Tweet
@RwandaHealth
-
@RwandaHealth
-
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 multiple 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.
Public health response- The Government of Rwanda is coordinating the response with support from WHO and partners.
- To support the early detection of cases, the Ministry of Health has shared the Rwanda Biomedical Center hotline number with the public to report symptoms.
- In-depth epidemiological investigation, contact tracing and follow-up is underway and suspected cases are being isolated for testing and treatment.
- Infection prevention and control (IPC) and Water, Sanitation and Hygiene (WASH) measures are being implemented in all health facilities.
- Risk communication and community engagement strategies (RCCE) to inform and mobilize communities, including strategies to manage rumours and misinformation are being strengthened.
- Following the initial confirmation in the country, WHO is supporting the transportation of samples to a regional reference laboratory for confirmation.
- WHO is working on delivering supplies including the shipment and prepositioning of laboratory testing kits and personal protective equipment.
- WHO and partners are working closely with the government to provide information and access to available candidate MVD vaccines and therapeutics for a possible clinical trial. The Ministry of Health has identified two experienced principal investigators to lead the trials.
- WHO is working with neighbouring countries Democratic Republic of Congo, Burundi, Kenya, Tanzania and Uganda to review its operational readiness capabilities to respond to Marburg. WHO is conducting an assessment of the risk for South Sudan due to trade routes between countries. The readiness of unaffected districts in Rwanda is also being ensured to mitigate the spread and quickly identify any spillover.
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.
WHO advice
MVD outbreak control relies on using a range of interventions, including prompt isolation and case management; surveillance including active case search, case investigation and contact tracing; an optimal laboratory service; infection prevention and control, including prompt safe and dignified burial; and social mobilization – community engagement is key to successfully controlling MVD outbreaks. Raising awareness of risk factors for Marburg virus infection and protective measures that individuals can take is an effective way to reduce human transmission. WHO advises the following risk reduction measures as an effective way to reduce MVD transmission in healthcare facilities and in communities:- To reduce human infections and deaths, it is essential to raise community awareness about the risk factors for Marburg virus infection and the protective measures individuals can take to minimize exposure to the virus. This includes encouraging anyone with symptoms to seek immediate care at a health facility or designated treatment centre to lower the risk of community transmission and improve their chances for recovery.
- Surveillance activities including the wider dissemination of MVD case detection should be strengthened in all affected provinces, including contact tracing and active case finding.
- Critical infection prevention and control measures in health facilities should be strengthened or implemented including:
- Establish a system for screening, referral and isolation of suspect MVD cases. Health facilities should ensure active screening of all persons entering the facility according to suspect MVD case definition and prompt isolation for suspect and confirmed cases.
- Health facilities should ensure IPC programmes and Water, Sanitation and Hygiene (WASH) services are in place, establish/activate their IPC committees for coordination purposes and ensure IPC guidelines, protocol, standard operating procedures for MVD are available (e.g. environmental cleaning, and disinfection, risk assessment for exposed health workers) and sufficient IPC/ personal protective equipment (PPE) supplies.
- Health workers caring for patients with confirmed or suspected MVD should apply Transmission-based precautions in addition to: Standard precautions, including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patient’s blood and other body fluids and with contaminated surfaces and objects.
- Health facilities should ensure the availability of PPE for health workers, cleaning and disinfection of the environment is conducted, processes for appropriate decontamination of medical devices, safe linen and waste management are in place. This includes training/refresher training of health workers on IPC and WASH.
- Rapid health facility IPC & WASH assessments should be undertaken to identify and address gaps.
- Equally important, the identification of deceased patients should be implemented in communities and safe and dignified burials, which requires strong engagement with communities.
- Timely laboratory confirmation of all suspected patients needs to be in place and supported with a sample transportation system in place.
WHO encourages all countries to send samples (positive or negative) to a WHO Collaborating Centre or a regional reference laboratory for confirmation. WHO recommends that clinical data from suspected and confirmed cases of Marburg disease are systematically collected to improve the limited understanding of the clinical course and direct causes and risk factors for poor outcomes. This can be done by contributing anonymized data to the WHO Global Clinical Platform for viral haemorrhagic fevers.
Based on the current risk assessment, WHO advises against any travel and trade restrictions with Rwanda.
