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This post was revised on October 4, 2024, to align guidance with the CDC Health Advisory issued for MVD on October 3, 2024.

Marburg virus disease (MVD) is a rare but severe viral hemorrhagic fever caused by Marburg virus, which is part of the filoviridae family that includes Ebola virus. Cases of MVD are rare but outbreaks occasionally arise in sub-Saharan Africa, where the virus circulates in the Egyptian fruit bat. Humans can be infected through contact with infected animals and through person-to-person spread. In countries where outbreaks have occurred, the case fatality rate for MVD is between 24 and 88 percent. Learn more about transmission. 

It is unlikely that EMS personnel in the United States will have to care for a patient with MVD during routine operations. However, an outbreak elsewhere in the world increases the risk of encountering a patient who recently traveled from the affected area and became infected.  

The virus can spread quickly within health care settings among personnel who do not use proper infection control while caring for patients suspected or confirmed to be infected with MVD. It is important that EMS professionals follow an identify, isolate, and inform strategy, and implement a hierarchy of controls to prevent transmission of infectious diseases. 

Identify, Isolate, and Inform for EMS   

The identify, isolate, and inform paradigm is a way for EMS personnel to:   

  • Assess the risk that the person they are interacting with might be infected with MVD, 
  • Prevent unprotected exposure to potentially infectious body fluids and safely transport and manage the patient, and 
  • Inform others that the person that they are caring for might be infected with MVD. 

Identify, isolate, and inform has been used by EMS and frontline health care personnel in the United States for Ebola virus disease in the past, and more recently for mpox.     

Identify   

It’s important to screen patients for signs and symptoms and review their travel and exposure history to figure out whether they might be infected with MVD.  

Patient screening can be done by the 911 call taker in the emergency medical dispatch center, by the personnel responding in the field, or both. 

Signs and symptoms

  • Fever, chills, muscle aches, diarrhea, nausea, vomiting, abdominal pain, headache, shortness of breath, chest pain 
  • More severe: Internal and external bleeding, mental status changes, multi-system organ failure, shock  

Learn more about the signs and symptoms. 

Travel and exposure

  • Travel to a country with an MVD outbreak in the last 21 days. Learn more about current and past MVD outbreaks (CDC, https://www.cdc.gov/marburg/outbreaks/, Accessed 10/4/2024). 
  • Exposure to someone with confirmed disease in the last 21 days.  

The incubation period for MVD is between 3-21 days, although signs and symptoms typically develop between 5-10 days. There is no evidence to date of asymptomatic transmission. Patients that may have been exposed to someone with MVD are not contagious until they have symptoms. Once they develop signs and symptoms, they can transmit the illness.   

In the initial stages, MVD can be difficult to distinguish from other infectious diseases that might be the cause of symptoms in a returning traveler. While you can’t conclude that the patient has MVD from this screening, it can raise suspicion. 

See the CDC’s Health Advisory for MVD for guidance on screening.

Isolate

MVD is transmitted through close contact with the blood or bodily fluids of infected individuals through broken skin or mucous membranes in the eyes, nose, or mouth. Infectious bodily fluids from patients infected with MVD include blood, saliva, vomit, diarrhea, urine, and sweat.  

To protect yourself from exposure to infectious bodily fluids, CDC recommends a PPE ensemble for suspected VHF patients who are stable (dry) and an ensemble providing a higher level of protection for confirmed cases or suspected cases that are unstable (wet). EMS personnel encountering a stable suspected MVD patient should implement standard, contact, and droplet precautions, with face shield for eye protection. A wet suspected MVD patient, or one that has confirmed disease requires the addition of a NIOSH-approved fit-tested N-95 respirator. Review important details about PPE guidance for managing clinically stable and clinically unstable patients in advance of patient contact when possible.

Inform

In an emergency, several people may respond to a 911 call and arrive on the scene. If you think that a patient might have MVD based on the signs, symptoms, travel, and exposure history of the patient, let other responders know, to avoid unprotected exposure.  

If you suspect a case of MVD, contact your local and state health departments as soon as possible. They may initiate special pathogen transport protocols to help manage and transport the patient. 

Inform your supervisory personnel, as some communities may have dedicated transport teams or designated facilities for transport and management of patients suspected or confirmed to be infected with special pathogens.  

Notify the receiving facility as soon as possible, that you suspect a patient may be infected with MVD, so that space is made available to properly isolate the patient on arrival and that receiving health care personnel are in appropriate PPE. 

