Generalization Phase: Day 1 up to Day 5 from the onset of clinical symptoms. MHF presents with a high fever 104 °F (~40˚C) and a sudden, severe headache, with accompanying chills, fatigue, nausea, vomiting, diarrhea, pharyngitis, maculopapular rash, abdominal pain, conjunctivitis, and malaise.[9]
Early Organ Phase: Day 5 up to Day 13. Symptoms include prostration,
dyspnea,
edema,
conjunctival injection, viral
exanthema, and CNS symptoms, including encephalitis, confusion, delirium, apathy, and aggression. Hemorrhagic symptoms typically occur late and herald the end of the early organ phase, leading either to eventual recovery or worsening and death. Symptoms include bloody stools,
ecchymoses, blood leakage from
venipuncture sites, mucosal and visceral hemorrhaging, and possibly
hematemesis.[9]
Late Organ Phase: Day 13 up to Day 21+. Symptoms bifurcate into two constellations for survivors and fatal cases. Survivors will enter a convalescence phase, experiencing
myalgia,
fibromyalgia,
hepatitis,
asthenia, ocular symptoms, and
psychosis. Fatal cases continue to deteriorate, experiencing continued fever,
obtundation,
coma,
convulsions, diffuse
coagulopathy, metabolic disturbances,
shock and death, with death typically occurring between days 8 and 16.[9]
Marburgviruses are endemic in
aridwoodlands of
equatorial Africa.[11][12][13] Most marburgvirus infections were repeatedly associated with people visiting natural
caves or working in
mines. In 2009, the successful isolation of infectious MARV and RAVV was reported from healthy
Egyptian fruit bat caught in caves.[4][14] This isolation strongly suggests that
Old Worldfruit bats are involved in the natural maintenance of marburgviruses and that visiting bat-infested caves is a risk factor for acquiring marburgvirus infections. Further studies are necessary to establish whether Egyptian rousettes are the actual hosts of MARV and RAVV or whether they get infected via contact with another animal and therefore serve only as intermediate hosts. Another risk factor is contact with nonhuman primates, although only one outbreak of MVD (in 1967) was due to contact with infected monkeys.[15]
Contrary to
Ebola virus disease (EVD), which has been associated with heavy
rains after long periods of dry weather,[12][16] triggering factors for spillover of marburgviruses into the human population have not yet been described.
The details of the initial transmission of MVD to humans remain incompletely understood. Transmission most likely occurs from
Egyptian fruit bats or another natural host, such as
non-human primates or through the consumption of
bushmeat, but the specific routes and body fluids involved are unknown. Human-to-human transmission of MVD occurs through direct contact with infected bodily fluids such as blood.[4] Transmission events are relatively rare – there have been only 11 recorded outbreaks of MARV between 1975 and 2011, with one event involving both MARV and RAVV.[32]
The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from
bats and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source.[citation needed]
During outbreaks
Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their
excretions and
body fluids, and any possibly
contaminated materials and utensils. Patients should be isolated, but still are safe to be visited by family members. Medical staff should be trained in and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional
burial rituals, especially those requiring
embalming of bodies, should be discouraged or modified, ideally with the help of local
traditional healers.[40]
Although supportive care can improve survival chances, marburg virus disease is fatal in the majority of cases. As of 2023[update] the
case fatality rate was assessed to be 61.9%.[44]
Epidemiology
Pandemic potential
The WHO identifies marburg virus disease as having
pandemic potential.[44]
Historical outbreaks