Further information- Rwanda Ministry of Health Press release on Marburg Virus Diseases, 27 September 2024. Available at https://x.com/RwandaHealth/status/1839656238105104424
- Rwanda Ministry of Health update as of 28 September 2024. Available at: https://x.com/RwandaHealth/status/1840112003123425741
- WHO press release on announcement by Rwanda, 28 September 2024. Available at: https://www.afro.who.int/countries/r...ases-confirmed
- WHO factsheet – Marburg virus disease. Available at: https://www.who.int/news-room/fact-s...-virus-disease
- WHO questions and answers – Marburg virus disease. Available at: https://www.who.int/news-room/questi...-virus-disease
- Infection prevention and control guidelines for Ebola and Marburg disease, August 2023. Available at: https://www.who.int/publications/i/i...CRS-HCR-2023.1
- Standard precautions for the prevention and control of infections: aide-memoire. Available at: https://www.who.int/publications/i/i...IHS-IPC-2022.1
- Transmission-based precautions for the prevention and control of infections: aide-memoire. Available at: https://www.who.int/publications/i/i...IHS-IPC-2022.2
- Steps to putting on PPE for Ebola/Marburg coverall. Available at: https://www.who.int/multi-media/deta...sease-coverall
- Steps to removing PPE for Ebola/Marburg disease coverall. Available at https://www.who.int/multi-media/deta...sease-coverall
- Steps to putting on PPE for Ebola/Marburg gown and headcover. Available at: https://www.who.int/multi-media/deta...-and-headcover
- Steps to removing PPE for Ebola/Marburg gown and headcover. Available at: https://www.who.int/multi-media/deta...-and-headcover
- Essential environmental health standards in healthcare facilities. Available at: https://www.who.int/publications/i/item/9789241547239
- WASH FIT implementation for WASH improvements in healthcare facilities WASH FIT Fact Sheets | WASH in Health Care Facilities (washinhcf.org) https://www.washinhcf.org/wash-fit-fact-sheets/
- World Health Organization (March 2009). Hand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices. Available at https://www.who.int/publications/i/item/9789241598606
- Ebola and Marburg diseases screening and treatment center design training. Available at: https://openwho.org/courses/ebola-ma...eat-facilities
- World Health Organization (2 June 2023). Disease Outbreak News; Marburg virus disease in the United Republic of Tanzania. Available at https://www.who.int/emergencies/dise...em/2023-DON471
- Markotter W, Coertse J, DeVries M, et al. Bat-borne viruses in Africa: a critical review. J of Zoology. 2020;311:77-98. doi:10.1111/jzo.12769. Available at: https://zslpublications.onlinelibrary.wiley.com/doi/10.1111/jzo.12769(link is external)
- Korine C Rousettus aegyptiacus. The IUCN Red List of Threatened Species 2016: e.T29730A22043105. Available at: https://www.iucnredlist.org/species/29730/22043105
- Cross RW, Longini IM, Becker S, Bok K, Boucher D, Carroll MW, et al. (2022) An introduction to the Marburg virus vaccine consortium, MARVAC. PLoS Pathog 18(10): e1010805. Available at: https://doi.org/10.1371/journal.ppat.1010805
- A WHO-Strategic Research Agenda for Filovirus Research and Monitoring (WHO-AFIRM). Available at: https://www.who.int/publications/m/i...---(who-afirm)
- Building research readiness for a future filovirus outbreak, Workshop February 20 - 22, 2024, Uganda. Available at: https://www.who.int/news-room/events...22-2024-uganda
- WHO Technical Advisory Group – candidate vaccine prioritization. Summary of the evaluations and recommendations on the four Marburg vaccines. Available at: https://www.who.int/publications/m/i...rburg-vaccines
- Marburg virus vaccine landscape. Available at: https://www.who.int/publications/m/i...cine-landscape
- Marburg virus therapeutics landscape. Available at: https://www.who.int/publications/m/i...tics-landscape
Citable reference: World Health Organization (30 September 2024). Disease Outbreak News; Marburg virus disease in the Republic of Rwanda. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON537
https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON537#:~:text=As%20of%2029%20September%202024,bei ng%20cared%20for%20in%20hospitals.
Comment
-
If 70% of the known cases are healthcare workers, this is not a good thing. Infections among healthcare workers means there has been some previous spread. Healthcare workers are usually secondary cases. It is one of the markers we look for.
