Marburg Virus Disease in Rwanda, 2024 — Public Health and Clinical Responses
Sabin Nsanzimana, Eric Remera, Menelas Nkeshimana, Ryan P. Westergaard, Tsion Firew, Muhammed Semakula, Eric Seruyange, Kara L. Neil, Marrigje Jacoba Kreuger, Abebe Bekele, Joseph Biramahire, Anselme Bizimana, Brian Chirombo, Janet Dı́az, Germaine Dushimimana, William A. Fischer, Thomas E. Fletcher, Robert Fowler, Michel R. Gatera, Ruggero Giuliani, Jacob A. Goldberg, Fidele Hakorimana, Richard Hatchett, Zainab Ingabire, Lambert Ingabire, Annick Ishimwe, Gisèle Isingizwe, Frédérique Jacquérioz, Etienne Kayigi, Serge Kazindu, A. Manirafasha, Edward J. Mills, Hassan Mugabo, Isabelle Mukagatare, Janvier Murayire, Clarisse Musanabaganwa, Evariste Mushuru, Léon Mutesa, Claude Mambo Muvunyi, Raissa Muvunyi, Louise Mwiseneza, Ernest Nahayo, Vincent Ndayiragije, Halifa Ndayisabye, Gentil Semahoro Ndayishimiye, Jean Claude Semuto Ngabonziza, Marie Grace Niwemuhoza, Nicolas Niyigaba, Patrick Niyonshuti, Marie Grace Niyonizeye, Olivier Nsekuye, Déo Kimalarungu Ntakambirwa, Emmanuel Ntawuyirusha, Jean Baptiste Ntihumbya, Gaston Nyirigira, Amanda Rojek, Athanase Rukundo, Jean Paul Rwabihama, Fernand Rwamwejo, Gloria Shumbusho, Jean Pierre Sibomana, David Turatsinze, Doris Uwamahoro, François Xavier Uwimana, Yvan Butera, Théogène Twagirumugabe, Edson Rwagasore
Abstract
BACKGROUND: On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals. METHODS: We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents. RESULTS: Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3-vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial. CONCLUSIONS: Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.