In November 2025, Ethiopia faced a historic and urgent public health challenge: its first confirmed outbreak of Marburg virus disease (MVD) in the southern Omo region, specifically in Jinka town. This event not only marked a significant milestone in the country’s epidemiological history but also raised pressing questions about regional preparedness, cross-border risks, and the global implications of emerging zoonotic diseases. The outbreak’s rapid confirmation, the swift mobilization of national and international resources, and the transparent communication by Ethiopian authorities have been widely commended by global health leaders, including the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC).
The Marburg Virus: Background and Historical Context
Virology and Natural Reservoirs
Marburg virus (MARV) is a member of the Filoviridae family, closely related to the Ebola virus, and is classified within the genus Orthomarburgvirus. The disease it causes, Marburg virus disease (MVD), is a severe and often fatal hemorrhagic fever in humans and non-human primates. The natural reservoir of MARV is the Egyptian fruit bat (Rousettus aegyptiacus), a species widely distributed across sub-Saharan Africa. These bats harbor the virus asymptomatically, shedding it in saliva, urine, and feces, and are implicated in the zoonotic spillover events that initiate human outbreaks.
Human infection typically occurs through prolonged exposure to bat-inhabited caves or mines, or through contact with contaminated fruit or surfaces. Once introduced into the human population, MARV spreads via direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals, or with contaminated materials such as bedding and clothing. Nosocomial (healthcare-associated) transmission is a well-documented risk, particularly in settings with inadequate infection prevention and control (IPC) measures.
Clinical Features and Case Definitions
The incubation period for MVD ranges from 2 to 21 days. The disease begins abruptly with high fever, severe headache, and malaise, followed by muscle aches, watery diarrhea, abdominal pain, nausea, and vomiting. By days 5 to 7, many patients develop hemorrhagic manifestations, including bleeding from the nose, gums, and gastrointestinal tract. In fatal cases, death usually occurs between 8 and 9 days after symptom onset, often due to severe blood loss and shock. The case fatality rate (CFR) varies widely, from 24% to 88%, depending on the virus strain and the quality of supportive care.
Standard case definitions for surveillance include:
- Suspected case: Acute onset of fever with no response to treatment for common causes, plus at least one hemorrhagic sign (e.g., bloody diarrhea, bleeding gums, purpura).
- Confirmed case: Laboratory confirmation by PCR, antigen detection, or virus isolation.
- Community alert case: Fever with unexplained bleeding or sudden death in a previously healthy person.
Historical Outbreaks and Lessons Learned
Since its discovery in 1967 during simultaneous outbreaks in Germany and Serbia (linked to imported African green monkeys), Marburg virus has caused at least 18 recognized outbreaks in sub-Saharan Africa. Notable events include the massive 2005 Angola outbreak (252 cases, 227 deaths), the 1998–2000 Democratic Republic of the Congo outbreak among gold miners, and more recent outbreaks in Ghana (2022), Equatorial Guinea (2023), Tanzania (2023, 2025), and Rwanda (2024).
Each outbreak has underscored the importance of early detection, rapid isolation, robust laboratory capacity, community engagement, and international collaboration. The high CFR, lack of approved vaccines or antivirals, and the potential for cross-border spread make MVD a persistent threat to regional and global health security.
Timeline and Geographic Scope of the November 2025 Outbreak
Outbreak Chronology
The sequence of events in Ethiopia’s first Marburg outbreak unfolded with remarkable speed and transparency:
- 12 November 2025: An initial alert of suspected viral hemorrhagic fever was reported from Jinka, Omo region, to the Africa CDC and Ethiopian health authorities.
- 13 November 2025: WHO confirmed deployment of technical teams and supplies to support the investigation and response. Eight possible cases were under investigation, including health workers.
- 14 November 2025: Laboratory confirmation of Marburg virus disease by Ethiopia’s National Reference Laboratory. Genetic analysis revealed the strain’s similarity to those previously identified in East Africa.
- 14–15 November 2025: The Ministry of Health and Ethiopian Public Health Institute (EPHI) announced nine confirmed cases in Jinka, South Ethiopia Region, bordering South Sudan. Isolation, contact tracing, and community-wide screening were initiated. WHO and Africa CDC publicly commended Ethiopia’s rapid and transparent response.