This is also not positive - "The cases are reported from seven of the 30 districts in the country." Geographical spread is another marker.Comment
-
Marburg Virus Disease Outbreak in Rwanda
1 October 2024
ADDIS ABABA, Ethiopia, 1 October 2024 – The Ministry of Health of the Republic of Rwanda declared a Marburg virus disease (MVD) outbreak on 27 September 2024. As of 30 September, 27 confirmed cases and 9 deaths have been reported; most of the cases are health care workers. Over 297 contacts have been registered and are under follow-up.
The Ministry of Health is working tirelessly in collaboration with relevant partners to contain the deadly virus through enhanced preventive measures in all health facilities. Contact tracing is underway, and cases have been isolated for treatment. The Ministry of Health further urged Rwandans to remain vigilant and strengthen preventive measures by ensuring hygiene, washing hands with soap, sanitizing hands, and taking necessary precautionary measures when in contact with other individuals.
Marburg virus disease (MVD) is a severe and often fatal zoonotic haemorrhagic illness caused by the Marburg virus. The virus is usually transmitted to humans from fruit bats. Human-to-human transmission occurs through direct contact with an infected person’s body fluids, or with equipment and materials contaminated with infectious blood or tissues. There is currently no vaccine or specific treatment for MVD, so supportive therapy should be initiated immediately for any individuals presenting with the disease. The same infection prevention and control protocols used for other viral haemorrhagic fevers, such as Ebola, should be followed to prevent transmission.
On September 29th, the Africa Centers for Disease Control and Prevention (Africa CDC) dispatched a team of experts to aid in response efforts in Rwanda. Africa CDC is also collaborating with the Ministry of Health and neighbouring countries of Burundi, Uganda, Tanzania, and DR Congo to assist in addressing the cross-border aspects of the outbreak and to provide guidance on regional surveillance strategies to contain the outbreak.
The Minister of Health of Rwanda, H.E. Sabin Nsanzimana, will join the Africa CDC Press Briefing on Thursday, October 3, alongside the Director General of Africa CDC, Dr. Jean Kaseya, to discuss Rwanda’s efforts in curbing the Marburg virus.
About Africa CDC
The Africa Centres for Disease Control and Prevention (Africa CDC) is a continental autonomous public health agency of the African Union that supports member states in efforts to strengthen health systems and improve surveillance, emergency response, and prevention and control of diseases.
Learn more at: http://www.africacdc.org and connect with us on LinkedIn, Twitter, Facebook and YouTube
Media contacts:Margaret Edwin | Director of Communication and Public Information | EdwinM@africacdc.org
Comment
-
Ministry of Health | Rwanda
@RwandaHealth
·
20m
Amakuru mashya | Update Virusi ya Marburg - 01.10.2024
19
58
123
10K
Comment
-
Source: https://www.precisionvaccinations.co...eported-rwanda
10th Marburg Disease Death Reported in Rwanda
October 1, 2024 • 3:13 pm CDT
(Precision Vaccinations News)
The Republic of Rwanda's health ministry reported today that the sudden Marburg virus disease (MVD) outbreak had reached 29 cases and ten related fatalities.
On September 30, 2024, the World Health Organization confirmed MVD cases from seven of the 30 districts in Rwanda.
Over 70% of the confirmed cases are healthcare workers from two health facilities in Kigali, a city with about 1.5 million residents...Comment
-
Belgium -
Translation Google
02/10/2024
PRESS RELEASE FROM RISK MANAGEMENT GROUP – Increased vigilance following the Marburg virus outbreak in Rwanda
The Rwandan government officially informed the Belgian government on 28 September of a Marburg virus outbreak in their country. The Risk Assessment Group (RAG) and the Risk Management Group (RMG) are closely monitoring the situation. In Belgium, the risk to the general population is considered very low. Belgians present in Rwanda are urged to be extra vigilant. Travellers to Rwanda are advised to follow the advice of the FPS Foreign Affairs carefully.
What is the Marburg virus?
Marburg virus causes a severe form of viral hemorrhagic fever. Transmission occurs through direct contact with the blood or body fluids of infected people, or indirectly through contaminated surfaces. The incubation period varies from 2 to 21 days.
Symptoms begin with high fever, severe headache, and muscle aches, sometimes followed by watery diarrhea, vomiting, abdominal pain, and cramps. Many patients develop severe bleeding.
With a high mortality rate of over 80% and no approved treatment, the RMG stresses the importance of prevention and early detection.
Measures
Citizens who have been to Rwanda in the last 3 weeks and have symptoms or have been in contact with sick people are advised to contact their doctor immediately by phone and mention their travel history.
