A mathematical model of Marburg virus disease outbreaks and the potential role of vaccination in control
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Date
2023-11
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Abstract
Background Marburg virus disease is an acute haemorrhagic fever caused by Marburg virus. Marburg virus
is zoonotic, maintained in nature in Egyptian fruit bats, with occasional spillover infections into humans and nonhuman primates. Although rare, sporadic cases and outbreaks occur in Africa, usually associated with exposure to bats
in mines or caves, and sometimes with secondary human-to-human transmission. Outbreaks outside of Africa have
also occurred due to importation of infected monkeys. Although all previous Marburg virus disease outbreaks have
been brought under control without vaccination, there is nevertheless the potential for large outbreaks when implementation of public health measures is not possible or breaks down. Vaccines could thus be an important additional
tool, and development of several candidate vaccines is under way.
Methods We developed a branching process model of Marburg virus transmission and investigated the potential
efects of several prophylactic and reactive vaccination strategies in settings driven primarily by multiple spillover events as well as human-to-human transmission. Linelist data from the 15 outbreaks up until 2022, as well
as an Approximate Bayesian Computational framework, were used to inform the model parameters.
Results Our results show a low basic reproduction number which varied across outbreaks, from 0.5 [95% CI 0.05–1.8]
to 1.2 [95% CI 1.0–1.9] but a high case fatality ratio. Of six vaccination strategies explored, the two prophylactic strategies (mass and targeted vaccination of high-risk groups), as well as a combination of ring and targeted vaccination,
were generally most efective, with a probability of potential outbreaks being terminated within 1 year of 0.90 (95%
CI 0.90–0.91), 0.89 (95% CI 0.88–0.90), and 0.88 (95% CI 0.87–0.89) compared with 0.68 (0.67–0.69) for no vaccination,
especially if the outbreak is driven by zoonotic spillovers and the vaccination campaign initiated as soon as possible
after onset of the frst case.
Conclusions Our study shows that various vaccination strategies can be efective in helping to control outbreaks
of MVD, with the best approach varying with the particular epidemiologic circumstances of each outbreak.
Keywords Marburg, Marburgvirus, Filovirus, Vaccination, Zoonotic, Transmission, Modelling
Description
Keywords
Marburg, Marburgvirus, Filovirus, Vaccination, Zoonotic, Transmission, Modelling
Citation
Qian, George Y., W. John Edmunds, Daniel G. Bausch, et al. 'A Mathematical Model of Marburg Virus Disease Outbreaks and the Potential Role of Vaccination in Control', BMC Medicine, vol. 21/no. 1, (2023), pp. 1-439.