- 16 November 2025: Africa CDC, WHO, and international partners scaled up support, with ongoing epidemiological investigations and laboratory analyses. No additional cases were reported in neighboring countries, but cross-border risk was highlighted as a major concern.
Geographic Focus: Jinka and the Omo Region
The epicenter of the outbreak was Jinka, a town in the Omo region of southern Ethiopia. This area is characterized by its proximity to the borders of South Sudan and Kenya, its ethnolinguistic diversity, and its challenging terrain. The region is also notable for its caves and mines, which are potential habitats for Egyptian fruit bats – the natural reservoir of MARV.
The Omo region’s border with South Sudan, a country with a fragile health system and ongoing conflict, raised immediate concerns about cross-border transmission and the potential for regional spread. Surveillance was heightened in neighboring countries, and joint preparedness activities were initiated.
Key Outbreak Data as of 17 November 2025
| Parameter | Value |
| Location | Jinka, Omo region |
| Date of confirmation | 14 November 2025 |
| Confirmed cases | 9 |
| Deaths | Not specified* |
| Health worker cases | At least 1 |
| Cross-border risk | High (South Sudan) |
| Laboratory confirmation | National Reference Lab, EPHI |
| International support | WHO, Africa CDC, others |
*Note: As of the latest reports, the number of deaths had not been officially released, but the high CFR of MVD suggests significant mortality.
The rapid identification and containment of cases in Jinka were facilitated by Ethiopia’s strengthened laboratory and surveillance infrastructure, as well as the deployment of mobile diagnostic teams and isolation facilities.
Clinical Features, Diagnostics, and Genomic Analysis
Clinical Presentation and Case Management
Patients in the Jinka outbreak presented with the classic features of MVD: abrupt onset of high fever, severe headache, muscle pains, vomiting, diarrhea, and, in several cases, profuse bleeding from multiple body orifices. The disease’s progression from “dry” symptoms (fever, malaise) to “wet” symptoms (gastrointestinal distress, hemorrhage) within days is characteristic of Marburg infection.
Healthcare workers were among those infected, underscoring the occupational risks associated with inadequate IPC measures. The Ministry of Health quickly established isolation wards, and contact tracing teams monitored over 100 potential exposures. Community sensitization campaigns emphasized handwashing, safe burials, and avoidance of bushmeat – a known risk factor for zoonotic transmission.
Laboratory Confirmation and Genomic Surveillance
The confirmation of MVD in Ethiopia was achieved through advanced molecular diagnostics at the National Reference Laboratory, supported by EPHI and Africa CDC. PCR assays specific for Marburg virus, along with antigen-capture tests, enabled rapid identification of cases. Genetic sequencing revealed that the detected strain closely resembled those previously identified in East Africa, suggesting a regional lineage and possible bat-to-human spillover from local Egyptian fruit bat populations.
Africa CDC’s long-term investment in Ethiopia’s molecular diagnostic and genomic surveillance capacity proved instrumental. The provision of genome-sequencing equipment, reagents, and training for laboratory personnel allowed for real-time genomic analysis, which is critical for tracking viral evolution and informing public health interventions.
Laboratory and Genomic Capacity in Ethiopia
| Capacity Area | Status (2025) | Partners Involved |
| National Reference Lab | BSL-3, PCR, sequencing | EPHI, Africa CDC, WHO, Global Fund, UK Health Security Agency |
| Mobile BSL-3 Lab | Operational | EPHI, UNCT, FMOH |
| Genomic Surveillance | Enhanced (real-time) | Africa CDC, CERI, World Bank |
| Training and Biosafety | Extensive, ongoing | Africa CDC, EPHI, international partners |
Ethiopia’s experience highlights the value of sustained investment in laboratory infrastructure, biosafety, and workforce development for outbreak preparedness and response.
Public Health Response: National and International Collaboration
National Response Measures
The Ethiopian Ministry of Health, in coordination with EPHI and regional health authorities, activated a comprehensive outbreak response that included:
- Enhanced surveillance: Active case finding, community-wide screening, and daily monitoring of contacts.
- Isolation and clinical care: Establishment of dedicated isolation wards, provision of supportive care (rehydration, symptom management), and safe transport of patients.
- Contact tracing: Deployment of teams to identify and monitor over 100 potential contacts, with 21-day follow-up for symptom development.
