An Outbreak of the Ebola-like Marburg Virus Has the Global Health Community on Edge

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There are two ongoing outbreaks of Marburg Virus Disease, one in Tanzania and the other in Equatorial Guinea. Marburg is in the same family of diseases as Ebola and is extremely deadly, with a case-to-fatality ratio of up to 88%. Humans can become infected through contact with fruit bats, and like ebola, Marburg is transmissible between humans through contact with bodily fluids. Unlike Ebola, there is no working vaccine.

Joining me to discuss these outbreaks is Dele Ogunseitan, a professor of population, health and disease prevention at the University of California Irvine and a Visiting professor at Stanford University's Center for Innovation in Global Health. He also leads the training and empowerment objective for a USAID project called One Health Workforce Next Generation. 

We kick off discussing the history of Marburg before having a longer discussion about these two outbreaks and what can be done to stop Marburg from spreading further. 

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Dele Ogunseitan [00:02:57] Marburg is an extremely dangerous virus, just like Ebola that more people may be familiar with because we had an Ebola outbreak in West Africa not too long ago. Marburg was discovered through people who are infected after having visited a site where the virus is endemic in animal populations. It is known to be endemic in fruit bats, particularly the Egyptian fruit bat in Africa. And so when people contact animals that are infected, whether it's their feces or their urine or blood, they are likely to also be infected by Marburg virus. It is one of the most contagious and deadly viruses because the mortality rate is very high. 

Mark Leon Goldberg [00:03:56] How common are Marburg outbreaks in recent years? 

Dele Ogunseitan [00:04:04] We may never know the answer to that because people do die quickly. And if the contagion is limited, we may not know that there was an outbreak. So if it's limited to a family that's a little bit isolated, we may not know, but I think having a decade with outbreaks is maybe one too many – especially for something so dangerous. But somehow it seems to self limit,  I think because of the way that human to human interaction is necessary (it's not like COVID where people sneeze and it's transmitted through the air.) So we may not know if there are very short lived infections in isolated populations, but it's still concerning. 

Mark Leon Goldberg [00:05:00] So the reason I'm speaking with you about this is that there are two ongoing outbreaks of Marburg, one in Equatorial Guinea, the other in Tanzania. These are very far away from each other. So is it like a coincidence to you that there are two concurrent outbreaks, if indeed Marburg outbreaks are not commonly identified? 

Dele Ogunseitan [00:05:26] I think it's a problem for research to solve, and that research is ongoing. Now, looking at the genetic fingerprint of the viruses that have been isolated in Tanzania and comparing them to the viruses in Equatorial Guinea. I think they are independent viruses. I think the research is likely to show that the outbreaks emerged separate from one another, which it's not too unusual because the bat populations in both countries can have both the virus. And all it will take is for people to encounter those bats that have a spillover event.

The counter argument to that is that maybe food resources for the bats is shrinking. Climate change weather conditions are different. And bats migrate and move. And so the only way that one would confirm that there is a linkage between the Equatorial Guinea outbreak and the Tanzanian Guinea is that to show that the bats have migrated from one country to another or that people who are infected have moved from Equatorial Guinea to Tanzania, for example, or vice versa. 

I do think that the chances of those alternative explanations may be more remote than the idea that these are independent outbreaks that emerged because people in those two countries encountered infected bats. And the reason that's more likely is that in between the two countries, there are lots of opportunities for other people to be infected in countries in between. And we haven't seen that yet. But just because we have seen that doesn't mean it doesn't exist. Like I said, people tend to die very quickly after infection and if it's not fully diagnosed, we'll never know if it's Marburg or something else. 

Mark Leon Goldberg [00:07:43] So I take it that Marburg is transmitted in a way similar to Ebola contact with bodily fluids of infected people? And it's my understanding, just reading the latest from the World Health Organization and from reports that the outbreak in Tanzania is seemingly somewhat contained, whereas the one in Equatorial Guinea is probably not. Is that your sense in reading the data so far?