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Many Nigerians may not have heard of the Marburg virus disease (MVD), a viral haemorrhagic fever (VHF) currently raising concern in Equatorial Guinea which recorded the outbreak of the disease and the impact it could have on neighbouring African countries. Fear about MVD in some African countries including Nigeria, is however real. This is so considering the danger posed by the MVD which is caused by a virus from the same family as the Ebola Virus Disease (EVD). The fact that MVD is from the same family as the EVD is sufficient to destabilise any population. The period of EVD, a rare and deadly disease in people and nonhuman primates, is still very fresh in the memory of Nigerians most of whom were perplexed about the rapid pace that Ebola patients died. That is why when news broke that the first-ever outbreak of MVD was announced in Equatorial Guinea on February 13, most Nigerians fear that the Marburg could pose serious health challenge for Nigerians if not checked. The Nigeria Centre for Disease Control and Prevention (NCDC), which disclosed the development, said the death of nine people in Equatorial Guinea had prompted laboratory testing on samples of individuals experiencing symptoms of fever, fatigue, bloodstained vomit, and diarrhoea in two communities of the country’s western Kie Ntem province. “So far, one confirmed case, nine deaths and 16 suspected cases of MVD have been reported in Equatorial Guinea,” the NCDC said in a statement. In a statement, Director General of the Nigeria Centre for Disease Control and Prevention, Dr. Ifedayo Adetifa, has said that the overall risk of importing the Marburg virus into Nigeria is moderate. To this end, the NCDC has advised Nigerian citizens and residents to avoid all but essential travels to Equatorial Guinea at this time. “Persons with recent travel history to or transit through Equatorial Guinea within the past 21 days who experience symptoms such as fever, muscle pain, sore throat, diarrhoea, weakness, vomiting, stomach pain, or unexplained bleeding or bruising should not go to any health facility but call 6232 or their State Ministry of Health hotline immediately for assessment and testing.” What is MVD? Marburg virus disease is a highly virulent disease that causes haemorrhagic fever, with a fatality ratio of up to 88 per cent. Two large outbreaks that occurred simultaneously in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, in 1967, led to the initial recognition of the disease. The outbreak was associated with laboratory work using African green monkeys (Cercopithecus aethiops) imported from Uganda. Subsequently, outbreaks and sporadic cases have been reported in Angola, Democratic Republic of the Congo (DRC), Kenya, South Africa (in a person with recent travel history to Zimbabwe) and Uganda. In 2008, two independent cases were reported in travellers who visited a cave inhabited by Rousettus bat
colonies in Uganda. Human infection with Marburg virus disease initially results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Once an individual is infected with the virus, Marburg can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Adetifa said there are currently no cases of Marburg virus disease in Nigeria, however, the NCDC, relevant Ministries, Departments, Agencies, and partners have taken proactive measures to mitigate the risk of cross-border importation. The multi-sectoral National Emerging Viral Haemorrhagic Disease Technical Working Group (NEVHD TWG) led by NCDC, is responsible for coordinating the national response to all VHFs across pillars including surveillance, laboratory, case management and risk communication. The NEVHD TWG like it has always done in the past following news of MVD outbreaks conducted a dynamic risk assessment to inform Nigeria’s preparedness following this recent outbreak in Equatorial Guinea on February 17. According to Ifedayo, the extent of the outbreak in Equatorial Guinea has not yet been ascertained. “The likelihood of importation to Nigeria is high due to the direct flight between Nigeria and Equatorial Guinea. The proximity of Equatorial Guinea to Nigeria and the likelihood of spread in Nigeria following importation is high due to the gatherings and travel associated with upcoming national elections. “The case fatality rate of MVD ranges between 24 to 88 per cent. MVD does not currently have an effective drug for treatment or a licensed vaccine for prevention.” Ifedayo said Nigeria has also responded to viral haemorrhagic fever epidemics like the Ebola Outbreak in 2014 and built up her preparedness and response capabilities over the years. “We have the diagnostic capacity to test for MVD presently at the National Reference Laboratory (NRL) in Abuja and the University of Lagos Teaching Hospital laboratory Centre for Human and Zoonotic Virology (CHAZVY). However, the director general of the NCDC, stressed that diagnostic capacity will be scaled up to other laboratories in cities with important points of entry (POE) and others as may be required. An effective response system is in place with the availability of control capacities (trained rapid response teams, and an effective infection prevention and control programme) to limit the riskof spread in the event of a single imported case. Several measures have been taken to strengthen preparedness for the MVD in Nigeria.
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