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Rwanda Marburg virus disease outbreak

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Rwanda marburg disease outbreak
Initial case: 28 September 2024[1]
Map of Rwanda
Confirmed cases65[2]
Deaths15[2]
Notice in place to prevent the spread of Marburg virus in Rwanda, Kigali

The first-ever outbreak of Marburg virus disease (MVD) in Rwanda was reported to the World Health Organization (WHO) on 28 September 2024.[1][3][4] The outbreak is one of the biggest Marburg outbreaks ever documented. Most cases were in healthcare workers, especially those working in intensive care units. Cases have been reported in seven of the 30 districts with three districts in Kigali Province reporting the highest number. As of 10 October 2024, there were 58 confirmed cases and 13 fatalities. The outbreak was declared over by the WHO and the Rwandan government on 20 December 2024 after no new cases were reported in the preceding 42 days.

Background

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Transmission electron micrograph of Marburg virus

Marburg virus disease is a viral hemorrhagic fever which affects people and primates. The disease can cause serious illness or death.[5] The virus was first discovered in 1967 after outbreaks in Marburg and Frankfurt, Germany, which had been linked to lab work involving African green monkeys from Uganda.[6] Since then outbreaks have been recorded in Uganda, Guinea, Ghana, Equatorial Guinea, and Tanzania.[5]

Marburg virus can be transmitted to humans from fruit bats, and spreads through human-to-human contact, typically via bodily fluids and contaminated medical equipment.[7]

The fatality rate of Marburg virus disease is around 50 percent, but it can vary from 24 to 88 percent depending on several factors.[8]

In contrast to Ebola which has an Ebola vaccine,[9] there is no treatment or vaccine for MVD.[5] This is due to the economics of vaccines, and the fact that until the mid-2010s, there were few fatalities from filovirusses.[10] There are a number of candidate vaccines against Marburg virus disease. Legal monopolies are hindering production and testing of candidate vaccines.[11][12][13]

Epidemiology

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The index case for the outbreak is believed to be a 27-year-old man who was being treated at King Faisal Hospital in Kigali after being exposed to the virus from contact with bats.[14]

On 28 September 2024, the World Health Organization was informed of a first ever Marburg virus disease outbreak in Rwanda.[15] On that day, there were already 26 known cases, mostly in healthcare workers, eight of which had been fatal.[1][15][16][17][18][excessive citations]

As of 3 October 2024, there were 36 confirmed cases, at least 19 of whom were healthcare workers, most of them working in intensive care units,[19] and 11 people reportedly died of the infection,[20]

On 6 October 2024, there were 49 confirmed cases and 12 deaths,[21] and on October 7, 56 cases out of 2387 tests carried out.[22] As of 10 October 2024, there were 58 confirmed cases and 13 dead.[23]

On 20 October, authorities said that there was no community transmission of disease after no new cases were recorded in the preceding six days.[14]

As of 30 October 2024, Rwanda has recorded 66 illnesses and 15 deaths from Marburg while 75 percent of patients with Marburg had recovered.[24]

On 8 November 2024, the last patient to be treated for Marburg was released from hospital. On 20 December 2024, the WHO and the Rwandan government declared an end to the outbreak after no new cases were reported in the preceding 42 days.[25]

Geography

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As of October 3, cases had been reported in seven of the 30 districts in Rwanda. Three districts in Kigali Province reported the highest number of cases, namely Gasabo District, Kicukiro District and Nyarugenge District. Other districts included Nyagatare District and Gatsibo District in the Northeast, which border Tanzania, site of the 2023 Tanzania Marburg virus disease outbreak as well as Rubavu District in the Northwest bordering Democratic Republic of the Congo and Kamonyi District, which is adjacent to Kigali in the center.[19]

Responses

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The U.S. embassy in Rwanda issued an alert on the matter on 29 September 2024[26] and advised staff to work remotely.[27]

Contact tracing was started, and as of 3 October, 3,000 people were being monitored because they came in contact with the infected individuals.[19]

The WHO advised against travel and for trade restrictions with Rwanda.[28][29][30] The Centers for Disease Control issued a travel alert,[31] which was criticised as "unnecessary" and made without input from local authorities by Africa Centres for Disease Control and Prevention director-general Jean Kaseya, citing the Rwandan government's rapid response to the outbreak.[32]

Gilead Sciences donated 5,000 vials of remdesivir as emergency treatment.[33]

