CDC HAN: First Marburg Virus Disease Outbreak in the Republic of Rwanda

October 9, 2024
First Marburg Virus Disease Outbreak in the Republic of Rwanda

Current situation

• The Republic of Rwanda has confirmed their first Marburg virus outbreak with multiple cases of Marburg virus disease (Marburg) including deaths around the country.
• Marburg is a rare but severe hemorrhagic fever, like Ebola, that can cause serious illness and death.
• Currently, there are no reported cases of Marburg in the United States and the risk of infection with this virus in the United States is low.
• On October 7, 2024, CDC issued a Level 3 Travel Health Notice recommending that people reconsider nonessential travel to Rwanda.
• To keep this risk low, CDC will conduct public health screening of travelers entering the United States who have been in Rwanda in the past 21 days beginning the week of October 14.

Actions requested

• Identify: Recognize clinical features of Marburg and other viral hemorrhagic fevers (VHFs) and systematically assess patients with compatible symptoms and exposure risk for VHFs.
• Symptoms typically begin with “dry” symptoms, including fever, chills, malaise, and fatigue then progress to “wet” symptoms within 4-5 days, including severe diarrhea, nausea, vomiting and abdominal pain.
  • Be aware that bleeding is not universally present among patients with VHF.
• Consider common diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in a sick patient with recent international travel and evaluate and manage appropriately.
• Manage: Follow case management guidance for patients with suspected Marburg.
• Isolate and manage patients with exposure risks and symptoms compatible with Marburg in a healthcare facility until receiving a negative Marburg virus test result on a sample collected ≥72 hours after symptom onset.
• Employ a combination of infection prevention and control measures to prevent transmission of Marburg in hospital settings.
  • Do not defer routine laboratory testing or other measures necessary for standard patient care; patients with Marburg may present with concurrent infections.
• Test: Call Public Health if Marburg is suspected to approve and coordinate testing at Washington State Public Health Laboratory:
• Marburg virus diagnostic testing should not be delayed while awaiting results of other diagnostic testing.
  • For adults, collect two 4mL tubes of whole blood in a plastic tube preserved with EDTA. For pediatric patients, collect a minimum of 1 mL whole blood in a pediatric-sized collection tube preserved with EDTA. Follow guidelines for safe specimen collection.
• Educate: Counsel patients with planned to travel to the Republic of Rwanda in accordance with CDC Travel Notices.
• Counsel healthcare workers traveling to Rwanda for work in clinical setting of their potential increased risk of exposure to Marburg virus, the importance of following recommended infection prevention and control precautions, and the symptom monitoring and work-restriction they may need to follow when they return to the United States.
• Notify: Immediately report suspected cases of Marburg to Public Health at 206-296-4774.