A big one outbreak of the Marburg virus in Rwanda is raising international concerns about the potential for spread beyond the country’s borders.
The number of cases discovered so far 27already makes the outbreak one of the largest involving Marburg. Nine of these people have died. There are currently no approved vaccines to combat the disease.
Most of the cases detected so far – more than 70% – involve healthcare workers working in two hospitals in the capital Kigali, home to 1.7 million people. Kigali is also a regional and international travel hub; flights from the city go to destinations in approximately 20 countries in Africa, the Middle East and Asia.
In a statement issued late Monday, the World Health Organization categorized the risk of spread to neighboring countries as high. It also suggested there is a risk of spread beyond East Africa.
One contact of a suspected case – the person currently believed to be the first case or index case in this outbreak – has even traveled to another country, the WHO said. His statement did not identify the country, but a slide mapping what is known about the chains of transmission posted on the social media site X called it Belgium. Sources told STAT that Belgian authorities had been alerted to the possibility that the person may have been in contact with a case. The WHO statement said that “appropriate response measures have been implemented” by the country in question.
“WHO assesses the risk of this outbreak as very high at the national level, high at the regional level and low at the global level,” the WHO said. “Investigations are ongoing to determine the full extent of the outbreak and this risk assessment will be updated as more information is received.”
Although the disease causes illness similar to that caused by its cousin virus, Ebola, outbreaks in Marburg have historically involved fewer than ten cases. Only two outbreaks with more than 100 cases have been reported. The largest ever Marburg outbreak occurred in 2004-2005 in Uije, Angola, where there were 252 confirmed cases and 227 deaths.
Experts suggest Rwanda’s advanced healthcare system is up to the challenge of tackling this outbreak.
“Rwanda has really become a standout in the region because of its contribution to healthcare and it’s clearly an improved response, not just to these kinds of things – outbreaks and preparedness – but also to chronic diseases and many other things that have affected the region a little bit ravaged. in recent history,” said Craig Spencer, associate professor at Brown University’s School of Public Health.
Spencer, who has worked with Médecins Sans Frontières (or Médecins Sans Frontières in French) on a number of Ebola outbreaks – and contracted Ebola during the 2014 West African outbreak – has done response work in Rwanda, but not recently. The country has built up its capabilities to the point where it normally no longer needs outside help, Spencer says. “Their health care system has become remarkably stronger.”
It is not clear how long the outbreak has been going on, or in which part of the country it started. Cases have been detected in seven of the country’s 30 districts. The Rwandan government is conducting contact tracing to identify people who have been exposed to confirmed cases and may be infected. So far, 300 contacts are being monitored.
In many places plagued by outbreaks of viral hemorrhagic fever – Ebola and Marburg fall into this disease category – cases emerging among healthcare workers may indicate an outbreak that has been smoldering in the community for some time and only becomes apparent when healthcare workers become infected. This is particularly the case when an outbreak begins in a remote environment with poor road links to other locations.
But Spencer said the level of Rwandan healthcare and the quality of the country’s road network could mean this is not the situation at play here. It is possible, he suggested, that early patients had sought care in Kigali.
While the idea of Marburg or Ebola cases in a major city is often a source of fear – the West African outbreak exploded when Ebola hit urban centers – it may be less problematic in this case, due to the response capacity that exists in Kigali . , he said.
That’s what the WHO reportedly sent a team of seven experts to Rwanda to help with the response. The Centers for Disease Control and Prevention, which has had an office in Rwanda for more than two decades, has also offered help.
The outbreak comes at a time when several neighboring countries of Rwanda are experiencing outbreaks of mpox. Spencer, who has also worked in Burundi and the Democratic Republic of Congo, said if the virus were to spread to those countries, controlling this outbreak would become significantly more challenging.
There are several experimental drugs and vaccines for Marburg, but none have been licensed so far. The relative rarity of Marburg outbreaks and their small size have made it impossible to test these products in the field until now.
While the two approved Ebola vaccines were sponsored by pharmaceutical giants Merck and Janssen (a division of Johnson & Johnson), the Marburg vaccines are in development by non-profit organizations, IAVI and the Sabin Institute.
Rwanda should agree to test vaccines or drugs in this outbreak. But even if it does, Mark Feinburg, president and CEO of IAVI, says it does not currently have any doses of its vaccine available for testing. STAT has asked the Sabin Institute if it has doses that can be tested, but has not yet received a response.
This article has been updated with a revised case count from the Rwandan Ministry of Health.