On 6 October 2024, Rwandan health minister Sabin Nsanzimana confirmed that the country had received about 700 vaccine doses to be used in trial, which will be distributed on a priority basis starting with healthcare workers, the frontline response team and individuals who were in contact with the confirmed cases.[34] These trial vaccines were delivered by the Sabin Vaccine Institute as a support by the government of US and international partners.[35] As of 14 October, more than 200 people have been vaccinated.[36]

On 31 October 2024, the Sabin Vaccine Institute dispatched 1,000 additional investigational vaccine doses for a randomized clinical trial arm within an ongoing open-label study.[37][38] As of end of October, more than 1,500 frontline workers had been vaccinated in Rwanda with the Sabin vaccine.[38]

See also

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References

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  1. ^ a b c "Rwanda reports first-ever Marburg virus disease outbreak, with 26 cases confirmed". World Health Organization Africa. 28 September 2024. Archived from the original on 28 September 2024. Retrieved 29 September 2024.
  2. ^ a b "Marburg virus". rbc.gov. Retrieved 28 October 2024.
  3. ^ "Marburg virus kills 6 in Rwanda, health minister says". Voice of America. Reuters. 28 September 2024. Archived from the original on 29 September 2024. Retrieved 29 September 2024.
  4. ^ "Rwanda: Marbug virus has killed several people; WHO plans to send medical aid". Africanews. 29 September 2024. Retrieved 29 September 2024.
  5. ^ a b c "About Marburg Disease". CDC. 1 May 2024. Archived from the original on 27 September 2024. Retrieved 29 September 2024.
  6. ^ Brauburger, Kristina; Hume, Adam J.; Mühlberger, Elke; Olejnik, Judith (1 October 2012). "Forty-Five Years of Marburg Virus Research". Viruses. 4 (10): 1878–1927. doi:10.3390/v4101878. ISSN 1999-4915. PMC 3497034. PMID 23202446.
  7. ^ "Marburg Haemorrhagic Fever". World Health Organization Africa. 27 September 2024. Retrieved 29 September 2024.
  8. ^ "Marburg virus disease". www.who.int. Archived from the original on 2020-04-11. Retrieved 2024-09-29.
  9. ^ "Ebola Vaccine Product Information". CDC. 12 August 2024. Archived from the original on 27 September 2024. Retrieved 29 September 2024.
  10. ^ Reynolds P, Marzi A (August 2017). "Ebola and Marburg virus vaccines". Virus Genes. 53 (4): 501–515. doi:10.1007/s11262-017-1455-x. PMC 7089128. PMID 28447193.
  11. ^ "MSF's response to CEPI's policy regarding equitable access". Médecins Sans Frontières Access Campaign. September 25, 2018. Archived from the original on March 21, 2021. Retrieved April 10, 2020. In vaccine development, access to know how is important. Knowledge and expertise including but not limited to purification techniques, cell lines, materials, software codes and their transfer of this to alternative manufacturers in the event the awardee discontinues development of a promising vaccine is critically important. The recent example of Merck abandoning the development of rVSV vaccines for Marburg (rVSV-MARV) and for Sudan-Ebola (rVSV-SUDV) is a case in point. Merck continues to retain vital know-how on the rVSV platform as it developed the rVSV vaccine for Zaire-Ebola (rVSV-ZEBOV) with funding support from GAVI. While it has transferred the rights on these vaccines back to Public Health Agency of Canada, there is no mechanism to share know how on the rVSV platform with other vaccine developers who would like to also use rVSV as a vector against other pathogens.
  12. ^ "Why It's So Difficult to Develop a Shot for Ebola-like Marburg Virus". Bloomberg UK. 4 October 2024.
  13. ^ "An Ebola-like virus is spreading in Rwanda. Why isn't there an approved vaccine for Marburg?". Vox. 4 October 2024.
  14. ^ a b "Rwanda says no community transmission of Marburg virus, with zero new infections in recent days". Associated Press. 20 October 2024.
  15. ^ a b Volkmer, Anna (2 October 2024). "Marburg virus: First cases in Rwanda spark international alarm". British Medical Journal. 387: q2155. doi:10.1136/bmj.q2155. ISSN 1756-1833. PMID 39357913.
