Marburg virus disease in Rwanda

Rwanda reports their first ever Marburg virus disease outbreak

• This updates the news item of 3 October 2024

On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease (MVD). As of 9 October 2024, a total of 58 confirmed cases, including 13 deaths have been reported [1].

On 30 September, the World Health Organization stated that cases were reported from 7 of the 30 districts in the country: Gasabo, Gatsibo, Kamonyi, Kicukiro, Nyagatare, Nyarugenge and Rubavu districts. Among the confirmed cases, over 70% were healthcare workers from two health facilities in the capital city of Kigali [2].

This is the first time MVD has been reported in Rwanda.

The situation is evolving and updated information including case numbers and deaths will be reported on our Rwanda Country Information page: Outbreaks section.

An emergency response in Rwanda is underway, including infection prevention and control measures, contact tracing and case management in affected communities to prevent further spread.

The reservoir host of Marburg virus, the fruit bat, is widely distributed across Africa. MVD can be a severe, sometimes fatal haemorrhagic fever, which is clinically almost indistinguishable from Ebola virus disease [3]. Outbreaks and sporadic cases have occurred in previous years in Angola, the Democratic Republic of Congo, Equatorial Guinea, Kenya, Ghana, Guinea, Uganda, South Africa (associated with travel from Zimbabwe), and Tanzania [2-4]. The largest outbreak on record to date occurred in 2005 in Angola and involved 374 cases, including 329 deaths.

Whilst MVD is rare and very unusual in travellers, sporadic cases have been reported in travellers who spent prolonged periods in mines or caves inhabited by bat colonies [3].

Advice for travellers

Before you go

Check and follow the advice from the Foreign, Commonwealth & Development Office on safety, security, and any travel restrictions at your destinations.

Check our Country Information pages to research general health risks, prevention advice and any vaccine recommendations or malaria advice for your destination and make sure you obtain appropriate travel health insurance.

There is currently no licensed vaccine to protect against MVD [2, 3].

While you are there

Remain aware of up-to-date, reliable information on specific areas affected, as these may change over time.

You can become infected with Marburg disease if you have contact (such as through broken skin or mucous membranes in the eyes, nose, or mouth) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids [2].

If you plan to travel to Rwanda, follow precautions to reduce your risk of infection:

• Wash hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
• Avoid contact with people with symptoms of MVD, their bodily fluids, corpses and/or bodily fluids from deceased patients.
• Avoid participating in funeral or burial rituals.
• Avoid visiting traditional healers.
• Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
• Wash and peel fruit and vegetables before consumption.
• Practise safer sex.
• Avoid visiting mines or bat caves and contact with all wild animals; alive or dead, particularly bats.
• If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks.

Cases have been reported from two hospitals in Kigali, including in healthcare workers. Infection prevention and control measures are being implemented in all health facilities [2]. For non-urgent medical care or if you become unwell whilst you are away, speak to your insurance company or local healthcare provider for advice on the most suitable place to access healthcare.

When you return

Get medical advice if you become ill within 21 days of returning home. Call NHS111 or contact your GP by phone. Although it is very unlikely you have MVD, you should mention your dates and itinerary of travel and any potential exposure to the virus.

Other infectious diseases like malaria are present in Rwanda. You should be aware of the signs and symptoms of malaria and should seek immediate medical attention if these occur either while you are in Rwanda or up to a year after you return to the UK.

Advice for those working in affected areas

If you are living in or planning to visit outbreak areas for work related reasons that might bring you into contact with Marburg virus (e.g. humanitarian, health care), you should follow advice from your deploying organisation.

Organisations deploying staff in response to the outbreak must register with the UKHSA returning workers scheme (RWS) [5].

If you are working with infected individuals, infection prevention and control guidance on viral haemorrhagic fevers should be followed; strict barrier techniques should be implemented, and all staff provided with and trained in the use of protective equipment [6].

Advice for health professionals

Health professionals should remain alert for travellers returning from MVD affected areas who develop symptoms compatible with MVD. See UKHSA's MVD information page for symptoms and guidance.

Health professionals should practise strict universal precautions when caring for patients when MVD is suspected.

Guidance and information about high consequence infectious disease and their management in England and further information and guidance about Marburg fever is available from UK Health Security Agency. Rapid transfer to a designated High Consequence Infectious Disease Treatment Centre will be arranged for confirmed cases in the UK [6].

UKHSA has specialised laboratory facilities to provide a definitive MVD diagnosis at the Rare and imported pathogens laboratory (RIPL).