Rwandan health authorities said 11 people had died in the country's Marburg virus outbreak, with 36 cases confirmed and 25 patients in isolation. The government was still investigating the source after the first recognized infections were found among patients in health facilities.
Rwanda declared the outbreak on September 27 and reported six deaths the following day. By October 3, most people affected were healthcare workers across six of the country's 30 districts. Some patients lived in districts bordering the Democratic Republic of the Congo, Burundi, Uganda and Tanzania.
Officials identified at least 300 people who had been in contact with confirmed patients. An unspecified number were placed in isolation. Finding contacts quickly is a central part of controlling viral hemorrhagic fevers because Marburg spreads between people through direct contact with infected bodily fluids or contaminated materials such as bedding.
The World Health Organization assessed the threat as very high within Rwanda, high at the regional level and low globally. It noted that cases in Kigali created a route for possible international spread because the capital has an international airport and road connections to other East African cities.
Concern extended to Europe when two people returning from Rwanda were isolated in Hamburg, Germany, after one developed symptoms following time in a medical facility where Marburg patients had been treated. Both tested negative, according to the European Centre for Disease Prevention and Control.
Rwanda increased screening for people with fever, headaches and body aches. Health Minister Sabin Nsanzimana said 2,000 people had been tested and another 5,000 test kits were expected. He also said vaccine clinical trials would begin within days, although he did not identify the vaccine candidate. At that time there was no authorized vaccine or specific treatment for Marburg.
Public-health restrictions included suspending visits to schools and hospitals, limiting attendance at funerals for victims and prohibiting home vigils when a death was linked to the virus. Residents were urged to reduce physical contact. The US Embassy in Kigali advised staff to work remotely and avoid its offices.
Marburg is believed to originate in fruit bats and can produce fever, muscle pain, diarrhea, vomiting and severe bleeding. Without treatment, fatality rates in outbreaks can be high. Supportive care and rapid isolation can improve the response even without an approved medicine.
The rising toll showed that transmission had occurred, but the evidence did not establish how the initial patients became infected. Until investigators identified the origin and all chains of contact, health authorities faced simultaneous tasks: treating isolated patients, protecting medical staff and preventing the outbreak from crossing district or national borders.
