The majority of people infected in Rwanda’s Marburg virus outbreak are health workers, and some illnesses have been reported in districts that border three other African nations, both of which are among a number of concerning features of the event, the World Health Organization (WHO) said yesterday in its initial risk assessment.
The source of the Marburg virus outbreak—Rwanda’s first—still isn’t known, pending further investigation findings by Rwandan health officials, the WHO said. Rwanda’s health ministry today reported 2 more confirmed cases and 1 more death, raising the outbreak total to 29 cases, 10 of them fatal. The outbreak is already one of the biggest involving Marburg virus, a close cousin of Ebola.
The 26 cases noted in the WHO’s update include health workers at two hospitals in Kigali, the country’s capital. The WHO noted that infections in health workers can lead to further spread if not controlled early.
Border risks to the DRC, Uganda, and Tanzania
“The importance of screening all persons entering health facilities as well as inpatient surveillance for prompt identification, isolation, and notification cannot be overemphasized,” the WHO said. According to media reports, the country has banned hospital visits and that only one caregiver would be allowed per patient.
Confirmed cases in Kigali pose a risk of international spread, given that the capital city has an international airport, and road networks to several cities in East Africa.
One of the 300 contacts of the confirmed cases had traveled to Belgium. Health officials from Belgium told the WHO that the individual remains healthy, has completed the 21-day monitoring period, and is not a risk to public health.
Cases have been reported from seven of the countries, districts. Though most are in and around Kigali, some have been reported from Rubavu in the west on the border with the Democratic Republic of the Congo (DRC) and from Nyagatare near the border with Uganda and Tanzania.
Tanzania, along with Equatorial Guinea, reported its first Marburg virus outbreak in 2023. The WHO said the affected region in Tanzania’s outbreak was Kagera, which borders Rwanda.
The WHO assessed the risk of Marburg as very high for Rwanda, high for the region, and low at the global level.
Advantages, challenges ahead in Rwanda
On X yesterday, Craig Spencer, MD, MPH, an emergency medicine doctor who worked in West Africa during the region’s Ebola outbreak and is an Ebola survivor, said though Ebola and Marburg are similar viruses, there are important differences, notably approved vaccines and treatments for Ebola, but only experimental ones from Marburg, which he said is extremely frustrating after multiple Marburg outbreaks in recent years. He is currently with Brown University’s School of Public Health.
He said Rwanda’s outbreak has probably been simmering for weeks, but detecting the first cases can be hard, especially in countries that haven’t battled similar outbreaks before.
Rwanda’s healthcare system is strong and has already done an excellent job with the epidemiological investigation and contact tracing, Spencer said.
The higher concentration of cases in Kigali is concerning, but also allows health officials to more efficiently roll out mitigation and contact tracing steps, he said, adding that it would be more worrisome of most cases were located at the borders of countries, such as the DRC and Burundi, that have weaker health systems.
Supportive care can save lives, and clinical capacity is excellent in Rwanda, Spencer said. “But building up and maintaining a strong cohort of providers for the long haul is always really really hard, especially as some fall ill.”
