Rwanda Marburg virus disease outbreak

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Rwanda Marburg disease outbreak
Initial case: 28 September 2024[1]
Declared finished 20 December, 2024[2]
Map of Rwanda
Districts with Marburg cases, by province[3]
Confirmed cases66[4]
Deaths15[5]

Rwanda is currently experiencing its first-ever outbreak of Marburg virus disease (MVD).[6][7] The outbreak was first reported to the World Health Organization on September 28, 2024.[1][8][9] The U.S. embassy in Rwanda has issued an alert on the matter.[10] Currently the risk to the U.S. is low.[11]

The index case (the first documented patient in a disease epidemic within a population[12]), was unknown until 20 October; it is believed to be a 27-year-old man who was being treated at King Faisal Hospital in Kigali after being exposed to the virus from contact with bats.[13] On 6 October it was reported that the CDC would begin screening for travelers who have been to Rwanda in the last 21 days.[14] Furthermore, such flights would only be taken at New York JFK, Chicago O’Hare or Washington Dulles as special screening facilities exist at these airports.[15]It is currently the third biggest Marburg virus disease outbreak ever.[16] On 20 December, 2024 the WHO declared it over[17]

Epidemiology

Kigali

Three districts in Kigali Province reported the highest number of cases,[11] on 28 September 2024, the World Health Organization informed of a Marburg virus outbreak in Rwanda. Currently there are 26 known cases, 6 of which have been fatal.[1][18] Cases of the virus have been reported in seven districts of Rwanda.[1][19]

Contact tracing efforts are being made, and 161 people are being monitored because they came in contact with the infected individuals.[1]

On 1 October it was reported that the cases had risen to 36 with 11 fatalities.[20] Additionally, there are now more than 300 individuals being observed via contact tracing.[21]

On 6 October the Washington Post, among other media outlets, indicated there were now 46 confirmed cases and 12 deaths in Rwanda.[22][23] On 8 October this number has risen to 56 confirmed cases and 36 individuals in isolation(the fatalities have not changed) per the Rwanda Ministry of Health.[24]

On 9 October it was reported that the country of Rwanda had established a banned of anyone exposed to the Marburg virus from leaving the country. All travelers must complete a questionnaire prior to departing, so if you have been in contact with an infected individual you must wait 21 days before leaving(which is the incubation period).[25]

On 11 October it was reported that the Africa CDC indicated Rwanda's Marburg outbreak was now under control,[26] however in spite of this it was reported on the same day that a further 3 cases and another fatality had occurred.[27]

On 17 October it was reported by the Ministry of Health of Rwanda that 38 individuals had recovered from the viral infection.[28] Per WHO there are currently 800 individuals under follow up (contact tracing).[29]

On 20 October it was reported that only 3 people are still in isolation the rest have recovered. Per WHO the end of the outbreak would need, " [a] declaration can only be made after 42 days - two consecutive incubation periods - without a new confirmed case" per Tedros Adhanom Ghebreyesus, the head of the World Health Organization.[30][31]

On 24 October it was reported that a new case of Marburg virus disease was diagnosed, now the total is 63 cases.[32]The next day a further new case was identified by the Ministry of Health[33]

On 26 October the Ministry of Health indicated that the total cases had climbed to 65 individuals, with 5,239 diagnostic tests done so far.[34]

On 31 October another case was added (66 cases) and the diagnostic tests are approaching 6,000 at this point.[4]

On 9 November the WHO indicated that Rwanda had discharged the last individual that had been infected with Marburg virus disease. This starts the mandatory 42-day countdown to declare the outbreak over.[35]

On 2 December the CDC released a situation summary that indicated, "WHO and Rwandan health authorities could declare the outbreak officially over on December 22, 2024", should no further cases arise.[36] The WHO declared the outbreak over on 20 December, 2024[2]

Virology

Further information: Marburg virus

Marburg virus disease is a viral hemorrhagic fever which affects people and primates. The disease can cause serious illness or death.[37]

Marburg virus can be transmitted to humans from fruit bats, and spreads through human-to-human contact, typically via bodily fluids and contaminated medical equipment.[38]

The fatality rate of Marburg virus disease is around 50 percent, but it can vary from 24 to 88 percent depending on several factors.[39]

In contrast to Ebola which has a vaccine,[40] there is no treatment or vaccine for MVD.[37]

