Marburg virus epidemic in Rwanda – what you need to know

An epidemic of the Marburg virus – an often fatal disease with symptoms similar to the Ebola virus – broke out in Rwanda for the first time. So far, 46 cases have been reported and 12 deaths. The source of the epidemic is still unknown.

Seven hundred doses an experimental vaccine against the virus has just been shipped from the US to Rwanda. The vaccine is currently being administered mainly to healthcare workers, who have made up the majority of the victims so far.

The vaccine rollout is part of a clinical trial, so it will take some time before the vaccine’s effectiveness is known.

The Marburg virus is named after the city in Germany where it first appeared. In 1967, there were simultaneous outbreaks in laboratories in Marburg and Belgrade, Serbia (then part of Yugoslavia). The outbreak was caused by African green monkeys imported from Uganda for exploit in experiments. Seven people died.

Since then, there have been several outbreaks of Marburg virus in the country Sub-Saharan Africaincluding in countries bordering Rwanda.

Previous outbreaks have been reported in the Democratic Republic of Congo, Uganda and Tanzania. The most recent outbreaks were reported in Equatorial Guinea and Tanzania between February and June 2023, where nine cases were reported and six deaths.

Other countries that previously reported outbreaks include Angola, Ghana, Guinea, Kenya and South Africa. An outbreak in Angola in 2005 resulted in the death of 300 people.

Outbreaks usually occur when people come into contact with infected green monkeys, pigs or Egyptian rousette bats (a type of Ancient World fruit bat) – a common carrier of the virus. These bats can often be found in mines and caves. When a disease jumps from an infected animal to a human – so-called zoonotic transmission – it can spread from person to person through body fluids or through contact with contaminated surfaces such as bedding.

There are no antiviral drugs that can treat patients. People infected with Marburg virus must constantly hydrate their bodies blood loss is replaced by transfusion.

The incubation period, or the time between exposure to Marburg virus and the onset of symptoms, is five to ten days. Symptoms of Marburg virus disease may appear suddenly and include fever, muscle aches, diarrhea and vomiting.

The virus damages blood vessels and interferes with the blood’s ability to clot, which can lead to uncontrolled clotting bleeding from the nose, eyes, gums, rectum and, in women, from the vagina. The disease has a very high “case fatality rate”. Between 24 and 88% of people infected with Marburg virus die – usually as a result of significant blood loss and shock.

Marburg virus disease is not an airborne disease and is not considered contagious until symptoms appear. However, people can remain infectious for months after recovery and spread the disease through body fluids. Men are advised to wear a condom for one year after the first symptoms appear.

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Rwandan authorities are working to determine the source of the epidemic, the extent of its spread and the date of the first case.

While Marburg virus disease has been reported in seven of the 30 districts in the East African country, readiness is also being ensured in unaffected districts to limit the spread and quickly identify any side effects.

The World Health Organization (WHO) is working with Rwanda’s neighboring countries, including the Democratic Republic of Congo, Burundi, Kenya, Tanzania and Uganda, to review their preparedness to respond to the epidemic.

WHO assesses the risk of a Marburg virus outbreak as “very high” at the national level and “high” at the regional level. However, at a global level, the risk remains low.