- Community engagement: Risk communication campaigns to educate the public about symptoms, transmission, and prevention measures.
- Infection prevention and control: Distribution of personal protective equipment (PPE), training of healthcare workers, and implementation of strict IPC protocols in health facilities.
- Safe and dignified burials: Specialized teams conducted burials in accordance with cultural practices while minimizing transmission risk.
The Ministry’s transparent communication and rapid mobilization of resources were repeatedly praised by WHO and Africa CDC, setting a benchmark for outbreak management in the region.
Role of Africa CDC and International Partners
Africa CDC played a pivotal role in supporting Ethiopia’s response. Its contributions included:
- Technical support: Deployment of experts for risk assessment, laboratory diagnostics, and epidemiological investigations.
- Capacity building: Provision of genome-sequencing equipment, PCR kits, and training in biosafety, bioinformatics, and safe sample handling.
- Integrated response: Coordination with ongoing mpox (monkeypox) preparedness and surveillance to optimize resources and accelerate detection.
- Cross-border readiness: Engagement with neighboring countries (notably South Sudan and Kenya) to reinforce surveillance and prevent regional spread.
WHO, the Global Fund, and the UK Health Security Agency also provided essential supplies, including PPE, infection-prevention materials, and deployable isolation tents. The UN released emergency funds to support immediate response needs, and technical officers assisted with surveillance, testing, and IPC.
Community Engagement and Risk Communication
Effective risk communication and community engagement (RCCE) were central to the response. Authorities leveraged multiple channels – radio, social media, community meetings, and trusted local leaders – to disseminate accurate information, counter misinformation, and encourage early healthcare-seeking behavior. Special attention was given to:
- Cultural practices: Working with faith leaders and traditional healers to adapt burial rituals and caregiving norms in ways that respected local customs while reducing transmission risk.
- Stigma reduction: Addressing fears and misconceptions about MVD, supporting survivor reintegration, and promoting psychosocial support for affected families and healthcare workers.
- Community-based surveillance: Training local volunteers and health workers to detect and report suspected cases, particularly in remote or underserved areas.
Challenges and Complexities: Health System, Cross-Border Risk, and Socio-Cultural Factors
Health System Capacity and IPC
Ethiopia’s health system, while strengthened in recent years, faced significant challenges in mounting a rapid and effective response:
- Resource constraints: Limited availability of isolation beds, PPE, and trained personnel in rural areas.
- IPC gaps: The risk of nosocomial transmission was heightened by shortages of supplies and variable adherence to IPC protocols, especially in peripheral health facilities.
- Laboratory biosafety: Handling of high-risk specimens required strict adherence to biosafety standards, with ongoing training and supervision for laboratory staff.
The outbreak underscored the need for continued investment in health infrastructure, supply chains, and workforce development, particularly in regions at risk for zoonotic spillover.
Cross-Border and Conflict Zone Risks
The proximity of the Omo region to South Sudan – a country grappling with conflict, displacement, and a fragile health system – posed a substantial risk of cross-border transmission. Informal trade routes, population movements, and porous borders complicated surveillance and response efforts. Africa CDC and WHO worked closely with both countries to harmonize protocols, share information, and coordinate preparedness activities.
Conflict zones and areas with limited government presence presented additional barriers to case detection, contact tracing, and community engagement. These challenges highlight the importance of regional cooperation and the integration of health security into broader humanitarian and development agendas.
Socio-Cultural Practices and Community Dynamics
Traditional caregiving roles, funeral rituals involving close contact with the deceased, and the consumption of bushmeat are deeply embedded in local cultures. These practices can amplify transmission risk during outbreaks. However, experience from previous MVD and Ebola outbreaks demonstrates that communities are often willing to adapt rituals when engaged respectfully and provided with clear, culturally sensitive guidance.
Community mistrust, stigma, and misinformation can undermine response efforts. Proactive engagement with local leaders, transparent communication, and the involvement of survivors and affected families are essential for building trust and promoting protective behaviors.
Zoonotic Origins and Ecological Drivers
The Role of Egyptian Fruit Bats
The Egyptian fruit bat (Rousettus aegyptiacus) is the principal reservoir of Marburg virus. These bats are widely distributed across Africa and are known to roost in caves, mines, and sometimes in buildings. They shed MARV in saliva, urine, and feces, contaminating fruit and surfaces that may be accessed by humans or other animals.