The Belgian health authorities will inform the healthcare sector about the epidemic and will also ask them to be extra vigilant.
...
Comment
-
hat tip Shiloh
Ministry of Health | Rwanda
@RwandaHealth
·
3h
Amakuru mashya | Update Virusi ya Marburg - 02.10.2024
Comment
-
This Disease Outbreak News was revised on October 1, 2024, to provide further information about the contact that travelled internationally.
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. 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 to Belgium from Rwanda. WHO was made aware of this by the public health authorities in Belgium. They shared detailed information on the contact's situation, that they remained healthy, completed the 21-day monitoring period, did not present with any symptoms, and are not a risk to public health.
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 multiple 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. Public health response- The Government of Rwanda is coordinating the response with support from WHO and partners.
- To support the early detection of cases, the Ministry of Health has shared the Rwanda Biomedical Center hotline number with the public to report symptoms.
- In-depth epidemiological investigation, contact tracing and follow-up is underway and suspected cases are being isolated for testing and treatment.
- Infection prevention and control (IPC) and Water, Sanitation and Hygiene (WASH) measures are being implemented in all health facilities.
- Risk communication and community engagement strategies (RCCE) to inform and mobilize communities, including strategies to manage rumours and misinformation are being strengthened.
- Following the initial confirmation in the country, WHO is supporting the transportation of samples to a regional reference laboratory for confirmation.
- WHO is working on delivering supplies including the shipment and prepositioning of laboratory testing kits and personal protective equipment.
- WHO and partners are working closely with the government to provide information and access to available candidate MVD vaccines and therapeutics for a possible clinical trial. The Ministry of Health has identified two experienced principal investigators to lead the trials.
- WHO is working with neighbouring countries Democratic Republic of Congo, Burundi, Kenya, Tanzania and Uganda to review its operational readiness capabilities to respond to Marburg. WHO is conducting an assessment of the risk for South Sudan due to trade routes between countries. The readiness of unaffected districts in Rwanda is also being ensured to mitigate the spread and quickly identify any spillover.
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, to Belgium, 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.
WHO advice
MVD outbreak control relies on using a range of interventions, including prompt isolation and case management; surveillance including active case search, case investigation and contact tracing; an optimal laboratory service; infection prevention and control, including prompt safe and dignified burial; and social mobilization – community engagement is key to successfully controlling MVD outbreaks. Raising awareness of risk factors for Marburg virus infection and protective measures that individuals can take is an effective way to reduce human transmission. WHO advises the following risk reduction measures as an effective way to reduce MVD transmission in healthcare facilities and in communities:- To reduce human infections and deaths, it is essential to raise community awareness about the risk factors for Marburg virus infection and the protective measures individuals can take to minimize exposure to the virus. This includes encouraging anyone with symptoms to seek immediate care at a health facility or designated treatment centre to lower the risk of community transmission and improve their chances for recovery.
- Surveillance activities including the wider dissemination of MVD case detection should be strengthened in all affected provinces, including contact tracing and active case finding.
- Critical infection prevention and control measures in health facilities should be strengthened or implemented including:
- Establish a system for screening, referral and isolation of suspect MVD cases. Health facilities should ensure active screening of all persons entering the facility according to suspect MVD case definition and prompt isolation for suspect and confirmed cases.
- Health facilities should ensure IPC programmes and Water, Sanitation and Hygiene (WASH) services are in place, establish/activate their IPC committees for coordination purposes and ensure IPC guidelines, protocol, standard operating procedures for MVD are available (e.g. environmental cleaning, and disinfection, risk assessment for exposed health workers) and sufficient IPC/ personal protective equipment (PPE) supplies.
- Health workers caring for patients with confirmed or suspected MVD should apply Transmission-based precautions in addition to: Standard precautions, including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patient’s blood and other body fluids and with contaminated surfaces and objects.
- Health facilities should ensure the availability of PPE for health workers, cleaning and disinfection of the environment is conducted, processes for appropriate decontamination of medical devices, safe linen and waste management are in place. This includes training/refresher training of health workers on IPC and WASH.
- Rapid health facility IPC & WASH assessments should be undertaken to identify and address gaps.
- Equally important, the identification of deceased patients should be implemented in communities and safe and dignified burials, which requires strong engagement with communities.
- Timely laboratory confirmation of all suspected patients needs to be in place and supported with a sample transportation system in place.