Per a Nature article dated 24 October, the article states that," [the] virus strain is closely related to one detected in Uganda in 2014". Additionally the article indicates that, " [it was] sparked by a single jump of the pathogen from an animal to human" [41]

  • Scanning electron micrograph of Marburg virus particles (pink) both budding and attached to the surface of an infected VERO E6 cell[42]

    Scanning electron micrograph of Marburg virus particles (pink) both budding and attached to the surface of an infected VERO E6 cell[42]

  • Marburg virus liver injury(CDC)

    Marburg virus liver injury(CDC)

  • Transmission electron micrograph of Marburg virus

    Transmission electron micrograph of Marburg virus

History

Further information: Marburg virus disease

The Marburg virus was first discovered in 1967 after outbreaks in Marburg and Frankfurt, Germany. These outbreaks had been linked to lab work involving African green monkeys from Uganda.[43][44]

Some of the more recent outbreaks are listed:

Recent Marburg virus disease outbreaks [45]
Year Country Virus Human cases Human deaths Case fatality rate Notes
2012  Uganda MARV 18 9 50% [46][47]
2014  Uganda MARV 1 1 100% [48][49]
2017  Uganda MARV 3 3 100% [50]
2021  Guinea MARV 1 1 100% [51][52][53]
2022  Ghana MARV 3 2 66.66% [54]
2023  Equatorial Guinea MARV 40 35 88% [55][56][57]
2023  Tanzania MARV 9 6 66% [58][59]

Research

Vaccine

There is a candidate vaccine against the Marburg virus called rVSV-MARV. It was developed alongside vaccines for closely-related Ebolaviruses by the Canadian government in the early 2000s, twenty years before the outbreak. Merck acquired rights to all the closely-related candidate vaccines in 2014, while Merck returned the rights to the abandoned vaccines to the Public Health Agency of Canada, the vital rVSV vaccine production techniques which Merck had gained remain Merck's, and cannot be used by anyone else wishing to develop a rVSV vaccine.[60][61][62][63]

As of June 23, 2022, researchers working with the Public Health Agency of Canada conducted a study which showed promising results of a recombinant vesicular stomatitis virus (rVSV) vaccine in guinea pigs, entitled PHV01. According to the study, inoculation with the vaccine approximately one month prior to infection with the virus provided a high level of protection.[64]Even though there is much experimental research on Marburg virus, there is still no prominent vaccine. Human vaccination trials are either ultimately unsuccessful or are missing data specifically regarding Marburg virus.[65]

Clinical trials

On 4 October 2024 it was reported that experimental vaccines and treatments will begin arriving in Rwanda soon, a U.S. government official indicated clinical trials would hence start.[66] Sabin Vaccine Institute indicated on October 6, they had shipped 700 doses of an experimental vaccine[67]

On 11 October the Ministry of Health Rwanda, indicated that 501 vaccinations had been administered[68] On 12 October a further 1,000 vaccine doses were delivered[69] On 3 November it was reported that more than 1,600 vaccinations had been administered[70]

Remdesivir

Remdesivir

Gilead Sciences indicated late last week that it would donate 5,000 vials of the antiviral drug remdesivir. This would go to the Rwanda Medical Supply for emergency use in the outbreak.[71][72]

