Marburg hemorrhagic fever associated with multiple genetic lineages of virus.
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.
Bausch
Daniel G
DG
Centers for Disease Control and Prevention, Atlanta, USA.
Nichol
Stuart T
ST
Muyembe-Tamfum
Jean Jacques
JJ
Borchert
Matthias
M
Rollin
Pierre E
PE
Sleurs
Hilde
H
Campbell
Patricia
P
Tshioko
Florimund K
FK
Roth
Catherine
C
Colebunders
Robert
R
Pirard
Patricia
P
Mardel
Simon
S
Olinda
Loku A
LA
Zeller
Hervé
H
Tshomba
Antoine
A
Kulidri
Amayo
A
Libande
Modeste L
ML
Mulangu
Sabue
S
Formenty
Pierre
P
Grein
Thomas
T
Leirs
Herwig
H
Braack
Leo
L
Ksiazek
Tom
T
Zaki
Sherif
S
Bowen
Michael D
MD
Smit
Sheilagh B
SB
Leman
Patricia A
PA
Burt
Felicity J
FJ
Kemp
Alan
A
Swanepoel
Robert
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D005260:Female; D006046:Gold; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008379:Marburg Virus Disease / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission / Q000821:virology; D029024:Marburgvirus / Q000235:genetics* / Q000302:isolation & purification; D008875:Middle Aged; D008906:Mining; D012621:Seasons; D017422:Sequence Analysis, DNA
D006046:Gold