Marburg virus outbreak confirmed in Rwanda: a public health emergency
On September 27, 2024, the Rwanda Ministry of Health confirmed the country’s first outbreak of Marburg virus disease (MVD), a highly virulent disease that belongs to the same family as Ebola, reports a Kazinform News Agency correspondent. This marks a significant public health challenge for Rwanda, as the disease had not previously been reported within its borders.
According to the World Health Organization (WHO) blood samples collected from patients showing symptoms were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) at the National Reference Laboratory of the Rwanda Biomedical Center, confirming the presence of the Marburg virus.
Current situation
As of September 29, 2024, there have been 26 confirmed cases of MVD, including eight deaths, resulting in a case fatality rate (CFR) of 31%. The confirmed cases are spread across seven of Rwanda’s 30 districts, with a concentration of cases among healthcare workers from two facilities in Kigali, who account for more than 70% of the confirmed cases. These patients are currently receiving care in hospitals. Authorities are actively conducting contact tracing, and approximately 300 contacts are under surveillance. One of these contacts has traveled to Belgium, but they have completed their 21-day monitoring period without showing symptoms, alleviating concerns about international transmission.
What is Marburg virus disease?
MVD is a rare but severe viral hemorrhagic fever that can cause significant internal and external bleeding, multi-organ failure, and shock. It is clinically similar to Ebola, with which it shares the same virus family, Filoviridae. The Marburg virus is primarily transmitted to humans through direct contact with infected fruit bats of the Rousettus species, which often live in caves or mines. Once transmitted to humans, the virus spreads from person to person through direct contact with infected bodily fluids such as blood, urine, or saliva, or with surfaces and materials contaminated with these fluids.
The incubation period for MVD ranges from two to 21 days. Initial symptoms are often abrupt and include high fever, severe headache, and muscle aches. Gastrointestinal symptoms like nausea, vomiting, and diarrhea typically follow within a few days. In severe cases, bleeding from multiple body sites can occur, and death, if it occurs, generally happens within eight to nine days from symptom onset due to severe blood loss and shock.
The public health response
The Rwandan government, with support from the WHO and other international partners, has initiated a multi-faceted response. Key measures include intensified contact tracing, isolation of suspected cases, and an enhanced public communication campaign to raise awareness about the symptoms and transmission routes of MVD. Infection prevention and control (IPC) measures are also being strengthened, particularly in healthcare settings, to protect medical personnel and prevent further spread.
WHO is assisting with the transportation of samples to regional reference laboratories for further analysis and is providing essential supplies, such as personal protective equipment (PPE) and testing kits.
At the same time, WHO is also collaborating with neighboring countries like Uganda, Tanzania, and the Democratic Republic of the Congo to review and improve their preparedness for potential spread, given Rwanda’s geographic proximity to these countries. WHO has emphasized the importance of community engagement to help manage the outbreak. Risk communication strategies aim to keep communities informed and mitigate the spread of misinformation, which can lead to panic and hinder containment efforts.
Challenges and risks
One of the most pressing concerns about this outbreak is the high number of healthcare workers affected, which could severely impact the country’s ability to manage the disease if it spreads further. Healthcare-associated infections pose a serious risk of further transmission, making it critical to implement stringent screening and IPC measures in hospitals and clinics.
The outbreak poses a high risk at the national level and a significant risk at the regional level due to Rwanda’s borders with other East African countries. However, WHO has assessed the global risk level as low, given the current containment efforts and the early detection of cases.
No available treatment or vaccine
At present, there is no licensed treatment or vaccine for MVD, although several vaccine candidates are under development. For now, supportive care remains the mainstay of treatment, with interventions such as intravenous fluids, monitoring of vital signs, and the early management of complications helping to improve patient outcomes. WHO is supporting Rwanda in considering possible clinical trials for candidate vaccines and therapeutics during this outbreak.
WHO urges all countries to send both positive and negative Marburg virus samples to WHO Collaborating Centers or regional labs for confirmation. They also recommend collecting clinical data from suspected and confirmed cases to better understand the disease and its risks. This allows countries to share anonymized data through the WHO Global Clinical Platform for viral hemorrhagic fevers.
Based on the current risk assessment, WHO advises against any travel and trade restrictions with Rwanda.