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 "Rwanda reports first-ever Marburg virus disease outbreak, with 26 cases confirmed | WHO | Regional Office for Africa". www.afro.who.int. 28 September 2024. Archived from the original on 28 September 2024. Retrieved 29 September 2024.
  2. ↑ 2.0 2.1 "Rwanda and WHO declare end of Marburg outbreak after no new cases reported". AP News. 20 December 2024. Retrieved 20 December 2024.
  3. ↑ "Marburg in Rwanda - Level 2 - Level 2 - Practice Enhanced Precautions - Travel Health Notices | Travelers' Health | CDC". wwwnc.cdc.gov. Archived from the original on 3 October 2024. Retrieved 4 October 2024.
  4. ↑ 4.0 4.1 "Marburg virus". rbc.gov. Retrieved 31 October 2024.
  5. ↑ "More Marburg vaccine arrives in Rwanda as outbreak numbers slow | CIDRAP". www.cidrap.umn.edu. 14 October 2024. Retrieved 14 October 2024.
  6. ↑ Wafula Simiyu, Benjamin; Ndabashinze, Rodrigue; Sah, Sanjit; Bushi, Ganesh; Mehta, Rachana; Verma, Amogh (1 November 2024). "First Marburg virus outbreak in Rwanda: A new public health challenge". Clinical Infection in Practice. 24: 100392. doi:10.1016/j.clinpr.2024.100392. ISSN 2590-1702.
  7. ↑ "Rwanda: Marbug virus has killed several people; WHO plans to send medical aid". Africanews. 2024. Archived from the original on 2 October 2024. Retrieved 29 September 2024.
  8. ↑ "MSN". www.msn.com. Archived from the original on 2 October 2024. Retrieved 29 September 2024.
  9. ↑ "Marburg virus kills 6 in Rwanda, health minister says". Voice of America. 28 September 2024. Archived from the original on 29 September 2024. Retrieved 29 September 2024.
  10. ↑ Rwanda, U. S. Embassy (28 September 2024). "Health Alert – U.S. Embassy Kigali". U.S. Embassy in Rwanda. Archived from the original on 30 September 2024. Retrieved 29 September 2024.
  11. ↑ 11.0 11.1 "Health Alert Network (HAN) - 00517 | First Marburg Virus Disease Outbreak in the Republic of Rwanda". emergency.cdc.gov. 3 October 2024. Archived from the original on 9 October 2024. Retrieved 3 October 2024.
  12. ↑ "Diseases – Activity 1 – Glossary, page 3 of 5". science.education.nih.gov. Archived from the original on 2017-11-10. Retrieved 2017-11-10.
  13. ↑ "Rwanda says no community transmission of Marburg virus, with zero new infections in recent days". AP News. 20 October 2024. Retrieved 20 October 2024.
  14. ↑ "MSN". www.msn.com. Archived from the original on 2024-10-09. Retrieved 2024-10-07.
  15. ↑ "Marburg virus: US limits Rwanda flights into New York, Chicago or Washington". The Independent. 17 October 2024. Retrieved 17 October 2024.
  16. ↑ "History of Marburg Outbreaks". Marburg Virus Disease. 3 October 2024. Archived from the original on 8 October 2024. Retrieved 12 October 2024.
  17. ↑ "Marburg outbreak in Rwanda declared over | WHO | Regional Office for Africa". www.afro.who.int. 20 December 2024. Archived from the original on 20 December 2024. Retrieved 20 December 2024.
  18. ↑ "Rwanda reports first-ever Marburg virus disease outbreak, with 26 cases confirmed - Rwanda | ReliefWeb". reliefweb.int. 29 September 2024. Archived from the original on 29 September 2024. Retrieved 29 September 2024.
  19. ↑ "Marburg outbreak". Reuters. Retrieved 29 September 2024.
  20. ↑ "Rwanda reports dozens of Marburg virus cases, with 11 dead, alarming public health officials". Yahoo News. 3 October 2024. Archived from the original on 6 October 2024. Retrieved 3 October 2024.
  21. ↑ "Marburg virus" (PDF). UNICEF. Retrieved 3 October 2024.
  22. ↑ "Rwanda will deploy Marburg vaccine under trial as death toll rises to 12". Washington Post. 6 October 2024. Retrieved 6 October 2024.
  23. ↑ Institute, Sabin Vaccine (5 October 2024). "Sabin Vaccine Institute Delivers Marburg Vaccines to Combat Outbreak in Rwanda". GlobeNewswire News Room. Archived from the original on 9 October 2024. Retrieved 6 October 2024.
  24. ↑ "Rwanda Ministry of Health". Rwanda Ministry of Health. Archived from the original on 9 October 2024. Retrieved 7 October 2024.
  25. ↑ "MSN". www.msn.com. Retrieved 10 October 2024.
