Rwanda Contains Marburg Outbreak but Preaches Need for Vigilance

ADF STAFF

Rwanda’s first-ever Marburg virus outbreak was brought under control quickly and produced substantially fewer deaths than outbreaks elsewhere, in part thanks to the government’s rapid, well-organized response, according to observers.

“We’re pleased to see that there have been no new cases in the past six days, and we hope that remains the case,” World Health Organization Director-General Tedros Adhanom Ghebreyesus told a news conference in Kigali on October 20. “But we are dealing with one of the world’s most dangerous viruses, and continued vigilance is essential.”

When Rwanda’s Marburg outbreak began in late September, the government launched its National Response Workforce to minimize transmission.

Rwanda’s Health Management Information System proved vital to detecting the outbreak early, identifying the source and responding quickly to limit the spread. The system was set up 15 years ago to collect and analyze data from the country’s 450 health centers each month.

The same system relies on more than 60,000 community health workers to be the eyes and ears of the health care system in local communities. Community health workers monitor health issues and promote early interventions as they form the first line of defense against disease outbreaks.

“Rwanda’s investment in public and private health infrastructure has also been critical,” analyst Sam Mandela Muzinga wrote recently in The New Times. Along with expanding its health care facilities, Rwanda has developed the technology needed to model disease spread on computers and track it in the real world.

Rwanda’s response to the disease shows that a rapid, urgent response can mitigate the severity of an outbreak, Angela Rasmussen, a virologist at the University of Saskatchewan in Saskatoon, Canada, told Nature magazine.

The country’s coordinated, multilevel response brought the disease under control in less than a month with a fatality rate of 24%. On average, Marburg kills 50% to 80% of its victims.

As of late October, Rwandan health officials documented 65 Marburg infections, the majority of which were among health care workers. Fifteen of those patients died. However, two infected patients were believed to be the first in Africa to recover from Marburg after spending time on life support.

Marburg outbreaks have appeared repeatedly across Sub-Saharan Africa over the past two decades, with two-thirds happening in the DRC, Tanzania and Uganda — all countries that border Rwanda. Before the Rwandan outbreak, Marburg infections killed 17 people last year in Equatorial Guinea and Tanzania.

Marburg is a zoonotic infection, like Ebola, that comes from contact with infected animals and then spreads from person to person. Like Ebola, Marburg spreads through contact with blood and other bodily fluids.

Rwandan Health Minister Dr. Sabin Nsanzimana told a news briefing in late October that health authorities had identified where the outbreak began: a cave where fruit bats live near a mining region. Nsanzimana said the genetics of the current Marburg strain resemble one discovered in 2014.

“The current focus for us is to ensure that these fruit bats living in caves are not interacting with humans,” Nsanzimana said. “And we also ensure that what happens here is very important information for public health or science that can be useful for other parts of the world.”

Although Marburg is less virulent than Ebola, both cause vomiting and weaken the walls of the victim’s blood vessels, leading them to bleed easily and excessively. Rwandan medical authorities treated patients with hydration and blood transfusions to give their bodies time to fight off the infection.

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 benefiting from the ongoing development of multiple vaccines with the potential to prevent Marburg infections.

Rwanda received thousands of doses of trial vaccines from several sources to test against the outbreak. On October 7, health officials began vaccinating front-line health workers and high-risk populations to ensure that they could respond effectively to the outbreak.

“Rwanda’s proactive measures in response to the Marburg virus outbreak demonstrate the country’s commitment to public health and safety,” the Health Ministry said in a statement. “The collaborative efforts of health authorities, international partners, and local communities are crucial in overcoming this challenge and ensuring a safer future for all.”