Marburg virus Agent Information Sheet (keep for redirect)

Boston University
Research Occupational Health Program (ROHP)
617-414-7647

Agent

Marburg virus is a member of the Filoviridae family. The filamentous viral particles contain a nucleocapsid and are enveloped. On average, they are about 800 nm long with a uniform diameter of 88 nm. Each virion contains one molecule of single-stranded, negative-sense viral genomic RNA.

Disease/Infection

Marburg hemorrhagic fever (Marburg HF)

Pathogenicity

Marburg hemorrhagic fever (Marburg HF) is a rare, severe type of hemorrhagic fever which affects both humans and non-human primates. Marburg virus was first isolated in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Murg and Frankfurt, Germany and Belgrade, Yugoslavia. The first infected people had been exposed to African Green monkeys or their tissues where they had been imported for research. Case fatality rates have ranged between 25-90%.

Biosafety Information

Risk Group/BSL
Risk Group 4
BSL-4

Modes of Transmission

Host Range/Reservoir
The natural reservoir is unknown, but is likely African fruit bats (Rousettus aegyptiacus). Humans and non-human primates (e.g. the African green monkey) are susceptible to infection but incidental hosts.

Symptoms
Sudden onset with high fever, malaise, myalgias, vomiting, diarrhea; maculopapular rash, renal and hepatic involvement and hemorrhagic diathesis; involvement of liver, pancreas, kidney, and to a much less degree the CNS and heart; leukopenia, thrombocytopenia marked toxicity often leading to shock and death.

Incubation Period
3-10 days

Viability
Sodium hypochlorite, β-propiolactone, 3 % acetic acid (pH 2.5), phenolic disinfectants, formaldehyde and paraformaldehyde, 1 % glutaraldehyde, formalin, lipid solvents, and detergents    such as SDS.

Heating for 30 minutes to 60 minutes at 60°C, boiling for 5 minutes, gamma irradiation (1.2 x10⁶ rads to 1.27 x10⁶ rads) and UV radiation.

Survival Outside Host
Can survive for up to 4 to 5 days on contaminated surfaces, and can survive in liquid or dried material for a number of days.

Information for Lab Workers

Laboratory PPE

One-piece positive pressure ventilated suit with life support system is utilized. Long sleeve scrub suits will be worn under the positive pressure suit with inner gloves providing added protection against outer glove tear.

Containment

BSL-4 practices and facilities are recommended for activities involving the propagation and manipulation of production quantities or concentrates of Marburg virus. ABSL-4 practices and facilities are recommended for activities involving animals.

In Case of Exposure/Disease

Immediately after exposure, lab workers should follow the HIGH AND MAXIMUM CONTAINMENT MEDICAL INCIDENT RESPONSE PLAN (ERP C.1) as provided on site and during training.

• For all lab exposures which involve BSL-4 pathogens (splashes, needle sticks, punctures, cuts, scratches, …) and for all medical events which require immediate evaluation and treatment (traumatic injury, heart attack, stroke, seizure, … ):
  • Medical Campus: call or have a coworker call the Control Center at 4-6666.
    You will be referred to or transported to the appropriate health care location by the emergency response team.The Control Center operator will activate a communication tree which includes the BU Research Occupational Health Program (ROHP) officer who will help guide the response.

• You will be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.

Vaccination

None available

Information for First Responders/Medical Personnel

Public Health Issues

After exposure: Immediately after an exposure to Marburg virus, the lab worker is not considered infectious. He/she can be cared for with standard PPE. On campus exposures will be escorted directly from NEIDL triage room to the Patient Isolation Unit at Boston Medical Center (BMC) where lab workers will be received by a team of physicians and nurses at BMC. In case of a lab worker presenting to BMC ED or other outside medical facility, either the exposed or the caring physicians should immediately contact ROHP for further instructions.

In case of (suspected) illness: Lab worker should contact ROHP directly and where possible, transport will be arranged to bring the patient to BMC’s Patient Isolation Unit. Patient should prevent close contact with household members pending evaluation, if possible. If the worker presents to BMC ED or other outside medical facility, caring physicians should contact ROHP for further instructions and to be connected to infectious diseases specialists.

Person-to-person transmission is reported via close personal contact with an infected individual or their body fluids during the late stages of infection. PPE requirements for care of this patient are listed below.

PPE: Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and barrier precautions when blood exposure likely. Use N95 or higher respiratory protection when aerosol-generating procedure performed. Airborne precautions should be considered if prominent cough, vomiting, diarrhea, hemorrhage. 

Other guidance for outside providers: Blood work should be minimized, if possible.

Specimen should be handled with extreme care and enclosed in appropriate shatter proof and spill proof packing for transport to lab. Diagnostic laboratory staff should be notified of suspicion of infection, and tests should be performed under proper containment if Marburg is suspected. Please contact ROHP immediately for further details.

Public health officials should be notified.

 Diagnosis/Surveillance

• Monitor for symptoms. RT- PCR used for diagnosis.
• Other tests include indirect immunofluorescence to detect virus, or antiviral antibodies.
• Potential alternate diagnoses with similar presentationould be considered, such as influenza or other respiratory viruses.

First Aid/Post Exposure Prophylaxis

Standard management of potential exposure to Marburg virus is solely based on observation, potential isolation and with symptomatic and supportive treatments.

Treatment

No anti-viral therapy currently available. Supportive therapy should be provided to maintain renal function, fluid and electrolyte balance, oxygen status and blood pressure, replace lost blood and clotting factors, and complicating infections. Transfusion of convalescent serum may be beneficial. Ribavirin has poor in vitro and in vivo activity against filoviruses.

Medical countermeasures may be available for treatment through CDC and ROHP should be contacted immediately to coordinate potential access to investigational measures.

References

Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. US Government Printing Office, Washington, 2007.

Marburg Hemorrhagic Fever Fact Sheet http://www.cdc.gov/vhf/marburg/resources/Marburg-FactSheet.pdf

Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American journal of infection control 2007 Dec;35(10 Suppl 2):S65-164.

Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2010.

Revised: 9/8/2015