Ebola and Marburg Virus Infections in Resource-Rich Countries: Implications for Future Outbreaks

Purpose of Review: Ebolavirus and Marburgvirus are Filoviruses that cause an extremely virulent hemorrhagic fever syndrome. Most Ebolavirus (EVD) and Marburgvirus (MVD) disease outbreaks occurred in Africa, usually in remote, rural settings. The aim of this review is to compare collated data on EVD/MVD cases treated in resource-rich countries with data from local outbreak conditions. Recent Findings: A longitudinal view of EVD outbreaks suggest increased recognition of outbreaks the last 30 years , but a declining case fatality rate. This probably reflects improved diagnostics and better recognition of less severe cases. Compared to the data from Africa, cases treated in resource-rich countries fared much better, with a cumulative case fatality rate that was about half that reported from Africa for EVD and about a third that reported for MVD. High rates of secondary cases were reported from Africa among household contacts, often associated with unhygienic funerary practices. In addition, nosocomial transmission had resulted in alarming rates of secondary cases among healthcare workers. Collated information from resource-rich countries suggests that with even in the absence of specific EVD targeted measures, with standard hygiene practices and infection control measures, the secondary case rate was <1% in healthcare workers, with no secondary cases reported from household or community contacts. Summary: EVD/ MVD are severe, life-threatening infections, but very high case fatality rates and secondary case reported from Africa may reflect poverty and lack of adequate medical infrastructure. The risk posed to healthcare workers is significantly mitigated by the universal availability of standard hygiene and infection control measures. No secondary cases were reported among community contacts in high-income countries. Therefore, rigorous infection-control measures may cause delays in the diagnosis and treatment of other important life-threatening infections.