Editing Marburg virus disease (section)

== Prevention ==
{{Main|Prevention of viral hemorrhagic fever}}
Marburgviruses are highly [[infection|infectious]], but not very [[Contagious disease|contagious]]. They do not get transmitted by [[aerosol]] during natural MVD outbreaks. Due to the absence of an approved vaccine, prevention of MVD therefore relies predominantly on [[quarantine]] of confirmed or high probability cases, proper [[personal protective equipment]], and [[sterilization (microbiology)|sterilization]] and [[disinfection]].{{citation needed|date=October 2017}}

=== Vaccine development ===
{{main|Marburg vaccine}}
There are currently no [[Food and Drug Administration]]-approved [[vaccine]]s for the prevention of MVD. Many candidate vaccines have been developed and tested in various animal models.<ref name="Garbutt2004">{{Cite journal |last=Garbutt |first=M. |last2=Liebscher |first2=R. |last3=Wahl-Jensen |first3=V. |last4=Jones |first4=S. |last5=Möller |first5=P. |last6=Wagner |first6=R. |last7=Volchkov |first7=V. |last8=Klenk |first8=H. D. |last9=Feldmann |first9=H. |last10=Ströher |first10=U. |year=2004 |title=Properties of Replication-Competent Vesicular Stomatitis Virus Vectors Expressing Glycoproteins of Filoviruses and Arenaviruses |journal=Journal of Virology |volume=78 |issue=10 |pages=5458–5465 |doi=10.1128/JVI.78.10.5458-5465.2004 |pmc=400370 |pmid=15113924}}</ref><ref name="Daddario-DiCaprio2006">{{Cite journal |last=Daddario-Dicaprio |first=K. M. |last2=Geisbert |first2=T. W. |last3=Geisbert |first3=J. B. |last4=Ströher |first4=U. |last5=Hensley |first5=L. E. |last6=Grolla |first6=A. |last7=Fritz |first7=E. A. |last8=Feldmann |first8=F. |last9=Feldmann |first9=H. |last10=Jones |first10=S. M. |year=2006 |title=Cross-Protection against Marburg Virus Strains by Using a Live, Attenuated Recombinant Vaccine |journal=Journal of Virology |volume=80 |issue=19 |pages=9659–9666 |doi=10.1128/JVI.00959-06 |pmc=1617222 |pmid=16973570}}</ref><ref name="Swenson2008">{{Cite journal |last=Swenson |first=D. L. |last2=Warfield |first2=K. L. |last3=Larsen |first3=T. |last4=Alves |first4=D. A. |last5=Coberley |first5=S. S. |last6=Bavari |first6=S. |year=2008 |title=Monovalent virus-like particle vaccine protects guinea pigs and nonhuman primates against infection with multiple Marburg viruses |journal=Expert Review of Vaccines |volume=7 |issue=4 |pages=417–429 |doi=10.1586/14760584.7.4.417 |pmid=18444889 |s2cid=23200723}}</ref> Of those, the most promising ones are [[DNA vaccination|DNA vaccines]]<ref name="Riemenschneider2003">{{Cite journal |last=Riemenschneider |first=J. |last2=Garrison |first2=A. |last3=Geisbert |first3=J. |last4=Jahrling |first4=P. |last5=Hevey |first5=M. |last6=Negley |first6=D. |last7=Schmaljohn |first7=A. |last8=Lee |first8=J. |last9=Hart |first9=M. K. |last10=Vanderzanden |first10=L. |last11=Custer |first11=D. |last12=Bray |first12=M. |last13=Ruff |first13=A. |last14=Ivins |first14=B. |last15=Bassett |first15=A. |year=2003 |title=Comparison of individual and combination DNA vaccines for B. Anthracis, Ebola virus, Marburg virus and Venezuelan equine encephalitis virus |url=https://zenodo.org/record/1259961 |url-status=live |journal=Vaccine |volume=21 |issue=25–26 |pages=4071–4080 |doi=10.1016/S0264-410X(03)00362-1 |pmid=12922144 |archive-url=https://web.archive.org/web/20210828155902/https://zenodo.org/record/1259961/preview/article.pdf |archive-date=2021-08-28 |access-date=2019-06-29 |last16=Rossi |first16=C. |last17=Schmaljohn |first17=C.}}</ref> or based on [[Venezuelan equine encephalitis virus]] [[Replicon (genetics)|replicons]],<ref name="Hevey1998">{{Cite journal |last=Hevey |first=M. |last2=Negley |first2=D. |last3=Pushko |first3=P. |last4=Smith |first4=J. |last5=Schmaljohn |first5=A. |date=Nov 1998 |title=Marburg virus vaccines based upon alphavirus replicons protect guinea pigs and nonhuman primates |journal=Virology |volume=251 |issue=1 |pages=28–37 |doi=10.1006/viro.1998.9367 |issn=0042-6822 |pmid=9813200 |doi-access=free}}</ref> [[vesicular stomatitis virus|vesicular stomatitis Indiana virus (VSIV)]]<ref name=Daddario-DiCaprio2006/><ref name="Jones2005">{{Cite journal |last=Jones |first=M. |last2=Feldmann |first2=H. |last3=Ströher |first3=U. |last4=Geisbert |first4=J. B. |last5=Fernando |first5=L. |last6=Grolla |first6=A. |last7=Klenk |first7=H. D. |last8=Sullivan |first8=N. J. |last9=Volchkov |first9=V. E. |last10=Fritz |first10=E. A. |last11=Daddario |first11=K. M. |last12=Hensley |first12=L. E. |last13=Jahrling |first13=P. B. |last14=Geisbert |first14=T. W. |year=2005 |title=Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses |journal=Nature Medicine |volume=11 |issue=7 |pages=786–790 |doi=10.1038/nm1258 |pmid=15937495 |s2cid=5450135 |doi-access=free}}</ref> or [[virus-like particle|filovirus-like particles (VLPs)]]<ref name=Swenson2008/> as all of these candidates could protect nonhuman primates from marburgvirus-induced disease. DNA vaccines have entered clinical trials.<ref name="NIAIDVaccineDevelopment">{{Cite press release |title=Ebola/Marburg Vaccine Development |date=2008-09-15 |publisher=National Institute of Allergy and Infectious Diseases |url=http://www3.niaid.nih.gov/topics/ebolaMarburg/default.htm |archive-url=https://web.archive.org/web/20100306223732/https://www3.niaid.nih.gov/topics/ebolaMarburg/default.htm |archive-date=2010-03-06}}</ref>

