Risk of Marburg outbreak reaching Portugal is low, but exists

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Relatively rare, but with a high lethality, Marburg’s disease poses a greater risk to Portugal when it strikes countries with greater connections.

The infectious disease specialist Jaime Nina considers that Portugal can be “relatively” relaxed about the Marburg outbreak in Equatorial Guinea, despite the risk of imported cases, electing Angola as the biggest threat if the disease hits this country again.

In an interview with Lusa news agency regarding the outbreak of the disease in Equatorial Guinea, which has already caused nine deaths in the country and has expanded to Cameroon, Jaime Nina recalled that Portugal has a prepared response that will be activated in suspected cases.

The system was tested several times during the threat of Ebola (a virus “cousin” of Marburg) in 2013 – 2014, during an outbreak in Guinea-Conakry (which borders Guinea-Bissau), Sierra Leone and Liberia, electing as reference hospitals São João, in Porto, and Curry Cabral and Dona Estefânia hospitals in Lisbon.

Relatively rare, but with a high lethality, Marburg disease represents a greater risk for Portugal when it reaches countries with greater connections, as happened in 2004 – 2005, in Angola, stage of the largest Marburg outbreak, with the epicenter in Uige.

According to Jaime Nina, who was present at the time on the scene of the outbreak and can testify to how the authorities dealt with it, of the 374 confirmed cases, 329 were fatal, which represents a lethality rate of 81%.

“The biggest risk is Angola, which probably has infected bats,” which at any moment can pass the disease to a human, and is a country with which Portugal has strong ties, he said, adding, “If a person wants to worry, think of Angola.”

In relation to the main stage of the current outbreak – Equatorial Guinea, a member of the Community of Portuguese Speaking Countries (CPLP) – the infectious disease specialist at Egas Moniz Hospital and professor of Infectious Diseases and Tropical Medicine at the New University of Lisbon says that few people will travel to and from Portugal, which immediately reduces the risk.

And he recalled that contagion is “relatively difficult,” unlike viruses such as the one that causes covid-19, requiring contact with the person, their blood, vomit, or feces.

While there is no absolute truth about its causes, it is known that this hemorrhagic fever is caused by the Marburg virus, so named because it was identified in the German town of the same name.

In this city, a research center was working with monkeys imported from Belgrade, some of which had originated in Uganda and were reportedly the infected source identified in 1967.

The reservoir of the virus is the bat, an animal that roosts in the thin, high branches of trees above the monkeys, to which it has transmitted the virus through the feces it produces during its sleep.

Jaime Nina says that there have been outbreaks all over intertropical Africa: “Angola, the Democratic Republic of Congo, Uganda, Kenya, Guinea and Cameroon. It was only a matter of time before it was diagnosed in Equatorial Guinea.”

But he stresses that “you can only find what you’re looking for.”

“For a case to be reported you need a case, someone to diagnose it, and for the diagnosed case to be reported. In other words, you need doctors to make the diagnosis and a public health network to notify cases, but in most African countries this does not work,” he said.

For this reason, he concludes: “Most probably there have been outbreaks without anyone noticing,” and the isolation of infected people has contributed to this.

A virus as lethal as Marburg requires rapid and timely screening, isolation of patients and their close contacts, and adequate protection of health care workers, along with disinfection, measures that should be known to the public so that they understand them when they are applied.

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