The International Health Regulations, revised in 2005 after earlier versions proved inadequate, require all 196 signatory states to develop core capacities for detecting, reporting, and responding to public health events at their borders. Under the framework, countries must designate Points of Entry, including international airports, seaports, and major ground crossings, where routine health screening, emergency medical services, and communication systems must be available around the clock. When an event rises to the level of a Public Health Emergency of International Concern, as COVID-19 did in January 2020, these entry points become critical nodes in a worldwide surveillance and containment network. Yet the regulations have long been implemented unevenly, particularly in resource-constrained settings, and the new study set out to document precisely where those implementation gaps lie in Bangladesh.

The research team conducted an exploratory qualitative study between October 2022 and June 2023, in the aftermath of the pandemic’s acute phase. They selected four designated Points of Entry: Hazrat Shahjalal International Airport, the country’s busiest international air gateway; Shah Amanat International Airport in Chattogram; Chittagong Seaport, one of the largest maritime hubs in South Asia; and Benapole Ground Crossing, the principal land border crossing between Bangladesh and India. Data collection involved 30 interviews in total, comprising 20 in-depth interviews with frontline service providers and port users, and 10 key informant interviews with decision-makers and experienced service providers. All interviews were transcribed, coded, and subjected to thematic analysis using ATLAS.ti software, version 7.5.10, allowing the researchers to identify recurring patterns in how officials and travelers experience border health operations.

The central finding is stark: the study revealed more challenges than enablers on both the regulatory and public sides of IHR-2005 implementation. Among the most fundamental problems was a lack of understanding of the regulations themselves and their role in global infectious disease prevention and control. This is not a trivial administrative detail. If the officers stationed at an entry point do not grasp what the framework requires of them, or why it matters, the entire architecture of border health security weakens at its foundation. The researchers also identified inadequate training on IHR-2005 as a persistent barrier, compounding the knowledge deficit and leaving staff ill-prepared to execute the screening, reporting, and coordination duties the regulations demand.

Human resources emerged as another severe constraint. The study documented a critical shortage of personnel at the entry points, a problem familiar across many low- and middle-income countries where health workforces are stretched thin and border health posts compete with hospitals and clinics for scarce staff. Screening travelers for symptoms, managing health declarations, and responding to suspected cases all require trained people on the ground, and without them even well-designed protocols exist only on paper. The shortage interacts with the training gap in a damaging cycle: too few staff means those who are present cannot be spared for training, while untrained staff cannot build the institutional competence that would justify expanding the workforce.

Practical logistics added further friction. The researchers found limited availability of ambulances for transporting ill travelers, meaning that even when a potentially infectious passenger was identified, moving that person safely to a treatment facility could be difficult or delayed. Health offices were often inaccessible or not conveniently located at every Point of Entry, fragmenting the chain of command and slowing communication between border staff and the health authorities who must authorize and support public health actions. On the public side of the counter, the study recorded uncooperative behavior from travelers, a challenge that frontline screeners worldwide have encountered but which carries particular weight in crowded, high-throughput crossings where delays provoke frustration and evasion.

Not all entry points fared equally. The study found that Benapole Ground Crossing encountered the most significant obstacles in ensuring effective implementation of the regulations, and that the overall environment there was suboptimal. This finding matters because Benapole is one of the busiest land crossings in South Asia, handling enormous daily flows of passengers and goods between Bangladesh and India. Land crossings are inherently harder to manage than airports: passenger processing is less structured, infrastructure is often older, and the sheer volume of movement makes comprehensive screening difficult. By contrast, the other designated Points of Entry, including the two international airports and Chittagong Seaport, demonstrated good communication and coordination capacities, available medical and technical services, and a generally good environment, suggesting that implementation success in Bangladesh is less a uniform national failure than a uneven landscape in which some sites have achieved functional capacity while others lag far behind.

