Marburg virus disease has killed 11 people and sickened 25 others in Rwanda, which declared an outbreak on Sept. 27.

Similar to Ebola, the rare but very severe illness can be fatal in up to 88% of people who become sick depending on the viral strain and management of the case.

That’s why German authorities closed two tracks at Hamburg’s main train station on Oct. 2 after two train passengers were suspected of carrying the virus.

Rwanda has confirmed 36 cases as of Oct. 2, including at least 19 in healthcare workers, most of whom work in intensive care units.

Several cases are of unknown origin, suggesting additional cases may not have been detected or reported, according to a health alert issued Oct. 3 by the Centers for Disease Control and Prevention.

This is the first time the disease has been reported in Rwanda.

“WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level,” the World Health Organization said on Sept. 30.

Here is everything you need to know about Marburg virus disease as the outbreak continues in Rwanda.

What is Marburg virus disease?

Marburg virus disease, also known as Marburg hemorrhagic fever, is most often found in sub-Saharan Africa.

The disease, initially detected in 1967 after outbreaks in Germany and Serbia, is caused by the Marburg or Ravn virus, which are classified as orthomarburgviruses.

Orthomarburgviruses are naturally found in the Egyptian rousette bat. The cave-dwelling fruit bats, which make their home throughout Africa and the Middle East, can spread the disease to people via their excretions.

Symptoms, which include fever, rash, and severe bleeding, can appear abruptly and rapidly worsen. There is no treatment for Marburg, and infection often leads to serious illness or death.

How it spreads

Animals can contract Marburg by eating fruit bats have been feeding on or by being bitten by an infected bat.

Humans can become sick from contact with infected animals, needles, objects or surfaces contaminated with the virus.

Marburg is spread through contact with bodily fluids — the blood, urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid or semen — of someone infected with the virus via broken skin or mucous membranes in the eyes, nose or mouth.

Marburg is not an airborne disease.

Symptoms

Marburg patients typically begin experiencing symptoms two to 21 days after exposure. Symptoms appear flu-like at first but eventually can progress to liver failure, hemorrhaging and multi-organ dysfunction.

• Fever
• Headache
• Chills
• Muscle, chest and joint pain
• Sore throat
• Fatigue
• Loss of appetite
• Rash with both flat and raised bumps, often on the torso
• Nausea, vomiting and diarrhea
• Unexplained bleeding

Treatment

The US Food and Drug Administration has not approved a Marburg vaccine or treatment.

Early supportive care, including rest, hydration, management of oxygen status and blood pressure and treatment of secondary infections, can improve survival chances.

Death tends to occur eight to nine days after symptoms begin and severe blood loss and shock sets in.