Marburg Virus Disease (MVD) Outbreak in Republic of Rwanda
Marburg Virus Disease (MVD) Outbreak in Republic of Rwanda
11 October 2024
Dear Colleague:
You may have recently learned about the Marburg Virus Disease (MVD) Outbreak in the Republic of Rwanda (Rwanda) as reported by the CDC in its Health Advisory on October 3, 2024 and by the Virginia Department of Health (VDH) in its Clinician Letter on October 8, 2024. It is important to properly screen febrile patients early in your differential diagnosis for any recent travel to Rwanda or other affected areas. MVD is a rare but highly fatal viral hemorrhagic fever for which there is no current vaccine or treatment.
To date, there have been no confirmed cases of MVD related to this outbreak reported in the United States or other countries outside of Rwanda. Currently, the risk of MVD in the United States is LOW.
While the risk is low that febrile patients or travelers presenting in your healthcare facility may have MVD, it is important to consider MVD (with any recent travel history to affected areas, including Rwanda) early in the differential diagnosis. Based on the most recent best practices and guidance from CDC and VDH, Arlington County Public Health Division (ACPHD) recommends you and your staff take the actions provided below in response to the current MVD Outbreak in Rwanda.
ACTIONS FOR YOU TO TAKE:
I. Recognize the potential for imported MVD cases and the clinical presentations of viral hemorrhagic fevers like MVD, in patients with recent travel history to areas with reported cases.
- Systematically assess all acutely ill patients returning from travel to Rwanda or other affected areas with active MVD outbreak in the past 21 days who present 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 all of the following:
- been to an area with an active MVD outbreak in the past 21 days, AND
- compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND
- reported epidemiologically compatible risk factors – including exposure to a confirmed or suspected case – 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.
II. Call ACPHD staff IMMEDIATELY if you suspect MVD.
Staff are available to provide guidance and initiate the request for testing. Once approved, ACPHD will provide instructions for specimen collection,* and proper infection control measures. You can reach ACPHD staff 24/7 to report suspect cases of MVD disease:
- Monday to Friday, from 8 AM to 4:30 PM, call 703-228-5200, option #1.
- Nights (after 4:30 PM) and weekends, call 703-558-2222 and ask for the Public Health Duty Officer.
* 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.
III. Follow proper isolation and infection control procedures for patients with suspected MVD or other viral hemorrhagic fevers.
- Immediately 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 patients.
- 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.
IV. Monitor healthcare workers returning to U.S. after exposures in Rwandan healthcare facilities
In response to the MVD Outbreak in Rwanda, CDC has issued guidance for returning U.S. healthcare workers who have been in any healthcare facility in Rwanda within the last 21 days.
In partnership with ACPHD, the following recommendations should be followed:
- Returning healthcare workers should be excluded from work duties in a U.S. healthcare facility (clinical or non-clinical role).
- Returning healthcare workers should be placed under symptom monitoring until 21 days after their last presence in a healthcare facility in Rwanda.
These recommendations may be updated based on information available from the evolving outbreak situation in Rwanda. They may also be updated if any U.S.-based healthcare personnel are identified as having MVD while in or after departing Rwanda.
V. Stay informed on the MVD Outbreak. Use these CDC and VDH resources to stay up to date on developments:
Thank you for all you do to control and prevent the spread of communicable diseases in our community.
Sincerely,
Reuben K. Varghese, MD, MPH
Health Director & Director, Public Health Division
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