Hierarchy of Controls   

Implement the hierarchy of controls, including environmental changes, changes in administrative policies and work practices, and the use of personal protective equipment (PPE) to prevent exposure to infectious bodily fluids. 

Make changes to the ambulance environment 

  • Separate the driver compartment and the patient compartment.  
  • Adjust air handling to introduce fresh air into both compartments.   
  • Turn exhaust fans on high in the patient compartment.  
  • Drape the ambulance’s interior to protect environmental surfaces from exposure to infectious bodily fluids in case the patient vomits or has uncontrolled diarrhea. If that happened, it would contaminate the surfaces of the ambulance and it would make it more difficult to clean and disinfect.    

Prepare the patient for transport 

  • Put a surgical mask on the patient to avoid transmission of the virus through saliva.  
  • Wrap the patient in an impervious sheet or have them wear a coverall, if tolerated, to contain any contamination from their clothes and help contain infectious bodily fluids.   
  • Consider placing the patient in undergarments that can collect potentially infectious diarrhea. Have a leak proof container on hand for vomiting.   
  • Consider pretreating the patient with anti-nausea medicine before transporting the patient to reduce the risk of vomiting.   

Establish protective behaviors for EMS personnel  

  • Stay at least 6 feet from the patient, when possible, to reduce the chance of transmission, in particular from heavy droplets.   
  • Limit the number of personnel that are in direct care of the patient.   
  • The ambulance operator should not make contact with the patient, to avoid contaminating the driver’s compartment. The driver should wear an N-95 respirator if you are unsure whether the driver compartment is isolated from the patient compartment. 

Practice safe clinical care 

  • Implement strict infection prevention procedures.
  • Use caution if implementing aerosol-generating procedures.

Follow PPE and precaution best practices 

  • When caring for a patient with confirmed MVD or one who is clinically unstable (diaphoretic, vomiting, bleeding, or having diarrhea), the CDC recommendation for PPE (CDC, https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html, Accessed 3/9/2023) is an impermeable gown or coverall, full-face shield, NIOSH-approved, fit-tested N95 respirator or higher protection, double gloves, boot covers, and apron. 
  • If the patient is suspected of being infected with MVD but is stable—for instance, someone presenting with fever but no bleeding, vomiting, or diarrhea—the CDC recommendation for PPE (CDC, https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html, Accessed 3/9/2023) is a fluid resistant gown or coverall, full face shield, simple surgical mask, and double gloves. 
  • Use PPE checklists for donning and doffing, ideally with a trained observer (CDC, https://www.cdc.gov/vhf/ebola/hcp/ppe-training/trained-observer/observer_01.html, Accessed 3/9/2023). See NETEC’s flyer on the role of the trained observer. 

 
Dispose of waste and clean and disinfect the ambulance   

  • MVD-contaminated waste must be managed as a Category A infectious substance; leave waste with the receiving facility for disposal, if possible.
  • After transfer of care to the receiving facility, clean and disinfect all surfaces of the ambulance and equipment with an EPA-registered hospital grade disinfectant.

Follow up with EMS personnel 

  • Evaluate the crew for signs and symptoms for a full incubation cycle of 21 days or until the patient has been ruled out for MVD.  
  • Coordinate with local and state public health departments. 

Prevention and Treatment   

There are no licensed vaccines or therapies for Marburg. However, one monoclonal antibody has been used in humans, and several promising vaccine platforms are being studied. 

Supportive care is the mainstay of treatment for patients with MVD and, if provided early, can increase chances of recovery. This may include IV fluids and electrolytes to replace those lost through vomiting and diarrhea, maintenance of blood pressure, ventilatory assistance, and even renal replacement therapy. 

How ready is your EMS agency for the next special pathogen event? 

If you are not sure, take our self-assessment to guide you toward the right help. Our free assessment tool measures your agency’s readiness across a matrix of categories to help you prepare. Take the Self-Assessment 

Additional EMS Resources 

EMS Biosafety Transport: Viral Hemorrhagic Fevers: Ebola Virus Disease  

Guidance for Emergency Medical Services and 9 1 1 communication centers (CDC, https://www.cdc.gov/vhf/ebola/clinicians/emergency-services/ems-systems.html, Accessed 10/4/2024)

Guidance for Developing a Plan for Interfacility Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the United States

EMS Infectious Disease Playbook 

Considerations for safe EMS transport of patients infected with Ebola virus 

Transport and management of patients with confirmed or suspected Ebola virus disease 

Ebola: Knowledge resources for responders 

Regional Transport Ebola Tabletop Exercise Template 

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