There is not yet an approved vaccine, because of [[economics of vaccines|economic factors in vaccine development]], and because filoviruses killed few before the 2010s.<ref>{{Cite journal |vauthors=Reynolds P, Marzi A |date=August 2017 |title=Ebola and Marburg virus vaccines |journal=Virus Genes |volume=53 |issue=4 |pages=501–515 |doi=10.1007/s11262-017-1455-x |pmc=7089128 |pmid=28447193}}</ref>

=== Endemic zones ===
The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from [[bat]]s and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source.{{citation needed|date=October 2017}}

=== During outbreaks ===
Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their [[excretion]]s and [[body fluids]], and any possibly [[contamination|contaminated]] materials and utensils. Patients should be isolated, but still are safe to be visited by family members. Medical staff should be trained in and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional [[burial]] rituals, especially those requiring [[embalming]] of bodies, should be discouraged or modified, ideally with the help of local [[traditional healer]]s.<ref>{{Cite book |last=Centers for Disease Control and Prevention and World Health Organization |url=https://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/entire.pdf |title=Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting |publisher=Centers for Disease Control and Prevention |year=1998 |location=Atlanta, Georgia, USA |ref=CITEREFCDCWHO1998 |access-date=2009-05-31 |archive-url=https://web.archive.org/web/20090507233051/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/entire.pdf |archive-date=2009-05-07}}</ref>

=== In the laboratory ===
Marburgviruses are [[World Health Organization]] Risk Group 4 Pathogens, requiring [[Biosafety|Biosafety Level 4-equivalent containment]],<ref name="BMBL5">{{Cite web |last=US Department of Health and Human Services |title=Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition |url=https://www.cdc.gov/biosafety/publications/bmbl5/ |url-status=live |archive-url=https://web.archive.org/web/20200423220253/https://www.cdc.gov/biosafety/publications/bmbl5/ |archive-date=2020-04-23 |access-date=2011-10-16}}</ref> laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.