The first two people with Marburg also had malaria, which slowed down their diagnosis, Rwandan Health Minister Dr Sabin Nsanzimana told a media briefing on Thursday hosted by the Africa Centres for Disease Control and Prevention (Africa CDC).

This follows the revelation that the suspected index case died on 8 September, according to Dr Brian Chirombo, the World Health Organization’s (WHO) Rwanda representative, speaking at a global WHO briefing held at the same time. 

However, Nsanzimana stressed that Marburg was only confirmed on 26 September.

“The hospital that was attending to the first suspected cases raised the alarm, saying we’re seeing patients, two cases, that are not responding to usual [malaria] treatment. The symptoms for Marburg are very similar to those of  malaria,” said Nsanzimana.

“Its high fever, a severe headache, muscle pain and joint pain and fatigue, and later on, gastrointestinal [pain], nausea, vomiting.  For malaria-endemic countries, these are well known symptoms for malaria.”

As the first case was becoming very sick, Rwanda’s Biomedical Centre, the National Public Health Institute and National Reference Laboratory were called in to investigate and take samples. After running a multitude of tests, they eventually diagnosed Marburg last Thursday.

The outbreak, now comprising 36 confirmed cases, stems from a single cluster in Kigali. This is centred on the two hospitals that treated the earliest suspected cases – the University Teaching Hospital of Kigali (known as CHUK) and the King Faisal Hospital. 

All cases reported in other districts first had contact either with the index case or the health workers who treated him in the capital city before travelling elsewhere. However, the minister added that an Africa CDC map (below) of affected districts was slightly misleading as included districts with case contacts as well as cases.

Nsanzimana confirmed that one case has been confirmed in the district alongside the Democratic Republic of Congo (DRC), but as the incubation period for Marburg is up to 21 days, more cases could emerge in the coming days.

Some 80% of Marburg cases are health workers, while new cases steam from their “very close contacts”, said Nsanzimana. Eleven people have died so far.

‘No travel ban’

Meanwhile, in the absence of a Marburg diagnosis, widow of the earliest known case travelled to Belgium. However, she did not have symptoms, had since tested negative and completed 21 days’ quarantine under the guidance of Belgian authorities.

A young German medical student who had been an intern in own of the hospitals had also returned to Germany, but had also tested negative for the virus.

However, the health minister said said his country would be tightening controls at airports. None of the contacts of cases would be allowed to leave the country until they had completed the 21-day quarantine. Thermal cameras were already in use at the siport to screen for people with high temperatures.

Earlier, the Rwandan government suspended visits to hospital patients and boarding school students.

However, Africa CDC Director General Dr Jean Kaseya was emphatic that “there is no travel ban policy”. He reported being inundated by people asking whether they should continue to travel to Rwanda.

“We are flying to Rwanda. I will be in Rwanda, attending meetings. It’s an outbreak that is managed and, as we have outbreaks in all other countries, there is no travel ban. And I repeat it: travellers should not cancel their trips to Rwanda,” said Kaseya.

Pipeline for Marburg vaccines and therapeutics

Dr Ana Maria Restrepo, WHO Co-Lead of R&D Blueprint for epidemics, said that while there were candidate vaccines and therapeutics for Marburg, “they don’t yet have the clinical efficacy data that will allow our colleagues in the regulatory team to proceed with emergency use listing”.

“WHO has been working with a consortium of over 180 researchers and developers from all around the world, and we hope that we all continue to work collectively and together to support the government Rwanda, to seek the opportunity to evaluate these candidates and therapeutics using a state of the art randomized trials,” Restrepo told the WHO press briefing.

In the absence of any approved treatment, Gilead has donated around 5000 doses of its anti-viral medication, remdesivir, which is being given to patients, said Kaseya.

Mpox continues to surge

While mpox has been upstaged by the more deadly Marburg, there continues to be a steady uptick in cases – around 2,500 every week – said Kaseya.

Currently, there are 34,297 suspected cases but the confirmed cases remain a very low due 6,806 due to a myriad of logistical problems. Ghana this week became the 16th African country to confirm an mpox case.

Kaseya also reported that cases in DRC capital of Kinshasa had surged in late September, coinciding with the reopening of schools. Some 46% of all mpox cases are in children.

Trials would soon begin to test the efficacy of a new therapeutic drug, Brincidofovir, while another trial testing the efficacy of “fractional doses” of the current Bavarian Nordic MVA-BN vaccine is also imminent. If successful, this could massively reduce the need for vaccines, which are in short supply.

Meanwhile, the WHO’s director of regulation and pre-qualification, Dr Rogerio Gaspar, reported that the global body was on the brink of authorising Bavarian Nordic’s MVA-BN vaccine for children aged 12 to 17, and was still engaged with the Japanese producer of the vaccine LC16, which has emergency use listing.