susceptible to filovirus infection and can shed the virus

Transmission

• natural infection is most likely associated with contact with Rousettus bat colonies
• subsequent transmission of virus from person-to-person requires close contact with blood or bodily fluids from an infected patient (2):
  • faeces, vomit, urine, saliva and respiratory secretions contain a high concentration of virus, particularly when these fluids contain the patient’s blood
  • sexual transmission of the virus can occur, and the virus may remain in semen for several weeks after clinical recovery, with some reports of virus present up to 203 days after disease onset
  • transmission of the virus via contaminated injection equipment or needle-stick injuries is associated with more severe disease
  • close contact with the body or body fluids of people who have died of MARD during preparation for burial is a recognised source of infection

Clinical features

• incubation period of MARD is typically 3 to 10 days, but can take up to 21 days from the date of exposure to the virus for symptoms to appear (2)
  • have been rare reports of longer incubation periods up to 28 days (although the precise mechanism of transmission in these cases was not well documented)
• onset of illness is sudden, with:
  • severe headache
  • malaise
  • high fever
  • progressive and rapid debilitation
• by about the third day symptoms include:
  • watery diarrhoea
  • abdominal pain
  • abdominal cramping
  • nausea
  • vomiting
• symptoms can become increasingly severe, and many patients develop a maculopapular rash after 5 to 7 days
• severe cases usually exhibit some form of bleeding, including bleeding under the skin, bleeding from mucous membranes and from venepuncture sites

Diagnosis

• relies on molecular tools such as real-time reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay, as well as clinical and epidemiological assessments (1)

Treatment

• are currently no licensed vaccines or specific antivirals to treat MARD
  • treatment is therefore mainly supportive

Reference:

1. Uppala PK, Karanam SK, Kandra NV, Edhi S. Marburg virus disease: Emerging threat, pathogenesis, and global public health strategies. World J Virol. 2025 Jun 25;14(2):103576.
2. UK Health Security Agency (November 17th 2025). Marburg virus disease: origins, reservoirs, transmission and guidelines.