By Hope Sloop

The U.S. Centers for Disease Control and Prevention (CDC) has issued a warning to people traveling to two African countries over a deadly Marburg outbreak after it announced it is sending personnel to monitor the disease.

The CDC announced this week it will send the National Center for Emerging and Zoonotic Infectious Diseases to respond to the outbreaks in Guinea and Tanzania.

The virus, according to the World Health Organization, has a death rate ranging from around 25 to 90 percent, has recently spread from rural districts in Equatorial Guinea to more densely populated areas and main transport hubs.

CDC officials have recommended travelers heading to Africa avoid contact with sick individuals and healthcare facilities and monitor any potential symptoms.

Symptoms of the virus - which is a cousin to Ebola - can include fever, sore throat, rash, stomach pain, bloody nose or gums, random bruising and, in severe cases, the patient will often start bleeding from different orifices including their eyes.

An outbreak first occurred in Equatorial Guinea in February.

In the weeks since, the country has reported nine cases with an additional 20 probable cases, according to WHO. All of the additional probable cases have died.

In Tanzania, there have been eight cases, five of whom are confirmed to have died.

Health officials have contacted at least 161 people believed to have had contact with the infected in Tanzania. The cases there are in the northern city of Bukoba, Kagera province, which is home to 120,000 people.

In Gabon and Cameroon - both countries bordering Equatorial Guinea - are currently on high alert over the virus.

The African nations have put in place certain travel restrictions as the virus continues to spread.

According to the CDC, the virus is spread through 'blood or body fluids of a person infected with or who has died from Marburg.'

The illness is also spread through contact with contaminated objects - things like clothing, needles, and medical equipment - or by contact with animals such as bats.

The serious virus causes patients to take on a sunken, almost ghost-like appearance with drawn features, lethargy, and deep.

Like Ebola, it’s a hemorrhagic fever, meaning they cause bleeding from multiple organs within the body. In the later stages of the disease, the patient will often start bleeding from different orifices.

At this time, the WHO has stated that the 'risk at the global level is assessed to be low,' but the situation is still being taken very seriously.

Dr Matshidiso Moeti, WHO Regional Director for Africa said last week they are tracking the spread and monitoring it closely.

'The confirmation of these new cases is a critical signal to scale up response efforts to quickly stop the chain of transmission and avert a potential large-scale outbreak and loss of life,' Dr. Moeti stated.

The global health body maintains that at the global level, the risk is believed to be low.

The virus is endemic to areas of central Africa, however, including Angola and the Democratic Republic of the Congo. It has also previously cropped up in Kenya.

Kenyan officials have taken steps to increase surveillance and bolster testing infrastructure along the borders with Uganda and Tanzania.

In Uganda, just north of Tanzania, officials have ordered screening and testing to take place at Kasensero and Mutukula border points.

How deadly is Marburg?

Marburg is one of the deadliest pathogens known to man.

The WHO says it has a case-fatality ratio (CFR) of up to 90 percent.

But experts estimate that it probably sits closer to the 50 percent mark, similar to its cousin Ebola — another member of the filoviridae family.

That means that out of every 100 people confirmed to be infected with Marburg, half would be expected to die.

Scientists don't, however, know the infection-fatality rate, which measures everyone who gets infected — not just cases that test positive.

For comparison, Covid had a CFR of around three percent when it burst onto the scene.

What are the tell-tale symptoms?

Symptoms appear abruptly and include severe headaches, fever, diarrhoea, stomach pain and vomiting. They become increasingly severe.

In the early stages of MVD — the disease it causes — it is very difficult to distinguish from other tropical illnesses, such as Ebola, and malaria.

Infected patients become 'ghost-like', often developing deep-set eyes and expressionless faces.

This is usually accompanied by bleeding from multiple orifices — including the nose, gums, eyes and vagina.

Like Ebola, even dead bodies can spread the virus to people exposed to its fluids.

How does the virus spread?

Human infections typically start in areas where people have prolonged exposure to mines or caves inhabited by infected fruit bat colonies.

Fruit bats naturally harbor the virus.

It can, however, then spread between humans, through direct contact with the bodily fluids of infected people, surfaces and materials.

Contaminated clothing and bedding are a risk, as are burial ceremonies that involve direct contact with the deceased.

In Equatorial Guinea, the virus was found in samples taken from deceased patients suffering from symptoms including fever, fatigue and blood-stained vomit and diarrhea.

Healthcare workers have been frequently infected while treating Marburg patients.

Gavi, an international organization promoting vaccine access, says that people in Africa should avoid eating or handling bushmeat.

Is there a vaccine?

No vaccines are currently approved to treat the virus.

The WHO convened an urgent meeting on Monday over the rising cases, calling in experts from around the world.

Members of the Marburg virus vaccine consortium (MARVAC) — speaking to the WHO — said it could take months for effective vaccines and therapeutics to become available, as manufacturers would need to gather materials and perform trials.

Experts identified 28 experimental vaccine candidates that could be effective against the virus — most of which were developed to combat Ebola.

Five were highlighted in particular as vaccines to be explored.

Three vaccine developers — Janssen Pharmaceuticals, Public Health Vaccines and the Sabin Vaccine Institute — said they may be able to make doses available to test in the current outbreak.

The vaccines from Janssen and Sabin have already gone through phase one clinical trials. However, none of the vaccines are available in large quantities.

Public Health Vaccines' jab was also recently found to protect against the virus in monkeys, and the Food and Drug Administration has cleared it for human testing.

How bad were previous Marburg clusters and where were they?

Before this outbreak, only 30 cases had been recorded globally from 2007 to 2022.

Angola, in central Africa, faced the largest known outbreak in 2004. It had a 90 percent fatality rate, with 227 deaths among 252 infected people, according to the Angolan Government.

Last September, Ghana declared the end of a Marburg outbreak which affected the country’s Ashanti, Savannah and Western regions.

Could it reach Britain or the US?

Most outbreaks of Marburg fizzle out after infecting a few people.

For this reason, experts say the chances of it sparking a pandemic are tiny. Yet, it is not impossible.

Professor Whitworth said yesterday: 'Marburg outbreaks are always concerning because of the high case fatality rate and the potential for spreading from person to person by close contact.'

However, the speed at which the outbreak in Equatorial Guinea was spotted by officials may have helped dampen the spread of infection so far, he advised.

He said: 'This outbreak has occurred in a remote forested area of Equatorial Guinea which limits the potential for spreading fast or affecting many people.

'It also appears to have been spotted quickly, the number of suspected cases is small and the first death under investigation occurred on January 7, so only about five weeks ago.'

But he added: 'The outbreak has occurred close to the international borders with Cameroun and Gabon so international coordination will be required.

'So, overall, the risk for Equatorial Guinea and the region is moderate, and the risk of it spreading outside the region is very low.'