Post-exposure prevention in Marburg virus outbreaks: potential role of remdesivir in emergency response

Marburg virus (MARV), a close relative of the Ebola virus, causes severe hemorrhagic fevers with a case fatality rate of up to 88%. In the absence of specific treatment or vaccine, its rapid spread through epidemics in Africa, particularly in Angola, DRC, Guinea, Uganda, and recently Tanzania, poses a major threat to global public health. The use of post-exposure prevention, already effective against viruses such as HIV and rabies, could offer a promising strategy to interrupt infection in recently exposed individuals. Remdesivir, a nucleotide analog initially developed against the Ebola virus and used for SARS-CoV-2, has shown significant antiviral activity against MARV in animal models. Administered within 24-48 hours of exposure, it reduces viral load and improves survival. This asymptomatic but active window of viral replication provides a valuable opportunity for intervention. Although clinical results are still lacking, preclinical data support urgent consideration of remdesivir as a rapid response tool. However, its logistical constraints (injectable form) limit its deployment in remote areas. Nevertheless, its integration into emergency protocols, accompanied by investments in research, early authorizations, and strategic stockpiles, could strengthen response capacities. While awaiting a vaccine, each antiviral option deserves rigorous attention to limit transmission and mortality during future Marburg outbreaks.