German emergency personnel in full protective gear shut down two railroad tracks at Hamburg’s central station on Wednesday after two passengers were suspected of having contracted the deadly Marburg virus.
A 26-year-old medical student and his girlfriend developed flu-like symptoms while on a train from Frankfurt, according to local reports. The train was evacuated after health authorities suspected they had contracted the Marburg virus — a rare disease that has a fatality rate as high as 88 per cent.
The suspicion arose because the student had recently arrived by plane from Rwanda, where he had been in contact with a patient later diagnosed with the virus, local media reported. The passengers later tested negative for the deadly and contagious virus.
But the emergency response raises the question: what if it had been Marburg?
Rwanda is currently grappling with an outbreak that began Sept. 27. According to the health ministry, the death toll has risen to 11, with at least 36 confirmed cases.
“Marburg virus is a very severe infection. It’s found in Africa and it’s very similar to the Ebola virus,” explained Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital.
“We know there’s been periodic outbreaks of Marburg virus for the last few decades. Whenever there’s an outbreak of this, it’s taken extremely seriously because it can be potentially fatal in a short period of time.”
While the situation in Hamburg was ultimately a false alarm, Bogoch said local and international health agencies are staying vigilant as the outbreak in Rwanda progresses.
Here’s what you need to know about the virus.
Marburg is a virus from the same family as Ebola.
It causes hemorrhagic fever and has an average fatality rate of 50 per cent, according to the World Health Organization (WHO), although rates have been as high as 88 per cent in previous outbreaks.
Symptoms typically include a sudden high fever and extreme headache, as well as vomiting and diarrhea, followed by uncontrolled bleeding.
Like Ebola, the Marburg virus is believed to originate in fruit bats and spreads between people through close contact with the bodily fluids of infected individuals or with surfaces, such as needles or contaminated bed sheets.
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The virus was first identified in Marburg, a city in Germany, and Belgrade, Serbia, in 1967, after laboratory work with African green monkeys from Uganda led to human infections, according to the WHO. Since then, there have been outbreaks and sporadic cases in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda, the WHO said.
The virus spreads to humans from prolonged exposure to mines or caves where fruit bats live, according to the U.S. Centers for Disease Control and Prevention (CDC).
It can also spread between humans, through direct contact with the bodily fluids of infected people, or with surfaces or materials contaminated with those fluids, such as blood. It is not airborne.
“It’s a communicable infection. So the longer it takes to enact infection prevention and control measures, the more people who can get infected, the bigger the outbreak can get,” Bogoch said.
“And sadly, the more people (who) will also come to this illness.“
There are no approved vaccines or treatments for Marburg.
Early supportive care with rehydration and symptomatic treatment improves survival, the WHO said.
Although there is no approved vaccine, on Thursday Rwandan health officials announced they will begin clinical trials of experimental vaccines and treatments in the coming weeks.
“This is part of our efforts to help people recover quickly by utilizing vaccines and medicines specifically developed to fight this outbreak, currently in the final phase of research,” the country’s health minister, Sabin Nsanzimana, told Reuters.
“We are collaborating with the pharmaceutical companies that developed these, alongside the World Health Organization, to expedite the process through multilateral collaboration.”
The WHO said it was working with the government and had held a meeting of industry, academic and government partners to speed up access to vaccine and treatment doses for trials.
Four vaccine candidates have been evaluated for potential use in trials by the WHO, but only one, made by the Sabin Vaccine Institute non-profit, has data from early-stage human trials showing it is safe and led to an immune response.
Further testing of the vaccines outside of outbreak settings is not possible because of the risks involved.
Several treatments could be trialled, including Gilead Science’s remdesivir, an antiviral used during the pandemic to treat COVID-19 and originally developed to treat Ebola, which is related to Marburg.
“While there is no antiviral drug dedicated to Marburg or no licensed vaccine, there are candidate drugs and candidate vaccines that possibly have efficacy,” Bogoch said.
“Sometimes those would be used in these outbreaks in an ethical manner study and evaluate if this could help quell an outbreak and generate data to support future outbreaks.”
Outbreaks of Marburg virus are largely in Africa. There have not been any cases in Canada, the Public Health Agency of Canada (PHAC) reported.
As long as precautions are taken, there is a low risk of contracting Marburg virus disease in a country where the disease is present, PHAC added.
The virus has also been a nationally notifiable disease in Canada since 2000. As a nationally notifiable disease, Marburg virus disease cases are reported to PHAC through national surveillance systems.
PHAC said it also works closely with its national and international partners, including the WHO, to track any Marburg outbreaks.
Although the virus has not spread to Canada or the United States, Bogoch said it is still important to control it as it is a highly contagious disease.
“We know, for example, from a related virus, the Ebola virus, there was a massive outbreak in West Africa in 2014 spanning multiple countries. And it’s very difficult to get those under control when the size of the outbreak is so large,” he said.
“One of the big concerns is not just spread throughout other parts of Rwanda, but also across borders, especially in areas where contact tracing and isolation and medical care might be a little more challenging.”
He emphasized that the best approach is an “all hands on deck” strategy to contain the outbreak quickly and prevent its spread both within Rwanda and to neighbouring countries.
— with files from Global News’ Katherine Ward and Reuters