Based on the current risk assessment, WHO advises against any travel and trade restrictions with Rwanda.
Comment
-
Translation Google
Rwanda: Concerns mount over spread of Marburg virus
By Africanews Editorial and Diana Iriza
Last update: 7 hours ago
RWANDA
Rwanda's health ministry on Friday confirmed the country's first outbreak of the Marburg virus, with 11 deaths reported.
The deadly virus, related to Ebola and with a fatality rate of up to 88%, is transmitted to humans by fruit bats and through contact with infected bodily fluids.
The ministry advised the public to avoid close contact with people showing symptoms, such as fever, headache, muscle aches, vomiting and diarrhea.
...
As Rwanda faces this unprecedented situation, the urgency for awareness and protective measures continues to grow.
“In the country, one of the first people tested was from one of the universities in Kigali. The patient is currently in an intensive care unit. Many cases were investigated and he was found to be positive. From there, we did contact tracing and we noticed that some health care providers were already showing symptoms,” said Sabin Nsanzimana, Rwanda’s Minister of Health.
The Rwandan Ministry of Health has issued guidelines that stipulate that patients should not receive visitors for the next 14 days.
-----------------------------------------
Rwanda to launch clinical trials against Marburg virus
By Africanews Editorial
Last update: 5 hours ago
RWANDA
Rwanda has announced clinical trials to develop a vaccine to contain the Marburg virus.
This initiative was confirmed according to several sources by the Deputy Minister of Health, Yvan Butera, this Thursday. This viral hemorrhagic fever similar to the Ebola virus, has already caused 11 deaths since the outbreak of the disease at the end of September. Efforts to develop a vaccine are crucial to prevent the spread of this disease in the region. In order to limit any risk of acceleration of transmissions, the Ministry of Health is closely monitoring 410 people who have been in contact with suspected cases.
The date for the start of clinical trials has not been communicated by the health authorities. Before Rwanda, Tanzania in 2023 had reported cases of the Marburg virus and Uganda in 2017.
...
Comment
-
First Marburg Virus Disease Outbreak in the Republic of Rwanda
Distributed via the CDC Health Alert Network
October 3, 2024, 12:15 PM ET
CDCHAN-00517
Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and health departments about the Republic of Rwanda’s first confirmed outbreak of Marburg virus disease (MVD) with 36 laboratory confirmed cases and 11 deaths reported as of October 2, 2024, including at least 19 cases in healthcare workers. This report summarizes CDC’s recommendations for public health departments and clinicians in the United States on case identification and testing and clinical laboratory biosafety considerations. No confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of the Republic of Rwanda to date. Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases.
Background
MVD is a rare but highly fatal viral hemorrhagic fever (VHF) caused by infection with one of two zoonotic viruses, Marburg virus or Ravn virus. Both Marburg virus and Ravn virus are within the virus family Filoviridae, which also includes Ebola viruses. A person infected with the Marburg virus is not contagious before symptoms appear. Symptoms may include fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Marburg virus is spread through direct contact with broken skin or mucous membranes with the body fluids of someone who is sick with MVD, or who recently died from their infection. These body fluids include blood, urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, or semen. People can also contract MVD if they have contact with infected animals, or with needles, or with other objects or surfaces contaminated with the virus. Marburg virus is not spread through airborne transmission.
On September 27, 2024, the Ministry of Health of the Republic of Rwanda reported cases of MVD in health facilities in the country. These are the first known cases of MVD in Rwanda. As of October 2, 2024, Rwanda has recorded 36 laboratory confirmed cases, including 11 deaths (31% case fatality rate) from MVD. At least 19 cases are in healthcare workers, the majority of whom work in intensive care units. There are also several cases unlinked to known transmission chains, suggesting additional cases may have been undetected or unreported. Cases have been reported from seven of the 30 districts in Rwanda, with three districts (Gasabo, Kicukiro, Nyarugenge) in Kigali Province reporting the highest number of cases. Other districts reporting cases include Nyagatare, Gatsibo, Kamonyi, and Rubavu. Approximately 300 contacts to cases are being monitored in Rwanda. Investigations are ongoing to determine timeline, transmission chains, and potential source of the outbreak.
CDC has reached out to U.S.-based nongovernmental organizations and medical centers with staff working in the affected areas to provide guidance on education and how to conduct health assessments of U.S.-based staff before, during, and after their deployment. On October 3, 2024, CDC issued interim recommendations for public health management of U.S.-based healthcare personnel who were present in a healthcare facility in Rwanda in the previous 21 days.