  26. ↑ "Rwanda's Marburg outbreak is now 'controlled,' Africa CDC says". Yahoo News. 11 October 2024. Retrieved 11 October 2024.
  27. ↑ "Marburg infects 3 more in Rwanda; most outbreak cases tied to hospital clusters | CIDRAP". www.cidrap.umn.edu. 11 October 2024.
  28. ↑ "Marburg virus disease". rbc.gov. Archived from the original on 9 October 2024. Retrieved 17 October 2024.
  29. ↑ "Marburg virus disease – Rwanda". www.who.int. Retrieved 18 October 2024.
  30. ↑ "WHO urges Rwanda to see off Marburg outbreak". Voice of America. 20 October 2024. Retrieved 20 October 2024.
  31. ↑ "Marburg virus". rbc.gov. Retrieved 20 October 2024.
  32. ↑ Reporter, Times (24 October 2024). "Rwanda records first Marburg case in eight days". The New Times. Retrieved 24 October 2024.
  33. ↑ "Marburg virus". rbc.gov.rw. Retrieved 25 October 2024.
  34. ↑ "Marburg virus". rbc.gov. Retrieved 27 October 2024.
  35. ↑ "Rwanda begins countdown to declare Marburg outbreak over | WHO | Regional Office for Africa". www.afro.who.int. 9 November 2024. Retrieved 9 November 2024.
  36. ↑ "Marburg Outbreak in Rwanda Situation Summary". Marburg Virus Disease. 2 December 2024. Retrieved 3 December 2024.
  37. ↑ 37.0 37.1 "About Marburg Disease". Marburg virus disease. 24 June 2024. Archived from the original on 27 September 2024. Retrieved 29 September 2024.
  38. ↑ "Marburg Haemorrhagic Fever | WHO | Regional Office for Africa". www.afro.who.int. 27 September 2024. Archived from the original on 29 September 2024. Retrieved 29 September 2024.
  39. ↑ "Marburg virus disease". www.who.int. Archived from the original on 2020-04-11. Retrieved 2024-09-29.
  40. ↑ "Ebola Vaccine Product Information". Ebola. 12 August 2024. Archived from the original on 27 September 2024. Retrieved 29 September 2024.
  41. ↑ Kozlov, Max (24 October 2024). "Animal-to-human viral leap sparked deadly Marburg outbreak". Nature. doi:10.1038/d41586-024-03457-4.
  42. ↑ "Marburg Virus Particles". NIAID. 6 August 2023. Archived from the original on 2 October 2024. Retrieved 1 October 2024.
  43. ↑ Brauburger, Kristina; Hume, Adam J.; Mühlberger, Elke; Olejnik, Judith (1 October 2012). "Forty-Five Years of Marburg Virus Research". Viruses. 4 (10): 1878–1927. doi:10.3390/v4101878. ISSN 1999-4915. PMC 3497034. PMID 23202446.
  44. ↑ Martini, G. A.; Siegert, R. (1971). Marburg Virus Disease. Berlin, Germany: Springer-Verlag. ISBN 978-0-387-05199-4.
  45. ↑ "Outbreak Table | Marburg Hemorrhagic Fever | CDC". www.cdc.gov. Centers for Disease Control and Prevention. Archived from the original on 21 January 2015. Retrieved 4 August 2018.
  46. ↑ "Marburg hemorrhagic fever outbreak continues in Uganda". October 2012. Archived from the original on 2018-06-12. Retrieved 2014-10-08.
  47. ↑ "WHO | Marburg haemorrhagic fever in Uganda – update". www.who.int. Archived from the original on August 10, 2014. Retrieved 29 October 2017.
  48. ↑ "1st LD-Writethru: Deadly Marburg hemorrhagic fever breaks out in Uganda". October 5, 2014. Archived from the original on December 5, 2017. Retrieved October 8, 2014.
  49. ↑ "WHO | Marburg virus disease – Uganda". www.who.int. Archived from the original on November 17, 2014. Retrieved 29 October 2017.
  50. ↑ "Uganda controls deadly Marburg fever outbreak, WHO says". ABC News. Archived from the original on 8 December 2017. Retrieved 8 December 2017.
  51. ↑ "Guinea records probable case of Ebola-like Marburg virus". Reuters. 7 August 2021. Retrieved 7 August 2021.
  52. ↑ "West Africa's first-ever case of Marburg virus disease confirmed in Guinea". who.int. 9 August 2021. Archived from the original on 2 October 2024. Retrieved 30 September 2024.
  53. ↑ "Guinea records West Africa's first Marburg virus death, WHO says". Reuters. August 10, 2021. Retrieved August 10, 2021.
  54. ↑ "Ghana confirms first cases of deadly Marburg virus". BBC News. 18 July 2022. Archived from the original on 2 October 2024. Retrieved 18 July 2022.
  55. ↑ "Equatorial Guinea declares outbreak of Ebola-like Marburg virus". BNO News. 13 February 2023. Archived from the original on 20 February 2023. Retrieved 14 February 2023.
