Implications of the Marburg virus disease outbreak in Rwanda for the EU/EEA, 2024

This threat assessment addresses the implications of the ongoing Marburg virus disease (MVD) outbreak in Rwanda for the European Union/European Economic Area (EU/EEA). MVD is a severe disease in humans and, although uncommon, it has the potential to cause epidemics with significant case fatality. All recorded MVD outbreaks to date have originated in Africa. MVD is not an airborne disease and is considered not to be contagious before symptoms appear. Direct contact with the blood and other body fluids of infected people and animals or indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment is required for transmission. The risk of infection is minimised when proper infection prevention and control precautions are strictly followed. There is no approved treatment or vaccine for MVD; however, several pharmaceuticals and candidate MVD vaccines are under investigation.

Epidemiological situation

On 27 September 2024, Rwanda reported its first MVD outbreak. As of 9 October 2024, 58 cases, including 13 deaths, have been reported in the country. According to limited available information, the majority are healthcare workers. Cases have been reported from eight of Rwanda’s 30 districts. In response to this outbreak, the Rwandan Ministry of Health is implementing measures such as restrictions on hospital visits and attendance at funerals, measures for educational settings, places of worship, and meetings, as well as a travel advice. Routine temperature checks are conducted at points of entry and exit screening is being implemented at Kigali airport. Vaccination of healthcare workers with an investigative vaccine is also being implemented as part of a study.

Risk assessment

We assess the overall risk for EU/EEA citizens visiting or living in Rwanda as low. This is because the likelihood of exposure to MVD – considering the low number of cases reported and the mode of transmission – and the impact are both assessed as low.

In the event of MVD cases being imported into the EU/EEA, we consider the likelihood of further transmission to be very low, and the associated impact low. Therefore, the overall risk for the EU/EEA is assessed as low.

Recommendations

Early detection and rapid isolation of an imported case of MVD, timely contact tracing, and strict infection prevention and control (IPC) protocols are crucial to mitigate further transmission of the virus. EU/EEA countries should raise healthcare workers’ awareness of MVD and the ongoing outbreak for early recognition of people suspected of being infected, and also ensure availability of diagnostics, review viral haemorrhagic fever (VHF) case management protocols, make sure healthcare workers are trained in the relevant IPC protocols, and have appropriate PPE available.

Suspected cases (people with clinical manifestations compatible with MVD and with epidemiological links to MVD cases) should be tested. People suspected or confirmed as having MVD should immediately be reported to the EU’s Early Warning and Response System as a serious cross-border threat to health alert.

All contacts should be traced and followed up closely for 21 days after the last known contact. High-risk contacts need to be quarantined and may need to be hospitalised for close monitoring.

Risk communication should be undertaken by public health authorities targeting those travelling to and returning from Rwanda. Travellers should be made aware of the ongoing outbreak in the country and be advised to follow all the recommendations of the local health authorities. Specific information should be provided on the symptoms and transmission modes of MVD. Upon return, travellers should be advised how and where to seek medical care if they develop MVD-compatible symptoms, and mention their travel and/or contact history.