Rwanda is dealing with the first outbreak of Marburg virus disease, a deadly disease related to Ebola. The disease has no approved vaccine or treatment. From October 6the outbreak infected 56 people and killed 12 of them, according to Rwanda’s Ministry of Health. With the support of the African Centers for Disease Control and Prevention (Africa CDC) and other partners, the Rwandan government is implementing strict testing, contact tracing and quarantine measures to contain the outbreak. A clinical trial of a vaccine candidate The Sabin Vaccine Institute will soon be operational after delivering around 700 doses at the request of the Rwandan government. But challenges remain, including the similarity of the disease’s symptoms to malaria, the need for faster diagnostic tools, and the fact that most infected people are healthcare workers.
The Rwandan government, Africa’s CDC and others are working to contain the outbreak and are currently tracking the contacts of about 400 people who may have been exposed to the virus. Cases have been identified in eight of the country’s 30 districts, representing a staggering 80 percent of those confirmed to be infected by health workers. Concerns about possible international spread were heightened when Germany reported that a medical student who had traveled to Rwanda and his partner had come into contact with a confirmed case, but both later. gave a negative.
“It is known to be associated with the Marburg virus very high death rateif not the first, perhaps the second deadliest virus known to date in terms of affecting the human body and destroying the immune response and causing mortality,” says Rwanda’s health minister Sabin Nsanzimana. He describes the high proportion of cases among health care workers as an unfortunate reality “They are the ones that such diseases the first they suffer, because they have patients from different places and different origins”, says Nsanzimana.
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Jean Kaseya, Director General of the CDC for Africa, emphasizes the need to support Rwanda by decentralizing testing capabilities and ensuring adequate supplies. “We need to avoid widespread community transmission,” where a disease spreads among people who have no known contact with other infected people. “The government is doing its best in testing, and our mission is to stop Rwanda from supplies,” Kaseya added. “Since there is no rapid test available yet, we are working to decentralize PCR (polymerase chain reaction) tests so that all regions can respond quickly.” (These PCR tests are very specific molecular tests of the virus).
Nsanzimana, who is leading the charge to stop the Marburg outbreak, spoke American scientific about its current situation and Rwanda’s containment measures.
(Below is an edited transcript of the interviews.)
What measures is Rwanda taking to prevent the international spread of the Marburg virus, especially with possible cases emerging in countries as far away as Germany?
We have implemented several strategies to prevent the virus from spreading beyond our borders. Key among these is expanding our contact tracing and quarantine efforts. We are testing people regularly and have increased screening at entry and exit points. The more contacts you scan, the better because you exhaust all the possibilities of spreading the virus or outbreak.
We sent a travel advisory to further enforce these protocols. This ensures that no potential cases, such as a recent case involving a student who has been in contact with a confirmed case, will travel internationally. The student tested negative before leaving Rwanda and again upon arrival in Germany. This cooperation in accordance with international health regulations shows the effectiveness of our measures. We are also strengthening exit screening, especially for those in the incubation phase of the virus, to minimize the risk of transmission. We will stop this outbreak before it affects other parts of the country, region or even beyond.
What challenges did you face in controlling the outbreak?
An initial challenge in identifying Marburg cases was the similarity of its symptoms to malaria, a common disease in the region. Symptoms of both diseases include high fever, severe headache, muscle and joint pain and fatigue, and later gastrointestinal symptoms, nausea, vomiting, which are very common with malaria.
How big is the outbreak at the moment, and how is Rwanda managing it?
At the moment, we are mainly monitoring an important set of cases. This cluster is concentrated in a single hospital department, specifically the intensive care unit (ICU), where the initial patient was treated. Unfortunately, several doctors and nurses became infected while performing resuscitation and other critical procedures. We have identified around 400 contacts and are following them closely to ensure we do not miss any potential cases.
The cases have been largely confined to this ICU cluster, and we have not seen a wide spread beyond that. To further mitigate the risk, we have increased community surveillance and are testing anyone with Marburg virus-like symptoms such as high fever, headache and muscle aches. Given that these symptoms are consistent with malaria, our screening efforts are cautious but comprehensive so as not to miss a single case.
What resources are needed in Rwanda to effectively control the outbreak, and how quickly are you able to detect cases?
Our primary testing method is polymerase chain reaction (PCR), which provides results in eight to 10 hours. This response time has been essential for the rapid identification of cases, especially given the urgent need to contain the outbreak. As we collect more samples from community surveillance, however, our labs are expanding.
To improve our response, we need rapid diagnostic tools that will ease the burden on our PCR testing facilities. Right now we are also working to further expand our PCR capabilities. We are in the process of decentralizing testing, ensuring more regions have the ability to test and respond quickly.
In terms of genomic epidemiology, we have been building our genomic sequencing infrastructure. This will help us track the virus more effectively. Although we already have a strong base, our teams are prioritizing case identification to ensure we catch all positive cases. As we progress, we will begin sharing genomic data that will provide deeper insight into the outbreak.
Rwanda already has a strong genomic sequencing infrastructure. Why haven’t we seen faster genomic analysis in this outbreak?
While we have developed significant genomic sequencing capabilities, our priority has been to rapidly test and identify positive cases. Our teams are working around the clock to make sure we don’t miss any cases, but now we’re starting to analyze and generate genomic data. As we continue to gain a clearer picture of the genetic makeup of the virus, we will share more information with our partners and the public.
Is the outbreak currently under control?
The explosion is under control, but not yet fully contained. We are making progress every day, and remain vigilant in our efforts to investigate and monitor all potential cases. Our main priority is to prevent the virus from spreading beyond the current cluster. With ongoing testing, quarantine efforts and community vigilance, we are confident that we will be able to contain the situation.
There is no approved vaccine available, but can you share information about the clinical trial of the vaccine?
For this trial we have opted for a vaccination protocol that will allow us to mature over time—a fast and rapid protocol that meets all the requirements.
