H5N1 Protective Clothing and Beyond: Essential PPE for Current and Future Infectious Disease Outbreaks

Right now, there are numerous infectious disease outbreaks going on across the globe, including outbreaks of the deadly pathogens H5N1 and Marburg viruses. As a leading international safety clothing manufacturer, International Enviroguard is dedicated to helping our clients from a wide range of industries procure the personal protective equipment (PPE) necessary to mitigate and fight these mass outbreaks.

In this article, we discuss some current infectious diseases of concern, including their common signs and symptoms, how they're contracted and spread to humans and/or animals, how infectious and deadly these diseases are, and the types of infectious disease PPE recommended, including best-practice Marburg and H5N1 protective clothing.

Marburg Virus Outbreak

According to the World Health Organization, the small African country of Equatorial Guinea has for the first time confirmed an outbreak of Marburg virus disease (MVD), beginning in February 2023. As of March 22, 2023, authorities have documented at least nine laboratory-confirmed cases of MVD and 20 probable cases. On their website, the WHO notes that seven out of nine laboratory confirmed cases along with "all probable cases" have resulted in death.

On March 24, 2023, the WHO also reported that the United Republic of Tanzania also declared an outbreak of MVD; the most up-to-date tally includes eight confirmed cases and five deaths. Other recently reported outbreaks of MVD include Ghana (three confirmed cases in 2022), Guinea (2021), Uganda (2017, 2014, 2012, 2007), and Angola (2004-2005).

What is Marburg Virus?

Marburg virus is a member of the Filoviridae family of viruses (Ebola is also a member of the Filoviridae family). Signs and symptoms of Marburg virus, which can present anywhere from 2 to 21 days following initial exposure, include:

  • Intense fever and headache
  • Vomiting
  • Diarrhea
  • Stomach pain
  • A "ghost-like" appearance, including deep-set eyes, extreme fatigue, and flat affect (expressionless facial features)

In most patients, the disease becomes severe and can lead to excessive hemorrhaging (bleeding) from several areas of the body, including the gums, nose, gastrointestinal tract, genitals, and IV access sites. If it spreads to the nervous system, MVD can lead to confusion, aggression, and irritability.

People who die of MVD typically pass away after about 8 to 9 days of symptom onset, typically as a result of severe blood loss, organ failure, and/or shock.

How Is Marburg Virus Contracted?

Marburg virus is a zoonotic pathogen, meaning it can transmit from animals to humans. The fruit bat (Rousettus aegyptiacus) is considered a natural host.

A human infected with the Marburg virus can spread the pathogen to others via their blood, secretions, organs, and other bodily fluids, to which people can be exposed via direct contact (e.g., through broken skin or mucous membranes), or via indirect contact with contaminated surfaces and objects (e.g., bedding, clothing).

Family members and close contacts of infected individuals, as well as healthcare workers and those involved in burial activities of people who have died of the disease, are at especially higher risk of infection.

Marburg Virus and Ebola Differences

While the Ebola virus may be more familiar to the general public given widespread news coverage over the few decades, the Marburg virus is a similar threat. Both pathogens come from the same family of viruses and can cause similar signs and symptoms. One of the key Marburg virus and Ebola differences, however, is that the latter virus appears to be slightly more virulent (harmful) than Marburg virus, experts say.

That said, Marburg virus is still extremely dangerous to humans. The estimated case-fatality ratio of MVD is as high as 88 percent, according to the WHO.

Recommended PPE for Marburg Virus

As an industry leader in infectious disease PPE, International Enviroguard is rated a top choice for Ebola PPE by Regional Ebola and Special Pathogen Treatment Centers (RESPTCs). Our ViroGuard 2 product line was specifically created to fight Ebola and meets all guidelines for the treatment of Ebola according to the WHO and the United States Centers for Disease Control and Prevention (CDC).

Like the Ebola virus, control measures used to prevent MVD in healthcare workers and other individuals at risk of exposure include:

  • Prompt screening and identification of suspected or confirmed cases
  • Strict isolation of individuals with known or suspected cases
  • Prompt notification of local and state health departments, as well as first responder/healthcare personnel

The National Emerging Special Pathogens Training & Education Center (NETEC) recommends the following products for appropriate Marburg virus PPE:

  • Impermeable gown or coverall
  • Full-face shield
  • NIOSH-approved, fit-tested N95 respirator (or higher)
  • Double gloves
  • Shoe or boot covers
  • Apron

Healthcare workers, first responders, and frontline forces from around the world trust International Enviroguard's ViroGuard 2 product line for their PPE of choice in the fight against MVD. Our coveralls and other options pass ASTM F1670 & F1671 tests for protection against blood, bodily fluids, and bloodborne pathogens and have been meticulously designed to optimize durability, effectiveness, and comfort.

Highly Pathogenic Avian Influenza (H5N1) Outbreak

On January 30, 2023, NETEC reported that the current outbreak of Highly Pathogenic Avian Influenza A (H5N1) has been "the worst in United States history," responsible for the death or culling of at least 60 million birds, including wild fowl and domesticated poultry. Additionally, at least one human case of avian flu was reported in the United States in 2022.

More recently, the South American country of Ecuador reported its first avian influenza case in early January 2023. The infected individual was a nine-year-old girl who came in contact with poultry in her backyard.

Overall, there have been 868 confirmed human cases of H5N1 since 2003, slightly over half of which (457) were fatal.

What is H5N1?

According to the WHO, H5N1 is a type of influenza virus that can cause a highly infectious and severe respiratory disease in birds ("bird flu" or "avian flu"). Among birds, H5N1 features nearly a 100 percent case fatality rate.