Below is a table of outbreaks concerning MVD from 1967 to 2023:
MVD was first documented in 1967, when 31 people became ill in the
German towns of
Marburg and
Frankfurt am Main, and in
Belgrade,
Yugoslavia. The outbreak involved 25 primary MARV infections and seven deaths, and six nonlethal secondary cases. The outbreak was traced to infected
grivets (species Chlorocebus aethiops) imported from an undisclosed location in
Uganda and used in developing
poliomyelitisvaccines. The monkeys were received by Behringwerke, a Marburg company founded by the first winner of the
Nobel Prize in Medicine,
Emil von Behring. The company, which at the time was owned by
Hoechst, was originally set up to develop
sera against
tetanus and
diphtheria. Primary infections occurred in Behringwerke
laboratory staff while working with grivet tissues or tissue cultures without adequate
personal protective equipment. Secondary cases involved two
physicians, a
nurse, a post-mortem attendant, and the wife of a
veterinarian. All secondary cases had direct contact, usually involving blood, with a primary case. Both physicians became infected through accidental skin pricks when drawing blood from patients.[62][63][64][65]
1975 cases
In 1975, an Australian tourist became infected with MARV in
Rhodesia (today
Zimbabwe). He died in a hospital in
Johannesburg,
South Africa. His girlfriend and an attending nurse were subsequently infected with MVD, but survived.[66][67][68]
1980 cases
A case of MARV infection occurred in 1980 in
Kenya. A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to
Bungoma) at the base of
Mount Elgon (which contains
Kitum Cave), became infected by unknown means and died on 15 January shortly after admission to
Nairobi Hospital.[69] The attending physician contracted MVD, but survived.[70] A popular science account of these cases can be found in
Richard Preston's book The Hot Zone (the French man is referred to under the
pseudonym "Charles Monet", whereas the physician is identified under his real name, Shem Musoke).[71]
1987 case
In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in
Kisumu,
Kenya. He had visited
Kitum Cave on
Mount Elgon prior to travelling to
Mombasa, where he developed clinical signs of infection. The boy died after transfer to
Nairobi Hospital.[72] A popular science account of this case can be found in
Richard Preston's book The Hot Zone (the boy is referred to under the
pseudonym "Peter Cardinal").[71]
1988 laboratory infection
In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of
guinea pigs. The accident occurred at the Scientific-Production Association "Vektor" (today the
State Research Center of Virology and Biotechnology "Vektor") in
Koltsovo,
USSR (today
Russia).[73] Very little information is publicly available about this MVD case because Ustinov's experiments were classified. A popular science account of this case can be found in
Ken Alibek's book Biohazard.[74]
A major MVD outbreak occurred among illegal
gold miners around Goroumbwa mine in
Durba and
Watsa,
Democratic Republic of Congo from 1998 to 2000, when co-circulating MARV and RAVV caused 154 cases of MVD and 128 deaths. The outbreak ended with the flooding of the mine.[5][76][77]
2004–2005 outbreak
In early 2005, the
World Health Organization (WHO) began investigating an outbreak of
viral hemorrhagic fever in
Angola, which was centered in the northeastern
Uíge Province but also affected many other provinces. The Angolan government had to ask for international assistance, pointing out that there were only approximately 1,200 doctors in the entire country, with some provinces having as few as two. Health care workers also complained about a shortage of
personal protective equipment such as gloves, gowns, and masks.
Médecins Sans Frontières (MSF) reported that when their team arrived at the provincial hospital at the center of the outbreak, they found it operating without
water and
electricity.