Recent ecological studies using micro-GPS tracking have revealed that these bats routinely travel long distances – up to 57 km in a single night – to forage in cultivated fruit trees near human settlements. This behavior creates numerous opportunities for virus spillover, especially when humans consume partially eaten fruit or come into contact with bat excreta.
Human–Bat Interactions and Spillover Risk
In the Omo region and similar settings, human activities such as mining, cave exploration, and the collection of bat guano for fertilizer increase the likelihood of contact with bat colonies. The consumption of bushmeat and partially eaten fruit further elevates the risk of zoonotic transmission. Seasonal pulses of MARV infection in juvenile bats coincide with periods of increased human exposure, suggesting a complex interplay between bat ecology, human behavior, and outbreak risk.
Efforts to control MARV through bat extermination have proven ineffective and may even increase spillover risk by disrupting bat populations and promoting recolonization by infected juveniles. Conservation strategies that protect bat habitats, combined with public education about safe behaviors, are essential for reducing the risk of future outbreaks.
Key Zoonotic Risk Factors
| Risk Factor | Description |
| Cave/mining exposure | Prolonged human presence in bat-inhabited sites |
| Consumption of bushmeat | Handling/eating bats or primates |
| Contact with contaminated fruit | Eating fruit partially eaten by bats |
| Collection of bat guano | Handling bat feces for fertilizer |
| Traditional burial practices | Direct contact with deceased |
| Inadequate IPC in healthcare | Nosocomial transmission |
Genomic Surveillance and Regional Implications
Advances in Genomic Surveillance
The 2025 Ethiopia outbreak showcased the growing capacity for real-time genomic surveillance in Africa. Investments by Africa CDC, the World Bank, and international partners have enabled countries like Ethiopia to rapidly sequence viral genomes, track transmission chains, and detect emerging variants. The integration of genomic data with epidemiological investigations enhances outbreak response and informs vaccine and therapeutic development.
The detected MARV strain in Ethiopia was closely related to those circulating in East Africa, supporting the hypothesis of a regional reservoir and highlighting the need for coordinated surveillance across borders.
Regional and Global Health Security
The outbreak’s proximity to South Sudan and Kenya, both of which have experienced previous MVD or Ebola events, underscored the interconnectedness of regional health security. The risk of cross-border spread, especially in areas affected by conflict or displacement, remains a persistent challenge.
At the global level, the Ethiopia outbreak reinforced the importance of the International Health Regulations (IHR), the need for rapid information sharing, and the value of international solidarity in responding to emerging infectious diseases. The experience also highlighted gaps in vaccine and therapeutic development, the need for sustainable financing, and the critical role of community engagement in outbreak control.
Infection Prevention and Control: Protecting Healthcare Workers and Communities
IPC Guidelines and Implementation
WHO’s updated infection prevention and control (IPC) guidelines for Ebola and Marburg disease, released in 2023, provided the foundation for Ethiopia’s response. Key recommendations included:
- Personal protective equipment (PPE): Appropriate use of gloves, gowns, masks, and eye protection for all patient care activities.
- Hand hygiene: Rigorous handwashing protocols for healthcare workers and caregivers.
- Environmental cleaning: Regular disinfection of surfaces and safe management of medical waste.
- Safe injection practices: Use of single-use needles and avoidance of unnecessary injections.
- Safe and dignified burials: Specialized teams to handle deceased patients, minimizing contact while respecting cultural norms.
The “IPC ring approach” – rapidly mobilizing teams to enhance IPC activities in at-risk areas – was deployed to contain the outbreak in Jinka and surrounding communities.
Healthcare Worker Safety and Training
Healthcare workers are at heightened risk during MVD outbreaks, particularly in settings with limited resources. Ethiopia’s response included:
- Training: Intensive IPC training for frontline staff, including donning and doffing of PPE, safe sample handling, and waste management.
- Psychosocial support: Counseling and support services for healthcare workers facing stress, stigma, and the risk of infection.
- Monitoring and supervision: Regular audits of IPC practices and rapid feedback to address gaps.
The protection of healthcare workers is not only a moral imperative but also essential for maintaining public trust and sustaining the outbreak response.