There is currently no Food and Drug Administration (FDA)-approved vaccine or treatment for MVD. In the absence of early diagnosis and appropriate supportive care, MVD has a high mortality rate of 23%–90%, depending on the virus strain and the level of case management. With early intensive supportive care and fluid replacement, mortality rates might be lower.
Recommendations for Clinicians- Systematically assess patients with exposure risk and compatible symptoms for the possibility of viral hemorrhagic fevers including MVD through a triage and evaluation process including a travel history. Early identification of MVD or other viral hemorrhagic fevers is important for providing appropriate and prompt patient care and preventing the spread of infection.
- Include MVD in the differential diagnosis for an ill person who has been to an area with an active MVD outbreak in the past 21 days, AND who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND has reported epidemiologically compatible risk factors like any one or more of the below, within the 21 days before symptom onset:
- Had direct contact with a symptomatic person with suspected or confirmed MVD, or with any objects contaminated by their body fluids.
- Experienced a breach in infection prevention and control precautions that resulted in the potential for contact with body fluids of a patient with suspected or confirmed MVD.
- Participated in any of the following activities while in an area with an active MVD outbreak:
- Contact with someone who was sick or died or with any objects contaminated by their body fluids.
- Attended or participated in funeral rituals, including preparing bodies for funeral or burial.
- Visited or worked in a healthcare facility or laboratory.
- Contact with cave-dwelling bats or non-human primates.
- Worked or spent time in a mine or cave.
- Consider more common diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in an ill patient with recent international travel, and evaluate and manage appropriately.
- Know that patients with a Marburg virus infection may present with concurrent infections (e.g., co-infection with malaria), and the possibility of a concurrent infection should be considered if a patient has a clinical and epidemiologic history compatible with MVD. Travel to or from Rwanda in the past 21 days should not be a reason to defer routine laboratory testing or other measures necessary for standard patient care.
- Isolate and manage patients with exposure risks and symptoms compatible with MVD in a healthcare facility until receiving a negative Marburg virus test result on a sample collected ≥ 72 hours after symptom onset. If a sample collected is <72 hours after symptom onset and is negative, the patient should remain in the healthcare facility and another test should be performed on a new sample taken ≥ 72 hours after initial symptom onset. Routine laboratory testing to monitor the patient’s clinical status and diagnostic testing for other potential causes of the patient’s illness should be pursued while Marburg virus testing is underway. Marburg virus diagnostic testing should not be delayed while awaiting results of other diagnostic testing.
- Patients should be held in isolation at their presenting medical facility and cared for by personnel wearing appropriate PPE, pending test results.
- If a patient tests positive, they would be transferred to a Regional Emerging Special Pathogens Treatment Center or a state-designated special pathogens treatment center. depending on the jurisdiction.
- Contact your state, territorial, local or Tribal (STLT) health department immediately (via 24-hour Epi-on-Call contact list) if MVD is suspected and follow jurisdictional protocols for patient assessment. If a diagnosis of MVD is considered, health departments will work with CDC and the clinical team to coordinate care and testing for the patient and ensure appropriate precautions are taken to help prevent potential spread.
- Counsel patients with planned travel to an MVD outbreak-affected area on ways to prevent exposure during their travel. Prevention methods include:
- Avoiding contact with blood and body fluids (or with materials possibly contaminated with blood and body fluids) of people who are sick.
- Not participating in funeral or burial practices that involve touching the body of someone who died from suspected or confirmed MVD.
- voiding contact with cave-dwelling fruit bats and non-human primates.
- Refraining from entering areas known to be inhabited by cave-dwelling fruit bats, such as mines or caves.
- For this outbreak, travelers are additionally advised to avoid visiting healthcare facilities in the outbreak area for nonurgent medical care or for nonmedical reasons, and to avoid visiting traditional healers.
- Counsel healthcare workers traveling to Rwanda for work in clinical settings of their potential increased risk of exposure to Marburg virus, the importance of following recommended infection prevention and control precautions, and the symptom monitoring and work-restriction they may need to follow after their return to the United States.
Recommendations for Infection Prevention and Control Measures in Hospitals- Employ a combination of infection prevention and control measures to prevent transmission of MVD in hospitals. These infection prevention and control measures include, but are not limited to:
- Isolating patients in a private room with a private bathroom or covered bedside toilet if MVD is suspected. Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care.