Contact tracing was complicated by the fact that the country's roads and other infrastructure were devastated after nearly three decades of
civil war and the countryside remained littered with
land mines. Americo Boa Vida Hospital in the Angolan
capitalLuanda set up a special isolation ward to treat infected people from the countryside. Unfortunately, because MVD often results in death, some people came to view hospitals and medical workers with suspicion and treated helpers with hostility. For instance, a specially-equipped isolation ward at the provincial hospital in Uíge was reported to be empty during much of the epidemic, even though the facility was at the center of the outbreak. WHO was forced to implement what it described as a "harm reduction strategy", which entailed distributing disinfectants to affected families who refused hospital care. Of the 252 people who contracted MVD during outbreak, 227 died.[78][79][80][81][82][83][84]
2007 cases
In 2007, four
miners became infected with marburgviruses in
Kamwenge District,
Uganda. The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection.[14][85]
2008 cases
On July 10, 2008, the
Netherlands National Institute for Public Health and the Environment reported that a 41-year-old Dutch woman, who had visited Python Cave in
Maramagambo Forest during her holiday in
Uganda, had MVD due to MARV infection, and had been admitted to a hospital in the
Netherlands. The woman died under treatment in the
Leiden University Medical Centre in
Leiden on July 11. The Ugandan Ministry of Health closed the cave after this case.[86] On January 9 of that year an infectious diseases physician notified the Colorado Department of Public Health and the Environment that a 44-year-old American woman who had returned from
Uganda had been hospitalized with a
fever of unknown origin. At the time, serologic testing was negative for
viral hemorrhagic fever. She was discharged on January 19, 2008. After the death of the Dutch patient and the discovery that the American woman had visited Python Cave, further testing confirmed the patient demonstrated MARV
antibodies and
RNA.[87]
In October 2017 an outbreak of Marburg virus disease was detected in
Kween District, Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to
Kenya before the death. A close contact of the second confirmed case traveled to
Kampala. It is reported that several hundred people may have been exposed to infection.[88][89]
In August 2021, two months after the re-emergent Ebola epidemic in the
Guéckédou prefecture was declared over, a case of the Marburg disease was confirmed by health authorities through laboratory analysis.[54] Other potential case of the disease in a contact awaits official results. This was the first case of the Marburg hemorrhagic fever confirmed to happen in West Africa. The case of Marburg also has been identified in
Guéckédou.[53] During the outbreak, a total of one confirmed case, who died (
CFR=100%), and 173 contacts were identified, including 14 high-risk contacts based on exposure.[90] Among them, 172 were followed for a period of 21 days, of which none developed symptoms. One high-risk contact was lost to follow up.[90] Sequencing of an isolate from the Guinean patient showed that this outbreak was caused by the Angola-like Marburg virus.[91] A colony of
Egyptian rousettus bats (
reservoir host of
Marburg virus) was found in close proximity (4.5 km) to the village, where the Marburg virus disease outbreak emerged in 2021.[92] Two of sampled fruit bats from this colony were PCR-positive on the Marburg virus.[92]
In July 2022, preliminary analysis of samples taken from two patients – both deceased – in
Ghana indicated the cases were positive for Marburg. However, per standard procedure, the samples were sent to the
Pasteur Institute of Dakar for confirmation.[93] On 17 July 2022 the two cases were confirmed by Ghana,[94] which caused the country to declare a Marburg virus disease outbreak.[95] An additional case was identified, bringing the total to three.[96]
In February 2023,
Equatorial Guinea reported an outbreak of Marburg virus disease.[97] Neighbouring
Cameroon detected two suspected cases of Marburg virus disease on 13 February 2023.[98]
Research
Experimentally, recombinant
vesicular stomatitis Indiana virus (VSIV) expressing the glycoprotein of MARV has been used successfully in nonhuman primate models as post-exposure prophylaxis.[99] A vaccine candidate has been effective in nonhuman primates.[100] Experimental therapeutic regimens relying on
antisense technology have shown promise, with
phosphorodiamidate morpholino oligomers (PMOs) targeting the MARV genome [101] New therapies from
Sarepta[102] and Tekmira [103] have also been successfully used in humans as well as primates.
^
abcBausch, D. G.; Nichol, S. T.; Muyembe-Tamfum, J. J.; Borchert, M.; Rollin, P. E.; Sleurs, H.; Campbell, P.; Tshioko, F. K.; Roth, C.; Colebunders, R.; Pirard, P.; Mardel, S.; Olinda, L. A.; Zeller, H.; Tshomba, A.; Kulidri, A.; Libande, M. L.; Mulangu, S.; Formenty, P.; Grein, T.; Leirs, H.; Braack, L.; Ksiazek, T.; Zaki, S.; Bowen, M. D.; Smit, S. B.; Leman, P. A.; Burt, F. J.; Kemp, A.; Swanepoel, R. (2006).
"Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus"(PDF). New England Journal of Medicine. 355 (9): 909–919.
doi:
10.1056/NEJMoa051465.