The methodological contribution of the study is also notable. According to the authors, no qualitative research on IHR-2005 implementation at designated Points of Entry in Bangladesh had been conducted before, making this the first in-depth account of how the framework operates, or fails to operate, at the country’s borders. Qualitative approaches of this kind capture dimensions that quantitative audits miss: the lived experience of officers who lack clear guidance, the frustrations of port users navigating health checks, and the informal workarounds that develop when formal systems fall short. The study received ethical approval from the Institutional Review Board of icddr,b under research protocol number PR-22149, with informed written consent obtained from all participants and transcripts anonymized and stored in password-protected databases. The work was funded by the Disease Control program of the Directorate General of Health Services, with core support from the governments of Bangladesh and Canada.

The findings carry implications well beyond Bangladesh’s borders. The COVID-19 pandemic demonstrated that a pathogen detected in one country can circle the globe within days, and that the strength of the weakest border health system can determine the speed of international spread. The World Health Organization has repeatedly emphasized that global health security depends on every country meeting the core capacity requirements of the regulations, and independent assessments have consistently shown that many low- and middle-income countries remain short of those benchmarks. Bangladesh’s experience illustrates the specific mechanisms by which the gap opens: knowledge deficits among staff, inadequate training pipelines, chronic understaffing, missing transport and infrastructure, and public non-cooperation. Each of these is addressable, but only with sustained investment and political attention rather than emergency-time improvisation.

The researchers conclude that the implementation of IHR-2005 at designated Points of Entry in Bangladesh faces significant challenges that hinder its effectiveness, and that addressing these barriers is essential to strengthen enforcement of the regulations and enhance the country’s ability to prevent and control the spread of infectious diseases at its key entry points. Their evidence suggests a clear agenda: systematic training on the regulations for all border health staff, recruitment to close the human resource gap, guaranteed ambulance and transport capacity for ill travelers, and health offices physically present and accessible at every designated entry point, with particular urgency at Benapole Ground Crossing. As the world prepares for future pandemics that experts consider inevitable rather than hypothetical, studies like this one provide the granular, ground-level evidence that turns abstract international commitments into workable practice. The borders of Bangladesh, like those of many countries, are only as secure against infectious disease as the people, training, and equipment stationed there, and this study shows exactly where those defenses need reinforcement.

Subject of Research: Implementation of the International Health Regulations 2005 for infectious disease control at designated Points of Entry in Bangladesh

Article Title: Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh

Article References: Dutta, G. K., Hasan, M. K., Sanin, K. I., Roy, B. R., Ali, M. S., Islam, M. N., Islam, M. S., Khan, M. N. A., Mahmud, M., Nadia, N., Noushin, F., & Tofail, F. (2026). Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh. BMC Public Health. https://doi.org/10.1186/s12889-026-29658-2

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29658-2

Keywords: IHR-2005, Points of Entry, Bangladesh, global health security, infectious disease control, border health, COVID-19, public health emergency, qualitative research, LMICs, Benapole Ground Crossing, WHO

A comprehensive review published in the Journal of Emergency and Disaster Medicine by Sherief Musa of Cairo University’s Endemic Medicine Department synthesizes decades of research on the virus, drawing on 70 studies selected from an initial pool of 1,564 articles identified through PubMed, Web of Science, and African Journals Online, covering literature from 1968 through the end of 2025, together with guidance documents from the World Health Organization and the Centers for Disease Control and Prevention. The review arrives at a moment of genuine inflection: Marburg virus outbreaks have grown both more frequent and more geographically dispersed, with first-time occurrences reported in Guinea in 2021, Ghana in 2022, Equatorial Guinea and Tanzania in 2023, Rwanda in 2024, and now Ethiopia. The virus was first identified in 1967, when laboratory workers in Marburg and Frankfurt in Germany and in Belgrade in the former Yugoslavia fell ill after handling infected African green monkeys, Cercopithecus aethiops, imported from Uganda for pharmaceutical research. Since then, nearly twenty outbreaks have been documented, almost all in sub-Saharan Africa, ranging from isolated single cases to explosive community epidemics such as those in the Democratic Republic of the Congo in 1998 to 2000 and Angola in 2004 to 2005.