Community Engagement, Risk Communication, and Cultural Adaptation
Principles of Effective RCCE
Risk communication and community engagement (RCCE) are vital for outbreak control. WHO’s interim guidance emphasizes:
- Timely, transparent communication: Sharing accurate information about risks, symptoms, and prevention measures through trusted channels.
- Community involvement: Engaging local leaders, faith-based organizations, and traditional healers in co-developing and disseminating messages.
- Addressing misinformation: Proactively countering rumors and myths, especially those related to transmission, treatment, and stigma.
- Cultural sensitivity: Adapting interventions to local customs, languages, and beliefs, particularly regarding caregiving and burial practices.
- Feedback mechanisms: Establishing channels for community input, questions, and concerns, and using this feedback to adjust response strategies.
Adapting Burial and Care Practices
Traditional burial rituals, which often involve washing and touching the deceased, are high-risk activities for MARV transmission. Ethiopia’s response teams worked with community and religious leaders to develop safe and dignified burial protocols that respected cultural values while minimizing infection risk. This collaborative approach increased community acceptance and reduced resistance to public health measures.
Caregiving roles, often filled by women, were also addressed through targeted education and the provision of PPE for home-based caregivers when necessary.
Stigma, Survivor Support, and Mental Health
Stigma and discrimination against survivors, families, and healthcare workers can have profound psychological and social consequences. Ethiopia’s response included:
- Survivor support programs: Counseling, medical follow-up, and community reintegration assistance.
- Mental health services: Psychosocial support for affected individuals and responders.
- Public messaging: Emphasizing that MVD is transmitted through close contact, not by casual interaction, and that survivors pose no risk once recovered.
Treatment, Clinical Care, and Survivor Support
Supportive Care: The Cornerstone of MVD Management
There is currently no approved antiviral treatment or vaccine for Marburg virus disease. Management is limited to supportive care, which can significantly improve survival rates:
- Fluid and electrolyte replacement: Oral or intravenous rehydration to prevent shock and organ failure.
- Symptom management: Antipyretics, antiemetics, and pain relief as needed.
- Treatment of complications: Blood transfusions, management of co-infections, and intensive care for severe cases.
- Nutritional support: Addressing malnutrition, especially in prolonged cases or among vulnerable populations.
Early access to supportive care is associated with lower mortality, underscoring the importance of rapid case identification and referral.
Experimental Therapies and Vaccine Research
Several candidate vaccines and therapeutics are in development, including monoclonal antibodies and antiviral agents. Clinical trials have been conducted in recent outbreaks (e.g., Rwanda, 2024), but none are yet licensed for widespread use. Ethiopia’s outbreak highlighted the urgent need for continued research and the ethical challenges of deploying experimental interventions during emergencies.
Survivor Care and Long-Term Sequelae
Survivors of MVD may experience prolonged convalescence and a range of physical and psychological sequelae, including fatigue, joint pain, vision problems, and post-traumatic stress. The virus can persist in immune-privileged sites (e.g., testes, eyes), raising concerns about potential sexual transmission and relapse. WHO recommends regular follow-up, counseling, and, where available, semen testing for male survivors.
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Diagnostics Capacity and Laboratory Biosafety in Ethiopia
Laboratory Infrastructure and Biosafety
Ethiopia’s laboratory system, anchored by EPHI’s National Reference Laboratory, has undergone significant upgrades in recent years. The establishment of BSL-3 facilities, mobile laboratories, and regional diagnostic centers has enhanced the country’s ability to detect and respond to high-risk pathogens, including MARV.
Key elements of Ethiopia’s laboratory capacity include:
- BSL-3 containment: Safe handling of high-consequence pathogens, with strict protocols for sample processing, waste management, and decontamination.
- Mobile laboratories: Rapid deployment to outbreak sites, enabling on-site diagnostics and reducing turnaround times.
- Quality assurance: Participation in external quality assessment programs and adherence to international biosafety standards.
- Workforce development: Ongoing training for laboratory personnel in molecular diagnostics, biosafety, and bioinformatics.
Environmental and Social Considerations
The expansion of laboratory capacity has been accompanied by environmental and social impact assessments, stakeholder consultations, and the development of waste management and emergency preparedness plans. These measures are essential for ensuring the safety of workers, communities, and the environment during outbreak response and routine operations.
