TY - JOUR
T1 - Marburg Virus Disease in Rwanda, 2024 — Public Health and Clinical Responses
AU - Rwanda MVD Outbreak Response Team
AU - Nsanzimana, Sabin
AU - Remera, Eric
AU - Nkeshimana, Menelas
AU - Westergaard, Ryan P.
AU - Firew, Tsion
AU - Semakula, Muhammed
AU - Seruyange, Eric
AU - Neil, Kara L.
AU - Kreuger, Marrigje Jacoba
AU - Bekele, Abebe
AU - Biramahire, Joseph
AU - Bizimana, Anselme
AU - Chirombo, Brian
AU - Diaz, Janet
AU - Dushimimana, Germaine
AU - Fischer, William A.
AU - Fletcher, Thomas E.
AU - Fowler, Robert
AU - Gatera, Michel R.
AU - Giuliani, Ruggero
AU - Goldberg, Jacob
AU - Hakorimana, Fidele
AU - Hatchett, Richard
AU - Ingabire, Zainab
AU - Ingabire, Lambert
AU - Ishimwe, Annick
AU - Isingizwe, Gisele
AU - Jacquerioz, Frederique
AU - Kayigi, Etienne
AU - Kazindu, Serge
AU - Manirafasha, Apollinaire
AU - Mills, Edward J.
AU - Mugabo, Hassan
AU - Mukagatare, Isabelle
AU - Murayire, Janvier
AU - Musanabaganwa, Clarisse
AU - Mushuru, Evariste
AU - Mutesa, Leon
AU - Muvunyi, Claude Mambo
AU - Muvunyi, Raissa
AU - Mwiseneza, Louise
AU - Nahayo, Ernest
AU - Ndayiragije, Vincent
AU - Ndayisabye, Halifa
AU - Ndayishimiye, Gentil Semahoro
AU - Ngabonziza, Jean Claude S.
AU - Niwemuhoza, Marie Grace
AU - Niyigaba, Nicolas
AU - Niyonshuti, Patrick
AU - Niyonizeye, Marie Grace
N1 - Publisher Copyright:
Copyright © 2025 Massachusetts Medical Society.
PY - 2025/9/11
Y1 - 2025/9/11
N2 - On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals. METHODS We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents. RESULTS Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3–vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial. CONCLUSIONS Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.
AB - On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals. METHODS We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents. RESULTS Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3–vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial. CONCLUSIONS Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.
U2 - 10.1056/NEJMoa2415816
DO - 10.1056/NEJMoa2415816
M3 - Article
C2 - 40929633
AN - SCOPUS:105015656363
SN - 0028-4793
VL - 393
SP - 983
EP - 993
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 10
ER -
