The US should lift its Marburg-related entry restrictions on people travelling from Rwanda as they are “killing” that country’s economy, according to Dr Jean Kaseya.

The US requires people who have visited Rwanda in the past 21 days to fly to one of only three airports for health screening.

“Now that we are out of the [US] election, let us start to talk science and let us lift this entry status,” said Kaseya, Director-General of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya added that not a single Marburg case had been transmitted out of Rwanda. Rwanda has had no new Marburg cases in the past week, and its 66 cases are all linked to the index case and health workers who treated him.

Kaseya also called on the US to deliver on the pledge made by President Joe Biden to contribute $500 million to assist Africa with the current mpox outbreak. He added that less than 20% of partners’ mpox pledges had been delivered to the continent.

Mpox outbreak continues 

Meanwhile, Mpox cases continue to rise, particularly in Central Africa, with 2,532 new cases in the past week – including 20 in Rwanda, which hadn’t recorded any cases in the past few weeks, and a new district of the Central Africa Republic bordering Chad.

While vaccinations were generally progressing well in the DRC and Rwanda, Burundi has not yet received any doses as the Africa CDC was still discussing some issues with the country, Kaseya noted.

However, despite a high case load, Burundi had not yet reported a single death.

Africa CDC’s mpox lead, Dr Ngashi Ngongo, attributed this to dedicated inpatient treatment centres for mpox patients that offered treatment as well as nutritional and psycho-social support.

While the overall case fatality rate is 9,3%, the death rate for younger children is four or five times that of adults, said Ngongo, adding that a forthcoming paper would offer more analysis about the contributing factors to the high mortality in children.

“The context is important. In some of these countries, especially in Central Africa, there’s a high malnutrition rate in those children. In Burundi, about 53% of children below five are chronically malnourished. In DRC, it’s about 42%,” said Ngongo.

“The second element that might be contributing to the DRC figure is that in the case of malnourished children who are so fragile, the more time you take to seek care, I think the more advanced the disease and the poorer the outcome.”

Kaseya added that children’s co-infection with measles was also contributing to the higher deaths.

However, he added that, as Burundi had not recorded any deaths despite high malnutrition,  “there are many things we don’t yet understand”.

The continent is still struggling to protect young children from mpox, as the MVA-BN vaccines at hand can only be used on children from 12 years of age. The Japanese LC16 vaccines that can be used on children are not yet available.

The World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization has advised that, although MVA-BN is currently not licensed for persons under 18 years of age, it may be used “off-label” in infants, children and adolescents, and in pregnant and immunocompromised people in outbreak settings where the benefits of vaccination outweigh the potential risks.

So far, the mpox cases in Africa this year are 545% higher than in 2023 and cases are increasing at a steady pace of between 2000 and 3000 cases every week, Kaseya noted.