At the molecular level, Marburg virus is a non-segmented, single-stranded, negative-sense RNA virus of the family Filoviridae, a name derived from the Latin word for thread-like, a reference to the filamentous shape of viral particles. Unlike Ebola, the genus Marburgvirus contains a single species, Orthomarburgvirus marburgense, comprising two recognized variants, the Lake Victoria and Ravn viruses, whose genomes share at least 79 percent sequence homology. The viral genome spans approximately 19,000 bases and encodes seven genes arranged in a fixed order, each protein performing a specialized function in the viral life cycle. The nucleoprotein encapsidates the RNA genome into the nucleocapsid, essential for replication and transcription. Viral protein 35 acts as a polymerase cofactor while simultaneously suppressing interferon signaling, one of the body’s first lines of antiviral defense. Viral protein 40 drives the budding of new particles and further antagonizes the interferon response, and the surface glycoprotein binds host receptors to trigger internalization through endocytosis. The large protein, designated L, serves as the RNA-dependent RNA polymerase that copies the genome, and it is precisely this enzyme that several experimental antiviral drugs are designed to inhibit.

The pathogenesis of Marburg virus disease explains its devastating clinical course. After entering through mucosal surfaces or broken skin, the virus preferentially infects mononuclear phagocytic cells, including macrophages and dendritic cells. From these initial targets it spreads to regional lymph nodes and then disseminates through the bloodstream to the liver, spleen, and other lymphoid tissues, where it induces extensive necrosis. The virus suppresses the production of type I interferons and interferes with their signaling pathways, disabling innate immunity before it can mount an effective response. Dendritic cell activation is inhibited, impairing antigen presentation and leaving T-lymphocytes poorly stimulated, while inflammatory mediators drive so-called bystander apoptosis that depletes lymphocytes and hollows out adaptive immunity. Uncontrolled activation of infected macrophages then floods the circulation with pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor, producing the cytokine storm that drives vascular permeability upward and sets the stage for coagulation abnormalities.

The downstream consequences are what give the disease its hemorrhagic character. Endothelial injury, increased vascular leakage, and microvascular clotting culminate in disseminated intravascular coagulation, in which clotting factors are consumed faster than they can be replaced. Infection of hepatocytes impairs liver function and reduces the production of coagulation proteins, worsening bleeding tendencies, while infection of the adrenal cortex disrupts hormone production and destabilizes blood pressure regulation. Widespread vascular leakage depletes circulating blood volume, producing hypovolemic shock and falling perfusion to vital organs, and the terminal result is a shock-like syndrome combining vascular dysfunction, disseminated coagulopathy, and multi-organ failure. After an incubation period of 3 to 21 days, typically 5 to 10, the illness unfolds in three phases: a generalization phase of roughly five days marked by abrupt high fever around 40 degrees Celsius, severe headache, chills, myalgia, and prostration; an early organ phase from day 5 to day 13, dominated by gastrointestinal symptoms, escalating mucosal or gastrointestinal bleeding, and sometimes neurological manifestations including disorientation, agitation, seizures, and coma; and finally either recovery or a fatal outcome, typically during the second week of illness.

