title: Marburg hemorrhagic fever associated with multiple genetic lineages of virus.
abstract: 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.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Nichol
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Muyembe-Tamfum
authors.forename: Matthias
authors.initials: M
authors.lastname: Borchert
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Rollin
authors.forename: Hilde
authors.initials: H
authors.lastname: Sleurs
authors.forename: Patricia
authors.initials: P
authors.lastname: Campbell
authors.forename: Florimund K
authors.initials: FK
authors.lastname: Tshioko
authors.forename: Catherine
authors.initials: C
authors.lastname: Roth
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Patricia
authors.initials: P
authors.lastname: Pirard
authors.forename: Simon
authors.initials: S
authors.lastname: Mardel
authors.forename: Loku A
authors.initials: LA
authors.lastname: Olinda
authors.forename: Hervé
authors.initials: H
authors.lastname: Zeller
authors.forename: Antoine
authors.initials: A
authors.lastname: Tshomba
authors.forename: Amayo
authors.initials: A
authors.lastname: Kulidri
authors.forename: Modeste L
authors.initials: ML
authors.lastname: Libande
authors.forename: Sabue
authors.initials: S
authors.lastname: Mulangu
authors.forename: Pierre
authors.initials: P
authors.lastname: Formenty
authors.forename: Thomas
authors.initials: T
authors.lastname: Grein
authors.forename: Herwig
authors.initials: H
authors.lastname: Leirs
authors.forename: Leo
authors.initials: L
authors.lastname: Braack
authors.forename: Tom
authors.initials: T
authors.lastname: Ksiazek
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaki
authors.forename: Michael D
authors.initials: MD
authors.lastname: Bowen
authors.forename: Sheilagh B
authors.initials: SB
authors.lastname: Smit
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Leman
authors.forename: Felicity J
authors.initials: FJ
authors.lastname: Burt
authors.forename: Alan
authors.initials: A
authors.lastname: Kemp
authors.forename: Robert
authors.initials: R
authors.lastname: Swanepoel
mesh_terms: 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
chemical_list: D006046:Gold