Bleeding eye disease: An outbreak of Marburg virus disease (MVD) has killed at least 15 people, and infected at least 66 in Rwanda as of November 29, the country’s Ministry of Health announced. Often referred to as the “bleeding eye virus”, MVD is one of the deadliest pathogens known to infect humans. Case fatality rates ranging from 24% to 88% in past outbreaks, depending on virus strain and case management. The first case in Rwanda this year was reported in September. Here is all you need to know about the virus, and why even regional outbreaks cause global concern. Ebola’s lesser-known twin Marburg belongs to the filovirus family, like the much better known Ebola. Both pathogens are clinically similar, and although rare, can cause outbreaks with high fatality rates. The first recognised MVD outbreak occurred in the town of Marburg in Germany in 1967. Since then, subsequent outbreaks have been mostly reported across Africa, most recently in Tanzania, Ghana, and now Rwanda. The World Health Organisation has put MVD in a list of pathogens that pose the greatest threat to public health, and do not have adequate drugs and vaccines against them. Spread from bats, human contact Initially, human MVD infections were caused by prolonged exposure to mines or caves inhabited by colonies of Rousettus bats, most notably the Egyptian fruit bat (Rousettus aegyptiacus). However, according to the World Health Organization (WHO), the virus also spreads through human-to-human contact: both directly (through contact with blood and other bodily fluids of infected people), and indirectly (through surfaces and materials like bedding, clothing, etc. contaminated with these fluids). Can cause haemorrhagic symptoms The interval between infection and onset of symptoms varies from 2 to 21 days. Initial symptoms, according to the WHO, include high fever, severe headache, muscle ache, severe watery diarrhoea, abdominal pain and cramping, and vomiting. Many patients develop haemorrhagic symptoms (bleeding), often in many places including the digestive system (faeces and vomit often come with fresh blood), the nose, gums, the eyes (hence “bleeding eye disease”), and vagina. Haemmorage leads to most MVD fatalities, with death in fatal cases occurring 8 to 9 days after the onset of symptoms, usually of severe blood loss and shock. Treatments still in the works Currently, there are no approved vaccines or specific treatments for MVD. According to WHO, supportive care — rehydration with oral or intravenous fluids — and treatment of specific symptoms, improves survival. Some treatments are also being further divised. Rwanda Health Minister Sabin Nsanzimana had said in October that the country is seeking experimental vaccines and treatments. The US-based Sabin Vaccine Institute had provided Rwanda with 700 doses of its experimental Marburg vaccine, which were administered to healthcare professionals at the frontlines. Its efficacy is still unclear. This is an updated version of an explainer published in October.
