Therapeutic advances in Marburg virus disease: from experimental treatments to vaccine development

The Marburg virus (MARV), discovered in 1967, has led to devastating outbreaks over the world; the mortality rate of Marburg virus disease (MVD) varies according to the outbreak and viral type. The very first known filovirus hemorrhagic fever outbreaks occurred in Germany and the former Yugoslavia. MVD is a deadly illness caused by the MARV virus, part of the Filoviridae family. It progresses with early viral replication that damages immune cells, followed by destruction of organs like the spleen, liver, and lymphoid tissues. Combatting this disease requires proper health education, and strong strategies. MVD is a lethal single-stranded RNA virus transmitted by Egyptian rousette bats, with a fatality rate of approximately 90%. This work explored ongoing studies on the recent vaccine developments and experimental therapies, such as a recombinant vesicular stomatitis virus (VSV)-based vaccine and MVA-BN-Filo, aiming to combat this deadly infection. Over the previous years, MARV has also spread to non-endemic African countries, demonstrating its potential to cause epidemics. Although MARV-specific vaccines are evaluated in preclinical and clinical research, none have been approved for human use. Studies revealed that Modified Vaccinia virus Ankara, a well-established viral vector used to generate vaccines against emerging pathogens, can deliver multiple antigens and has a remarkable clinical safety and immunogenicity record. MVD has been recently reported in Rwanda in 2024, an African country, and nearly 15 outbreaks of MVD have been reported. This review describes the nature of the MVD, key outbreaks, the virus's pathogenesis, mode of transmission, clinical and laboratory diagnosis, and control and prevention measures to advance MVD treatment, drug development, vaccine creation, and prevention of MVD.