Given the increasing number of Marburg virus disease (MVD) survivors, the World Health Organization (WHO) is supporting the Government of Rwanda in the establishment of a programme for them, the UN agency said on October 11.
This, it indicated, can done by sharing technical guidance and protocols for the establishment of a related national programme, including exploring a potential prospective observational study.
Data from the Ministry of Health shows that since the announcement of the outbreak on September 27, 61 cases of Marburg virus had been confirmed as of October 11. They comprise 14 people who had died, 31 who were in isolation and receiving treatment, and 16 who recovered.
"The Ministry of Health is very interested in initiating a Marburg Survivor Programme in Rwanda. WHO will support this initiative with guidelines and SOPs (standard operating procedures), including protocols for laboratory testing of viral persistence in survivors,” the UN health agency stated in a weekly operational update on response to Marburg Virus Disease in Rwanda published on October 10.
Regarding care for MVD survivors, WHO observes that all survivors, their partners and families should be shown respect, dignity, and compassion.
It does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Marburg virus, warning that survivors of the disease might suffer from clinical and psychological sequelae – a condition which is the consequence of a previous disease.
WHO encourages affected countries to consider the establishment of a survivor care programme to alleviate sequelae, support to community reintegration and offer counselling and biological testing.
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Marburg virus is known to persist in immune-privileged sites in some people who have recovered. These sites include the testicles and the inside of the eye, according to WHO.
It indicated that Marburg virus transmission through infected semen has been documented up to seven weeks after clinical recovery.
To mitigate the risk of potential transmission through exposure to infected semen, a semen testing programme should be implemented to offer counselling to male MVD survivors and their sexual partners, as needed, to inform them on potential risk and support them in adhering to safer sex practices (including condom provision and good hand and personal hygiene); and to offer monthly semen testing until obtention of two consecutive negative test results.
After obtaining two consecutive negative test results, MVD survivors can safely resume normal sexual practices with minimised risk of Marburg virus transmission, WHO indicated. As noted, in the absence of a semen testing programme, male survivors should follow safer sex practices for 12 months.
MVD is a severe, often fatal disease in humans that can cause haemorrhagic fever. It has a case fatality ratio of up to 88 per cent but can be much lower with good and early patient care, according to WHO.