#18,328
As we've seen in past Marburg (and Ebola) outbreaks, Healthcare workers are often disproportionately affected, and 70% of cases in Rwanda so far are said to be HCWs.
The WHO currently `. . . assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.' Due to its length, I've only posted excerpts from today's WHO DON. Follow the link to read it in its entirety.
Disease Outbreak News
Marburg virus disease - Rwanda
30 September 2024
Situation at a glance
On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease (MVD). Blood samples taken from people showing symptoms were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) at the National Reference Laboratory of the Rwanda Biomedical Center and were positive for Marburg virus.
As of 29 September 2024, a total of 26 confirmed cases, including eight deaths have been reported. The cases are reported from seven of the 30 districts in the country. Among the confirmed cases, over 70% are healthcare workers from two health facilities in Kigali. The patients are being cared for in hospitals. Contact tracing is underway, with 300 contacts under follow-up. This is the first time MVD has been reported in Rwanda. The Government of Rwanda is coordinating the response with support from WHO and partners. There is currently no available treatment or vaccine for MVD. This is why it is important for people showing Marburg-like symptoms to seek care early for supportive treatment which can improve patient survival. WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
Description of the situation
On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of MVD in patients in health facilities in the country. Blood samples collected from suspected cases were sent to the National Reference Laboratory of the Rwanda Biomedical Center for testing and were positive for Marburg virus by RT-PCR on 26 September 2024. Samples are being sent to a regional reference laboratory for further confirmation.
As of 29 September 2024, a total of 26 confirmed cases, including eight deaths (CFR: 31%), have been reported. The cases are reported from seven of the 30 districts in the county namely: Gasabo, Gatsibo, Kamonyi, Kicukiro, Nyagatare, Nyarugenge and Rubavu districts. Healthcare workers from two health facilities in Kigali account for over 70% of confirmed cases. The patients are being cared for in hospitals.
Contact tracing is underway, with about 300 contacts under follow-up as of 29 September 2024. One contact travelled internationally. They remained healthy, completed the monitoring period and did not present with any symptoms.
The source of the infection is still under investigation and additional information will be provided when available.
This is the first report of MVD in Rwanda.
Epidemiology
MVD is a highly virulent disease that can cause haemorrhagic fever and is clinically similar to Ebola diseases. Marburg and Ebola viruses are both members of the Filoviridae family (filovirus). People are initially infected with Marburg virus when they come into close contact with Rousettus bats, a type of fruit bat, that can carry the Marburg virus and are often found in mines or caves.
Marburg virus spreads between people via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. Healthcare workers have previously been infected while treating patients with suspected or confirmed MVD. Burial ceremonies that involve direct contact with the body of the deceased can also contribute to the transmission of Marburg virus.
The incubation period varies from two to 21 days. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting can begin on the third day. Although not all cases present with haemorrhagic signs, severe haemorrhagic manifestations may appear between five and seven days from symptoms onset, and fatal cases usually have some form of bleeding, often from multiassesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.ple areas. In fatal cases, death occurs most often between eight and nine days after symptom onset, usually preceded by severe blood loss and shock. There is currently no available treatment or vaccine for MVD. Some candidate vaccines are currently under development.
Several outbreaks of MVD have previously been reported from countries neighbouring Rwanda, including the Democratic Republic of the Congo, Uganda and the United Republic of Tanzania. The most recent outbreaks were reported in Equatorial Guinea and the United Republic of Tanzania between February and June 2023. The affected region in the United Republic of Tanzania was the Kagera region, which borders Rwanda. Additional countries that previously reported outbreaks of MVD in the African Region included Angola, Ghana, Guinea, Kenya, and South Africa.
WHO risk assessment
Marburg virus disease (MVD) is caused by the same family of viruses (Filoviridae) that causes Ebola disease. MVD is an epidemic-prone disease associated with high CFR (24-88%). In the early course of the disease clinical diagnosis of MVD is challenging to distinguish from other infectious diseases such as malaria, typhoid fever, shigellosis, meningitis and other viral haemorrhagic fevers. Epidemiologic features can help differentiate between viral hemorrhagic fevers (including history of exposure to bats, caves, or mining) and laboratory testing is important to confirm the diagnosis.
The notification of 26 confirmed cases, of which over 70% are healthcare workers from two different health facilities in the country is of great concern. Healthcare-associated infections (also known as nosocomial infections) of this disease can lead to further spread if not controlled early. The importance of screening all persons entering health facilities as well as inpatient surveillance for prompt identification, isolation, and notification cannot be overemphasized. This is in addition to the importance of contact identification and monitoring of all probable and confirmed cases. The source of the outbreak, geographical extent, the likely date of onset, and additional epidemiological information on cases are still pending further outbreak investigation.
There is a risk of this outbreak spreading to neighbouring countries since cases have been reported in districts located at the borders with the Democratic Republic of the Congo, the United Republic of Tanzania, and Uganda. Further risk of international spread is also high as confirmed cases have been reported in the capital city with an international airport and road networks to several cities in East Africa. A contact is known to have travelled internationally, and appropriate response measures have been implemented. Optimized supportive care for patients, which includes careful monitoring, intravenous fluid, and early treatment of complications, can improve patient survival. There are promising vaccines and therapeutic candidates for MVD, but these must be proven in clinical trials. WHO has provided guidance to the Ministry of Health on how to manage cases.
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level. Investigations are ongoing to determine the full extent of the outbreak and this risk assessment will be updated as more information is received.
