Marburg virus disease: the next threat in the making?

Re-emerging filoviral zoonoses remain an imminent threat to global public health as demonstrated by frequent spillovers. Marburg virus disease (MVD) is caused by the Marburg virus (MARV), originally identified in 1967. From that period onward, many outbreaks with high case fatality have been documented, primarily in sub-Saharan Africa. MARV outbreaks are initiated through contact with the natural reservoir host, Rousettus aegyptiacus, and are further sustained by human-to-human transmission. The pathogenesis of MVD is driven by host immune system evasion and efficient viral replication, resulting in a cytokine storm, coagulopathy, and multi-organ failure. In absence of licensed specific therapeutics, the most reliable measures remain intensive supportive care. Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may contribute to reduced mortality from MVD. In November 2025, Ethiopia declared its first-ever MVD outbreak with a total of 14 confirmed (including nine deaths) and five probable cases (all deaths). Despite the end of the outbreak in January 2026, it has raised concerns regarding the increasing frequency of MARV outbreaks and the potential to cause a global pandemic. Furthermore, potential exploitation as a biological weapon underscores the need for coordinated efforts from researchers, health organizations and policymakers to enhance preparedness and ensure effective response strategies addressing natural and intentional outbreaks. This review outlines the epidemiology, pathogenesis, current and promising management strategies of MVD. It also highlights risk assessments and strategies to counter the spread of this fatal disease.