Detection of Marburg virus illness in Guinea

For the editor:

Determine 1. Determine 1. Timeline and map of Marburg virus (MARV) an infection in Guinea.

Panel A exhibits the timeline of occasions within the prognosis of MARV an infection in a 46-year-old man in Guéckédou prefecture in Guinea in August 2021. On September 3, the Guéckédou Viral Hemorrhagic Fevers Laboratory shared the footage MARV genetics with the general public (https://virological.org/t/marburg-virus-sequence-from-guinea-2021/755) to assist the general public well being response in addition to the event and analysis of diagnostic checks and therapeutic brokers for MARV an infection. IPD designates the Pasteur Institute of Dakar. Panel B exhibits a map depicting elements of Guinea, Sierra Leone, Liberia and Côte d’Ivoire, with an emphasis on the Guinean forests (Guinea Forestière) and Guéckédou prefecture, the place the case of MARV an infection appeared. Related areas of web sites with reported proof of MARV circulation in bats and people in Sierra Leone are proven, together with websites in Guinea the place bat species identified to be potential reservoir hosts of MARV have been recognized, together with Méliandou (the situation of the 2014-2016 Ebola virus illness outbreak), in addition to Mongo Forest, Koundou Forest, Bakama Cave, and Ziama Massif. Particulars concerning the mapping process are offered within the supplementary appendix.

On August 2, 2021, a 46-year-old man from Temessadou M’Boké, a village in Guéckédou prefecture in Guinea, died after hemorrhaging from a number of pure orifices. On August 3, an preliminary prognosis of Marburg virus (MARV) an infection was made after a real-time reverse transcriptase–polymerase chain response check of a autopsy buccal specimen obtained from the affected person revealed a cycle threshold worth of 13.4 (Figure 1A). Area investigation groups had been deployed and the diagnostic end result was validated in two further laboratories inside days. In-country next-generation metagenomic sequencing resulted within the restoration of the whole MARV genome (99.3%), and phylogenetic evaluation indicated that the brand new Guinea MARV pressure that was recognized within the affected person was grouped with strains MARVs remoted from bats in Sierra Leone and people in Angola (Fig. S1 and Desk S1 within the Supplementary Appendix, accessible with the total textual content of this letter on NEJM.org). Shut monitoring for a interval of 21 days confirmed that the entire affected person’s contacts remained asymptomatic, and no further instances had been detected.

The forests of Guinea, in addition to different areas of West Africa, together with Sierra Leone, are thought-about appropriate for the zoonotic transmission of Marburg virus illness by bats and particularly by bats. Rousettus aegyptiacus (Egyptian fruit bat), which has been recognized as a pure reservoir host of MARV (Figure 1B).^1-3 Among the many MARV bat reservoirs is Koundou, which is near the place the case arose. The affected person had restricted social interactions and lived in a family of 4. There was no proof of a historical past of journey outdoors of Guinea for the affected person or his shut contacts or contact with returning travellers. He was a farmer dwelling in shut contact with nature and wildlife and subsequently might have been repeatedly uncovered to an surroundings or meals contaminated with feces from MARV-infected bats. Neighborhood surveys have proven that though he might have harvested wild fruit for private consumption, there was no proof that he had visited caves or participated in looking actions for bushmeat, together with bats. mouse. Conventional practices of consuming or making ready bushmeat (i.e. direct publicity to bodily fluids) can’t be absolutely dominated out, as such exposures are unlikely to have been disclosed because of the nationwide ban on such consumption that was enforced after the 2021 Ebola outbreak. viral illness.

The New Guinea MARV clade and the Angola MARV clade share a typical ancestor that in all probability existed in 1965 (95% confidence interval, 1944 to 1981 on Bayesian molecular clock evaluation). This discovering signifies that roughly 55 years in the past, these lineages diverged from a typical ancestor, and every developed independently in its respective reservoir host, with the presence of Guinea MARV remaining undetected till this spillover occasion. 2021. This multi-decade timescale offered ample alternative for the virus to be dispersed over massive distances by bat migration. A parallel might be drawn with the emergence of the West African Ebola virus lineage (Makona) which diverged from a central African ancestor and developed independently in its host till the overflow occasion to happen.⁴ Within the case of MARV, the basal clustering of bat MARV in Sierra Leone means that even the Angola epidemic might have its roots in West Africa.

Epidemiological traits and phylogenetic historical past argue in opposition to the likelihood that the newly rising MARV may have been imported. Total, it appears believable that the viral emergence in Guinea was as a result of a zoonotic transmission occasion from a bat reservoir in late July 2021.

The affected person’s remoted way of life probably performed a job in minimizing the danger of secondary infections. Notably, well timed laboratory prognosis has been facilitated by the institution of capability constructing applications, long-term collaborative partnerships, and decentralized laboratories with well-trained employees. The identical capabilities proved important through the current re-emergence of Ebola virus illness in Guinea.⁵

Fara R. Koundouno, M.Sc.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Liana E. Kafetzopoulou, Ph.D.
KU Leuven, Leuven, Belgium

Martin Faye, Ph.D.
Pasteur Institute of Dakar, Dakar, Senegal

Annick Renevey, Ph.D.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Barrè Soropogui, M.Sc.
Gamal Abdel Nasser College, Conakry, Guinea

Kekoura Ifono, B.Sc.
Emily V. Nelson, Ph.D.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Aly A. Kamano, MPH, MD
World Well being Group Guinea, Conakry, Guinea

Charles Tolno, MPH, MD
Medical doctors With out Borders Belgium, Conakry, Guinea

Giuditta Annibaldis, Ph.D.
Saa L. Millimono, B.Sc.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Jacob Camara, Pharm.D.
Gamal Abdel Nasser College, Conakry, Guinea

Karifa Kourouma, B.Sc.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Ahmadou Doré, B.Sc.
Gamal Abdel Nasser College, Conakry, Guinea

Tamba E. Millimouno, B.Sc.
Fernand MB Tolno, B.Sc.
Julia Hinzmann, MLT
Hugo Soubrier, M.Sc.
Mette Hinrichs, MLT
Anke Thielebein, Ph.D.
Glaucia Herzer, M.Sc.
Meike Pahlmann, Ph.D.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Georges A. Ki-Zerbo, MD
World Well being Group Guinea, Conakry, Guinea

Pierre Formenty, DVM
Anaïs Legand, MPH
World Well being Group, Geneva, Switzerland

Michael R. Wiley, Ph.D.
College of Nebraska Medical Middle, Omaha, NE

Ousmane Faye, Ph.D.
Moussa M. Diagne, Ph.D.
Amadou A. Sall, Ph.D.
Pasteur Institute of Dakar, Dakar, Senegal

Philippe Lemey, Ph.D.
KU Leuven, Leuven, Belgium

Aïssatou Bah, B.Sc.
Gamal Abdel Nasser College, Conakry, Guinea

Stephan Günther, MD, Ph.D.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany

Sakoba Keita, MD
Nationwide Well being Safety Company, Conakry, Guinea

Sophie Duraffour, Ph.D.
Bernhard Nocht Institute of Tropical Medication, Hamburg, Germany
[email protected]

N’Faly Magassouba, Ph.D.
Guinea Viral Hemorrhagic Fevers Laboratory, Conakry, Guinea