Rwanda Marburg virus disease outbreak

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

Contents

Background

Transmission electron micrograph of Marburg virus Marburg virus.jpg
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

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

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

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

Related Research Articles

<span class="mw-page-title-main">Marburg virus disease</span> Human viral disease

Marburg virus disease (MVD), formerly Marburg hemorrhagic fever (MHF) is a viral hemorrhagic fever in human and non-human primates caused by either of the two Marburgviruses: Marburg virus (MARV) and Ravn virus (RAVV). Its clinical symptoms are very similar to those of Ebola virus disease (EVD).

The species Sudan ebolavirus is a virological taxon included in the genus Ebolavirus, family Filoviridae, order Mononegavirales. The species has a single virus member, Sudan virus (SUDV). The members of the species are called Sudan ebolaviruses. It was discovered in 1977 and causes Ebola clinically indistinguishable from the ebola Zaire strain, but is less transmissible than it. Unlike with ebola Zaire there is no vaccine available.

<span class="mw-page-title-main">Marburg virus</span> Species of filamentous virus responsible for hemorrhagic fever

Marburg virus (MARV) is a hemorrhagic fever virus of the Filoviridae family of viruses and a member of the species Marburg marburgvirus, genus Marburgvirus. It causes Marburg virus disease in primates, a form of viral hemorrhagic fever. The World Health Organization (WHO) rates it as a Risk Group 4 Pathogen. In the United States, the National Institute of Allergy and Infectious Diseases ranks it as a Category A Priority Pathogen and the Centers for Disease Control and Prevention lists it as a Category A Bioterrorism Agent. It is also listed as a biological agent for export control by the Australia Group.

<span class="mw-page-title-main">Ebola</span> Viral hemorrhagic fever of humans and other primates caused by ebolaviruses

Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a viral hemorrhagic fever in humans and other primates, caused by ebolaviruses. Symptoms typically start anywhere between two days and three weeks after infection. The first symptoms are usually fever, sore throat, muscle pain, and headaches. These are usually followed by vomiting, diarrhoea, rash and decreased liver and kidney function, at which point some people begin to bleed both internally and externally. It kills between 25% and 90% of those infected – about 50% on average. Death is often due to shock from fluid loss, and typically occurs between six and 16 days after the first symptoms appear. Early treatment of symptoms increases the survival rate considerably compared to late start. An Ebola vaccine was approved by the US FDA in December 2019.

<span class="mw-page-title-main">Western African Ebola epidemic</span> 2013–2016 major disease outbreak

The 2013–2016 epidemic of Ebola virus disease, centered in West Africa, was the most widespread outbreak of the disease in history. It caused major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and Sierra Leone. The first cases were recorded in Guinea in December 2013; the disease spread to neighbouring Liberia and Sierra Leone, with minor outbreaks occurring in Nigeria and Mali. Secondary infections of medical workers occurred in the United States and Spain. Isolated cases were recorded in Senegal, the United Kingdom and Italy. The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources.

rVSV-ZEBOV vaccine Vaccine against Ebola virus disease

Recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV), also known as Ebola Zaire vaccine live and sold under the brand name Ervebo, is an Ebola vaccine for adults that prevents Ebola caused by the Zaire ebolavirus. When used in ring vaccination, rVSV-ZEBOV has shown a high level of protection. Around half the people given the vaccine have mild to moderate adverse effects that include headache, fatigue, and muscle pain.

<span class="mw-page-title-main">Ebola virus epidemic in Guinea</span> 2013–2016 disease outbreak in Guinea

An epidemic of Ebola virus disease in Guinea from 2013 to 2016 represented the first-ever outbreak of Ebola in a West African country. Previous outbreaks had been confined to several countries in Sub-Saharan Africa.

<span class="mw-page-title-main">Ebola vaccine</span> Vaccine against Ebola

Ebola vaccines are vaccines either approved or in development to prevent Ebola. As of 2022, there are only vaccines against the Zaire ebolavirus. The first vaccine to be approved in the United States was rVSV-ZEBOV in December 2019. It had been used extensively in the Kivu Ebola epidemic under a compassionate use protocol. During the early 21st century, several vaccine candidates displayed efficacy to protect nonhuman primates against lethal infection.

<span class="mw-page-title-main">Ebola in Nigeria</span>

Cases of the Ebola virus disease in Nigeria were reported in 2014 as a small part of the epidemic of Ebola virus disease which originated in Guinea that represented the first outbreak of the disease in a West African country. Previous outbreaks had been confined to countries in Central Africa.

<span class="mw-page-title-main">Ring vaccination</span> Strategy to inhibit the spread of a disease by vaccinating those most likely to be infected

Ring vaccination is a strategy to inhibit the spread of a disease by vaccinating those who are most likely to be infected.

<span class="mw-page-title-main">2017 Democratic Republic of the Congo Ebola outbreak</span> Disease outbreak in the Democratic Republic of the Congo

On 11 May 2017, the Democratic Republic of the Congo (DRC) was identified by the World Health Organization (WHO) as having one Ebola-related death.

