Rwanda Credits Preparation and Innovation for Controlling Marburg Outbreak

ADF STAFF

Public health officials say Rwanda’s response to its recent Marburg virus outbreak demonstrates the benefit of preparedness and quick response.

Rwanda’s outbreak, which began in late September, is the latest surge of the virus after episodes last year in Equatorial Guinea and Tanzania that killed 17 people.

Rwanda’s first Marburg virus epidemic left more than 60 people infected and 15 dead across 30 districts of the country. However, Rwanda has one of Africa’s strongest health care systems and public health officials have been planning for a Marburg-type viral event since 2018. At the same time, Rwanda is benefitting from the ongoing development of multiple vaccines with the potential to treat Marburg infections.

“Rwanda also has a strong infectious disease surveillance system and a history of successfully containing outbreaks,” Jess Craig, a global health expert, wrote recently for Vox. “Like with Ebola, researchers can try to roll out a trial in the middle of an outbreak. That is exactly what public health officials and vaccine manufacturers are doing right now amid the emergency situation in Rwanda.”

Marburg outbreaks have been reported across Sub-Saharan Africa over the last 20 years, from Angola to Uganda. However, two-thirds of those cases struck Rwanda’s neighbors, the Democratic Republic of the Congo, Tanzania and Uganda.

Like the Ebola virus, Marburg is a zoonotic infection acquired from contact with infected animals that then moves among people. Marburg is less virulent than Ebola, but both are hemorrhagic infections that cause vomiting and weaken the walls of the victim’s blood vessels, leading them to bleed easily and excessively. Also like Ebola, Marburg spreads through contact with infected bodily fluids.

Historically, Marburg has had a fatality rate of 50%, rising to as high as 80% in some outbreaks. Medical treatments, including intravenous hydration and blood transfusions, can counter the virus’s effects long enough for some patients to survive it.

During outbreaks in Equatorial Guinea and Tanzania in 2023, 17 of the 24 infected patients died — a rate of 71%. Rwanda’s Marburg fatality rate, by comparison, is about 24%.

According to Rwandan health officials, most of their cases are connected to two hospitals in the capital, Kigali. Eighty percent of those infected have been health care workers, creating the risk that the disease might spread among hospitalized patients.

About 10 days after the outbreak began in late September, Rwanda’s health authorities began vaccinating people who had been in contact with victims, using several trial vaccines that had been qualified for use by the World Health Organization (WHO).

WHO Director-General Dr. Tedros Adhanom Ghebreyesus praised Rwanda’s rapid response to contain the outbreak. At a recent press briefing with Rwandan Health Minister Dr. Sabin Nsanzimana, Tedros reported that two patients whose conditions had required them to be placed on life support had recovered enough to breathe on their own — a first for Africa, he said.

“These patients would have died in previous outbreaks,” Tedros added.

Nsanzimana told Le Monde newspaper that the COVID-19 pandemic helped strengthen Rwanda’s disease screening capabilities. Jean-Claude Manuguerra, director of the Institut Pasteur’s Laboratory for Urgent Response to Biological Threats, said Rwanda’s response to Marburg reflects years of preparation by leaders there.

“Once we’re prepared, we can react more quickly, and waste less time making the diagnosis,” Manuguerra told Le Monde.

Researchers in Rwanda traced the Marburg outbreak to a single person who encountered an infected bat. All subsequent infections were closely related to that original infection. The 2024 Marburg strain shares a common ancestor with a 2014 Marburg outbreak, showing a limited amount of mutation over a decade, according to researchers.

Writing on X, Minister of State Yvan Butera described the lack of mutation as a good sign.

“While we found some mutations, none suggest the virus is spreading more easily or becoming more severe,” Butera wrote.