OUTBREAK: Marburg Virus

Background

Marburg Virus Disease (MVD) is a zoonotic infectious disease caused by the Marburg virus (MARV), belonging to the Filoviridae viral family. It was first discovered in 1967 after two simultaneous outbreaks occurred among laboratory workers in Germany and Serbia (formerly Yugoslavia). The laboratory workers were handling African Green Monkeys imported from Uganda. Since then, several MVD outbreaks have occurred predominantly in sub-Saharan Africa. Rousettus aegyptiactus bats are considered the natural animal reservoir for MARV and human infections have occurred after prolonged exposure to mines and caves where these bats live. 

MVD can be a fatal disease with a case-fatality ratio of up to 88%. Clinical presentation is similar to Ebola virus disease. Infected individuals commonly develop fever, severe gastrointestinal symptoms, and haemorrhagic manifestations. MARV is transmitted via direct contact with an infected person’s (or animal’s) blood, bodily fluids, deceased body, or surfaces contaminated with these fluids, putting healthcare workers at increased risk. Among those who survive MVD, the MARV is known to persist in the placenta, breast milk, and semen. There are no licensed vaccines or therapeutics against MARV however, several medical countermeasures are in development. 

Current Outbreak

On 27 September 2024, Rwanda declared its first outbreak of MVD. As of 29 September 2024, there have been 26 confirmed cases and eight deaths (CFR 31%) from 7/30 districts. The source of the infection remains unknown. Healthcare workers are most affected and account for 70% of the confirmed cases. Kigali, Rwanda’s capital city, has an international airport and a road network to East Africa, raising concern that confirmed cases within Kigali could lead to further spread. One contact of a confirmed case is already known to have traveled internationally. 

The World Health Organization (WHO) has assessed the risk of this outbreak at a national level as ‘very high’, at a regional level as ‘high’, and at a global level as ‘low’. Rwanda and neighboring countries, with support from the WHO, are taking rapid actions, including engaging communities, to contain this outbreak. Further research is needed to support public health efforts. 

For more information about the ongoing Marburg Virus Disease outbreak in Rwanda, click here. 

Key public health and research updates 

September 2024:

• Rwanda confirms cases of Marburg Virus Disease for the first time.

August 2024: 

• The WHO published infection prevention and control research priorities in healthcare settings for Ebola and Marburg.

March 2024:

• The WHO published a Core Trial Protocol for a platform adaptive randomised trial for new and repurposed Filovirus treatments.

April 2023: 

• The WHO Technical Advisory Group published candidate vaccines prioritised for inclusion in a Phase 1/2/3 study against MVD. 

March 2023: 

• The GloPID-R Research and Policy Team shared a ‘Marburg Outbreak Brief’ with its members (relating to an outbreak in Tanzania and Equatorial Guinea) which includes information from a rapid review of clinical trial registries. They found 12 active MARV research projects all of which were at the pre-clinical or basic science stage. 
• A WHO R&D meeting with the MARVAC consortium was held to discuss medical countermeasures in development and integrating research during an outbreak.

February 2023: 

• The WHO published a Marburg virus therapeutics and vaccine landscape outlining candidates in development.
• A systematic review by Rigby et al. (2023) on clinical management guidelines for high-priority viral haemorrhagic fevers found only two guidelines for MVD. Both were of limited scope and quality. 

July 2022: 

• A protocol for an international, randomized clinical trial platform based on a ring vaccination trial design, was developed by the Marburg Vaccine Trial Core Protocol Working Group.

June 2022: 

• The WHO R&D blueprint team published a Strategic Research Agenda for Filovirus Research and Monitoring (WHO-AFIRM) which outlines a long-term global strategy for filovirus research and monitoring between 2021-2031. 

Outbreak-Specific Research Priorities

The WHO R&D team published a Roadmap outlining research priorities for Ebola/Marburg in 2019. A more updated Strategic Research Agenda for Filovirus (2021-2031) was published in 2021. This outlines strategic goals and milestones for Filovirus research under three pillars: Anticipation (to prevent and control outbreaks), Reinforcement (to develop and evaluate vaccines), and Cure (to develop post-exposure therapies). 

Relevant Links

• A WHO-Strategic Research Agenda for Filovirus. Research and Monitoring (WHO AFIRM). WHO-AFRIM Strategy Roadmap 2021-2031. 
• Ebola/Marburg Research and Development (R&D) Roadmap. January 2019 – Advanced draft.

Clinical Trials Landscape 

A review of the landscape of our funding data on clinical trials can be obtained by applying the filters: Disease =Marburg > Study type = Clinical > Research categories = Therapeutics research development and implementation AND/OR vaccines research development and implementation on the left-hand filter bar.   

We have collated additional data from clinical trials registries.  See our most up-to-date analyses here.  

Pandemic PACT Data

See below our data visualisations for Marburg virus disease research funding, including alignment to the outbreak-specific research priorities. Visit our ‘Explore’ page and filter for Marburg to review the details of the research grants funded and their linked publications.