<span class="mw-page-title-main">2017 Uganda Marburg virus outbreak</span> Disease outbreak in Uganda

The 2017 Uganda Marburg virus outbreak was confirmed by the World Health Organization (WHO) on 20 October 2017 after there had been an initial fatality due to the virus.

<span class="mw-page-title-main">2018 Équateur province Ebola outbreak</span> Disease outbreak in the Democratic Republic of the Congo

The 2018 Équateur province Ebola outbreak occurred in the north-west of the Democratic Republic of the Congo (DRC) from May to July 2018. It was contained entirely within Équateur province, and was the first time that vaccination with the rVSV-ZEBOV Ebola vaccine had been attempted in the early stages of an Ebola outbreak, with a total of 3,481 people vaccinated. It was the ninth recorded Ebola outbreak in the DRC.

<span class="mw-page-title-main">Kivu Ebola epidemic</span> Ebola virus outbreak in the eastern DRC from 2018 to 2020

The Kivu Ebola epidemic was an outbreak of Ebola virus disease (EVD) mainly in eastern Democratic Republic of the Congo (DRC), and in other parts of Central Africa, from 2018 to 2020. Between 1 August 2018 and 25 June 2020 it resulted in 3,470 reported cases. The Kivu outbreak also affected Ituri Province, whose first case was confirmed on 13 August 2018. In November 2018, the outbreak became the biggest Ebola outbreak in the DRC's history, and had become the second-largest Ebola outbreak in recorded history worldwide, behind only the 2013–2016 Western Africa epidemic. In June 2019, the virus reached Uganda, having infected a 5-year-old Congolese boy who entered Uganda with his family, but was contained.

<span class="mw-page-title-main">COVID-19 pandemic in Rwanda</span>

The COVID-19 pandemic in Rwanda was a part of the ongoing worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. The virus was confirmed to have reached Rwanda in March 2020. Rwanda's response to the pandemic has received international praise for its effectiveness. Despite limited resources, the country's well organised healthcare system, rapid deployment of testing procedures and high public trust in medical authorities have led to a successful public health response. As of 15 December 2021, there were 100,763 total confirmed cases, 1,344 confirmed deaths, 7 million first vaccine shots, and 1 critical case.

<span class="mw-page-title-main">2022–2023 Uganda Ebola outbreak</span> Disease outbreak in East Africa

The 2022–2023 Uganda Ebola outbreak was an outbreak of the Sudan ebolavirus, which causes Ebola, from 20 September 2022 until 10 January 2023 in the Western and Central Regions of Uganda. Over 160 people were infected, including 77 people who died. It was Uganda's fifth outbreak with Sudan ebolavirus. The Ugandan Ministry of Health declared the outbreak on 20 September 2022. As of 25 October 2022, there were confirmed cases in the Mubende, Kyegegwa, Kassanda, Kagadi, Bunyanga, Kampala and Wakiso districts. As of 24 October 2022, there were a total of 90 confirmed or probable cases and 44 deaths. On 12 October, the first recorded death in the capital of Kampala occurred; 12 days later on 24 October, there had been a total of 14 infections in the capital in the last two days. On 11 January 2023 after 42 days without new cases the outbreak was declared over.

<span class="mw-page-title-main">2023 Equatorial Guinea Marburg virus disease outbreak</span> Marburg disease outbreak in Equatorial Guinea

A disease outbreak was first reported in Equatorial Guinea on 7 February 2023 and, on 13 February 2023, it was identified as being Marburg virus disease. It was the first time the disease was detected in the country. As of 4 April 2023, there were 14 confirmed cases and 28 suspected cases, including ten confirmed deaths from the disease in Equatorial Guinea. On 8 June 2023, the World Health Organization declared the outbreak over. In total, 17 laboratory-confirmed cases and 12 deaths were recorded. All the 23 probable cases reportedly died. Four patients recovered from the virus and have been enrolled in a survivors programme to receive psychosocial and other post-recovery support.

The 2023 Tanzania Marburg virus disease outbreak lasted from March until June. It was first reported on 21 March 2023 by the Ministry of Health of Tanzania and the first time that Tanzania reported an outbreak of Marburg virus disease. On 2 June 2023, Tanzania declared the outbreak over.

A Marburg vaccine would protect against Marburg virus disease (MVD). There are currently no Food and Drug Administration-approved vaccines for the prevention of MVD. Many candidate vaccines have been developed and tested in various animal models. There is not yet an approved vaccine, because of economic factors in vaccine development, and because filoviruses killed few before the 2010s.

References

  1. 1 2 3 "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. 1 2 "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. 1 2 3 "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. 1 2 "Rwanda says no community transmission of Marburg virus, with zero new infections in recent days". Associated Press . 20 October 2024.
  15. 1 2 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. 1 2 3 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. 1 2 "Sabin Vaccine Institute: Sabin Sends More Marburg Vaccines for Rwanda's Outbreak". FinanzNachrichten.de (in German). Retrieved 2024-11-01.
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