Nsanzimana Sabin, Remera Eric, Nkeshimana Menelas, Westergaard Ryan P, Firew Tsion, Semakula Muhammed, Seruyange Eric, Neil Kara L, Kreuger Marrigje Jacoba, Bekele Abebe, Biramahire Joseph, Bizimana Anselme, Chirombo Brian, Diaz Janet, Dushimimana Germaine, Fischer William A, Fletcher Thomas E, Fowler Robert, Gatera Michel R, Giuliani Ruggero, Goldberg Jacob, Hakorimana Fidele, Hatchett Richard, Ingabire Zainab, Ingabire Lambert, Ishimwe Annick, Isingizwe Gisele, Jacquerioz Frederique, Kayigi Etienne, Kazindu Serge, Manirafasha Apollinaire, Mills Edward J, Mugabo Hassan, Mukagatare Isabelle, Murayire Janvier, Musanabaganwa Clarisse, Mushuru Evariste, Mutesa Leon, Muvunyi Claude Mambo, Muvunyi Raissa, Mwiseneza Louise, Nahayo Ernest, Ndayiragije Vincent, Ndayisabye Halifa, Ndayishimiye Gentil Semahoro, Ngabonziza Jean Claude S, Niwemuhoza Marie Grace, Niyigaba Nicolas, Niyonshuti Patrick, Niyonizeye Marie Grace, Nsekuye Olivier, Ntakambirwa Déo Kimalarungu, Ntawuyirusha Emmanuel, Ntihumbya Jean Baptiste, Nyirigira Gaston, Rojek Amanda, Rukundo Athanase, Rwabihama Jean Paul, Rwamwejo Fernand, Shumbusho Gloria, Sibomana Jean Pierre, Turatsinze David, Uwamahoro Doris Lorette, Uwimana François Xavier, Butera Yvan, Twagirumugabe Théogène, Rwagasore Edson
Rwanda Ministry of Health, Kigali.
Rwanda Biomedical Center, Kigali.
N Engl J Med. 2025 Sep 11;393(10):983-993. doi: 10.1056/NEJMoa2415816.
On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals.
We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents.
Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3-vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial.
Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.
