Marburg virus disease: origins, reservoirs, transmission and guidelines
Source: gov.uk (2025-11-17)

Marburg virus is a filovirus which, along with Ebola virus, can cause a severe and often fatal viral haemorrhagic fever (VHF).

Marburg virus belongs to the Filovirus family, along with Ebola (https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance). It can cause a severe and often fatal haemorrhagic fever called Marburg disease (MARD) which is clinically almost indistinguishable from Ebola virus disease.

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

MARD was first recognised in 1967 when outbreaks of haemorrhagic fever occurred simultaneously in laboratories in both Marburg and Frankfurt in Germany, and Belgrade in Yugoslavia (now Serbia). A total of 31 people became ill, including 25 laboratory workers, medical personnel and a family member who had cared for them. The laboratory workers all had contact with the blood, organs or cell-cultures from a batch of imported African green monkeys from north-western Uganda.

It 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.

Epidemiology

Recorded cases of MARD are rare.

Outbreaks and sporadic cases have been reported in Angola, the Democratic Republic of the Congo (DRC), Equatorial Guinea, Ethiopia, Kenya, Ghana, Guinea, Rwanda, Uganda, South Africa (in a person who had recently travelled to Zimbabwe) and Tanzania.

The first recorded large outbreak occurred in the DRC between 1998 and 2000 and involved 154 cases, including 128 deaths.

The largest outbreak on record occurred in 2005 in Angola and involved 252 cases, including 227 deaths.

While reports of MARD outbreaks in West Africa are rare, sporadic cases have been identified, including 1 fatal case reported from Guinea (https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON331) in August 2021, and 2 fatal cases reported from Ghana (https://www.afro.who.int/countries/ghana/news/ghana-reports-first-ever-suspected-cases-marburg-virus-disease) in July 2022.

Cases detected outside the African Region are extremely rare. Two unrelated sporadic cases in travellers occurred during 2008 following visits to the ‘python cave’ in the Maramagambo Forest in western Uganda; this cave is home to a large colony of Egyptian fruit bats. Both people became ill upon return to their home country; one in the Netherlands and one in the United States. A single case was detected in Russia in 1990 and occurred through laboratory exposure.

Map of MARD in Africa

See the HCID: country specific risk webpage (https://www.gov.uk/guidance/high-consequence-infectious-disease-country-specific-risk) for further information on incidents, outbreaks and travel associated MARD cases outside of Africa.

Symptoms

The 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. There 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).

The 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.

Many of the early symptoms of MARD are similar to those of other infectious diseases, such as malaria or typhoid. Confirmation of the disease requires laboratory testing.

Transmission

Evidence gathered to date suggests that 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. 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.

Diagnosis

In the UK, clinicians who suspect that a patient may have MARD should seek urgent advice from the UK Health Security Agency (UKHSA)’s Imported Fever Service (https://www.gov.uk/guidance/imported-fever-service-ifs) (IFS) on xx-xxxx-xxxx.

The IFS operates 24/7 and provides advice on risk assessment, immediate management and infection control. The IFS will also coordinate urgent testing at UKHSA’s Rare and Imported Pathogens Laboratory (https://www.gov.uk/government/collections/rare-and-imported-pathogens-laboratory-ripl) (RIPL), Porton Down.

RIPL provides polymerase chain reaction (PCR) testing for MARD including out of hours if indicated. See VHF sample testing advice (https://www.gov.uk/government/publications/viral-haemorrhagic-fever-sample-testing-advice).

Treatment

There are currently no licensed vaccines or specific antivirals to treat MARD. Treatment is therefore mainly supportive and includes:
- replacing blood components
- balancing fluids and electrolytes
- maintaining oxygen status and blood pressure
- organ support as needed
UK guidelines

The UK has specialist guidance on the management (including infection control) of patients with viral haemorrhagic fevers (VHFs) (https://www.gov.uk/government/publications/viral-haemorrhagic-fever-algorithm-and-guidance-on-management-of-patients) including MARD.

The guidelines provide advice on risk assessment, testing and management of suspected MARD cases presenting to healthcare services within the UK.

Public health guidance in UK settings for Marburg including contact tracing is available here (https://www.gov.uk/government/collections/marburg-contact-tracing).

Prevention and control

MARD is a VHF: measures for prevention of secondary transmission of Marburg virus are similar to those used for other haemorrhagic fever viruses, and focus on avoiding contact with infected bodily fluids.

Suspected cases must be immediately isolated and assessed using appropriate VHF assessment personal protective equipment. See the ACDP algorithm and guidance on management of patients (https://www.gov.uk/government/publications/viral-haemorrhagic-fever-algorithm-and-guidance-on-management-of-patients) and the NIPCM (https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/addendum-on-hcid-ppe/) for further information.

In the UK, confirmed cases will be notified immediately to the High Consequence Infectious Diseases Network to arrange urgent transport to a High Level Isolation Unit.