On September 27, 2024, Rwanda’s Ministry of Health reported the first outbreak of Marburg virus disease (MVD) in the country. As of October 2, 2024, a total of 36 cases, including 11 deaths, have been reported in the country. Epidemiological investigations including contact tracing, strengthening infection prevention and control protocols and other measures are being implemented by the Government of Rwanda to control the outbreak. Of the contacts investigated in Rwanda, one who had traveled to Belgium has completed the monitoring period (21 days) and is not considered a public health risk.

Because person-to-person transmission requires contact with the bodily fluids of a symptomatic case, the likelihood of exposure to and infection with Marburg virus for EU/EEA citizens traveling or staying in the affected areas in Rwanda is currently considered low considered. Based on the available information, the risk of exposure to MVD in a healthcare setting is moderate. In the event of import of an MVD case into the EU/EEA, the risk of onward transmission is considered very low, if appropriate measures are applied.

Advice to travelers

Travelers to Rwanda should be informed of the ongoing outbreak in Rwanda and affected areas and follow the advice of local health authorities. They should be advised to:

• Avoid contact with anyone exhibiting MVD symptoms (such as fever, vomiting, diarrhea, or bleeding) or contact with materials and surfaces contaminated by the body fluids of infected individuals. This includes avoiding contact with the dead bodies of infected persons and the burial process.

• Avoid visiting healthcare facilities in the MVD affected areas for non-urgent medical care or non-medical reasons.

• Avoid habitats that may be populated by bats, such as caves or mines, and any form of close contact with wildlife, including monkeys, forest antelopes, rodents and bats, both living and dead, and any form of manipulation or consumption of bushmeat.

Travelers returning to the EU/EEA from Rwanda should be advised to seek immediate medical attention if they develop MVD-compatible symptoms and report their travel history, as well as possible exposure history and close contacts.

ECDC is in contact with international partners to obtain more information and is developing guidance for EU public health authorities.

More information about the Marburg virus

The Marburg virus is present in certain animal species in several sub-Saharan countries. Transmission from animals to humans is rare; However, such events can cause outbreaks due to subsequent human-to-human transmission.

MVD is not an airborne disease and is not considered contagious before symptoms appear. Direct contact with the blood and other bodily fluids of an infected person or animal is the most common route of transmission. Indirect contact with surfaces and materials such as clothing, bedding and medical equipment that are contaminated with infected blood or bodily fluids can also lead to transmission of the virus. Therefore, if proper infection prevention and control precautions are strictly followed, the chance of infection is considered very low.

The incubation period of MVD is usually five to ten days. The onset of MVD is usually abrupt, with nonspecific, flu-like symptoms such as high fever, severe headache, chills, and malaise. More than half of patients experience rapid deterioration within 2 to 5 days, characterized by gastrointestinal symptoms such as anorexia, abdominal pain, severe nausea, vomiting and diarrhea. In severe cases, a rash may develop along with bleeding from various parts of the body.