Introduction

Healthcare workers are essential in controlling disease outbreaks. Yet during Marburg virus outbreaks, as with other diseases, they are often among the first at risk, especially before a patient is diagnosed. The Marburg virus is a highly dangerous pathogen that causes viral haemorrhagic fever. It can spread easily through contact with bodily fluids, making hospitals a high-risk zone.

This article explains how the Marburg virus can spread in healthcare settings and why early diagnosis, proper precautions, and infection controls are essential. Whether you are a clinician, carer, or simply curious, this article will help explain how to stop the Marburg virus from spreading.

What is Marburg Virus?

Marburg virus disease (MVD) is a serious illness caused by viruses in a group called the orthomarburgvirus genus. A genus is a scientific way of grouping closely related viruses. In this case, the genus includes the Marburg virus and the Ravn virus. Marburg virus spreads through contact with infected animals or people.¹ MVD belongs to the Filoviridae family, the same virus family as Ebola, and is most commonly found in sub-Saharan Africa.²

Symptoms

MVD incubation periods (the period from infection to onset of symptoms) range from 2 to 21 days, with symptoms typically developing after 5 to 10 days.³ Symptoms of MVD change as the disease progresses:⁴

Early symptoms start suddenly and include:

• High fever
• Severe headache
• Severe malaise (a general feeling of illness or discomfort)
• Muscle aches

Symptoms by day three:

• Watery diarrhoea
• Abdominal pain and cramping
• Vomiting and nausea
• Non-itchy rash

Symptoms by day five:

• Bleeding from the nose, gums, or vagina
• Fresh blood in vomit or stool
• Confusion, irritability, and aggression
• Orchitis (inflammation of one or both testicles) has been reported in some cases⁵

In deadly cases, people usually die between days 8 and 9, which is often due to heavy bleeding and shock.⁵ As many early symptoms overlap with other infectious diseases, such as typhoid and malaria, confirmation of the virus in a laboratory is important for diagnosis.⁶

Right now, there are no approved vaccines or medicines that treat MVD. The average fatality rate is around 50%, but it has ranged from 24% to 88% in past outbreaks.⁵ Therefore, supportive care focuses on rehydration, blood pressure management, and treatment of secondary infections can improve the survival rate.⁴

How is Marburg Virus Transmitted?

Initially, human MVD results from prolonged exposure to Rousettus fruit bat colonies in caves or mines. Once introduced into the human population, it can spread in many different ways.⁵ 

Human-to-human MVD spreads through:⁵

• Direct contact with blood, saliva, vomit, urine, faeces, or other bodily fluids
• Broken skin or mucous membrane exposure. This is the moist, soft lining found inside parts of the body such as the mouth, nose, eyes, and genitals.
• Sexual transmission, with MVD detected in semen up to 203 days after onset
• Contaminated surfaces such as bedding, clothing, or medical equipment
• Traditional burial ceremonies, where bodies are touched by family members

While people are only contagious once symptoms appear, they remain infectious as long as the virus is present in body fluids.

Prevention and Control

Community engagement is essential to controlling any outbreaks, with intervention approaches including:⁴

• Quarantining infected individuals
• Surveillance and contact tracing
• Rapid diagnostic testing
• Infection prevention and control (IPC) in healthcare
• Practising safe burial techniques

Strategies to reduce the risk of infection include:⁴ 

• Avoiding caves and mines with fruit bat colonies
• Wearing Personal Protective Equipment (PPE) in bat habitats
• Avoiding contact with infected patients
• Educate communities on transmission and symptoms

Rapid identification of the virus and isolation of infected individuals are essential to help contain MVD.

Why are Healthcare Settings High-Risk?

Hospitals are especially vulnerable to MVD transmission because:⁷

• Before a proper diagnosis is made, patients often show symptoms that can be mistaken for other illnesses
• Close physical contact between patients and healthcare providers is normal
• Procedures such as drawing blood, catheter insertions, and wound care involve bodily fluids
• PPE shortages or inappropriate use increase exposure risk
• Overcrowded wards and shared equipment increase transmission

In past outbreaks, needle-stick injuries and handling contaminated waste or surfaces can lead to infections. These exposure risk factors can cause more severe and rapid disease progression.⁴

Diagnosis

Diagnosing MVD is challenging, as symptoms can overlap with other illnesses. However, there are several laboratory tests able to test for this disease, such as:^4,7

• Reverse transcriptase polymerase chain reaction (RT-PCR)
• Antigen-capture ELISA testing
• IgM-capture enzyme-linked immunosorbent assay (ELISA)
• Virus isolation by cell culture (growing the virus in a lab using living cells)

Because samples of the virus are highly dangerous, any testing on untreated samples must be carried out in labs with the highest level of safety and containment.⁵

Controlling Spread Within Healthcare Settings

All healthcare workers should follow standard precautions, even before diagnosis is confirmed.

