For the first time ever, Marburg virus disease has been confirmed in West Africa. The case was reported by health authorities in Guinea’s southern Gueckedou prefecture, where the country’s latest Ebola outbreak was declared over less than two months ago. Guinea is currently dealing with a third wave of covid-19 cases.

Guinea’s health ministry said that on 25 July the patient arrived at a local clinic in the Koundou area of Gueckedou for treatment and a medical investigation team was dispatched to investigate his worsening symptoms, including fever, headache, fatigue, abdominal pain and bleeding gums. He died on 2 August. A field laboratory in Gueckedou collected samples from the deceased patient and Guinea’s national haemorrhagic fever laboratory confirmed he had Marburg virus. The Pasteur Institute in Senegal also confirmed the result.

Described by the World Health Organization (WHO) as a highly infectious virus that causes haemorrhagic fever, Marburg belongs to the same family as the Ebola virus.

Matshidiso Moeti, regional director for Africa at the WHO, noted that the ability of the country to quickly stem the spread of the disease largely relies on local health authorities and health officials being able to quickly detect the disease. Response to the outbreak is being built on Guinea’s past experience and expertise in managing Ebola, which is transmitted in a similar way, Moeti said.

The most recent outbreak of Marburg virus occurred in Uganda in 2017 during which three cases were confirmed. All three patients died. In 2005, the largest documented Marburg outbreak occurred in Angola, with 329 people dying out of a total of 374 cases.

While vaccines and some treatment options are now available for Ebola, there are none approved for Marburg aside from supportive care, including rehydration and treatment of specific symptoms.

The government of Guinea said it is working with its partners to quickly implement contact tracing in order to find anyone who could have been in contact with the man who was confirmed to have contracted Marburg virus. It is also introducing public education and enlisting community members to raise awareness, as this is the first time that the disease has been recorded in the country.

WHO said it already has a team of infectious disease experts in the area, and that cross-border surveillance is being enhanced to quickly detect any cases, with neighbouring countries on alert.

“The Ebola control systems in place in Guinea and in neighbouring countries are crucial to the emergency response to the Marburg virus,”  said a WHO statement.

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Nearly 1 million people are now taking pre-exposure prophylaxis (PrEP), medicine that can slash the risk of HIV infections. While early use of the drug was mostly limited to Western nations, the number of users in sub-Saharan Africa (SSA) has now drastically increased, accounting for more than half of the world’s PrEP users.

Kate Segal at AVAC, a New York-based non-profit focused on global HIV prevention, presented the latest data on PrEP use at the virtual HIV Research for Prevention Conference on 26 January. She said there had been a major expansion of PrEP users in 2020, with a rise of more than 300,000 from the previous year. In SSA, expanded access saw the number of new users jump from 4154 in 2016 to more than 517,000 in 2020, representing 56 per cent of the global total.

Out of the 10 , seven are in SSA. South Africa has surpassed 100,000 users, while Kenya has about 83,000 as of December 2020, followed closely by Zambia and Uganda.

Segal attributed the trend to investments from the US President’s Emergency Plan For AIDS Relief, a major funder of HIV programmes across SSA, along with commitments by many governments in the region to offer wide access to PrEP.

“In South Africa and Kenya, credit policies [to fund access] and guidelines were adopted, ambitious targets were set and sufficient resources were allocated by national governments to meet them,” Segal told żěè¶ĚĘÓƵ.

She says that SSA countries have ensured the drugs are available to the general population, as well as for groups at greater risk of infection, such as men who have sex with men and sex workers. This contrasts with the approach in countries such as the UK, which has long resisted providing general access to PrEP.

Segal says there are still opportunities to expand access in SSA, such as making PrEP available at local pharmacies and other outlets, and informing the public about the drug.

“Many of the general population still don’t know that PrEP exists or what it is or how to access it. So we really need to normalise it and increase demand,” she says.

John Nkengasong at the Africa Centres for Disease Control and Prevention says the ongoing coronavirus pandemic may hamper these efforts.

“Covid-19 has impacted all our health programmes, not just HIV. I suspect that there’ll be a lot of effect on PrEP initiations in Africa this year,” he says. “We know and we anticipate that there will be harm to our HIV and other programmes.”

But in Nigeria, where PrEP users grew from 76 in 2016 to nearly 32,000 in 2020, there is optimism that the decision to centrally coordinate will further expand access to PrEP. Ifeanyi Nsofor, CEO of Nigerian public health consultancy EpiAfric, says that with HIV prevalence significantly dropping in Africa, efforts are now turning to prevention measures such as PrEP, especially among young people.

“Focus should be on prevention and scaling up youth-friendly health facilities and deploying technology to provide information on PrEP and other issues to adolescents via mobile phones and social media,” he says.

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