While Rwanda appears to have its Marburg virus outbreak under control with no new cases reported in the past three days in Rwanda, mpox continues to spread – now affecting 18 countries with 3051 new cases in the past week.

Since declaring the Marburg outbreak three weeks ago, Rwanda has confirmed 62 cases, of which 15 have died, 38 have recovered and nine cases are still receiving treatment with the majority improving, said Health Minister Dr Sabin Nsanzimana on Thursday.

“The case fatality rate overall is 24% and we’ve vaccinated 856 people,” Nsanzimana told an Africa Centres for Disease Control and Prevention (CDC) briefing, describing the trend as “very encouraging”.

As the vaccine is “investigational”, its rollout required more rigorous consent, sampling and documentation, but demand for it has been “very high”, he added.

the vaccines you are providing highly accepted, especially among healthcare providers. Around 90% of those infected are health workers and their close contacts from the intensive care units of two hospitals that treated the very first patients. The index patients was co-infected with malaria which slowed the diagnosis of Marburg, which has similar symptoms.

Rwanda’s health ministry has also tested over 4,000 people “to make sure we don’t miss any cases”, added Nsanzimana.

He attributed “intense activity on the ground”, ring vaccination [vaccinating the close contacts of people with Marburg] and new antivirals for the turnaround in what is the biggest Marburg outbreak ever recorded. 

The virus, which is from the same family as Ebola and, in some outbreaks, has killed over 80% of those infected.

While the zoonotic origin of the outbreak is still unknown, Nsanzimana said Rwanda will be reporting its findings on the the serology and gene sequencing of the virus within a few days. At the same time, it has a team on the ground hunting for the source of the virus.

Mpox ‘not under control’

Mpox cases have now been identified in 18 African countries, with new additions being Zambia and Zimbabwe. In the past week, 3051 new cases have been reported – including two male prisoners in Uganda.

“Mpox is not under control,” warned Africa CDC Director-General Dr Jean Kaseya.

Despite calling a continental meeting in April to warn countries of the risk, cases have risen exponentially: from slightly under 6,000 then to 42,438 suspected mpox cases at present – although only 8,113 have been clinically confirmed.

A rapid test to diagnose mpox is in the pipeline and will transform the testing landscape, said Kaseya.

Kaseya flagged the threat to internally displaced people (IDP), particularly in the Democratic Republic of Congo (DRC), and prisoners – both groups characterised by close contact.

In the eastern DRC, conflict has displaced some 2.5 million people who are now living in camps in close quarters with limited access to water, sanitation and hygiene. 

The two Ugandan prisoners were initially diagnosed with chicken pox – which has small lesions that are itchy not painful like mpox.

DRC vaccination plan includes MSM, transgender people

The DRC’s vaccination campaign started two weeks ago in three provinces – North Kivu, South Kivu and Tshopo – and is “moving well”, said Kaseya, who hails from DRC.

The country’s plan includes men who have sex with men (MSM) and sex workers, as mpox can be sexually transmitted.

In DRC, same-sex sexual contact is not outlawed as it is in many of the other countries currently affected by mpox – Uganda, Burundi, Kenya, Tanzania, Zambia and Zimbabwe.

“When are talking about MSM, we are clear as Africa CDC. We are saying all human beings have the same rights, and we are supporting countries to plan vaccination for all of them, including men having sex with other men,” said Kaseya empathically.

“We are proud and we are glad to see in DRC that we have MSM included,” he added.

Kaseya said that early messaging about mpox Clade 1B only being associated with sexual transmission was wrong – as was the failure to talk about MSM as the main mode of transmission iun the 2022 outbreak.

“There was the stigma talking about men having sex with other men as the main transmission mode of mpox. But if we put it in the context in Africa, that one in some countries is still a taboo. 

“We believe with our effort, what we are doing is sensitizing countries, and we are proud to see that DRC are mentioning that.”

He added that risk communication and community engagement involving “people who are openly saying we are these key populations” was also important.

Uganda tightened its anti-LGBTQ laws recently and, while it plans to test all 1,087 prisoners who possibly had contact with the two prisoners recently diagnosed with mpox, it is unclear how it will approach MSM as a mode of transmission other than to crack down further on smae-sex activity.