Rwanda's Health Minister, Dr Sabin Nsanzimana, who coauthored the report, announced its release in a post on X.
"One year later, our @NEJM study (out today) reports how science-guided detection and rapid action stopped Rwanda's first Marburg outbreak in weeks, achieving the lowest recorded fatality," he wrote on September 11.
The outbreak, declared on September 27, 2024, began in two major hospitals in Kigali after a cluster of viral hemorrhagic fever cases was identified. Within a week, more than 20 health care workers had been infected.
A total of 6,340 suspected cases were tested, of which 66 were laboratory-confirmed, including 51 health workers. The outbreak's case fatality rate was 23%, significantly lower than previous MVD outbreaks in Africa, which have ranged from 83% to 90%.
Epidemiological investigations traced the index patient to a 27-year-old miner exposed to Egyptian fruit bats, indicating a zoonotic origin. Subsequent transmission occurred primarily among health care workers and family members. Rigorous contact tracing, surveillance, and hospital protocols helped limit the spread.
Clinical management combined advanced supportive care with investigational therapies. Fifty-two patients received remdesivir, with only three fatalities, while ten patients received the monoclonal antibody MBP091. No immediate adverse effects from either treatment were reported.
Rwanda also deployed the ChAd3-MARV vaccine within 13 days of the outbreak declaration, prioritising frontline health workers and high-risk contacts. By the end of October, 1,710 individuals had been vaccinated under emergency use authorisation and a concurrent phase 2 clinical trial.
The study emphasises the role of early detection, aggressive clinical care, investigational treatments, and emergency vaccination in reducing mortality. It also highlights the importance of infection prevention in health care settings, particularly given that 77% of cases occurred through nosocomial transmission.
The authors note that Rwanda's experience provides a model for responding to filovirus outbreaks in urban settings, showing that rapid, coordinated, science-driven interventions can save lives and prevent widespread transmission.
Rwanda, with its partners, including the World Health Organisation (WHO), declared the end of the Marburg Virus Disease (MVD) outbreak on December 20, 2024. The declaration followed 42 consecutive days without new cases.
Wycliffe Nyamasege
