Epidemic hazard

According to several local media, the national health authorities of Rwanda have officially reported on September 27, 2024 the occurrence of “a few cases in different health facilities” of Marburg virus disease (MVD). An RFI has been immediately sent to EpiCore members in the area considering the potential public health implications of the event. Members have been asked to support in the collection of further details from reliable sources, particularly in terms of updates on suspected and confirmed cases, and where were these identified. In addition, it has been asked to provide, if possible, suggestions about where to closely monitor online official updates in the coming days. The EpiCore network has confirmed the occurrence of the event and clarified that the epidemiological details about cases included by the national authorities in the first statement of September 27 were limited and referring generically to some cases documented in different areas of the country. The authorities explained that the situation was closely monitored, and further updates would have been made available as soon as possible. In addition, it was announced that enhanced preventive measures had been implemented immediately in all health facilities countrywide, with isolation of cases and active contact tracing ongoing. The population was asked to not panic and to refer to the closest health facility (or to call a specific hotline) in case of individuals experiencing symptoms such as a high fever, strong headaches, vomiting, muscle aches, and stomach aches. As announced, on September 28 the authorities have provided an epidemiological update and WHO AFRO has complemented this information with additional relevant details. Based on the feedback collected, the authorities have informed about a total of 26 MVD cases, including 6 deaths, mainly health workers working in intensive care units (ICUs). Cases were identified in 7 out of the 30 districts (NB, districts have not been specified). Contact tracing activities have initially identified 161 people who came into contact with cases, currently closely clinically monitored. The 20 cases under treatment had been isolated and WHO is collaborating closely with the national authorities to provide all the needed support in terms of case management and in the investigation activities to determine the origin of the infection. On September 30, 2024 WHO has provided an update reporting two more deaths among the 26 cases confirmed as of Sep. 29 and specifying that over 70% were healthcare workers from two health facilities in Kigali; the number of contacts under clinical follow-up was updated to 300. Based on the latest update, WHO has assessed the risk of further spread in Rwanda as “very high” and “high” in neighbouring countries since cases have been reported in districts located at the borders with DRC, Tanzania, and Uganda. There is also for WHO a hight risk of regional spread (beyond East Africa) as cases have been reported in Kigali where an international airport is active. The risk of spread at global level is for now considered “low”. It should be noted that WHO is informing that one of the contacts identified is known to have travelled internationally and appropriate response measures are reported to have been implemented in response to that. Based on social media quoting authorities in Rwanda, this case is a "close contact" of the suspected index case, and the country is Belgium (cf. sources). WHO has later confirmed this informaton as the the public health authorities of Belgium have informed about this identification adding that the person has already completed the 21-day monitoring period without presenting with any symptoms. This is the first time MVD is confirmed in Rwanda: the latest outbreaks in the region have been reported in 2023 in Tanzania (Kagera, one probable and 8 confirmed cases including 5 deaths) and in Equatorial Guinea (several provinces, 16 confirmed cases including 12 deaths); in 2022 in Ghana (Ashanti, 3 cases and 2 deaths); in 2021 in Guinea (Guéckédou, 1 fatal case). Cases have been reported in Uganda also back in 2017, 2014 and in 2012. The RFI has been supported with relevant details about this event extracted from official online sources and media/social media directly quoting national health authorities. The Ministry of Health and relevant international partners are now regularly providing online updates about the ongoing situation in the country: this summary may be updated only in case the network provides relevant details about additional suspected cases reported in Rwanda as well as in the neighbouring countries. OFFICIAL SOURCES - WHO statement with risk assessment details (Sep 30, 2024 modified on Oct 2): https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON537 - Ministry of Health of Rwanda (Sep 28, 2024): https://x.com/RwandaHealth/status/1840112003123425741 - WHO AFRO (Sep 28, 2024): https://www.afro.who.int/countries/rwanda/news/rwanda-reports-first-ever-marburg-virus-disease-outbreak-26-cases-confirmed - Ministry of Health of Rwanda (Sep 27, 2024): https://x.com/RwandaHealth/status/1839656238105104424/photo/1 and https://x.com/RwandaHealth/status/1839656238105104424 MEDIA QUOTING HEALTH AUTHORITIES (examples): - https://x.com/NOlivier17/status/1840478266458529988 (SM with details on contacts - Sep 29, 2024) - https://www.newtimes.co.rw/article/20493/news/health/marburg-who-says-to-scale-up-support-to-rwanda-in-virus-fight (Sep 28, 2024) - https://www.newtimes.co.rw/article/20504/news/health/marburg-how-past-outbreaks-unfolded (Sep 28, 2024) - https://www.newtimes.co.rw/article/20505/news/health/marburg-update-six-people-succumb-to-viral-disease (Sep 28, 2024) - https://www.bbc.com/gahuza/articles/cy80gnvx156o (Sep 27, 2024)