Marburg Virus Disease Update
October 8, 2024
Dear Colleague:
This letter provides an update on the Marburg Virus Disease Outbreak in the Republic of Rwanda.
Marburg Outbreak in the Republic of Rwanda
On October 3, 2024, the Centers for Disease Control and Prevention (CDC) released a Health Alert Network (HAN) Health Advisory about the Marburg virus disease (MVD) outbreak in the Republic of Rwanda. MVD is a rare but highly fatal hemorrhagic fever for which there is no current vaccine or treatment. To date, no confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of the Republic of Rwanda. CDC has indicated that the risk of MVD in the United States is low.
Below is a summary of the CDC recommendations for clinicians. Please refer to the HAN Advisory for complete details.
- The majority of febrile patients or travelers presenting in U.S. healthcare facilities do not have MVD, but early consideration of MVD in the differential diagnosis is important.
- Assess all acutely ill patients returning from Rwanda with compatible symptoms for the possibility of viral hemorrhagic fevers, including MVD. Collect a detailed travel history and use a triage and evaluation process to assess exposure risk.
- Include MVD in the differential diagnosis for an ill person who has been to an area with an active MVD outbreak in the past 21 days, and who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), and has reported epidemiologically compatible risk factors within the 21 days before symptom onset.
- Consider more common diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in an ill patient with recent international travel.
- Isolate and manage any patient if MVD is suspected until receiving a negative Marburg virus test result on a sample collected at least 72 hours after symptom onset.
- Patient should be placed in a private room with a private bathroom or covered bedside toilet.
- Dedicated medical equipment (preferably disposable, when possible) should be used.
- Follow infection prevention and control procedures to prevent transmission, including wearing appropriate personal protective equipment (PPE) for managing clinically stable and clinically unstable
- Marburg virus is not spread through airborne transmission.
- Limit procedures that increase risk of environmental contamination with infectious material (e.g., use of needles/sharps, aerosol-generating procedures).
- Follow environmental cleaning and disinfection guidance and procedures for safe handling and management of waste.
- Use only essential healthcare workers trained in their designated roles for patient care. Keep a log of everyone who enters the patient’s room.
- Have an onsite manager supervise each and every step of PPE donning and doffing and personnel providing care at all times.
- Inform your local health department immediately for consultation about a suspected case and requests for testing for MVD.
- If testing is approved by VDH and CDC, the state public health laboratory (DCLS) will test the patient’s blood. CDC will perform confirmatory testing, if needed.
CDC issued additional guidance for U.S. healthcare workers who have been in any healthcare facility in Rwanda within the last 21 days. Returning healthcare workers should be excluded from work duties in a U.S. healthcare facility (clinical or non-clinical role). In partnership with public health, they should be placed under symptom monitoring until 21 days after their last presence in a healthcare facility in Rwanda.
This is an evolving situation; please monitor the VDH and CDC websites for the most current information.
Thank you for your continued partnership.
Sincerely,
Karen Shelton, MD
State Health Commissioner