A recent aggregation of clinical data covering 325 patients, approximately 45 percent of all reported Marburg cases across five decades, has sharpened the clinical picture considerably. Fever proved the most consistent symptom, present in 91 percent of cases, followed by fatigue at 75 percent, headache at 64 percent, and myalgia at 47 percent. Gastrointestinal complaints were prominent, with nausea or vomiting in 66 percent of patients, diarrhea in 53 percent, and abdominal pain in 43 percent. Among hemorrhagic manifestations, hematemesis was the most frequent at 43 percent, followed by bloody diarrhea at 34 percent, bleeding gums at 23 percent, and epistaxis at 20 percent. The overall case fatality rate in that pooled analysis was 77 percent, falling to 44 percent among cases confirmed by polymerase chain reaction, and mortality across outbreaks has historically ranged from 25 to 80 percent depending on context and the quality of available medical care. Diagnosis remains difficult because early symptoms mimic malaria, typhoid fever, leptospirosis, and dengue, and hemorrhagic signs appear too late to guide early detection. Reverse transcription polymerase chain reaction testing of whole blood or plasma is the most reliable method, though a negative early sample does not exclude infection, and repeat testing is essential. Samples are extremely biohazardous and must be shipped in triple packaging for testing at biosafety level 3 or level 4 facilities, infrastructure that many African countries lack, and unlike Ebola, no field-validated rapid diagnostic test yet exists for Marburg virus.

Treatment remains the weakest pillar of the response. No licensed specific therapeutics exist, and the cornerstone of survival is intensive supportive care in designated treatment centers: intravenous fluids, vasopressors, and electrolyte correction to maintain hemodynamic stability; blood components to address hemorrhage; mechanical ventilation and renal replacement therapy for organ support; broad-spectrum antibiotics to prevent secondary bacterial infection; adequate nutrition; and psychological support. Rwanda’s 2024 outbreak demonstrated what such care can achieve, with a 77 percent survival rate that inverts historical fatality figures. Promising experimental agents are advancing through the pipeline, guided by knowledge of virus-host interactions. Small-molecule antivirals targeting the RNA-dependent RNA polymerase can impede replication, monoclonal antibodies against the viral glycoprotein have effectively neutralized the virus in preclinical studies, and phosphorodiamidate morpholino oligomers and small interfering RNAs targeting viral messenger RNAs have shown protective effects in non-human primates. Combination therapy pairing remdesivir with monoclonal antibodies was deployed during the 2024 Rwandan outbreak and reportedly improved outcomes. On the vaccine front, the World Health Organization’s Research and Development Blueprint established the Marburg Virus Vaccine Consortium to coordinate candidate development, and its technical advisory group has prioritized four viral-vectored candidates for human trials: two based on non-replicating chimpanzee adenoviruses, ChAd3 and ChAdOx1, and two on replicating vesicular stomatitis virus vectors. During the Ethiopian outbreak, the Ministry of Health reported that 2,500 doses of the cAd3-Marburg vaccine were offered to healthcare professionals and contacts of cases, echoing the experimental deployment of the ChAd3 vaccine in Rwanda in October 2024 as a real-world test of the 100-Day Mission, an initiative to develop and authorize emergency-use vaccines within 100 days of identifying an emerging pathogen.

Ethiopia’s containment of the outbreak offers lessons in adaptability. Health authorities, working with international partners, rapidly trained frontline healthcare workers, distributed critical supplies, intensified community-level monitoring, and traced contacts; as of 25 January 2026, a total of 857 contacts had been listed and had completed 21 days of follow-up. Epidemiological modeling suggests that without mitigation, Marburg virus propagates with a doubling time of 12 days in a susceptible population, but case isolation is effective if initiated no later than three days after symptom onset, underscoring the decisive value of speed. The World Health Organization declares an outbreak over 42 days, two consecutive incubation periods, after the last patient dies or tests negative and is discharged. Yet the regional risk did not vanish with Ethiopia’s declaration: the Africa Centres for Disease Control and Prevention reported suspected Marburg deaths in South Sudan in December 2025 and an alert in Wajaale, a border city in the Somaliland region, reflecting the danger of cross-border transmission along road networks connecting Ethiopia to Kenya, South Sudan, and Somalia.

