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By Karen Springen
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Since an outbreak of the deadly Marburg virus surfaced in Angola last fall, 215 people have died. The deadly illness--first reported in Marburg, Germany, in 1967--causes high fever, liver and kidney failure and bleeding from the nose, mouth, eyes and rectum, killing nine out of every 10 victims. What threat does the virus pose to Americans and others around the world? NEWSWEEK's Karen Springen asked Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Excerpts:
NEWSWEEK: For those who've heard of "The Hot Zone," Richard Preston's true story of a highly infectious, deadly virus from the central African rain forest that suddenly appeared in Washington, D.C., the Marburg virus sounds scary. Could it spread outside Africa?
Dr. Anthony Fauci: It is extremely unlikely to cause a public health threat, other than a very isolated case outside of a setting like sub-Saharan Africa, where there's a healthcare delivery issue. It is not easily spread. It requires very close personal contact. That's the reason why health workers, family members who take care of the patient or morticians who handle the body are at grave risk. It is not spread by casual contact. The next issue that makes it extremely unlikely that it would pose a global health threat in the developed world is that people can only transmit the virus when they're deathly ill, unlike influenza or maybe even SARS, where people can transmit it when they're not feeling very well but they're well enough to travel. Someone with influenza can get on a plane and fly. But the people who have Marburg, when they are capable of transmitting the infection, it is when they are bleeding from the nose, the mouth, the rectum, the vagina. You would not expect someone who could pass on an infection to be walking around the streets, getting on a plane. As horrible as the disease is for the person who has it, the circumstances of how it spreads make it very unlikely for it, in a developed world, to pose a public health threat. No "Hot Zone II"?
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Absolutely not. It isn't like I'm walking down the street and somebody sneezes on me. That's not the way it happens. You have to be intimately close with a person with advanced disease. When you handle the virus in the laboratory, you have to wear that hot-zone suit.
So Americans shouldn't be concerned?
I don't want to belittle the disease. All emerging and re-emerging diseases are of concern. This particular one, as horrifying as it is, is not one that would spread in a manner that would pose a major public health threat in the United States. It is one of the hemorrhagic fevers we'd be concerned about in a bioterrorist attack. But as a naturally acquired infection, that is not something we're overly concerned about in the United States.
Bioterrorists?
We know the Soviets back in the '70s were growing Marburg and Ebola.
Anyone else?
Not sure. Unlikely. Certainly the Soviets were doing it, together with smallpox and anthrax.
What about now?
They've purportedly stopped. If you aerosolize it and throw it around a crowded subway, you could infect a lot of people, if it's made in a weaponized form.
There's no commercial air travel between Angola and the United States. Should we find that reassuring?
Again, it gets back to my question. It doesn't matter where the airport is. Somebody's not going to get on the plane because they're going to be too sick [if they had the Marburg virus].
Should the United States do anything, other than hope that African health authorities contain the virus?
The way you contain this, since there is not a vaccine or treatment, is by careful isolation and hospital control practices and by educating the public about how you take care of someone who's suspected of having Marburg. Family members should not try to take care of the patients themselves at home because it's likely they'll get infected. They should take the patients to various isolation wards in hospitals in Angola. Second, family members and morticians who handle the dead bodies of people who have died of Marburg should be extremely careful, and the family members should avoid the traditional way they interact with a dead family member, namely hugging and kissing them, which is part of the tradition in Angola. They must be educated to avoid that. That's how people get infected inadvertently.
How do you detect and then contain a virus like this one?
The way you find out about it is the characteristic symptoms: diarrhea, vomiting, bleeding from the eyes, the vagina, the rectum. If you see something like that, you're very highly suspicious that you're dealing with Marburg or Ebola. You confirm it with laboratory tests through the World Health Organization or the Centers for Disease Control.
How does a virus like this one--around for decades--get started again?
We don't know. Sometimes with years intervening, that's a big puzzle. The fact that it appears and reappears means there's an animal reservoir we haven't identified. Some people have said rodents, some people have said bats. I'm not going to guess for you. Most infections that are perpetually around, you see the infection to a greater or lesser degree almost all the time because the reservoir is the human. That's what you see with measles, with mumps. There are other diseases in which the reservoir is an animal reservoir. The reservoir for West Nile virus are birds or, in some cases, horses. We do not know what the natural reservoir of Marburg or Ebola is. We do know that monkeys can get infected, but we do not know the natural reservoir. First it was isolated in Marburg, Germany, in monkeys.
There is no vaccine or effective treatment for Marburg?
That is correct.
What percent of people who are infected die?
Approximately 90 percent. Right now there have been 235 cases in Angola. 215 have died. Let's do that right now. That's 92 percent mortality.
If the virus did appear in the United States, what would public health authorities do?
It would be isolation and hospital infection-control practices. When someone is in the hospital, you isolate them, you wear the proper garments when you see them, you don't allow visitors. The chain of transmission is human to human. The way you stop an epidemic is you stop or interrupt the chain of transmission. You do that by isolation and good hospital practices.
The virus is described as "Ebola-like." How do they compare?
It's virtually identical. A little bit different molecular structure.
Where did it come from originally?
The very first identification was actually in Marburg, Germany, in people who were handling a monkey shipped from Uganda.
Are there other viruses we should be more worried about?
Probably the one that's the most threatening is the potential evolution of the avian flu. You could get an avian flu pandemic. I'm far more concerned about avian flu than I am about Marburg. Avian flu can spread very easily if it assumes the characteristics of person-to-person [infection]. Right now it's infecting humans in Asia, but it isn't spreading efficiently from person to person. But if it evolves [so it can spread from] person to person, we could have a real problem. Influenza viruses in general spread easily. Avian influenza is an influenza virus.
What should we be doing about the avian flu?
We're making a vaccine for it. [The Centers for Disease Control] is increasing their surveillance in Asia and the United States.
It can be treated?
It can.
What do you wish Americans knew about infectious diseases?
Infectious diseases continue to emerge and re-emerge, which is the reason they're going to be a perpetual challenge. That's why we need to have continual vigilance regarding the emergence and re-emergence of viruses. We have to be continually vigilant.
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