The Rwandan Ministry of Public Health confirmed on Friday the discovery of the deadly Marburg virus in certain health facilities. The population is called upon to be vigilant while strictly respecting hygiene measures. (SOS Averages Burundi)
The press release from the Rwandan Ministry of Health does not specify the number of cases, let alone the health establishments concerned.
Some information circulating on social networks reports deaths, particularly among medical personnel. But according to health authorities, no deaths have been reported to date.
The Rwanda Biomedical Center (RBC) said it has developed comprehensive guidelines for the detection and management of viral hemorrhagic fevers (VHF) in response to the increased frequency of emerging and re-emerging diseases in Africa. Rwanda’s neighbors are facing multiple outbreaks. Today, the guidelines aim to equip health care workers with the knowledge, skills and practices needed to safely prevent, prepare for and respond to them in health care settings and in the community, according to this center .
A national risk assessment carried out last year in Rwanda classified Marburg as “moderate” in a country where risks are increased due to its proximity to countries with FHV outbreaks, including Burundi and DR Congo, where the monkeypox pandemic is spreading at a very high speed, more than in other African countries, according to the WHO (World Health Organization).
In 2022, the land of a thousand hills was the scene of a major outbreak of Rift Valley Fever which affects both humans and animals. 22 human cases out of 125 and 516 cases out of 1, 339 animals died.
What is the deadly Marburg virus (WHO)?
The Marburg virus is the causative agent of Marburg virus disease, the fatality rate of which can reach 88%, although good patient care can significantly reduce this rate. Marburg virus disease was first detected in 1967, during outbreaks that occurred simultaneously in Marburg and Frankfurt (Germany), as well as in Belgrade (Serbia).
Both Marburg and Ebola viruses belong to the Filoviridae (filovirus) family. Although caused by two different viruses, the two diseases are clinically similar. They are both rare and have the capacity to cause epidemic outbreaks with a high fatality rate.
The disease was first recognized during two large epidemic outbreaks that occurred simultaneously in 1967 in Germany (in Marburg and Frankfurt) and in Serbia (in Belgrade). They were linked to laboratory work on African green monkeys (Cercopithecus aethiops) imported from Uganda. Subsequently, outbreaks and sporadic cases were reported in Angola, the Democratic Republic of Congo, Kenya, South Africa (in a person with recent travel to Zimbabwe), and Uganda. In 2008, two independent cases were reported in travelers who visited a cave housing colonies of flying foxes (Rousettus) in Uganda.
Transmission
Originally, infection in humans resulted from prolonged exposure in mines or caves with colonies of flying foxes.
Transmission is primarily human-to-human and results from direct contact (via a scratch or through mucous membranes) with blood, secretions, organs or biological fluids of infected people, or with surfaces and materials (e.g. sheets or clothing) contaminated by these liquids.
Health workers have frequently become infected while caring for suspected or confirmed cases of Marburg virus disease. These infections occurred during close contact with patients without properly implementing infection control precautions. Transmission through contaminated injection equipment or accidental needle sticks is accompanied by a more severe form of the disease, rapid deterioration of physical condition and possibly higher mortality.
Burial ceremonies in which there is direct contact with the body of the deceased may also contribute to the spread of Marburg virus disease.
Infected people remain contagious as long as the virus is present in their blood.
Symptoms of Marburg virus disease
The incubation period (the time between infection and the appearance of symptoms) ranges from 2 to 21 days.
The illness caused by the Marburg virus sets in suddenly, with high fever, severe headache and severe malaise. Myalgia and pain are common manifestations. Profuse watery diarrhea, abdominal pain and cramps, nausea and vomiting may appear on the third day. Diarrhea may persist for a week. Patients at this stage are often described as having a “ghost” appearance, with deep-set eyes, an expressionless face, and extreme lethargy. During the European outbreak in 1967, most patients had a non-itchy rash between the second and seventh day after the onset of symptoms.
Many patients develop severe hemorrhagic manifestations between the fifth and seventh day and fatal cases generally present with hemorrhage in one form or another, most often with multiple locations. The observation of fresh blood in vomit or stool is often accompanied by bleeding from the nose, gums and vagina. Spontaneous bleeding from venipuncture sites (to administer fluids or collect blood samples) can be particularly problematic. During the intense phase of the disease, high fever is observed. Impairment of the central nervous system can lead to confusion, irritability and aggression. Orchitis (inflammation of one or both testicles) has sometimes been reported in the late stage of the disease (15 days).
In fatal cases, death occurs 8 to 9 days after the onset of symptoms and is usually preceded by copious blood loss and shock.
Diagnostic
It may be difficult, based on clinical symptoms, to distinguish Marburg virus disease from other conditions such as malaria, typhoid fever, shigellosis, cholera, and other hemorrhagic viral fevers.
Treatment and vaccine
There is currently no approved vaccine or antiretroviral treatment for Marburg virus disease. However, supportive care – oral or intravenous rehydration – and treatment of certain specific symptoms improve patient survival.
Monoclonal antibodies are under development and antiretrovirals, such as Remdesivir and Favipiravir which have been used in clinical studies for Ebola virus disease, could also be tested for Marburg virus disease or make the subject to compassionate use or expanded access.
In May 2020, the European Medicines Agency issued a marketing authorization for the Zabdeno (Ad26.ZEBOV) and Mvabea (MVA-BN-Filo) vaccines against Ebola virus disease. The Mvabea vaccine contains a virus known as Vaccinia Ankara Bavarian Nordic, which has been modified to produce four proteins from the Zaire Ebolavirus species and three other viruses from the same group (filoviridae). It is possible that this vaccine may provide protection against Marburg virus disease, but its theoretical effectiveness has not been demonstrated in clinical trials.
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Photo: a health worker in a Mpox vaccination campaign in Rwanda, September 2024, DR
