Situation at a glance

On 16 September 2022, the Ministry of Health (MoH) of Ghana declared the end of the Marburg Virus Disease (MVD) outbreak that affected the country’s Ashanti, Savannah and Western regions. In accordance with WHO recommendations the declaration was made 42 days (twice the maximum incubation period for Marburg infection) after the second negative test of the last confirmed case on 5 August 2022.

Description of the outbreak

Between 28 June and 16 September 2022, the Ministry of Health of Ghana reported three confirmed cases of Marburg Virus Disease (MVD) including two deaths (CFR 67%). All three cases were from the same household.

The Ministry of Health of Ghana declared the outbreak on 7 July 2022, after confirmation of Marburg virus on 1 July 2022 in a 26-year-old male (the index case) by reverse transcriptase polymerase chain reaction (RT-PCR) at Noguchi Memorial Institute for Medical Research (NMIMR). Blood samples were sent to Institute Pasteur, Dakar for confirmation. The onset of his symptoms was the 22 June with subsequent bleeding from the nose and mouth. The patient was admitted to a hospital on 26 June 2022 and died the following day.

The second patient, a 14-month-old child, developed symptoms and was admitted on 17 July; he died on the third day of admission. The third patient, a 24-year-old female was admitted to a government-designated isolation center on 26 July 2022.

A total of 198 contacts were identified, monitored, and completed their recommended initial 21-day observation period which was then extended for another 21 days by the health authorities.

On 16 September 2022, the MoH declared the end of the outbreak, 42 days (twice the maximum incubation period) after the second negative test of the last confirmed case on 5 August 2022.

Epidemiology of the disease 

Marburg Virus Disease (MVD) is an epidemic-prone disease associated with high case fatality ratios (CFR; 24-88%). In the early course of the disease, the clinical diagnosis of MVD is difficult to distinguish from many other tropical febrile illnesses due to the similarities in the clinical symptoms. Other VHFs need to be excluded, including Ebola virus disease, as well as malaria, typhoid fever, leptospirosis, rickettsial infections, and plague. Human MVD infection can result from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Marburg virus spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with infected people’s blood, secretions, organs or other bodily fluids, and surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Although no vaccines or antiviral treatments are approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms improve survival. A range of potential treatments are being evaluated, including blood products, immune therapies, and drug therapies.

In 2021, an outbreak of MVD was reported for the first time in West Africa in Guinea. Genetic sequencing results indicated that the Marburg virus (MARV) genomes from Ghana are related to the sequence from the 2021 outbreak and overall, group with sequences obtained from bats in Sierra Leone and an outbreak that occurred in Angola in 2004-2005.

• Overall Response: The MoH established a national coordination mechanism and response activities were initiated by WHO and other key partners, US Center for Disease Control, UNICEF and United Kingdom, Foreign, Commonwealth & Development Office (FCDO). Technical experts were deployed by WHO to support the country in strengthening Infection Prevention and Control (IPC), coordination, surveillance, and to conduct investigations and risk assessment.
• Surveillance and Contract Tracing: An integrated disease surveillance and response (IDSR) system was in place and reported alerts were tested. Surveillance activities were implemented including epidemiological investigation and 198 contacts were followed up.
• Infection Prevention and Control: Health care workers were sensitized on case definition and infection prevention.
• Laboratory: Samples of all suspected cases were tested at the laboratory of NMIMR. Genomic sequencing was performed on samples from two of the confirmed cases at NMIMR and IPD.
• Community Engagement: Orientation was held for community-based surveillance volunteers to enhance surveillance in the community.

The current outbreak of MVD in Ghana has been declared over, with no new cases reported for 42-days after the second negative test of the last confirmed case on 5 August 2022. This was the first MVD outbreak reported in Ghana. Outbreaks of MVD are not frequent in West Africa. The most recent MVD outbreak was reported in the Republic of Guinea (one confirmed case) in August 2021. Countries in the African Region that have previously reported outbreaks of MVD include Angola, the Democratic Republic of the Congo, Kenya, South Africa, and Uganda.

The epidemiological investigation has not yet identified the source of this outbreak, which highlights the need to intensify community-based surveillance. The risk of this outbreak at its onset was assessed high at the national level, moderate at the regional level, and low at the global level.

Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and/or bodily fluids of infected persons, and health care related transmission of Marburg virus has been reported when appropriate infection control measures have not been implemented.

Infection Prevention and Control at Health Care Facilities: Health care workers caring for patients with suspected or confirmed Marburg virus disease should apply standard and transmission-based IPC precautions to avoid any exposure to blood and/or bodily fluids, as well as unprotected contact with the possibly contaminated environment. IPC precautions include:

• Early recognition (screening, triage) and isolation of suspected cases.
• Appropriate isolation capacity (including infrastructure and human resources).
• Health care workers’ access to hand hygiene resources (i.e., soap and water or alcohol-based hand rub).
• Appropriate and accessible PPE for health care workers.
• Safe injection practices (emphasize on single-use only needles).
• Procedures and resources for decontamination and sterilization of medical devices.
• Appropriate management of infectious waste.

Integrated disease surveillance and response activities, including community-based surveillance, must continue to be strengthened within all affected health zones.

Community Awareness for Infection prevention and control: Raising awareness of the risk factors for Marburg virus disease and the protective measures individuals can take to reduce human exposure to the virus are the key measures to reduce human infections and deaths. Key public health communication messages include:

• Reducing the risk of human-to-human transmission in the community arising from direct contact with infected patients, particularly with their bodily fluids.
• Avoiding close physical contact with patients who have Marburg virus disease.
• Any suspected case should not be managed at home, but immediately transferred to a health facility for treatment and isolation. During this transfer, health care workers should wear appropriate PPE.
• Regular hand washing should be performed after visiting sick relatives in hospital.
• Communities affected by Marburg should make efforts to ensure that the population is well informed, both about the nature of the disease itself to avoid further transmission, community stigmatization, and encourage early presentation to treatment centers and other necessary outbreak containment measures, including safe burial of the dead. People who have died from Marburg should be promptly and safely buried.

Reduce the risk of wildlife-to-human transmissions, such as through contact with fruit bats, monkeys, and apes:

• Handle wildlife with gloves and other appropriate protective clothing.
• Cook animal products such as blood and meat thoroughly before consumption and avoid consumption of raw meat.
• During work, research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing including masks.

• WHO, Marburg Virus Disease health topic: https://www.who.int/health-topics/marburg-virus-disease#tab=tab_1
• WHO, Marburg Virus Disease fact sheet: https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease
• WHO, Ghana reports first-ever suspected cases of Marburg virus disease, 7 July 2022: https://www.afro.who.int/countries/ghana/news/ghana-reports-first-ever-suspected-cases-marburg-virus-disease
• WHO, disease outbreak news: Marburg virus disease-Ghana, 22 July, 2022 https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON402
• WHO, Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola, 2014. https://apps.who.int/iris/handle/10665/130596
• Ghana Ministry of Health Press release on suspected Marburg Virus Diseases, 7 July 2022: https://twitter.com/_GHSofficial/status/1545113106828902401?s=20&t=PCl0VBd0LjORCwNFFvKnZw
• Investigating Ebola Virus in bats in Ghana, Richard D. Suu-Ire (http://indepth-network.org/workshop/2016/presentations/ebola_feb_2016/dr_suu-Ire%20Bat%20Sampling%20Presentation.pdf(link is external))

Citable reference: World Health Organization (28 September 2022). Disease Outbreak News; Marburg Virus Disease – Ghana. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON409