Reading Global Signs: How India’s Health System Can Strengthen Its Marburg Readiness
From triage to isolation protocols, Dr. Swapnil Khadke offers a clinician’s perspective on building practical Marburg readiness across Indian hospitals. Khadke is the head of critical care department at Fortis Hiranandani Hospital in Vashi.
In the context of India, how concerned should hospitals be about a spill-over of Marburg virus disease, given recent outbreaks in East Africa and new geographies?
Indian hospitals should maintain a high level of vigilance, but keep the concern measured and realistic. While Marburg remains primarily an African zoonosis with geographically focal, sporadic outbreaks, the 2024–25 signals from East Africa ,including Rwanda, Tanzania, and more recent alerts from the Ohon region, confirm that the virus can re-emerge in new locales. These events demonstrate that health-care workers are particularly vulnerable and hospital-based amplification is possible if infection-control lapses occur. For India, this means enhanced alertness at points of entry, tertiary-care centres, and referral hospitals treating febrile haemorrhagic fevers. Preparedness, not panic, is the operative approach, consistent with WHO guidance.
What specific early clinical signs or lab findings should Indian clinicians watch for, especially since initial symptoms (fever, diarrhoea, vomiting) are common to many infections?
Clinicians must look beyond nonspecific prodromal features like fever, diarrhoea, and vomiting, and focus on patterns that progress rapidly. Key early indicators include severe Myalgia, marked fatigue, and a swift transition to prominent gastrointestinal involvement such as profuse watery diarrhoea and persistent vomiting. Early severe asthenia and hypotension that appear disproportionate to routine gastroenteritis should heighten suspicion. Any bleeding , petechiae, mucosal bleeding, hematemesis, or melena, even if initially limited, is an important warning signal.
Laboratory red flags include Leukopenia, Lymphopenia, marked Thrombocytopenia, and disproportionately elevated transaminases and creatinine, indicating early multi-organ involvement. When these signs cluster with an epidemiologic link, health-worker exposure, or travel history to affected regions, clinicians must immediately initiate airborne, droplet, and contact precautions and notify public-health authorities.
Given India’s public-health infrastructure and hospital-care realities, what are the most critical interventions to raise survival chances in Marburg patients, especially when no licensed antivirals exist?
Survival depends almost entirely on the timeliness and quality of supportive care. Early, aggressive fluid resuscitation guided by hemodynamic monitoring is essential, along with meticulous correction of electrolyte and acid–base disturbances. Targeted transfusion support for coagulopathy and significant bleeding, proactive management of secondary infections, and structured organ-support strategies ,including renal-replacement therapy where indicated , are central to improving outcomes.
Equally critical are systems-level enablers: rapid triage and isolation of suspects, early laboratory surveillance to guide fluid and transfusion decisions, and uninterrupted availability of IV fluids, blood products, vasopressors, oxygen, and skilled critical-care nursing. Outcomes correlate far more strongly with the speed and quality of organ-supportive therapy than with any specific antiviral, a position reinforced by WHO.
How should hospital administrators and infection-control teams in India prepare for a possible Marburg case, covering isolation, PPE, contact-tracing and cross-border vigilance?
Administrators must operationalise a realistic, upgraded preparedness plan. This includes designating a single-entry triage pathway for febrile patients with travel or contact risks, and pre-identifying an isolation room or cohorting area with dedicated staff. PPE readiness must be ensured: impermeable gowns, double gloves, eye protection, N95 or equivalent respirators, and impermeable shoe covers, alongside supervised donning and doffing. Strict biomedical-waste management and safe sharps handling are non-negotiable to prevent health-worker exposure.
Infection-control teams should formalise rapid contact-tracing algorithms in coordination with public-health authorities, maintain a register of exposed staff for serial monitoring, and build active linkages with airport, port-health, and cross-border surveillance units. Regular simulation drills, including laboratory transport and mortuary pathways, are essential to surface operational gaps before an actual event.
From a policy and systems viewpoint, what gaps in India’s surveillance, referral systems or public awareness must be addressed now so that if Marburg reaches Indian shores, we are not caught flat-footed?
Key vulnerabilities lie in uneven sentinel surveillance for viral haemorrhagic fevers outside major metros and the need for strengthened laboratory networks with reliable PCR capacity and clear specimen-referral pathways. Triage and referral protocols
across primary, secondary, and tertiary tiers remain inconsistent; India needs standardised case definitions and expedited transport protocols for suspected VHFs (viral hemorrhagic fevers).
Supply-chain fragility also poses a risk ,periodic stock-outs of blood products, IV fluids, PPE, and other essentials highlight the need for dedicated reserve caches and stronger logistics management. Public and clinician awareness gaps must be closed through risk-proportionate communication, targeted campaigns, and short modular training for frontline clinicians. Finally, intersectoral coordination, across health, civil aviation, animal health, and border authorities , must be codified so that surveillance signals trigger timely, calibrated operational responses rather than ad-hoc measures.
Got a story that Healthcare Executive should dig into? Shoot it over to arunima.rajan@hosmac.com—no PR fluff, just solid leads.