PMID16943403.
^Martini, G. A.; Knauff, H. G.; Schmidt, H. A.; Mayer, G.; Baltzer, G. (2009). "Über eine bisher unbekannte, von Affen eingeschleppte Infektionskrankheit: Marburg-Virus-Krankheit". Deutsche Medizinische Wochenschrift. 93 (12): 559–571.
doi:
10.1055/s-0028-1105098.
PMID4966280.
S2CID260056835.
^Stille, W.; Böhle, E.; Helm, E.; Van Rey, W.; Siede, W. (2009). "Über eine durch Cercopithecus aethiops übertragene Infektionskrankheit". Deutsche Medizinische Wochenschrift. 93 (12): 572–582.
doi:
10.1055/s-0028-1105099.
PMID4966281.
S2CID260058558.
^Martini, G. A. (1971). "Marburg Virus Disease. Clinical Syndrome". In Martini, G. A.; Siegert, R. (eds.). Marburg Virus Disease. Berlin, Germany: Springer-Verlag. pp. 1–9.
ISBN978-0-387-05199-4.
^Steven B. Bradfute; Sina Bavari; Peter B. Jahrling; Jens H. Kuhn (2014).
"Marburg Virus Disease". In Singh, Sunit K.; Ruzek, Daniel (eds.). Viral Hemorrhagic Fevers. Boca Raton: CRC Press. pp. 457–480.
doi:
10.1201/b15172-30.
ISBN978-1-4398-8431-7. Retrieved 28 October 2017.
^
abPinzon, E.; Wilson, J. M.; Tucker, C. J. (2005). "Climate-based health monitoring systems for eco-climatic conditions associated with infectious diseases". Bulletin de la Société de Pathologie Exotique. 98 (3): 239–243.
PMID16267968.
^
abTowner, J. S.; Amman, B. R.; Sealy, T. K.; Carroll, S. A. R.; Comer, J. A.; Kemp, A.; Swanepoel, R.; Paddock, C. D.; Balinandi, S.; Khristova, M. L.; Formenty, P. B.; Albarino, C. G.; Miller, D. M.; Reed, Z. D.; Kayiwa, J. T.; Mills, J. N.; Cannon, D. L.; Greer, P. W.; Byaruhanga, E.; Farnon, E. C.; Atimnedi, P.; Okware, S.; Katongole-Mbidde, E.; Downing, R.; Tappero, J. W.; Zaki, S. R.; Ksiazek, T. G.; Nichol, S. T.; Rollin, P. E. (2009). Fouchier, Ron A. M. (ed.).
"Isolation of Genetically Diverse Marburg Viruses from Egyptian Fruit Bats". PLOS Pathogens. 5 (7): e1000536.
doi:10.1371/journal.ppat.1000536.
PMC2713404.
PMID19649327.
^
abSiegert, R.; Shu, H. L.; Slenczka, W.; Peters, D.; Müller, G. (2009). "Zur Ätiologie einer unbekannten, von Affen ausgegangenen menschlichen Infektionskrankheit". Deutsche Medizinische Wochenschrift. 92 (51): 2341–2343.
doi:
10.1055/s-0028-1106144.
PMID4294540.
S2CID116556454.
^Tucker, C. J.; Wilson, J. M.; Mahoney, R.; Anyamba, A.; Linthicum, K.; Myers, M. F. (2002). "Climatic and Ecological Context of the 1994–1996 Ebola Outbreaks". Photogrammetric Engineering and Remote Sensing. 68 (2): 144–52.
^Gear, J. H.; Ryan, J.; Rossouw, E. (1978). "A consideration of the diagnosis of dangerous infectious fevers in South Africa". South African Medical Journal. 53 (7): 235–237.
PMID565951.
^Grolla, A.; Lucht, A.; Dick, D.; Strong, J. E.; Feldmann, H. (2005). "Laboratory diagnosis of Ebola and Marburg hemorrhagic fever". Bulletin de la Société de Pathologie Exotique. 98 (3): 205–209.
