On 27 September 2024, the Rwanda Ministry of Health declared an outbreak of Marburg virus disease (MVD) following reports of laboratory-confirmed MVD cases in the country. This is the first-ever MVD outbreak to be reported in Rwanda. Twenty-six laboratory-confirmed cases and six deaths were initially reported from seven of the 30 districts in Rwanda. Since then, additional cases continue to be reported. As of 19 October 2024, 62 cases, including 15 deaths (CFR 24.2%, 15/62) and 44 recoveries, have been reported, while three are in isolation and receiving treatment. Cases have been reported across eight districts, with the majority in three districts within Kigali. Most cases (>80%) are healthcare workers emanating from a cluster in two healthcare facilities in Kigali. To date, no evidence of community transmission has been identified.
MVD is a contagious zoonotic disease with a high case fatality rate of 24 – 88%. The transmission of Marburg virus begins with zoonotic spillover; humans can contract the Marburg virus when they come in close contact with Rousettus bats that carry the virus and serve as natural reservoir. Other species of bats and other animals such as primates may also play a role in the natural ecological cycle of the virus and may pose risk for exposure, although this is not fully understood yet. Subsequent human-to-human transmission occurs through direct contact with infected blood, bodily fluids or contaminated surfaces and materials (such as patient bedding or clothes). The incubation period ranges from two to 21 days. Early symptoms include fever, malaise, myalgia, fatigue, severe headache, nausea, vomiting, and severe diarrhoea. Haemorrhaging may appear in severe cases on days 5 to 8 from symptoms onset, and fatal cases often bleed from multiple body areas and mucosal surfaces. Hemorrhaging is not always present. Currently, there is no approved treatment or registered vaccine for MVD, and patient care is limited to symptomatic and supportive management.
With support from partners and the World Health Organization (WHO), the Rwandan government has instituted various public health response measures to contain and prevent further spread. A public hotline to encourage early reporting of symptoms has been established. Investigations are ongoing to determine the origin of the infection and magnitude of the outbreak.
The WHO designated the outbreak as a Grade 3 emergency, the highest classification level within its Emergency Response Framework. The WHO considers the public health risk of MVD to be very high at the national level, high at the regional level, and low at the global level. However, risk assessment is ongoing and may be revised as more information becomes available. Based on the current risk assessment, WHO advises against any travel and trade restrictions with Rwanda.
As of 19 October 2024, there have been no suspected or confirmed MVD cases in South Africa associated with the current outbreak in Rwanda. However, given ongoing transmission in Rwanda, healthcare workers should have a high index of suspicion for suspected MVD cases as per the case definition. Additionally, it is important to exclude malaria in cases of febrile illness in returning travelers as part of the differential diagnosis.
For more information about Marburg virus disease, visit our updates page here.