The broader risk assessment is nuanced. The virus’s basic reproduction number is estimated at 1.59 with an average nine-day interval between successive cases, conditions under which large sustained epidemics are unlikely unless the virus mutates to enhance transmissibility, something experts recommend monitoring through sequence analysis of isolates from future outbreaks. A 2015 model estimated that up to 105 million people across 27 countries are vulnerable to zoonotic Marburg spillover, and the reservoir host, the Egyptian fruit bat Rousettus aegyptiacus, whose range defines the potential risk area, carries active infection in roughly 2 to 3 percent of bats at any time, with biannual seasonal pulses that coincide with heightened spillover risk. The 2014 to 2016 West African Ebola epidemic, which arose from a single spillover event and produced 28,000 cases and 11,000 deaths, stands as the cautionary precedent. Marburg virus is classified as a Category A bioterrorism agent by the CDC owing to its severity, mortality, and the absence of licensed countermeasures, adding an intentional-outbreak dimension to preparedness planning. With climate change, deforestation, mining, and urbanization expanding human-bat contact, and with the WHO and GAVI both ranking Marburg among priority pandemic threats, researchers and policymakers argue that sustained investment in diagnostics, vaccines, therapeutics, and One Health surveillance is no longer optional but essential to averting the next high-consequence filovirus crisis.

Subject of Research: Marburg virus disease epidemiology, pathogenesis, and outbreak preparedness in light of Ethiopia's first outbreak

Article Title: Marburg virus disease: the next threat in the making?

Article References: Musa, S. (2026). Marburg virus disease: the next threat in the making?. Journal of Emergency and Disaster Medicine, 2(1), Article 8. https://doi.org/10.1007/s44467-026-00011-2

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00011-2

Keywords: Marburg virus, Marburg virus disease, filoviruses, hemorrhagic fever, zoonosis, Ethiopia outbreak, Rousettus aegyptiacus, vaccine development, antiviral therapeutics, outbreak preparedness, cytokine storm, global health security

Dr. Morse’s academic and professional career has been profoundly rooted in infectious disease epidemiology and risk assessment, focusing intensively on emerging infections and the enhancement of early warning systems for disease outbreaks. His research has consistently sought to bridge the gap between theoretical epidemiological models and practical applications in public health emergency preparedness. This appointment underscores the journal’s ongoing commitment to maintaining scientific rigor and relevance in confronting complex disaster scenarios on a global scale.

Having served as Deputy Editor of DMPHP, Dr. Morse was thrust into a pivotal leadership position during the COVID-19 pandemic, acting as Guest Editor-in-Chief at a time when the world witnessed an unprecedented surge in scholarly submissions. During this period, he managed nearly two thousand manuscripts, navigating an immense influx of scientific articles dedicated to understanding and combatting one of the most consequential public health crises in modern history. His editorial stewardship ensured the timely dissemination of critical information to a diverse readership comprising clinicians, researchers, and policymakers.

Dr. Morse’s succession of Dr. James J. James, the founding Editor-in-Chief since the journal’s launch in 2007, signifies both a continuity of vision and the infusion of new perspectives necessary for addressing future challenges. Dr. James’ foundational work established DMPHP as a premier platform in disaster medicine and public health, elevating it into a resource indispensable for practitioners worldwide. Building on this legacy, Dr. Morse is poised to expand the journal’s scope, integrating emerging areas such as biosafety, technological innovation, and global health diplomacy.

A notable aspect of Dr. Morse’s profile is his longstanding association with public health agencies and institutes central to infectious disease control. As a founding Section Editor of the Centers for Disease Control and Prevention’s (CDC) journal Emerging Infectious Diseases, and as a member of the Editorial Board for Health Security, he has deep insights into issues at the confluence of epidemiology, bioterrorism, and health security policy. These affiliations enhance his editorial acumen and strategic positioning for advancing DMPHP’s role in shaping evidence-based disaster medicine practices.

