Doctors Revision

Infectious Diseases

Ebola Virus Disease / Marburg Virus Disease

Severe, often fatal, zoonotic multisystem febrile diseases caused by Ebola virus or Marburg virus (Filoviruses). Transmitted from animals (bats suspected reservoir, primates) to humans, then human-to-human via direct contact with body fluids. Notifiable diseases requiring immediate reporting and strict isolation.

Also known as: EVD, MVD, Viral Haemorrhagic Fever (VHF)

Open in the interactive guide
On this page

Referral and warning signs

When to refer

IMMEDIATE URGENT REFERRAL/TRANSFER (using safe transport protocols) to designated Ebola/VHF Treatment Unit (ETU) / Regional Referral Hospital for ALL suspected cases. IMMEDIATE NOTIFICATION to public health authorities.

Red flags

  • Acute fever +/- haemorrhage + epidemiological link (travel/contact).
  • Unexplained bleeding.
  • Signs of shock.
  • Multi-organ dysfunction.
  • Known contact with confirmed case or infected animal.

Signs and symptoms

  • Incubation period: 2-21 days.
  • Early Phase (Non-specific):
  • - Sudden onset of high fever.
  • - Intense weakness, fatigue, prostration.
  • - Severe headache.
  • - Muscle pain (myalgia), joint pain (arthralgia).
  • - Sore throat, loss of appetite.
  • - Conjunctivitis.
  • Later Phase (Multi-system involvement):
  • - Gastrointestinal: Vomiting, Diarrhoea (watery or bloody), Abdominal pain.
  • - Respiratory: Chest pain, shortness of breath, cough.
  • - Vascular/Haemorrhagic (Occurs in <50% of Ebola, variable in Marburg): Bleeding from mucous membranes (gums, nose), injection sites; petechiae, purpura, ecchymoses; haematemesis, melena; unexplained vaginal bleeding. Leads to circulatory shock.
  • - Neurological: Confusion, agitation, delirium, seizures, coma.
  • - Renal: Kidney injury.
  • - Hepatic: Liver damage (elevated AST/ALT).
  • - Maculopapular rash (may occur around day 5-7).
  • - Hiccups.
  • - Miscarriage in pregnancy.

Risk factors

  • Contact with infected animals (bats, primates, forest antelope - handling, butchering, eating raw meat).
  • Living in or travelling to endemic/outbreak areas.
  • Direct contact with body fluids (blood, vomit, faeces, urine, saliva, sweat, semen, breast milk) of an infected person (alive or deceased).
  • Contact with contaminated objects (needles, bedding, clothing).
  • Healthcare workers without adequate Infection Prevention and Control (IPC) measures.
  • Participation in traditional burial practices involving direct contact with deceased.
  • Sexual contact with survivor (virus persists in semen for months).

Diagnosis

Clinical assessment

High index of suspicion in patient with acute febrile illness +/- haemorrhagic signs OR unexplained multi-organ failure AND epidemiological link (travel to/residence in affected area OR contact with known/suspected case OR contact with specific animals) within 21 days.

Differential diagnosis

  • Malaria (severe).
  • Typhoid fever.
  • Meningitis.
  • Other Viral Haemorrhagic Fevers (Lassa, CCHF, Rift Valley Fever, Yellow Fever - depending on region).
  • Septic shock (bacterial).
  • Leptospirosis.
  • Rickettsial infections.
  • Severe viral hepatitis.
  • Dengue fever (severe forms).

Investigations

  • Requires specialized laboratory (e.g., UVRI) with high biosafety level.
  • RT-PCR: Detection of viral RNA in blood or other body fluids. Main diagnostic test during acute illness.
  • Antigen-detection tests (Rapid tests available, lower sensitivity than PCR).
  • Serology (IgM/IgG detection): Useful later in illness or retrospectively.
  • Specimen Handling: EXTREME caution required. Must be done by trained personnel using full PPE and specific protocols for collection, packaging, and transport.
  • Other tests (monitor complications): FBC (leukopenia then neutrophilia, thrombocytopenia), LFTs (AST>>ALT), Renal function, Electrolytes, Coagulation studies.