PMID16267962.
^Bogomolov, B. P. (1998). "Differential diagnosis of infectious diseases with hemorrhagic syndrome". Terapevticheskii Arkhiv. 70 (4): 63–68.
PMID9612907.
^Hofmann, H.; Kunz, C. (1968). ""Marburg virus" (Vervet monkey disease agent) in tissue cultures". Zentralblatt für Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene. 1. Abt. Medizinisch-hygienische Bakteriologie, Virusforschung und Parasitologie. Originale. 208 (1): 344–347.
PMID4988544.
^Ksiazek, Thomas G. (1991). "Laboratory diagnosis of filovirus infections in nonhuman primates". Lab Animal. 20 (7): 34–6.
^Weidmann, M.; Mühlberger, E.; Hufert, F. T. (2004). "Rapid detection protocol for filoviruses". Journal of Clinical Virology. 30 (1): 94–99.
doi:
10.1016/j.jcv.2003.09.004.
PMID15072761.
^Weidmann, M.; Hufert, F. T.; Sall, A. A. (2007). "Viral load among patients infected with Marburgvirus in Angola". Journal of Clinical Virology. 39 (1): 65–66.
doi:
10.1016/j.jcv.2006.12.023.
PMID17360231.
^Saijo, M.; Niikura, M.; Maeda, A.; Sata, T.; Kurata, T.; Kurane, I.; Morikawa, S. (2005). "Characterization of monoclonal antibodies to Marburg virus nucleoprotein (NP) that can be used for NP-capture enzyme-linked immunosorbent assay". Journal of Medical Virology. 76 (1): 111–118.
doi:
10.1002/jmv.20332.
PMID15778962.
S2CID24207187.
^Saijo, M.; Georges-Courbot, M. C.; Fukushi, S.; Mizutani, T.; Philippe, M.; Georges, A. J.; Kurane, I.; Morikawa, S. (2006). "Marburgvirus nucleoprotein-capture enzyme-linked immunosorbent assay using monoclonal antibodies to recombinant nucleoprotein: Detection of authentic Marburgvirus". Japanese Journal of Infectious Diseases. 59 (5): 323–325.
PMID17060700.
^
abSwenson, D. L.; Warfield, K. L.; Larsen, T.; Alves, D. A.; Coberley, S. S.; Bavari, S. (2008). "Monovalent virus-like particle vaccine protects guinea pigs and nonhuman primates against infection with multiple Marburg viruses". Expert Review of Vaccines. 7 (4): 417–429.
doi:
10.1586/14760584.7.4.417.
PMID18444889.
S2CID23200723.
^Bonin, O. (1969). "The Cercopithecus monkey disease in Marburg and Frankfurt (Main), 1967". Acta Zoologica et Pathologica Antverpiensia. 48: 319–331.
PMID5005859.
^Jacob, H.; Solcher, H. (1968). "An infectious disease transmitted by Cercopithecus aethiops ("marbury disease") with glial nodule encephalitis". Acta Neuropathologica. 11 (1): 29–44.
doi:
10.1007/bf00692793.
PMID5748997.
S2CID12791113.
^Stojkovic, L.; Bordjoski, M.; Gligic, A.; Stefanovic, Z. (1971). "Two Cases of Cercopithecus-Monkeys-Associated Haemorrhagic Fever". In Martini, G. A.; Siegert, R. (eds.). Marburg Virus Disease. Berlin, Germany: Springer-Verlag. pp. 24–33.
ISBN978-0-387-05199-4.
^Gear, J. H. (1977). "Haemorrhagic fevers of Africa: An account of two recent outbreaks". Journal of the South African Veterinary Association. 48 (1): 5–8.
PMID406394.
^Conrad, J. L.; Isaacson, M.; Smith, E. B.; Wulff, H.; Crees, M.; Geldenhuys, P.; Johnston, J. (1978). "Epidemiologic investigation of Marburg virus disease, Southern Africa, 1975". The American Journal of Tropical Medicine and Hygiene. 27 (6): 1210–1215.
doi:
10.4269/ajtmh.1978.27.1210.