Dr. Morse’s appointment will officially commence on July 1, 2025, at which time he will be supported by a highly skilled editorial team. The journal has designated Eric S. Weinstein, MD, MScDM, as Lead Senior Deputy Editor. Dr. Weinstein’s expertise in emergency medicine and mass casualty simulation complements the journal’s multidisciplinary approach, particularly in assessing educational strategies and operational readiness in disaster response. His role includes overseeing initial manuscript triage, ensuring that submissions align with the journal’s rigorous standards before proceeding to peer review.

Supporting these efforts are Senior Deputy Editors Attila J. Hertelendy, PhD, and Amir Khorram-Manesh, MD, PhD. Dr. Hertelendy’s leadership in disaster medicine research at Beth Israel Deaconess Medical Center is marked by a focus on artificial intelligence, advanced technology, and the implications of climate change on health systems resilience. His editorial stewardship is anticipated to promote the integration of cutting-edge scientific discoveries into disaster medicine scholarship. Dr. Khorram-Manesh, based at the University of Gothenburg, Sweden, brings an international dimension by managing submissions from the ASEAN region, ensuring that the journal remains globally representative and responsive to diverse disaster contexts.

Disaster Medicine and Public Health Preparedness stands as the foremost comprehensive publication emphasizing multidisciplinary aspects of disaster response, public health preparedness, and global health security. It serves healthcare professionals, researchers, policymakers, and all stakeholders involved in mitigating the impact of emergencies. The journal’s mission is to translate scientific findings into actionable practice, fostering integration across medical, public health, and emergency management sectors worldwide.

Published under the auspices of the SDMPH and produced by Cambridge University Press, DMPHP reflects the society’s commitment to fostering a distinct discipline that marries disaster medicine with public health. This integration is vital as disasters increasingly challenge the resilience of health systems and demand coordinated responses that transcend traditional boundaries. The appointment of Dr. Morse aligns with this vision, positioning the journal at the forefront of scholarly innovation and dissemination.

The SDMPH itself is dedicated to advancing global health security through robust education, training, and research geared toward effective disaster response. Its initiatives aim to empower health system responders with evidence-based knowledge and best practices, grounded in scientific evidence and sound educational principles. The society’s stewardship of DMPHP as a scholarly medium epitomizes this mission, providing a platform where knowledge dissemination and professional development converge to save lives and enhance preparedness.

Dr. Morse, upon taking the helm as Editor-in-Chief, expressed deep humility and honor, acknowledging the foundational leadership of his predecessor and emphasizing the collective effort of a global community of scholars and practitioners. His forward-looking editorial agenda includes not only maintaining the journal’s standards but also expanding its influence in emerging fields such as biosafety governance, climate change impacts on public health crises, and the role of artificial intelligence in disaster risk reduction.

The intricate responsibilities that accompany leading such a crucial journal underscore the evolving nature of disaster and public health scholarship in the 21st century. As threats become more interconnected and complex — spanning infectious diseases, technological disasters, and climate-related emergencies — journals like DMPHP must evolve to provide timely, scientifically robust content that informs policy and operational decisions worldwide. Dr. Morse’s appointment heralds a renewed commitment to this transformative journey.

In closing, the Society’s strategic decision to elevate Dr. Morse to Editor-in-Chief sets a progressive tone for the future of disaster medicine publishing. His expertise in epidemiology, commitment to interdisciplinary collaboration, and editorial leadership during the unprecedented COVID-19 pandemic position him uniquely to guide the journal toward greater scientific impact and practical relevance. The global community of health professionals and scholars eagerly anticipates the innovative directions and critical discourse that will emerge under his tenure.

Subject of Research:
Not applicable

Article Title:
Stephen S. Morse, Ph.D., Appointed Next Editor-in-Chief of Disaster Medicine and Public Health Preparedness

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Keywords:
Epidemiology; Public health; Scientific journals; Scientific organizations; Education research; Climate systems; Life sciences; Artificial intelligence