On Saturday September 28, 2024, the World Health Organization (WHO) reported the first outbreak of the deadly Marburg virus in Rwanda. This is the fourth largest Marburg outbreak documented in modern history. Local health authorities have confirmed 26 cases and six deaths so far. Cases have occurred in seven of the country’s 30 districts. Survivors are currently isolated and receiving treatment, while 161 people identified through contact tracing are being monitored.
This negatively stained transmission electron micrograph (TEM) shows a number of filamentous Marburg virions, which were grown on Vero cells and purified on sucrose rate-zone gradients. Note the morphological appearance of the virus with its characteristic “shepherd’s crook” shape; magnified approximately 100,000 times. [Photo: CDC / Dr. Erskine Palmer, Russell Regnery, Ph.D. via Wikimedia Commons]
The Rwandan Ministry of Health informed the public and international health authorities of these developments on Friday. Its statement said: “Marburg virus disease (MVD), a hemorrhagic fever, has been confirmed in a few patients in health facilities across the country. Investigations are underway to determine the origin of the infection. Reinforced preventive measures are implemented in all health establishments. Contact tracing is ongoing and cases have been isolated for treatment.”
The country’s Minister of Health, Dr. Sabin Nsanzimana, informed journalists the same day in a video statement on The vast majority of cases and deaths concern healthcare workers, mainly in intensive care units.
Loading Tweet …
The next day, addressing the audience, Dr. Nsanzimana told Rwandans via video:
I want to emphasize that people can continue their daily activities. No activity is prohibited. What we ask is that people who have symptoms, including high fever, severe headache, muscle pain, fatigue, diarrhea and vomiting, do not ignore them. These are the main symptoms indicating the appearance of this virus. Do not continue your daily activities. Instead, call 114 or go to the nearest health center. People should not panic as we have started identifying hotspots of the disease and are taking appropriate measures. We cannot implement directives that hinder people’s livelihoods.
There is no cure for this disease and palliative care in healthcare settings involves access to intensive care units with healthcare providers well trained in maintaining strict isolation controls. Basic care includes pain control, fluid and electrolyte balancing, antibiotics and antifungals deemed appropriate, and anticoagulation to prevent or control disseminated intravascular coagulation. Such measures are resource intensive and can quickly overwhelm health facilities in poor countries, even with just a few cases.
Marburg virus disease is a viral hemorrhagic fever whose clinical symptoms are similar to those of Ebola virus infection. Even with palliative care, mortality rates range from 24 to 88 percent. The incubation period after contamination lasts on average one week, but can range from two to 21 days, highlighting the importance of immediate public health efforts to trace all contacts.
The initial phase of infection (days one to five) is accompanied by a high fever (104º Fahrenheit or 40º Celsius) with severe headache, chills, extreme fatigue, nausea, vomiting, diarrhea and horrible sore throats. Additionally, red and purple discolorations cover the entire body. Most people experience abdominal cramps, discomfort, and red, inflamed eyes.
After one or two weeks, patients become listless in bed due to weakness. They also experience shortness of breath, swelling and marked redness of the eyes. They may suffer from central nervous system symptoms such as delirium, confusion and aggression, putting caregivers at risk of secondary infection. Infected people also have bloody stools and hemorrhages in the mucous membranes and blood collection sites.
Fatal cases during this period go through coma, convulsions, multiorgan failure accompanied by diffuse coagulopathy, metabolic disorders, shock and end in death. Those who survive and enter the recovery phase suffer widespread pain, liver dysfunction, muscle weakness, and possibly psychosis.
Transmission of Marburg virus disease is not well understood, but it can occur through exposure to a species of fruit bat or through consumption of bushmeat. The infection can spread from person to person through contact with bodily fluids during unprotected sex or a skin break.
The source of the infection in Rwanda remains to be determined. The majority of confirmed cases involve healthcare professionals in the capital, Kigali, and its surrounding areas, with a population of 1.2 million and an airport well connected to domestic and international destinations.
The previous year, neighboring Tanzania to the east reported its first outbreak of Marburg virus disease, with nine human cases and six deaths. At the same time, Equatorial Guinea, located on the western coast of the continent, almost 3,000 kilometers away, reported 40 human cases of Marburg virus disease and 35 deaths.
Given its continued occurrence in central Africa and densely populated cities, it is only a matter of time, as the 2022 mpox pandemic has demonstrated, for these extremely virulent diseases to quickly turn into crisis. world of infectious diseases. Marburg virus disease continues to be classified by the WHO as a neglected tropical disease because the research, funding, and attention given to it are limited compared to other infectious diseases. As the authors of a 2023 report on Marburg in Africa:
Lack of commercial incentives for drug development and limited investment in MVD vaccine development have hampered progress. In this context, global health agencies, governments and non-governmental organizations could prioritize MVD-specific research and development. Strengthening surveillance and diagnostic capacities, particularly in endemic regions, could contribute to rapid detection and response and could also potentially prevent an outbreak from spreading.
As another study last year on Marburg virus in sub-Saharan Africa explained, the continent has seen a 63 percent increase in zoonotic diseases over the past decade, the majority caused by emerging deadly viruses like Ebola and Marburg. These diseases have already put a strain on the region’s health systems and the overall quality of life of its population.
The COVID pandemic has only exacerbated these developments, which are the result of uncontrolled capitalist exploitation and urbanization of the continent without the creation of social infrastructure to meet the growing needs of the population, including protection from deadly viruses emerging from rainforests and other underdeveloped regions.
(Article published in English on September 30, 2024)