PMID569445.
^Dellatola, Lesley (May 1980).
"Victory for Virology". South African Panorama. 25 (5): 2–6 – via Internet Archive.
^Smith, D. H.; Johnson, B. K.; Isaacson, M.; Swanapoel, R.; Johnson, K. M.; Killey, M.; Bagshawe, A.; Siongok, T.; Keruga, W. K. (1982). "Marburg-virus disease in Kenya". Lancet. 1 (8276): 816–820.
doi:
10.1016/S0140-6736(82)91871-2.
PMID6122054.
S2CID42832324.
^Johnson, E. D.; Johnson, B. K.; Silverstein, D.; Tukei, P.; Geisbert, T. W.; Sanchez, A. N.; Jahrling, P. B. (1996). "Characterization of a new Marburg virus isolated from a 1987 fatal case in Kenya". In Tino F. Schwarz; Günter Siegl (eds.). Imported Virus Infections. Archives of Virology Supplement II. Vol. 11. Springer. pp. 101–114.
doi:
10.1007/978-3-7091-7482-1_10.
ISBN978-3-211-82829-8.
ISSN0939-1983.
PMID8800792.
^Nikiforov, V. V.; Turovskiĭ, I.; Kalinin, P. P.; Akinfeeva, L. A.; Katkova, L. R.; Barmin, V. S.; Riabchikova, E. I.; Popkova, N. I.; Shestopalov, A. M.; Nazarov, V. P. (1994). "A case of a laboratory infection with Marburg fever". Zhurnal Mikrobiologii, Epidemiologii, I Immunobiologii (3): 104–106.
PMID7941853.
^Bertherat, E.; Talarmin, A.; Zeller, H. (1999). "Democratic Republic of the Congo: Between civil war and the Marburg virus. International Committee of Technical and Scientific Coordination of the Durba Epidemic". Médecine Tropicale: Revue du Corps de Santé Colonial. 59 (2): 201–204.
PMID10546197.
^Hovette, P. (2005). "Epidemic of Marburg hemorrhagic fever in Angola". Médecine Tropicale: Revue du Corps de Santé Colonial. 65 (2): 127–128.
PMID16038348.
^Centers for Disease Control and Prevention (CDC) (2009). "Imported case of Marburg hemorrhagic fever - Colorado, 2008". MMWR. Morbidity and Mortality Weekly Report. 58 (49): 1377–1381.
PMID20019654.
^Warren, T. K.; Warfield, K. L.; Wells, J.; Swenson, D. L.; Donner, K. S.; Van Tongeren, S. A.; Garza, N. L.; Dong, L.; Mourich, D. V.; Crumley, S.; Nichols, D. K.; Iversen, P. L.; Bavari, S. (2010). "Advanced antisense therapies for postexposure protection against lethal filovirus infections". Nature Medicine. 16 (9): 991–994.
doi:
10.1038/nm.2202.
PMID20729866.
S2CID205387144.
Klenk, Hans-Dieter (1999). Marburg and Ebola Viruses. Current Topics in Microbiology and Immunology, vol. 235. Berlin, Germany: Springer-Verlag.
ISBN978-3-540-64729-4.
Klenk, Hans-Dieter; Feldmann, Heinz (2004). Ebola and Marburg Viruses: Molecular and Cellular Biology. Wymondham, Norfolk, UK: Horizon Bioscience.
ISBN978-0-9545232-3-7.
Kuhn, Jens H. (2008). Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement, vol. 20. Vienna, Austria: SpringerWienNewYork.
ISBN978-3-211-20670-6.
Martini, G. A.; Siegert, R. (1971). Marburg Virus Disease. Berlin, Germany: Springer-Verlag.
ISBN978-0-387-05199-4.
Ryabchikova, Elena I.; Price, Barbara B. (2004). Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy. Columbus, Ohio, USA: Battelle Press.
ISBN978-1-57477-131-2.
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