Ethiopia confirms its first Marburg outbreak, with 206 contacts under follow-up

Ethiopia has confirmed its first outbreak of Marburg virus disease. On 12 November the Ethiopian Ministry of Health and the Ethiopian Public Health Institute announced suspected viral haemorrhagic fever in Jinka town, in the South Ethiopia Regional State; on 14 November the ministry confirmed the cases were Marburg, after molecular testing at the National Reference Laboratory identified the virus in patient samples [s1]. WHO published its Disease Outbreak News notice on 21 November [s1].

As of 20 November, 33 laboratory tests had been performed, yielding six confirmed cases including three deaths [s1]. Three of the six confirmed patients were alive and receiving treatment [s1]. Three further cases were epidemiologically linked but could not be tested; all three had died and are recorded as probable [s1]. A total of 206 contacts have been identified and are under active follow-up, a number WHO expects to keep changing as the investigation proceeds [s1].

What is known and what is not

The source of infection has not been identified [s1]. Initial investigation by Ethiopia's One Health team found fruit bats — the natural reservoir of Marburg virus — present in the area [s1].

Clinically, patients presented with high-grade fever, headache, vomiting, abdominal pain, and watery or bloody diarrhoea; haemorrhagic manifestations including nose bleeding and vomiting blood were seen in five cases, consistent with multi-organ failure [s1]. Because this is Ethiopia's first Marburg outbreak, WHO has recommended that samples be shared with a reference laboratory for inter-laboratory comparison — a standard step when a country's diagnostic capability for a pathogen is being used in anger for the first time [s1].

That presentation lines up with what the literature describes. A review published in EClinicalMedicine on 22 October — three weeks before Ethiopia's announcement — assembled every published case report and outbreak investigation from 1967 through October 2024, covering 722 cases across 18 outbreaks, with detailed clinical data available for 325 of them [s2]. Fever, headache, fatigue and myalgia were the common symptoms; gastrointestinal symptoms were also frequent; haemorrhagic symptoms, chiefly haematemesis and bloody diarrhoea, were more specific to Marburg but less frequent [s2]. The review's own conclusion is that variability in which symptoms dominate from outbreak to outbreak complicates early recognition [s2] — which is one reason Ethiopia's first cases were reported as undifferentiated viral haemorrhagic fever for two days before the virus was named.

How lethal

WHO's notice puts Marburg's case fatality ratio at up to 88%, with a range of 24% to 88% across previous outbreaks, and notes it can be lowered substantially with good and early supportive care [s1].

The EClinicalMedicine review offers a more granular version of the same point. Across all reported cases since 1967, overall lethality was 72% (95% CI 68.8–75.0%), but among PCR-confirmed cases specifically it was 44% (95% CI 37.1–50.9%) [s2]. The authors read that gap two ways: patients whose infection was laboratory-confirmed may have reached appropriate care earlier, and some unconfirmed cases counted as Marburg deaths may have been other febrile illnesses [s2]. Either way, a confirmed-case fatality ratio around 44% is the more useful anchor for an outbreak like Ethiopia's, where testing is happening.

There are no approved treatments or vaccines for Marburg virus disease anywhere [s1]. Supportive treatment and early care improve survival; some vaccine and therapeutic candidates are under investigation [s1].

The response, and the risk

Ethiopia's Ministry of Health has established a national taskforce, launched a costed three-month response plan, and activated emergency operations centres at national and regional level with daily coordination meetings [s1]. Two hospitals have been designated as treatment centres [s1]. One rapid response team was deployed to Jinka for contact tracing and epidemiological investigation, and a second is strengthening infection prevention and control in facilities handling suspected cases [s1].

WHO rates the public health risk as high nationally, moderate regionally and low globally [s1]. Four things drive the national rating. All of the deaths involved unsupervised burials, which carries a risk of further community transmission — funeral contact with a body is one of the most reliable amplification routes for filoviruses [s1]. Healthcare workers are among the confirmed cases, suggesting occupational exposure inside health facilities [s1]. Information on the source, the geographical extent and the epidemiology remains limited while investigations continue [s1]. And Ethiopia is managing concurrent outbreaks of cholera, measles and dengue, which stretches the same staff and the same laboratories [s1].

The regional rating rests on geography. Jinka is far from Addis Ababa and from major international airports, but it is connected by road to neighbouring Kenya and South Sudan [s1]. No international transmission has been confirmed [s1].

Nineteen Marburg outbreaks had been reported globally before this one, the most recent in Tanzania between January and March 2025 [s1]. The other African countries that have reported outbreaks are Angola, the Democratic Republic of the Congo, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, South Africa and Uganda [s1]. Ethiopia is now on that list.

Sources

• [s1] Marburg virus disease - Ethiopia, World Health Organization, 21 November 2025. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON585
• [s2] Clinical features of Marburg virus disease: a review of all reported patients since 1967, EClinicalMedicine, 22 October 2025. https://doi.org/10.1016/j.eclinm.2025.103581