The Ministry of Health on Friday, September 27, announced that Marburg virus disease (MVD), a haemorrhagic fever, has been confirmed in a few patients in health facilities in the country. A related statement noted that investigations were being carried out to determine the origin of the infection. Hashyizweho Ingamba zo kwirinda no guhangana n'indwara y'umuriro mwinshi iterwa na virusi ya Marburg ---- Enhanced preventive measures implemented for viral fever pic.twitter.com/RonMVKYsyE — Ministry of Health | Rwanda (@RwandaHealth) September 27, 2024 The statement read: “Enhanced preventive measures are being implemented in all health facilities. Contact tracing is underway, and cases have been isolated for treatment. Such infections are transmitted through contact with blood and body fluids of people who are visibly sick. The virus is not believed to be transmitted by air. “Anyone experiencing symptoms such as a high fever, strong headaches, vomiting, muscle aches, and stomach aches should call Rwanda Biomedical Centre (RBC) on 114, or visit the nearest health facility. The Ministry of Health is closely monitoring the situation and will provide further updates on a regular basis. The public should continue with their usual activities while maintaining a high level of vigilance and hygiene.” What is Marburg virus disease? According to the World Health Organisation, marburg virus disease (MVD) is a severe, often fatal illness caused by the Marburg virus. The virus causes severe viral haemorrhagic fever in humans characterized by fever, headache, back pain, muscle pain, abdominal pain, vomiting, confusion, diarrhoea, and bleeding at very late stages. MVD was first identified in Marburg, Germany in 1967. Since then, there have been a limited number of outbreaks reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda. In 2023, two separate MVD outbreaks have been reported in two countries, Equatorial Guinea and the United Republic of Tanzania. While rare, MVD remains a severe public health threat due to its high mortality rate and the lack of an effective antiviral treatment or vaccine. Early symptoms The WHO notes that early symptoms of MVD can arise quickly after infection and may include high fever, chills, severe headache and severe tiredness. Muscle aches and pains are also common early symptoms. Symptoms become increasingly severe and can include nausea, vomiting, stomach and or chest pain, rash and diarrhoea which can last around a week. Late symptoms In later stages of the disease, according to WHO, bleeding from various sites such as the gums, nose and anus can occur. Patients can suffer shock, delirium and organ failure. The most reported MVD symptoms include: fever back pain muscle pain stomach-ache loss of appetite vomiting lethargy rash difficulty in swallowing headache diarrhoea hiccup difficulty breathing. How do people become infected with Marburg virus disease? People are initially infected with Marburg virus when they come in close contact with Rousettus bats, a type of fruit bat, that can carry the Marburg virus, and are often found in mines or caves, states the WHO. As noted, between humans, the virus is mainly transmitted through contact with the body fluids of infected people. It can spread through direct contact with body fluids (blood, faeces, vomit, saliva, urine, sweat, breast milk, semen, pregnancy fluids) of infected people or people who died from the disease, or from contact with surfaces or materials contaminated with these body fluids. The disease does not spread through the air. The virus often spreads to a family member or a local health worker who has cared for someone ill or who has died from MVD without proper protective equipment. People remain infectious as long as their blood contains the virus. This means patients must continue treatment at a dedicated health facility and wait for the laboratory test to confirm when they may safely return home. Rwanda Biomedical Centre (RBC) developed a comprehensive guideline for the detection and management of Viral Haemorrhagic Fevers (VHFs) in response to the increased frequency of emerging and re-emerging diseases across Africa. As noted, the VHFs are a group of epidemic-prone diseases caused by distinct families of highly infectious RNA viruses, characterized by sudden onset of symptoms such as muscle and joint pain, fever, and, in severe cases, bleeding from orifices and internal organs. With Rwanda being vulnerable to cross-border transmission from neighboring countries facing multiple outbreaks, the guideline aims to equip health workers with the necessary knowledge, skills, and practices to safely prevent, prepare for, and respond to VHF outbreaks in both health facilities and the community. According to the World Health Organization (WHO), given their capacity to cause high-fatality epidemics and the lack of specific treatments or vaccines for most VHFs (except yellow fever), these diseases pose a major public health challenge globally. ALSO READ: Regional health experts meet over deadly fevers Rwandan health officials have prioritised seven VHFs for prevention, control, and response for Rift Valley fever (RVF), Ebola disease, Marburg, yellow fever, Crimean-Congo hemorrhagic fever (CCHF), dengue fever, and chikungunya. The prioritisation is based on the complexity, severity, spread, and past outbreaks of these diseases in the region. As noted, several factors contribute to the emergence and re-emergence of VHFs in Africa, including unplanned urbanization, climate change, increased travel, and the spread of disease vectors. For Rwanda, the risk is further heightened due to its proximity to countries experiencing VHF outbreaks. Rwanda witnessed a large outbreak of Rift Valley fever in 2022, affecting both humans (125 confirmed cases, 22 deaths) and animals (1,339 cases, 516 deaths). A national risk assessment conducted in 2023 ranked RVF as a “very high” risk, Ebola disease as “high” and Marburg as “moderate.” With these risks, RBC’s guideline emphasises the need for early detection, laboratory testing, and effective infection control measures. The primary objectives of the RBC guideline include strengthening surveillance through sentinel sites, improving case management, and enhancing infection prevention and control (IPC) practices.
