London School of Hygiene & Tropical Medicine

An outbreak of Marburg Virus Disease (MVD) in Rwanda has officially been declared over by the Government of Rwanda, with no new cases recorded since the last patient tested negative on 7 November 2024, according to the World Health Organization (WHO).

The Ministry of Health of Rwanda confirmed the country’s first outbreak of MVD on 27 September 2024. Cases of infection with the Marburg virus, a filovirus similar to Ebola, typically present with high fever and headaches, followed by vomiting, diarrhoea and haemorrhagic symptoms. 

Marburg infections are often deadly, with case-fatality rates varying between 23% and 88%, depending on the outbreak and the level of medical care available in the region.

As a zoonotic disease, infections can occur following prolonged exposure to mines or caves inhabited by Rousettus bats, a type of fruit bat that carries the virus without showing significant symptoms. Once humans become infected, the virus spreads from person to person through direct contact with bodily fluids, such as blood, vomit, or saliva.

The countdown to declare the end of the MVD outbreak in Rwanda began after the last confirmed case received their second negative PCR results on 7 November 2024. The 42-day countdown period accounted for twice the maximum incubation period for Marburg virus infections.

In total, the outbreak comprised of 66 confirmed cases including 15 deaths, making this the third largest Marburg outbreak reported to date. Of these patients, 51 recovered and almost 80% of patients worked as healthcare workers in the region.

Response teams working to control the outbreak, supported by WHO, conducted over 7,408 Marburg virus tests, with approximately 100-350 samples being tested daily at the Rwanda Biomedical Center.   

Daniela Manno, Clinical Assistant Professor at LSHTM, said: “This is a clear example of the benefits of outbreak preparedness. Health systems in Rwanda had robust outbreak response plans and enacted them swiftly, ultimately saving many lives. 

“This Marburg outbreak has been particularly challenging due to its spread across multiple districts and a significant impact on healthcare workers. As with any highly virulent infection, healthcare workers are among those at the highest risk due to close contact with patients, particularly when the disease is not promptly identified and strict infection control measures are not adopted.

“This highlights the critical importance of early disease recognition and the implementation of appropriate infection control measures to protect frontline healthcare workers. Currently, no approved vaccine for Marburg virus exists, though several candidates are in various stages of development, offering hope as an additional tool to protect healthcare workers in the future.

“Countries at risk of Marburg outbreaks should remain vigilant, as factors like climate change, deforestation, and increased human-wildlife interaction may contribute to the risk of future outbreaks. Environmental changes are pushing people closer to habitats of bats, the natural carriers of the Marburg virus, increasing the chances of human exposure.

“To reduce future human infections and deaths, it is also essential to continue raising community awareness about the risk factors for Marburg virus infection, particularly human-to-human transmission, and the protective measures individuals can take to minimise their exposure to the virus.

“This includes encouraging anyone with symptoms to immediately contact the designated health authority or helpline to improve their chances of recovery and reduce the risk of community transmission.

“In this outbreak, 77% of patients survived, underscoring the importance of early medical care. Prompt treatment saves lives, and this message should be strongly emphasised within communities.”

During the outbreak, the UK-Public Health Rapid Support Team (UK-PHRST), a key international partner in epidemic disease response, responded to a Request for Assistance from the Global Outbreak and Response Network (GOARN) to support UNICEF in their role in strengthening the national response to Marburg virus in Rwanda.

Three UK-PHRST deployees, one from LSHTM and two from the UK Health Security Agency (UKHSA), were selected to provide expertise in social science, risk communication and community engagement and infection prevention and control. The deployment ran for nine weeks between October and December 2024.

Nadine Beckmann, Social Science Lead at UK-PHRST and Associate Professor in Social Science at LSHTM, said: “It was great to contribute social science expertise to Rwanda’s Marburg outbreak response efforts through a GOARN deployment with UNICEF.

“My deployment experience highlights the importance of collecting community-based qualitative data to target public health response measures effectively during disease outbreaks. Talking to those directly affected and most at-risk about their experience of the outbreak itself, and of the response interventions, helps create outbreak response measures that are based on what affected communities need in order to protect themselves from infection, and to seek care and treatment early.”

The UK-PHRST is an innovative partnership between UKHSA and LSHTM, funded with UK aid by the UK Department of Health and Social Care. It partners with low- and-middle income countries to respond to infectious disease outbreaks before they develop into global health emergencies.

Further LSHTM work

LSHTM continues to be involved in research projects that focus on improving outbreak preparedness for filovirus diseases, including Marburg. This includes studying the role of vaccines in controlling outbreaks and refining models that can provide insights during future epidemics. The ongoing work aims to improve rapid response capabilities and reduce the impact of future outbreaks, not only for Marburg but also for other high-risk viruses​.

LSHTM Data Compass