Ghana Marburg virus

 At a look, an outbreak

Marburg viral disease (MVD) has been linked to two fatal cases in Ghana's Ashanti region. These cases were reported to the appropriate health authorities on June 28, 2022, as suspected cases of viral hemorrhagic fever (VHF), and on July 1, 2022, Marburg virus testing was positive. This is the first time MVD has been made known in Ghana, and there has only ever been one earlier outbreak of the disease documented in West Africa. A MVD outbreak might pose a significant risk to the public's health because it is severe and frequently deadly.

The outbreak's description

Two probable instances of viral hemorrhagic fever (VHF) were reported to health officials in the Ashanti area of Ghana on June 28, 2022. (Figure 1). Ghana's middle belt contains this area, which is the most populous in the nation.

The first incidence was a 26-year-old male agricultural worker in the Ashanti region's Adansi North area who had previously visited the Western region. He traveled from the Western area to the Ashanti region before the commencement of symptoms on June 24. On June 26, he sought medical attention, and on June 27, he passed away. In the Sawla-Tuna-Kalba area of the Savannah region, which borders both Burkina Faso and Côte d'Ivoire, the case was moved and interred. Before the findings of the MVD laboratory testing were known, the burial was carried out.

The second incident involved a 51-year-old man who worked on a farm in Bekwai Municipality in the Ashanti region. On June 28, he went to the same hospital as the previous instance for care, but he passed away the same day. Fever, general malaise, bleeding from the mouth and nose, and subconjunctival hemorrhage were also symptoms in both cases (bleeding of the blood vessels in the eyes). Blood was drawn on June 27 for the first instance and June 28 for the second case, and both blood samples were transferred to the Noguchi Memorial Institute of Medicine Research (NMIMR) for analysis. Reverse transcriptase polymerase chain reaction testing for the Marburg virus revealed positive results for both patients on July 1. (RT-PCR). Samples from the two patients were transferred to Dakar, Senegal's Institute Pasteur (IPD) on July 12th, and on July 14th, 2022, the IPD validated the findings of the NMIMR.

Unknown is the origin of the illness. According to preliminary examinations, none of these instances had any prior contact with ill people, dead animals, or animals, and they had not been to any social gatherings within three weeks of the commencement of symptoms. Despite the fact that both cases involved farmers, they were employed in separate places and there was no evidence of an epidemiological connection between them. However, in both instances, the populations involved were forest-dwelling ones.

In all, 108 people were identified as contacts of the two cases (50 from the Ashanti area, 48 from the Savannah region, and 10 from the Western region), and they were all placed under self-quarantine and daily surveillance for 21 days. All contacts finished their follow-up period on July 20. These connections included medical professionals and the patients' close relatives. Despite one contact reporting some symptoms, a blood sample that was taken and examined on July 7 at NMIMR came out negative. Over the course of the follow-up period, all of the other contacts reported being in good health.

Epidemics of the illness

MVD is a disease that is prone to outbreaks and has high case fatality rates (CFR; 24-88 percent ). Due to the similarity of the clinical signs, it can be challenging to identify the early stages of MVD from many other tropical fever disorders. The presence of other VHFs must be ruled out, especially Ebola virus infection, malaria, typhoid fever, leptospirosis, rickettsial diseases, and plague. A prolonged exposure to mines or caves where Rousettus bat colonies live can lead to human MVD infection. Via direct contact (through damaged skin or mucous membranes) with the blood, secretions, organs, or other bodily fluids of infected persons, as well as with surfaces and items (such as bedding, clothes), contaminated with these fluids, the marburg virus travels from person to person.

Even though the virus has no licensed vaccinations or antiviral medicines, supportive care, such as rehydrating with oral or intravenous fluids, and treating particular symptoms, increase survival. Blood products, immunological therapies, and pharmacological therapies are just a few of the many possible treatments that are being looked at.

The first MVD epidemic in West Africa was discovered in Guinea in 2021.

WHO risk evaluation

At the national level, the danger of this epidemic is high, at the regional level it is moderate, and at the global level it is low.

Concern is raised by the notification of two MVD cases with a CFR of 100% (2/2). Since the source of this epidemic has not yet been determined by the epidemiological investigation, more community-based surveillance is needed.

Because the initial person left the Western area before showing symptoms, there is a chance that this outbreak will spread to nearby nations. If further instances are confirmed or spread to other regions, the Western region's shared border with Côte d'Ivoire may provide a danger of transborder transmission. Additionally, the first case was not properly interred in the Savannah area, which also borders Burkina Faso and Côte d'Ivoire. The risk of this epidemic has been rated as high at the national level, moderate at the regional level, and low at the global level by WHO.