By Olana Wakoya Gichile, MD, MSc

Emerging infectious diseases pose huge public health threats globally. The incidence of these diseases is significantly on the rise, demanding integrated and effective preparedness and responses. The Marburg virus disease (MVD) outbreak that was declared on September 27, 2024 by the Ministry of Health (MOH) of Rwanda provides a clear example of the necessity for resilient healthcare systems capable of managing such crises. This outbreak occurred concurrently with an ongoing Mpox epidemic in the region.

As of late November 2024, a total of 66 cases, including 15 deaths (Case Fatality Rate: 22.7%), have been reported by the Rwandan MOH. Healthcare providers constitute the majority of these confirmed cases. The MOH implemented several strategic interventions that contributed to the containment and control of the outbreak. These included rigorous infection prevention and control (IPC) measures across the country, extensive community awareness programs, thorough surveillance and contact tracing efforts, isolation, and supportive care for the confirmed cases.

 A vaccine, a monoclonal antibody, and remdesivir were emergently used for the first time during this outbreak. Stringent public health measures were also of vital importance to control the virus. Based on available updates from the outbreak investigation, the index case was a 27-year-old male patient with a history of exposure to bats in a cave in Rwanda.

MVD is a highly fatal zoonotic disease with a mortality rate of 23% – 90% caused by a filovirus, closely related to the Ebola virus. Characterized by severe hemorrhagic fever, MVD presents with initial symptoms that are often nonspecific and indistinguishable from other common infections such as malaria or typhoid fever, including headache, fever, muscle pains, and malaise. Transmission to humans primarily occurs through exposure to mines or caves inhabited by Rousettus bats, known reservoirs of the virus. Human-to-human transmission can follow through contact with the bodily fluids of infected individuals.

After the declaration of the outbreak by the MOH, the University of Global Health Equity (UGHE) immediately established a ‘Crisis Management Committee’,  which worked in close alignment with national health authorities. The committee has been communicating with the university community about the outbreak, providing reliable information sources, and addressing misinformation. The University also introduced rigorous screening processes, including regular temperature checks and mandatory handwashing/hand-sanitizing stations at university entrances. During the peak of the outbreak, non-essential travel was limited. These measures mirrored the national response strategy, which focused on early detection, isolation of cases, and community engagement to prevent transmission. Even though no MVD case has been confirmed at UGHE and affiliated hospitals as of now, the university has continued the infection prevention and control measures and is fully prepared and ready to respond to positive cases. Such proactive measures are informed by the university’s One Health Center.

UGHE’s One Health Center has been training healthcare providers on Pandemic Preparedness and Response (including a Master’s program One Health track). The center is focused on supporting institutions and practitioners to respond to complex health challenges, including emerging and reemerging infectious diseases. Given the alarming rise of these diseases, including the current MVD outbreak which is of zoonotic origin, there is a huge need to establish and strengthen the One Health approach globally. One Health is a holistic and integrative framework designed to improve and defend the health of all species by converging human, animal, and environmental health strategies​. This approach leverages interdisciplinary collaboration across various sectors, which is critical for addressing the complex interdependencies among the different elements of health ecosystems.

The current MVD outbreak in Rwanda and the active Mpox epidemic in the region showcase the increasing incidences of emerging and re-emerging infectious diseases. This necessitates effective and meaningful global collaboration across various disciplines to prepare for the imminent threat of future pandemics. Investing in a One Health approach is crucial for effectively and sustainably preventing future pandemics and epidemics.

References