Viral hemorrhagic fevers (VHF) such as Marburg virus disease have recently gained attention due to outbreaks in various parts of the world. Recently, over 60 confirmed cases of Marburg have been reported in Rwanda. Although the risk of Marburg virus disease remains low in the United States, experts at Mass General Brigham have worked closely with the U.S. Department of Health and Human Services (HHS) Region 1 Regional Emerging Special Pathogens Treatment Center (RESPTC) at Massachusetts General Hospital (MGH) to help frontline healthcare facilities prepare for potential cases. They have developed a toolkit aimed at ensuring critical laboratory testing is available for patients being evaluated for VHF, regardless of whether Marburg cases are suspected. A detailed paper outlining the toolkit was recently published in Infection Control & Hospital Epidemiology.

Ensuring Early Identification and Isolation of Marburg Virus Suspects

Although the likelihood of encountering a Marburg case in the U.S. is low, early identification and isolation of individuals with symptoms or epidemiological risk factors for Marburg virus disease are critical. Both patient safety and healthcare worker protection depend on the ability to quickly identify and isolate suspected cases. After identification and isolation, diagnostic testing becomes essential to confirm the presence of the virus and begin appropriate treatment.

Sarah E. Turbett, MD, co-lead author from the Division of Infectious Diseases and the Department of Pathology at Massachusetts General Hospital, emphasizes the importance of preparedness: “Once an at-risk patient is identified and isolated, diagnostic capacity is critical for patient evaluation. As Marburg virus disease could be presented at any healthcare facility, it is important to have a practical action plan in place for the isolation and initial care of such patients. Our toolkit provides generalizable and scalable resources to assist in developing this plan.”

Key Components of the Diagnostic Toolkit

The toolkit includes a “base plan” designed to guide healthcare facilities through the process of collecting, processing, and reporting laboratory test results for suspected VHF cases. It also provides valuable guidance on infection prevention and control, waste management, and occupational health practices—critical areas for ensuring the safety of both patients and healthcare workers.

Co-lead author Jacob E. Lazarus, MD, PhD, from the Division of Infectious Diseases at Massachusetts General Hospital, highlights the challenges faced by smaller healthcare facilities: “Handling laboratory samples in patients with possible VHF requires extreme care. Setting up a diagnostic program may seem daunting, particularly for smaller facilities, but being unprepared is simply not an option. We wanted to offer a starting point.” The toolkit also includes documents, templates, and checklists that healthcare facilities can customize based on their specific needs.

Learning from Past Outbreaks

The new toolkit draws on lessons learned from past viral outbreaks, such as the 2014-2016 West African Ebola Virus Disease outbreak. During this crisis, the CDC reported significant diagnostic failures, particularly among travelers returning to the U.S. who were suspected of having Ebola but were misdiagnosed with malaria. Erica S. Shenoy, MD, PhD, the senior author of the study, from the Division of Infectious Diseases at Massachusetts General Hospital and Infection Control at Mass General Brigham, emphasizes the need for improvement: “We must do better. Safe and effective care relies on the diagnostic capacity of every frontline facility. Our team hopes the tools we’ve developed will strengthen local preparedness efforts and ensure that healthcare providers are ready when emerging pathogens like Marburg present themselves.”

Supporting Local Preparedness and Response

The Region 1 RESPTC provides resources to healthcare organizations in New England to ensure readiness for emerging pathogens like Marburg. The toolkit is part of ongoing efforts to enhance the diagnostic capabilities of healthcare facilities, particularly in addressing rare but dangerous diseases like Marburg virus.

For more information or to access the toolkit, healthcare providers can contact the Region 1 RESPTC at Mghbrt@partners.org.

Source: Mass General Brigham

Date:Oct 26 2024