H5N1 Infection in humans is considered rare but is possible and in fact well-documented. Cases are generally found among poultry workers and anyone else who has direct contact with infected birds. The WHO estimates a mortality rate of about 60 percent when people become infected with H5N1. According to NETEC, the first human cases of H5N1 were documented in China and Hong Kong in 1997, causing an estimated 18 cases and six deaths.

Signs and symptoms of H5N1 infection in humans include:

  • Fever
  • Cough
  • Sore throat
  • Malaise
  • Muscle aches
  • Abdominal pain
  • Chest pain
  • Diarrhea

In severe cases, H5N1 can lead to difficulty breathing, shortness of breath, pneumonia, Acute Respiratory Distress Syndrome (ARDS), and neurological symptoms like seizures and altered mental status.

How Is H5N1 Virus Contracted?

Like the Marburg virus, H5N1 is zoonotic, meaning it can pass from animals to humans. Anyone who comes in direct or indirect contact with the saliva, mucous, feces, or dead carcasses of infected birds is at risk of infection with H5N1. However, H5N1 is distinct from Marburg and other Ebola-like viruses in that it is difficult to transmit from person-to-person.

Importantly, poultry and game birds are considered safe to eat provided they are thoroughly cooked (as the virus is sensitive to heat). However, individuals should be aware that home-slaughter and handling of birds may pose as a potential route of exposure to the virus.

Recommended PPE for H5N1

The CDC offers very specific guidelines for the appropriate type and use of H5N1 protective clothing. Workers in the poultry industry as well as all personnel involved in the response and mitigation of the current H5N1 outbreak should:

  • Wear disposable fluid-resistant coveralls, head covers or hair covers, and boot covers, along with unvented or indirectly vented safety goggles and a NIOSH-approved respirator such as an N95
  • Be properly fit-tested and trained in the donning, doffing, and general handling of EHM PPE
  • Practice excellent hygiene and contamination prevention techniques (e.g., never wear contaminated clothing or bring equipment outside the primary work area, shower at the end of each shift, wash hands frequently, never eat, drink, or smoke near the work area)

Equine Herpes Virus (EHM)

Some infectious diseases affect animals only and are not transmissible to humans. However, proper PPE and other mitigation strategies are still essential for personnel who may be caring for or interacting with sick and infected animals to help prevent the spread to other animals.

A great example is the equine herpes virus (EHV), which is a family of viruses that affects horses.

What is Equine Herpes Virus (EHM)?

Equine herpes viruses are relatively common in the environment and are considered highly contagious, although current research suggests that most horses affected by this virus do not develop any serious side effects. It's not clear why, but some horses who become infected with EHV go on to develop serious and potentially fatal complications.

According to the U.S. Department of Agriculture, at least nine distinct types of EHV have been identified. EHV-1, EHV-3, and EHV-4 are considered to pose the most serious risks to domesticated horses as well as to the United States equine industry, given the costs associated with screening, diagnosis, treatment, prevention, isolation, fatality, and culling.

EHV-1, for example, can lead to a neurological condition called equine herpes myeloencephalopathy (EHM). Horses infected with EHM may develop signs and symptoms including:

  • Fever
  • Nasal discharge
  • Swelling of the limbs
  • Coordination problems
  • Hind-quarter weakness
  • Lethargy
  • Head tilt
  • Inability to rise off the ground
  • Leaning against a fence or wall for balance
  • Urinary incontinence
  • Diminished tail tone
  • Paralysis and death in severe cases

Other types of EHV infection in horses can lead to complications including pregnancy complications (like abortion) and respiratory illness.

How Is EHM Contracted?

The virus that causes EHM is spread via direct horse-to-horse contact. A horse can also contract EHV by coming in contact with objects that have been contaminated by the virus, including trailers, feed, water buckets, wash rags, tacks, human hands and clothing, and other equine-, farming- and agricultural-related equipment. Experts believe that EHV can also become airborne, but only for short distances.

Remember, not all types of EHV cause EHM, and most horses who become infected with EHV show no clinical signs. And according to the California Department of Food and Agriculture, the long-term prognosis for horses who survive EHM is generally good.

However, about a third of horses who develop EHM will develop neurological signs, and an estimated 5 to 15% of horses diagnosed with EHM will die or have to be euthanized.

Recommended PPE and Control Strategies for EHM

Because the incubation period for EHV is highly variable among horses, and because horses can become infected via indirect contact with contaminated surfaces or objects, anyone working with horses should practice sound infection control and hygiene practices.

The American Association of Equine Practitioners recommends two key strategies to prevent the spread of EHV and associated diseases: vaccines and biosecurity. The AAEP defines biosecurity as "doing everything you can to reduce the chances of an infectious disease being carried onto your farm by people, animals, equipment, or vehicles, either accidentally or on purpose."

Recommendations include:

  • Wearing rubber or leather boots that can be disinfected
  • Regularly disinfecting all areas and equipment used on and around sick horses
  • Quarantine horses returning from shows for at least 7 days, and up to 21 days if horses are sick or if there was a known outbreak at the show

For equine workers, personal protective equipment including disposable coveralls, boot covers, and gloves can offer an added layer of protection and prevention.


The COVID-19 pandemic underscored the critical importance of infectious disease prevention and control. Infectious disease outbreaks can have significant negative impacts on the welfare of both humans and animals, as well as the global economy and environment at large.

If your organization is involved in healthcare, farming and agriculture, biomedical research, or a related industry, it is essential to be well-versed in the unique pathogenic risks your workforce may face and how to mitigate these risks through appropriate prevention control and PPE.