Media Coverage and Public Perception
National and International Media Response
The Ethiopian Marburg outbreak received extensive coverage in national and international media, with a focus on the novelty of the event, the severity of the disease, and the rapid response by authorities. Headlines emphasized the “first-ever” nature of the outbreak, the risk of cross-border spread, and the absence of approved treatments or vaccines.
Media outlets highlighted the commendations from WHO and Africa CDC, the deployment of technical teams, and the mobilization of supplies and funding. The transparent communication by Ethiopian authorities was widely praised as a model for outbreak management.
Public Perception and Community Response
Initial public reactions included fear, anxiety, and concern about the potential for widespread transmission. Community engagement efforts, risk communication campaigns, and the involvement of trusted local leaders helped to mitigate panic, promote protective behaviors, and encourage early healthcare-seeking.
Social media played a dual role, serving as a platform for both accurate information and misinformation. Authorities and partners monitored online discourse, addressed rumors, and provided regular updates to maintain public trust and counter stigma.
Data Visualization: Outbreak Metrics and Regional Comparisons
Recent Marburg Virus Disease Outbreaks in Africa (2021–2025)
| Year | Country | Cases | Deaths | CFR (%) | Notable Features |
| 2025 | Ethiopia | 9 | N/A* | N/A* | First outbreak, Jinka, Omo region |
| 2025 | Tanzania | 10 | 10 | 100 | Kagera region, rapid containment |
| 2024 | Rwanda | 66 | 15 | 23 | Kigali, healthcare worker infections |
| 2023 | Equatorial Guinea | 40 | 35 | 88 | Multi-province, high CFR |
| 2022 | Ghana | 3 | 2 | 67 | Ashanti region, family cluster |
| 2021 | Guinea | 1 | 1 | 100 | Single case, no secondary transmission |
*As of the latest reports, the number of deaths in Ethiopia’s outbreak had not been officially released.
This table illustrates the variability in outbreak size, CFR, and geographic distribution, highlighting the unpredictable nature of MVD and the importance of rapid response.
Research Gaps and Future Directions
Surveillance and Early Detection
- Hotspot identification: Enhanced ecological and genomic surveillance to map MARV reservoirs and high-risk human–bat interfaces.
- Community-based surveillance: Training and empowering local health workers and volunteers to detect and report suspected cases, especially in remote or underserved areas.
- Cross-border coordination: Harmonization of surveillance protocols and data sharing among neighboring countries to prevent regional spread.
Diagnostics, Treatment, and Vaccine Development
- Point-of-care diagnostics: Development and deployment of rapid, field-deployable tests for MARV detection.
- Therapeutic research: Clinical trials of candidate antivirals, monoclonal antibodies, and supportive care protocols.
- Vaccine trials: Continued evaluation of vaccine candidates in outbreak and inter-epidemic settings, with attention to ethical, logistical, and regulatory challenges.
Health System Strengthening
- IPC infrastructure: Investment in health facility upgrades, supply chains, and workforce training to ensure sustained IPC capacity.
- Laboratory biosafety: Expansion of BSL-3 and mobile laboratory networks, with robust quality assurance and waste management systems.
- Community engagement: Integration of RCCE into routine health services and emergency preparedness plans.
Social Science and Behavioral Research
- Cultural adaptation: Studies on the effectiveness of culturally tailored interventions for burial practices, caregiving, and stigma reduction.
- Risk communication: Evaluation of messaging strategies, feedback mechanisms, and the role of social media in outbreak response.
- Survivor support: Longitudinal research on the physical, psychological, and social outcomes of MVD survivors and their families.
Implications for Global Health and Preparedness
The November 2025 Marburg outbreak in Ethiopia serves as a stark reminder of the persistent threat posed by emerging zoonotic diseases. It highlights the interconnectedness of human, animal, and environmental health – the essence of the One Health approach – and the need for sustained investment in surveillance, laboratory capacity, health system resilience, and community engagement.
The outbreak also underscores the importance of international solidarity, rapid information sharing, and the ethical imperative to ensure equitable access to diagnostics, treatments, and vaccines. As climate change, urbanization, and ecological disruption continue to reshape the landscape of infectious disease risk, the lessons of Ethiopia’s experience must inform global strategies for preparedness, response, and research.
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