  16. ^ "Rwanda reports first-ever Marburg virus disease outbreak, with 26 cases confirmed". ReliefWeb. 29 September 2024. Retrieved 29 September 2024.
  17. ^ Nair, Devika; Girinema, Philbert (28 September 2024). Wallis, Daniel (ed.). "Six people died of Marburg virus in Rwanda, health minister says". Reuters. Retrieved 29 September 2024.
  18. ^ Ssuuna, Ignatius (October 1, 2024). "Rwanda reports 8 deaths linked to Ebola-like Marburg virus days after it declared an outbreak". Associated Press. Retrieved October 2, 2024.
  19. ^ a b c Health Alert Network (HAN) (2024-10-03). "First Marburg Virus Disease Outbreak in the Republic of Rwanda". emergency.cdc.gov. Retrieved 2024-10-04.
  20. ^ "Marburg virus death toll in Rwanda rises to 11 as travellers in Germany test negative". Euronews. 3 October 2024. Eleven people have died in Rwanda as the African country continues to fight an outbreak of Marburg virus. The Rwandan government said there were 36 confirmed cases of the virus in its latest update, with 25 people in isolation.
  21. ^ Rwanda Biomedical Centre (2024-10-06). "Marburg Virus Update".
  22. ^ Rwanda Biomedical Centre (2024-10-07). "Marburg virus update".
  23. ^ Sidik, Saima (2024-10-08). "Lethal Marburg virus is on the rise in Rwanda: why scientists are worried". Nature. 634 (8034): 522–523. Bibcode:2024Natur.634..522S. doi:10.1038/d41586-024-03275-8. PMID 39384913.
  24. ^ CDC (2024-10-31). "Marburg Outbreak in Rwanda Situation Summary". Marburg Virus Disease. Retrieved 2024-11-01.
  25. ^ "Rwanda and WHO declare end of Marburg outbreak after no new cases reported". Associated Press. 20 December 2024. Retrieved 20 December 2024.
  26. ^ "Health Alert – U.S. Embassy Kigali". U.S. Embassy in Rwanda. 28 September 2024. Retrieved 29 September 2024.
  27. ^ "Rwanda's Marburg outbreak is under control, Africa's health chief says". Associated Press. 11 October 2024. Retrieved 11 October 2024.
  28. ^ "Travel warning as eight die from incurable Marburg virus". The Independent. 3 October 2024. Based on the current risk assessment, WHO advises against any travel and trade restrictions with Rwanda.
  29. ^ "UK tourists warned 'do not travel' over incurable virus which has killed nine". Birmingham Live. 2 October 2024. A "do not travel" warning has been issued to UK tourists after nine died of an incurable virus. The World Health Organisation has warned people are being advised not to visit the country and to watch out for symptoms amid a "high risk".
  30. ^ "Travellers given warning as incurable disease spreads after eight die". Daily Record. 1 October 2024. The World Health Organisation has issued a 'high' risk warning after 26 cases and eight fatalities were linked to the spread of the deadly and incurable Marburg Virus Disease. Efforts are under way to trace 300 individuals who may have been in contact with those infected.
  31. ^ "Marburg in Rwanda - Level 2 - Practice Enhanced Precautions". Travelers' Health. CDC. Retrieved 2024-10-05.
  32. ^ "Travel bans unnecessary as Rwanda's Marburg fever situation improves". Africanews. October 11, 2024. Retrieved October 14, 2024.
  33. ^ Ntirenganya, Emmanuel (2024-10-05). "What is Remdesivir, the drug Rwanda will use for Marburg virus response?". The New Times. Retrieved 2024-10-06.
  34. ^ Umutesi, Alice (2024-10-06). "Rwanda gets 700 vaccine doses for Marburg virus". The New Times. Retrieved 2024-10-07.
  35. ^ "US ships Marburg vaccines to Rwanda after 11 die in outbreak". Reuters. October 5, 2024. Retrieved October 5, 2024.[dead link‍]
  36. ^ "Rwanda Marburg Outbreak: Health Minister says situation is under control as vaccines underway". Africanews. October 14, 2024. Retrieved October 14, 2024.
  37. ^ Hamer, M. J.; et al. (2023). "Safety, tolerability, and immunogenicity of the chimpanzee adenovirus type 3-vectored Marburg virus (cAd3-Marburg) vaccine in healthy adults in the USA: a first-in-human, phase 1, open-label, dose-escalation trial". Lancet. 401 (10373): 294–302. doi:10.1016/S0140-6736(22)02400-X. PMC 10127441. PMID 36709074.
  38. ^ a b "Sabin Vaccine Institute: Sabin Sends More Marburg Vaccines for Rwanda's Outbreak". FinanzNachrichten.de (in German). Retrieved 2024-11-01.
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