Narrative review on Marburg virus disease aetiopathogenesis and management

Abstract

Abstract On November 14th, 2025, the Ethiopian Ministry of Health confirmed the country’s first Marburg virus outbreak, representing another in a series of recent outbreaks across Africa in only 3 years. Marburg virus disease (MVD) is a highly lethal zoonotic haemorrhagic fever caused by the Marburg virus. This review synthesises the current evidence on MVD, covering epidemiology, pathogenesis, diagnostics, and emerging countermeasures, such as investigational antivirals and vaccines. Despite the severity of the disease outcome, no licensed treatment or vaccine exists. Recent outbreaks, including Rwanda (2024), Tanzania and Ethiopia (2025), have accelerated evaluation of investigational therapeutics such as remdesivir and monoclonal antibody MBP091 under expanded access and early‑phase studies; no randomised human efficacy data are currently available for MVD, alongside novel platforms including mRNA and adenovirus-vectored vaccines. Advances in molecular virology have helped to elucidate mechanisms of immune evasion and viral persistence, informing strategies for targeted interventions. Diagnostic capacity and therapeutic deployment remain constrained in resource-limited settings. Strengthening global preparedness will require integrated surveillance, rapid clinical trial frameworks, and equitable access to vaccines and antivirals.