  56. ↑ Schnirring, Lisa (4 April 2023). "Equatorial Guinea confirms another Marburg virus case". University of Minnesota. CIDRAP. Archived from the original on 4 April 2023. Retrieved 4 April 2023.
  57. ↑ Schnirring, Lisa (24 April 2023). "New fatal Marburg case reported in Equatorial Guinea". University of Minnesota. CIDRAP. Archived from the original on 25 April 2023. Retrieved 25 April 2023.
  58. ↑ Schnirring, Lisa (22 March 2023). "Tanzania declares Marburg virus outbreak". University of Minnesota. CIDRAP. Archived from the original on 2 October 2024. Retrieved 22 March 2023.
  59. ↑ "Tanzania reports additional Marburg virus disease case". Outbreak News Today. 24 April 2023. Archived from the original on 24 April 2023. Retrieved 25 April 2023.
  60. ↑ "MSF's response to CEPI's policy regarding equitable access". Médecins Sans Frontières Access Campaign. September 25, 2018. Archived from the original on March 21, 2021. Retrieved April 10, 2020. In vaccine development, access to know how is important. Knowledge and expertise including but not limited to purification techniques, cell lines, materials, software codes and their transfer of this to alternative manufacturers in the event the awardee discontinues development of a promising vaccine is critically important. The recent example of Merck abandoning the development of rVSV vaccines for Marburg (rVSV-MARV) and for Sudan-Ebola (rVSV-SUDV) is a case in point. Merck continues to retain vital know-how on the rVSV platform as it developed the rVSV vaccine for Zaire-Ebola (rVSV-ZEBOV) with funding support from GAVI. While it has transferred the rights on these vaccines back to Public Health Agency of Canada, there is no mechanism to share know how on the rVSV platform with other vaccine developers who would like to also use rVSV as a vector against other pathogens.
  61. ↑ "Merck & Co. Licenses NewLink's Ebola Vaccine Candidate". Genetic Engineering & Biotechnology News. November 24, 2014. Archived from the original on May 18, 2018. Retrieved January 20, 2016.
  62. ↑ "Canadian Ebola vaccine development taken over by Merck". Reuters. November 24, 2014. Archived from the original on April 2, 2018. Retrieved January 10, 2020.
  63. ↑ "First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response" (Press release). U.S. Food and Drug Administration (FDA). December 19, 2019. Archived from the original on December 20, 2019. Retrieved December 19, 2019. Public Domain This article incorporates text from this source, which is in the public domain.
  64. ↑ Zhu W, Liu G, Cao W, He S, Leung A, Ströher U, et al. (June 2022). "A Cloned Recombinant Vesicular Stomatitis Virus-Vectored Marburg Vaccine, PHV01, Protects Guinea Pigs from Lethal Marburg Virus Disease". Vaccines. 10 (7): 1004. doi:10.3390/vaccines10071004. PMC 9324024. PMID 35891170.
  65. ↑ Dulin N, Spanier A, Merino K, Hutter JN, Waterman PE, Lee C, Hamer MJ (January 2021). "Systematic review of Marburg virus vaccine nonhuman primate studies and human clinical trials". Vaccine. 39 (2): 202–208. doi:10.1016/j.vaccine.2020.11.042. PMID 33309082. S2CID 229178658.
  66. ↑ Branswell, Helen (4 October 2024). "Rwanda to receive experimental vaccines, therapeutics to combat Marburg outbreak". STAT. Archived from the original on 6 October 2024. Retrieved 5 October 2024.
  67. ↑ Bodwell, Greg (5 October 2024). "Sabin Vaccine Institute Delivers Marburg Vaccines to Combat Outbreak in Rwanda". Sabin Vaccine Institute. Archived from the original on 9 October 2024. Retrieved 6 October 2024.
  68. ↑ "Ministry of Health Rwanda/Marburg virus disease outbreak". rbc.gov.rw/. Retrieved 12 October 2024.
  69. ↑ Ntirenganya, Emmanuel (13 October 2024). "Rwanda gets 1,000 more vaccine doses for Marburg virus". The New Times.
  70. ↑ "Marburg vaccine". Medindia. Retrieved 3 November 2024.
  71. ↑ "Gilead to donate remdesivir for emergency use against Marburg disease in Rwanda". Reuters. Retrieved 6 October 2024.
  72. ↑ "Here's what's happening with the Marburg virus outbreak in Rwanda". Chemical & Engineering News. Retrieved 9 October 2024.

Further reading

External links

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