- Following separate PPE guidance for managing clinically stable and clinically unstable patients.
- Ensuring that healthcare workers caring for patients with VHFs have received comprehensive training and demonstrated competency in performing VHF-related infection control practices and procedures.
- Following the infection prevention and control measures as recommended for VHFs including using recommended PPE and limiting the number of personnel who enter the room for clinical evaluation and management.
- Having an onsite manager supervise personnel providing care to these patients at all times. A trained observer must also supervise each step of every PPE donning/doffing procedure to ensure established PPE protocols are completed correctly.
- Excluding individuals unable or unwilling to adhere to infection control and PPE use procedures from providing care for patients with VHFs.
- Know that healthcare personnel can be exposed through contact with a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nose, or mouth) are particularly hazardous.
- Minimize procedures that can increase environmental contamination with infectious material, involve handling of potentially contaminated needles or other sharps, or create aerosols.
Recommendations for Public Health Departments- Follow your established jurisdictional protocols regarding patient assessment to determine if testing for Marburg virus is warranted for a patient with concerning clinical and epidemiologic history for MVD is identified in your jurisdiction.
- Coordinate patient management, sample referral, and Marburg virus testing with State, Territorial, Local and Tribal health departments, CDC, and the clinical team.
- Contact CDC’s Viral Special Pathogens Branch (VSPB) 24/7 for consultations about Marburg virus disease or other viral hemorrhagic fevers. Call CDC Emergency Operations Center at 770-488-7100 and request VSPB’s on-call epidemiologist. For non-emergency inquiries, email spather@cdc.gov.
- For suspect cases, request testing for Marburg virus and other viral hemorrhagic fevers from CDC (Atlanta, Georgia) or the Laboratory Response Network (LRN).
- To date, 37 geographically diverse LRN laboratories and 13 Regional Emerging Special Pathogen Treatment Centers can test using the Biofire FilmArray NGDS Warrior Panel, with several more LRN laboratories working toward building testing capability.
- The Warrior Panel can detect orthomarburgviruses (Marburg and Ravn viruses) and orthoebolaviruses (Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses) in addition to other high-consequence pathogens.
- Per manufacturers’ recommendations, results from the Biofire FilmArray NGDS Warrior Panel are presumptive, and results require confirmatory testing which can be performed in CDC laboratories.
- Follow CDC travel guidance for Rwanda and consider engaging travel health clinics or other clinical and public health partners to increase awareness on MVD.
- Review CDC’s new interim recommendations for public health management of U.S.-based healthcare personnel who were present in a healthcare facility in Rwanda during the previous 21 days.
- These interim recommendations include post-arrival monitoring by health departments and exclusion from work duties in a U.S. healthcare facility until 21 days after their last presence in a healthcare facility in Rwanda.
Recommendations for Clinical Laboratory Biosafety- Be aware that early symptoms associated with MVD are similar to other illnesses associated with fever in recent international travelers.
- Follow Standard Precautions for All Patient Care and Universal Precautions for Preventing Transmission of Bloodborne Infections to safely perform common diagnostic testing for patients with suspected MVD.
- Have a written Exposure Control Plan in place to eliminate or minimize employees’ risk of exposure to blood, body fluids or other potentially infectious materials per Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard.
- Make recommended PPE available and train staff to properly put on and take off (don and doff) their PPE.
- If a facility does not have the appropriate risk mitigation capabilities, forward the specimen using appropriate packing and shipping requirements to another facility that does.
Recommendations for Healthcare Workers Returning from Work in Rwanda- On October 3, 2024, CDC issued interim recommendations for monitoring and managing U.S. healthcare workers who have been present in any healthcare facility, including outpatient settings or traditional healers, in Rwanda within the last 21 days and are returning to the United States.
- Returning workers and sponsoring organizations should review CDC’s new interim recommendations.
- These interim recommendations include post-arrival symptom monitoring by health departments and exclusion from work duties in a U.S. healthcare facility until 21 days after their last presence in a healthcare facility in Rwanda.
Recommendations for the Public- Protect yourself and prevent the spread of MVD when living in or traveling to a region where Marburg virus is potentially present or that is currently experiencing an outbreak.
- Take the following actions to protect yourself:
- Avoid contact with blood and other body fluids.
- Avoid materials possibly contaminated with blood or other body fluids of people who are sick.
