On 27 September 2024 the Rwanda Ministry of Health confirmed that an outbreak of Marburg Virus Disease was present in the country, following the detection of the Virus in the blood of two patients by real-time reverse transcription polymerase chain reaction analysis at the National Reference Laboratory of the Rwanda Biomedical Center, according to a press release issued by the World Health Organization on 30 September 2024.
As of 29 September 2024, 26 cases of the disease have been reported in seven of the country's thirty districts (Gasabo, Gatsibo, Kamonyi, Kicukiro, Nyagatare, Nyarugenge and Rubavu), with eight people having died of the disease, a case fatality rate of 31%. The majority of the patients are healthcare workers from two health facilities in Kigali; this is not uncommon with outbreaks of the Marburg and Ebola viruses, with the highly transmittable nature of these diseases often resulting in aa high mortality rate in healthcare workers around the initial locus of the outbreak.
Contract tracing has led to the screening of about 300 contacts of diagnosed patients, one of whom had travelled to Belgium, with all found to be healthy and not a threat to public health. The initial source of the outbreak is still under investigation.
Marburg Virus Disease is a haemorrhagic fever, similar to the closely related Ebola Virus Disease. Both are caused by single-strand negative-sense RNA viruses of the Filoviridae family. Both are easily spread though contact with bodily fluids, and can also spread by contaminated clothing and bedding.
Marburg Virus has an incubation period of between two and 21 days, manifesting at first as a high fever, combined with a severe headache and a strong sense of malaise. This is typically followed after about three days by severe abdominal pains, with watery diarrhoea and vomiting. In severe cases the disease develops to a haemorrhagic stage after five-to-seven days, manifesting as bleeding from some or all bodily orifices. This typically leads to death on day eight or nine, from severe blood loss and shock. There is currently no treatment or vaccine available for Marburg Virus, although a number of teams are working on trying to develop vaccines.
Previous outbreaks of Marburg Virus have been reported in Rwanda, as well as the neighbouring Democratic Republic of Congo and Tanzania. The Virus has also been reported in a number of other African countries, including Angola, Equatorial Guinea, Ghana, Guinea, Kenya, and South Africa. The most recent outbreaks occurred in January 2023, with unrelated epidemics in Tanzania and Equatorial Guinea.
The high rate of infection of healthcare workers seen in Marburg Virus is particularly alarming, as this tends to weaken communities ability to resist the Virus. The Virus can spread quickly in healthcare settings, infecting people whose immune systems are already stressed by other conditions, and creating aa reserve which can feed infections in the wider community. This makes it important to screen all people potentially infected with the disease as quickly as possible, and to arrange for patients to be treated in isolation, as well as quickly tracing all known contacts of any cases, and screening them for infection too.
Marburg Virus is a zoonotic infection (disease transferred from Animals to Humans), with a wild-reserve of the Virus known to be present in Egyptian Fruit Bats, Rousettus aegyptiacus, which are found across much of Africa, the Mediterranean region, the Middle East, and South Asia. These Bats form large colonies in caves or sometimes mines. They are frugivores, and can be major pests of farmed fruits, bringing them into conflict with Humans, and are sometimes hunted for food, all of which create potential avenues for the Marburg Virus to pass from a Bat host to a Human one.
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