To the Editor, Marburg virus, a filovirus closely related to Ebola, causes a severe haemorrhagic illness with case fatality rates ranging from 24 % to 88 %, depending on the timeliness and strength of the outbreak response 1. Transmission occurs through contact with infected body fluids or contaminated materials, and via exposure to infected fruit bats (Rousettus aegyptiacus), which have been recorded in several Nigerian ecological zones 1,2. Deforestation, wildlife trade, and settlement encroachment further elevate spill-over risk. Nigeria’s experiences with Lassa fever reveal enduring structural weaknesses: notably, delayed detection, limited laboratory coverage, and under-reporting, which would equally challenge any Marburg virus disease (MVD) response 3. Analyses of recent Marburg outbreaks in Ghana and Rwanda highlight diagnostic delays, infection prevention and control (IPC) breaches, and overstretched laboratory capacity as critical gaps 4,5. The rising frequency of viral haemorrhagic fever (VHF) outbreaks across sub-Saharan Africa necessitates immediate and strategic action from Nigerian public health authorities. In the past five years, MVD outbreaks have been confirmed in Guinea, Ghana, Tanzania, and Rwanda, reflecting expanding regional vulnerability 1,6. Although Nigeria has not yet reported any confirmed MVD cases, its porous borders, high population density, and concurrent Lassa fever and Mpox burdens make preparedness a national imperative 7. The recent cross-sectional assessment by Oisakede et al. 8 offers empirical confirmation of this vulnerability. The study, conducted among 216 healthcare workers at Nigeria’s national viral haemorrhagic fever reference centre (Irrua Specialist Teaching Hospital), revealed that only 19 % of doctors and 10 % of nurses had received formal MVD training, and less than half felt adequately protected by personal protective equipment (PPE). Confidence in hospital readiness was significantly lower among doctors (32.5 %) than nurses (65.6 %), indicating institutional and role-specific disparities in outbreak preparedness. These empirical findings from Oisakede et al. 8 and the regional evidence base reveal a clear preparedness gap. While Nigeria benefits from a national Lassa fever infrastructure, this platform is yet to be fully extended to filoviruses like Marburg. The 2026 data provide a measurable baseline for monitoring progress and justify targeted capacity-building funding within the National Action Plan for Health Security (2026–2030). Preparedness is thus not merely theoretical; it demands investment in people, protocols and platforms. Leveraging the Oisakede et al. 8 evidence for policy advocacy strengthens the argument that Nigeria must institutionalise training, simulation, and infrastructure before the next filovirus crisis arrives. Proposed Model for Reducing MVD and other VHF Transmission Currently, no licensed vaccine exists for the Marburg virus or other VHFs, although several candidates are in preclinical or early-phase trials. However, vaccine development may take several years before wide deployment. To mitigate transmission and reduce disease impact, we propose a four-tiered model that can function even in the absence of a vaccine, focusing on environmental, ecological, and health system interventions. This Oisakede’s Inverted Triangular Model (Fig. 1) outlines a sequential, evidence-based approach: • Safe Built Environment: Promote environmental hygiene and structural designs that minimise human contact with vectors or reservoirs (e.g., fruit bats). • Eliminate or Drive Out the Culprit: Target vector control and wildlife surveillance to limit zoonotic spillover. • Provide Timely Treatment: Ensure rapid diagnosis, case management, and IPC compliance to prevent nosocomial transmission. • Vaccination (When Available): Once safe and effective vaccines become available, immunisation programmes should prioritise high-risk communities. The model is initially inverted, representing the current phase where prevention and surveillance dominate due to a lack of vaccines. Once vaccines are available, the triangle can be flipped upright, symbolising a shift toward immunity-based protection for high-risk populations under Oisakede’s Triangular Model.
Emmanuel O. Oisakede (Sun,) studied this question.