- Avoid visiting healthcare facilities in the outbreak area for nonurgent medical care or for nonmedical reasons.
- Avoid visiting traditional healers.
- Do not participate in funeral or burial practices that involve touching the body of someone who died from suspected or confirmed MVD.
- Keep away from fruit bats and non-human primates and do not enter areas where fruit bats live, such as mines or caves.
- Monitor your health for 21 days after you return from an area experiencing an MVD outbreak.
- Isolate (separate) yourself immediately from others and seek medical care immediately if you develop symptoms of MVD. Before you enter a healthcare facility, alert the healthcare providers of your recent travel to an MVD-affected area.
- Take the following actions to protect yourself:
Comment
-
ECDC advice on Marburg virus disease
News story
3 Oct 2024
On 2 October 2024, Germany reported that two travellers returning from Rwanda were isolated in Hamburg due to a history of exposure in a medical facility in Rwanda where Marburg virus disease patients were being treated. ECDC has been in close contact with German public health authorities. Negative test results were reported on 3 October 2024
On 27 September 2024, the Ministry of Health of Rwanda reported the first outbreak of Marburg virus disease (MVD) in the country. As of 2 October 2024, a total of 36 cases, including 11 deaths, have been reported in the country. Epidemiological investigations, including contact tracing, strengthening of infection prevention and control protocols and other measures are being implemented by the government of Rwanda to control the outbreak. Among the investigated contacts in Rwanda, one that had travelled to Belgium has completed the monitoring period (21 days) and is not considered a public health risk.
Since person-to-person transmission requires contact with the bodily fluids of a symptomatic case, the likelihood of exposure and infection by Marburg virus for EU/EEA citizens travelling or residing in the affected areas in Rwanda is currently considered low. Based on the available information, the likelihood of exposure to MVD in a healthcare setting is moderate. In the event of an importation of an MVD case to the EU/EEA, the likelihood of further transmission is considered to be very low, if appropriate measures are applied.
Advice to travellers
Travellers to Rwanda should be made aware of the ongoing outbreak in Rwanda and the affected areas and follow the advice of the local health authorities. They should be advised to:- Avoid contact with anyone exhibiting MVD symptoms (like fever, vomiting, diarrhoea or bleeding) or contact with materials and surfaces contaminated by the bodily fluids of infected persons. This includes avoiding contact with the dead bodies of infected persons and the burial process.
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid habitats that may be populated by bats, such as caves or mines, as well as any form of close contact with wild animals, including monkeys, forest antelopes, rodents, and bats, both alive and dead, and manipulation or consumption of any type of bushmeat.
Travellers returning from Rwanda to the EU/EEA should be advised to seek prompt medical care if they develop MVD-compatible symptoms and mention their travel history, as well as possible exposure history and close contacts.
ECDC is in contact with international partners to acquire more information and is developing guidance for the EU public health authorities.
More information about Marburg Virus
Marburg virus is present in certain animal species in several sub-Saharan countries. Transmission from animals to humans is rare; however, such events may initiate outbreaks due to subsequent human-to-human transmissions.
MVD is not an airborne disease and is not considered contagious before symptoms appear. Direct contact with the blood and other body fluids of an infected person or animal is the most frequent route of transmission. Indirect contact with surfaces and materials like clothing, bedding and medical equipment contaminated with infected blood or body fluids may also result in transmission of the virus. Therefore, if proper infection prevention and control precautions are strictly followed, the likelihood of infection is regarded as very low.
The incubation period of MVD is usually five to ten days. The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhoea. In severe cases, a rash may develop, along with bleeding from various body areas.
...
Comment
-
80% of Marburg cases are healthcare Workers, Minister Reveals
October 3, 2024
Kigali, Rwanda — October 3, 2024: Healthcare workers represent over 80 percent of confirmed cases in Rwanda’s first outbreak of Marburg virus disease, according to Minister of Health Dr. Sabin Nsanzimana. This alarming statistic was shared during a press briefing on Thursday.
...
Dr. Nsanzimana highlighted the vulnerability of healthcare workers during such outbreaks, stating, “Most of the time, it is unfortunate but it is the reality that healthcare workers are the first to be affected by such diseases. This is because they face sick people from different places, different backgrounds.”
...
Comment
-
Ministry of Health | Rwanda
@RwandaHealth
·
24m
Amakuru mashya | Update Virusi ya Marburg - 03.10.2024
Comment
Comment