Marburg needlestick exposure — DTM&H MCQ

Correct answer: B — Wash wound, initiate 21-day monitoring, and consider investigational treatments

The correct answer is B, wash wound, initiate 21-day monitoring, and consider investigational treatments. Marburg virus disease has no licensed post-exposure prophylaxis or vaccine, so management of a high-risk percutaneous exposure follows the standard UKHSA viral haemorrhagic fever algorithm: immediate decontamination of the wound with soap and water, urgent risk assessment and notification, and daily symptom and temperature monitoring for the maximum incubation period (up to 21 days) to allow early isolation if disease develops. Investigational agents (monoclonal antibodies, antivirals) may be offered under compassionate use or trial protocols if approved by outbreak response teams, but this is adjunctive, not routine, care. This reflects filovirus biology, incubation timing, and the absence of any proven filovirus-specific PEP outside a research setting. Why the other options are wrong: E. rVSV-ZEBOV vaccine: this is a licensed Ebola Zaire vaccine only; it has no cross-protective efficacy against Marburg virus, which is a genetically distinct filovirus. C. Oral ribavirin: ribavirin has proven activity against arenaviruses such as Lassa fever, not filoviruses like Marburg, so it is pharmacologically ineffective here. A. No action needed: Marburg is transmitted via direct contact with blood and body fluids, and percutaneous inoculation from a contaminated needle is a recognised high-risk exposure route with substantial transmission risk. D. IV interferon-alpha: interferon-alpha has no established clinical efficacy against filovirus infection and is not part of any recognised post-exposure protocol. Key point: there is no licensed vaccine or PEP for Marburg, so management after a high-risk exposure is wound decontamination plus rigorous 21-day symptom surveillance, with investigational therapeutics only considered on compassionate or trial grounds.

Reference: UK Health Security Agency, Viral Haemorrhagic Fevers: Risk Assessment and Management Guidance (VHF ACDP algorithm and guidance on management of patients), gov.uk, https://www.gov.uk/government/publications/viral-haemorrhagic-fever-acdp-algorithm-and-guidance-on-management-of-patients