Marburg hemorrhagic fever associated with multiple genetic lineages of virus

Daniel G. Bausch, Stuart T. Nichol, Jean Jacques Muyembe-Tamfum, Matthias Borchert, Pierre E. Rollin, Hilde Sleurs, Patricia Campbell, Florimund K. Tshioko, Catherine Roth, Robert Colebunders, Patricia Pirard, Simon Mardel, Loku A. Olinda, Hervé Zeller, Antoine Tshomba, Amayo Kulidri, Modeste L. Libande, Sabue Mulangu, Pierre Formenty, Thomas GreinHerwig Leirs, Leo Braack, Tom Ksiazek, Sherif Zaki, Michael D. Bowen, Sheilagh B. Smit, Patricia A. Leman, Felicity J. Burt, Alan Kemp, Robert Swanepoel

Research output: Contribution to journalArticlepeer-review

213 Scopus citations


BACKGROUND: An outbreak of Marburg hemorrhagic fever was first observed in a gold-mining village in northeastern Democratic Republic of the Congo in October 1998. METHODS: We investigated the outbreak of Marburg hemorrhagic fever most intensively in May and October 1999. Sporadic cases and short chains of human-to-human transmission continued to occur until September 2000. Suspected cases were identified on the basis of a case definition; cases were confirmed by the detection of virus antigen and nucleic acid in blood, cell culture, antibody responses, and immunohistochemical analysis. RESULTS: A total of 154 cases (48 laboratory-confirmed and 106 suspected) were identified (case fatality rate, 83 percent); 52 percent of cases were in young male miners. Only 27 percent of these men reported having had contact with other affected persons, whereas 67 percent of patients who were not miners reported such contact (P<0.001). Most of the affected miners (94 percent) worked in an underground mine. Cessation of the outbreak coincided with flooding of the mine. Epidemiologic evidence of multiple introductions of infection into the population was substantiated by the detection of at least nine genetically distinct lineages of virus in circulation during the outbreak. CONCLUSIONS: Marburg hemorrhagic fever can have a very high case fatality rate. Since multiple genetic variants of virus were identified, ongoing introduction of virus into the population helped perpetuate this outbreak. The findings imply that reservoir hosts of Marburg virus inhabit caves, mines, or similar habitats.

Original languageEnglish (US)
Pages (from-to)909-919
Number of pages11
JournalNew England Journal of Medicine
Issue number9
StatePublished - Aug 31 2006
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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