Marburg Virus Spreads in Rwanda – But Not Belgium
Infectious Diseases 02/10/2024 •
Health workers being briefed about Marburg in Rwanda.

Twenty-nine people in Rwanda have been diagnosed with Marburg, the deadly haemorrhagic virus, and 10 have already died, according to the country’s health ministry on Tuesday.

This is three more cases and four more deaths since the outbreak was announced last Friday.

The Rwandan Ministry of Education suspended visits to students in boarding schools on Wednesday to prevent the spread of the virus in schools. 

This follows Sunday’s decision by the health ministry to suspend hospital visits and restrict the funerals of people suspected to have died of Marburg, confining their size to 50 people and outlawing home vigils and open caskets.

Some 70% of those infected are health workers at two facilities in the Rwandan capital, Kigali, and the 19 surviving patients are currently in isolation in hospital, according to the health ministry.

Cases have also been detected in three districts bordering Rwanda’s neighbours, the Democratic Republic of Congo (DRC), Uganda and Tanzania.These countries have weaker health systems and surveillance than Rwanda, and there are fears of that the disease might already be in those countries.

Marburg in Rwanda, October 2024

However, an alarmist report suggesting that Marburg may have spread to Belgium is untrue.

“Contact tracing is underway, with about 300 contacts under follow-up as of 29 September 2024,” according to the World Health Organization (WHO).

“One contact travelled to Belgium from Rwanda. WHO was made aware of this by the public health authorities in Belgium. They shared detailed information on the contact’s situation, that they remained healthy, completed the 21-day monitoring period, did not present with any symptoms, and are not a risk to public health.”

Marburg update, 1 October 2024

Transmission via fruit?

There is no vaccine or proven treatment for Marburg, a zoonotic disease from the same filovirus family as Ebola. Between 20-90% of people with the disease will die, according to the US CDC.

However, there are “several promising candidate medical countermeasures that are progressing through clinical development”, according to the WHO Africa region, which is “coordinating a consortium of experts to promote preclinical and clinical development of vaccines and therapeutics against Marburg virus disease”.

The Sabin Vaccine Institute’s vaccine candidate began Phase II trials in humans a year ago,.

The first known cases were identified in 1967 in Marburg, Germany, in people suspected of coming into contact with infected monkeys from Uganda.

Since then, Egyptian fruit bats have been identified as reservoirs for the Marburg virus.  Human contact between infected bats, including exposure to their urine and faeces, as well as contact with primates infected by bats are the main suspected routes of transmission.

However it is also possible that people could be infected via fruit, according to a 2021 study by Brian Amman of the Viral Special Pathogens Branch at the US CDC and colleagues.

They showed that Marburg-infected bats “can shed virus onto discarded fruit” that can remain stable for around six hours on mangoes and bananas, fruits that are enjoyed by bats and primates, including humans. 

“Consuming or handling of fruit bitten or spat-out by bats is a risk factor” for Marburg spillover to humans and other sensitive wildlife, according to the study.

But person-to-person transmission “requires extremely close contact with a patient,” according to the Africa Centres for Disease Control and Prevention (Africa CDC).

“Infection results from contact with blood or other body fluids (faeces, vomit, urine, saliva, and respiratory secretions) with high virus concentration, especially when these fluids contain blood. Transmission via infected semen can occur up to seven weeks after clinical recovery.”

The incubation period varies from two to 21 days. Thereafter, illness “begins abruptly, with high fever, severe headache and severe malaise”. 

On the third days, patients may experience “severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting”.

“Although not all cases present with haemorrhagic signs, severe haemorrhagic manifestations may appear between five and seven days from symptoms onset, and fatal cases usually have some form of bleeding, often from multiple areas,” Africa CDC notes.

Keep calm, urges health ministry

Rwandan Health Minister Dr Sabin Nsanzimana appealing for calm on national television on Sunday.

Rwanda’s Ministry of Health has urged Rwandans to “remain vigilant and strengthen preventive measures by ensuring hygiene, washing hands with soap, sanitizing hands, and taking necessary precautionary measures when in contact with other individuals”.

Health Minister Sabin Nsanzimana has also appealed for calm, saying that people can continue with their daily lives as the government “has begun to identify hot spots”. However, he appealed to those with symptoms to seek immediate health from their nearest health facility or via an emergency number.


The same infection prevention and control protocols used for other viral haemorrhagic fevers, such as Ebola, should be followed to prevent transmission, according to the WHO Africa Region.

In a joint effort with USAID, WHO has delivered over 500 clinical care, infection prevention and control supplies to Rwanda.

Image Credits: Ministry of Health, Rwanda.

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