Marburg virus disease in Equatorial Guinea

First ever outbreak of Marburg virus disease (MVD) in Equatorial Guinea affecting geographically distant areas

• This updates the news item of 13 April 2023

On 13 February 2023, the Ministry of Health and Social Welfare of Equatorial Guinea confirmed one case of Marburg virus disease (MVD) with additional suspected cases (and deaths) in eastern Kié-Ntem Province, Equatorial Guinea [1-3]. This is the first outbreak of MVD ever recorded in Equatorial Guinea [1-3].

Since the outbreak was first declared in February 2023, confirmed cases have been reported from Kié-Ntem, Litoral, Centre-Sur and Wele-Nzas provinces [4]. Kié-Ntem, Litoral and Centre-Sur provinces all have borders with Cameroon and Gabon, while Wele-Nzas province borders Gabon and although no cases are reported from these countries population movement over the borders is frequent [5].

Updated case numbers and deaths will be reported on the Equatorial Guinea Country Information page: Outbreaks section.

An emergency response is underway, including infection control measures, contact tracing and case management in affected communities, to prevent further spread [5].

The reservoir host of Marburg virus, the fruit bat, is widely distributed across Africa. MVD is a severe, often fatal haemorrhagic fever, which is clinically almost indistinguishable from Ebola virus disease [6].

There is a current outbreak of MVD reported in Tanzania which was declared on 21 March 2023. A previous recent outbreak was reported in Ghana in 2022, and additionally sporadic cases have occurred in previous years in Angola, the Democratic Republic of the Congo, Guinea, Kenya, South Africa (associated with travel from Zimbabwe), and Uganda [6].

Whilst MVD is rare and very unusual in travellers, sporadic cases have been reported in travellers who spent prolonged periods in mines or caves inhabited by bat colonies [6].

Advice for travellers

Before you go

Check and follow the advice from the Foreign, Commonwealth & Development Office on safety, security, and any travel restrictions at your destinations.

Check our Country Information pages to research general health risks, prevention advice and any vaccine recommendations or malaria advice for your destination and make sure you get comprehensive travel health insurance.

There is currently no licensed vaccine to protect against MVD [6].

While you are there

The risk of exposure to Marburg virus for the majority of those travelling to Central Africa is very low. If you have planned travel to Equatorial Guinea, follow enhanced precautions to reduce your risk of infection:

• Wash hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
• Avoid visiting mines or bat caves and contact with all wild animals; alive or dead, particularly bats.
• If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks.
• Avoid contact with symptomatic patients/their bodily fluids, corpses and/or bodily fluids from deceased patients.
• Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
• Wash and peel fruit and vegetables before consumption.
• Practice safer sex.

When you return

Get medical advice if you become ill within 21 days of returning home. Call NHS111 or contact your GP by phone. Although it is very unlikely you have MVD, you should mention your dates and itinerary of travel and any potential exposure to the virus.

While the risk of MVD is very low, other infectious disease like malaria are present in Equatorial Guinea. You should be aware of the signs and symptoms of malaria and should seek immediate medical attention if these occur either while you are in Equatorial Guinea or up to a year after you return to the UK.

Advice for those working in affected areas

If you are planning to visit outbreak areas for work related reasons (i.e. humanitarian, health care or media activities), you should follow advice from your deploying organisation.

As of 13 April 2023, organisations undertaking business in areas affected by Marburg must register with the UKHSA returning workers scheme (RWS) [7].

Advice for health professionals

Health professionals should remain alert for travellers returning from MVD affected areas who develop symptoms compatible with MVD. See UKHSA's MVD information page for symptoms and guidance.

Health professionals should practise strict universal precautions when caring for patients when MVD is suspected.

Guidance and information about high consequence infectious disease and their management in England and further information and guidance about Marburg fever is available from UK Health Security Agency. Rapid transfer to a designated High Consequence Infectious Disease Treatment Centre will be arranged [9].

UKHSA has specialised laboratory facilities to provide a definitive MVD diagnosis at the Rare and imported pathogens laboratory (RIPL).