Key actions include:^4,7

• Early isolation of suspected cases in private rooms
• Full PPE for anyone in contact with patients
• Limiting staff exposure by having only necessary personnel attend to patients
• Frequent hand hygiene
• Use single-use equipment

These actions help protect healthcare workers, patients, and visitors from risk.

Real-World Examples of Hospital Outbreaks

The history of MVD outbreaks has primarily occurred in Sub-Saharan Africa.⁸ 

1967: Germany and Yugoslavia 

• Outbreaks from handling African green monkeys imported from Uganda
• 31 cases and 7 deaths

2004-2005: Angola

• An outbreak in the Uige Province
• Many healthcare workers died after not wearing PPE when treating early-stage patients
• 252 cases and 227 deaths

2024: Kigali, Rwanda

• MVD was identified in two healthcare facilities, affecting mainly ICU staff
• 66 cases and 15 deaths

How Healthcare Staff Can Stay Safe

Healthcare workers to minimise their risk should follow the Identify, Isolate, and Inform Framework:^9,10

Identify:

• Ask about travel history to the outbreak area in the past 21 days
• Look for potential symptoms
• Assess any contact with infected individuals

Isolate:

• Place the patient in a private room away from other patients

Inform:

• Notify the facility’s IPC team
• Coordinate with local health authorities to reduce transmission

Personal Protective Equipment (PPE) Guidelines

When treating patients, PPE should include:^9,10

• Gown or coverall: Fluid-resistant that extends to the mid-calf
• Gloves: Double gloving is recommended
• Full-face shield with N95 respirator
• Boot/shoe covers
• Apron: Especially when caring for patients with vomiting and/or diarrhoea

These steps are essential to prevent self-contamination.

Waste Disposal, Cleaning, and Disinfection

To minimise environmental contamination:^9,10

• Clean reusable items according to the Spaulding Classification scheme
• Disinfect and clean surfaces frequently
• Manage infectious waste as a biohazard risk, with proper disposal protocols

These practices are similar to protocols used in Ebola virus outbreaks.

Challenges in Resource-Limited Settings

While there are preventative measures, there are also many challenges in resource-limited settings. For example:^4,7,11

• Delayed laboratory results, allowing the virus to spread
• PPE shortages
• Understaffed facilities
• Poor or inadequate training in outbreak protocols
• Cultural practices that involve contact with deceased patients

During the 2024 Rwanda outbreak, most deaths occurred among healthcare workers.¹¹ Misunderstandings and stigma make it harder to separate sick people and keep track of who is infected. Coordinated responses across borders and regional authorities are essential to prevent wider outbreaks.

What Can Be Done to Improve Safety

Prevention strategies should include educating the public about minimising contact with suspected cases, ensuring prompt reporting and medical help for symptomatic individuals, and reinforcing hygiene practices. To prevent the Marburg virus from spreading in hospitals, healthcare systems must be strengthened, especially in vulnerable or high-risk regions. Some solutions include:^4,7,11,12

System-Level Improvements:

• Investing in infection control infrastructure: Dedicated isolation rooms, resources, handwashing stations, and better ventilation
• Ensuring reliable PPE supply chains: Including local production of gowns, gloves, and masks
• Improve ventilation and waste systems

Staff Preparation:

• Simulation training: Regular drills to prepare staff for outbreak scenarios
• Implement outbreak response and mitigation plans

Community Involvement:

• Community engagement: Educating families and local leaders to recognise symptoms early 
• Run public education campaigns
• Working with religious leaders to promote safe burial practices

Research and Innovation:

• Mobile treatment units: Temporary clinics that can be rapidly deployed during outbreaks with rapid diagnostic testing capabilities.
• Improving rapid testing tools
• Funding and developing potential vaccines and therapeutics

Summary

Marburg virus disease (MVD) is a rare but highly dangerous illness that spreads through direct contact with bodily fluids such as blood, vomit, urine, or saliva. In healthcare settings, the risk of infection is especially high. This is because hospitals are places where close physical contact and exposure to fluids are common, particularly during procedures such as drawing blood, wound care, and catheter insertion.

Transmission can happen between patients and healthcare staff, through contaminated surfaces or equipment, or even during burial practices. Healthcare workers are often the first to be exposed, especially if protective equipment is not available, improperly used, or if the disease is mistaken for more common illnesses like malaria.

Early diagnosis, the use of full-body personal protective equipment (PPE), and strict infection prevention and control (IPC) protocols can stop the spread of Marburg in hospitals. However, in many low-resource settings, the lack of PPE, training, or isolation facilities can make containment more difficult. This puts healthcare staff and the wider community at greater risk.

To reduce transmission, healthcare systems must be strengthened with reliable supplies, staff training, and community education. The Marburg virus may be deadly, but with informed action, rapid response, and strong healthcare protections, its spread can be contained, and lives can be saved.