Diagnostic criteria

Clinical suspicion + Epidemiological link + Laboratory confirmation (usually RT-PCR).

Management

Non-pharmacological management

  • IMMEDIATE isolation in designated Ebola/VHF Treatment Unit (ETU) with strict IPC measures.
  • Notification: Report IMMEDIATELY to District Health Team / MOH.
  • Strict Infection Prevention and Control (IPC):
  • - Transmission-Based Precautions: Standard + Contact + Droplet. Airborne precautions (N95/FFP2/PAPR) recommended for aerosol-generating procedures.
  • - Full Personal Protective Equipment (PPE): Impermeable gown/coverall, gloves (double), mask (N95/FFP2), eye protection (goggles/face shield), head covering, apron, boots.
  • - Meticulous hand hygiene.
  • - Safe injection practices.
  • - Environmental cleaning/disinfection (0.5% chlorine).
  • - Safe waste management.
  • - Safe handling of linens.
  • - Safe management of the deceased (designated burial teams, minimal contact).
  • Optimized Supportive Care: (Mainstay of treatment in absence of specific antivirals)
  • - Fluid and Electrolyte Management: Aggressive replacement (oral rehydration if possible, IV fluids often necessary) guided by clinical assessment and monitoring (urine output, electrolytes if possible). Crucial to manage dehydration from vomiting/diarrhoea.
  • - **Nutritional Support.
  • - Symptomatic treatment (antiemetics, analgesics, antipyretics - avoid NSAIDs due to bleeding risk).
  • - Management of complications (shock, haemorrhage - blood products if available, renal failure, respiratory failure, secondary infections).
  • - Psychosocial support for patient and family.

Pharmacological treatment

  • No proven specific antiviral therapy widely available or standard for Marburg.
  • For Ebola: Specific monoclonal antibody treatments (e.g., Inmazeb, Ebanga) and antivirals (Remdesivir previously studied) have shown benefit and may be available during outbreaks under specific protocols/trials (Specialist/MOH guidance).
  • Treat secondary bacterial infections if suspected.

Monitoring

Intensive monitoring of vital signs, fluid balance (intake/output), electrolytes, organ function in ETU setting.

Complications

  • Severe dehydration.
  • Electrolyte imbalance.
  • Shock (hypovolemic, septic).
  • Haemorrhage / DIC.
  • Multi-organ failure (liver, kidney, respiratory).
  • Neurological complications (encephalitis, seizures).
  • Secondary bacterial infections.
  • Death (Case fatality rate high, varies by virus and outbreak: Ebola ~25-90%, Marburg ~24-88%).
  • Long-term sequelae in survivors (arthralgia, myalgia, eye problems, hearing loss, neurological issues, psychosocial).

Prevention

  • Avoid contact with reservoir hosts (bats, primates). Avoid bushmeat from endemic areas.
  • Strict IPC in healthcare settings.
  • Rapid identification and isolation of cases.
  • Contact Tracing and Monitoring: Identify and monitor all contacts of confirmed cases for 21 days.
  • Safe Burial Practices.
  • Community engagement and health education.
  • Vaccines: Effective Ebola vaccine (rVSV-ZEBOV - Ervebo) available, used in ring vaccination strategy during outbreaks and for high-risk groups (HCWs). Marburg vaccine development ongoing.
  • Use of condoms by male survivors for extended period (virus persists in semen).

Patient education

  • Explanation of the serious viral illness and how it spreads (body fluids).
  • Need for strict isolation and specialized care in ETU.
  • Importance of supportive care (fluids).
  • Information for family about transmission risk and IPC measures.
  • Safe burial practices if applicable.
  • Information for survivors about potential sequelae and viral persistence (semen).

Uganda-specific notes

Uganda has experienced outbreaks of both Ebola (Sudan and Bundibugyo strains) and Marburg virus disease. High vigilance, strong surveillance, rapid response capabilities, and strict IPC are crucial. UVRI provides diagnostic capacity. Ring vaccination used for Ebola outbreaks.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 2, Section 2.3.6.1

  • Ministry of Health, Uganda - National Guidelines for Management of Viral Haemorrhagic Fevers

    (Specific national documents)

Scroll to Top