Health

With the ongoing outbreak of the Marburg virus in some regions, travelers need to be cautious and well-informed about the risks and the necessary precautions to ensure their safety. The World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and the UK Foreign Office have all issued relevant advice to guide travelers in making safe decisions. Below is a summary of their recommendations and travel advice.

What is Marburg Virus?

Marburg virus is a highly contagious and deadly virus that causes Marburg Virus Disease (MVD), a hemorrhagic fever similar to Ebola. It is transmitted through direct contact with the bodily fluids of infected individuals, contaminated surfaces, or infected animals such as bats. The virus has a high fatality rate, and there is currently no specific treatment or vaccine.

Travel Recommendations

World Health Organization (WHO)

The WHO has not recommended any travel or trade restrictions with Rwanda or any other countries affected by the Marburg virus. However, the organization advises travelers to stay informed about the outbreak and take basic precautions to minimize the risk of exposure. WHO encourages all travelers to monitor official channels for updates on the outbreak and to follow local health authority guidance when in affected areas.

U.S. Centers for Disease Control and Prevention (CDC)

The CDC has issued a Level 2 travel notice for Rwanda, which means that travelers should practice enhanced precautions. Key recommendations include:

Avoiding contact with sick individuals who show symptoms consistent with Marburg Virus Disease (MVD), such as fever, vomiting, diarrhea, or unexplained bleeding.

Avoiding healthcare facilities in outbreak zones unless seeking urgent care.

Obtaining travel insurance that covers medical evacuation and treatment for infectious diseases before traveling.

Monitoring for symptoms of MVD for 21 days after leaving an outbreak area, such as fever, headache, muscle pain, rash, vomiting, or unexplained bleeding. In case of symptoms, travelers should immediately isolate and seek medical care.

CDC also advises travelers to stay updated on the outbreak and prepare for potential changes in travel conditions or advisories.

European Centre for Disease Prevention and Control (ECDC)

The ECDC emphasizes the importance of travelers being aware of the ongoing Marburg outbreak and following the guidance of local health authorities. Their key recommendations include:

Avoiding contact with individuals showing MVD symptoms and steering clear of healthcare facilities in affected areas for non-urgent medical reasons.

Avoiding wildlife habitats such as caves or mines that may be inhabited by bats, and refraining from handling or consuming bushmeat.

Reporting symptoms upon return from affected areas. Travelers returning to the EU/EEA should promptly seek medical attention if they develop symptoms consistent with MVD and disclose their travel history to healthcare providers.

UK Foreign Office

The UK Foreign Office has not yet advised against travel to Rwanda, but it acknowledges the outbreak on its website and urges travelers to consult local authorities before traveling. Organizations that send workers to affected areas are encouraged to register with the UK Health Security Agency (UKHSA) Returning Workers Scheme. This allows returning workers to be monitored for potential symptoms of MVD.

General Precautions for Travelers

Travelers heading to regions affected by the Marburg virus should consider the following precautions:

Avoid close contact with sick individuals, especially those showing symptoms such as fever, vomiting, diarrhea, or unexplained bleeding.

Steer clear of healthcare facilities in affected areas unless necessary.

Avoid high-risk activities such as visiting bat-inhabited caves or handling wildlife, particularly primates, bats, and bushmeat.

Monitor for symptoms for 21 days after leaving the outbreak area and seek immediate medical attention if symptoms develop.

Stay informed through reliable sources like the WHO, US CDC, Africa CDC, ECDC, and local health authorities about any changes in the outbreak and travel advisories.

Conclusion

While the Marburg virus outbreak poses serious health risks, taking proper precautions can significantly reduce the chances of exposure and infection. Travelers to affected areas should stay informed, avoid risky behaviors, and be prepared for potential changes in travel restrictions. By following the guidance of health organizations like WHO, CDC, ECDC, and the UK Foreign Office, travelers can protect themselves and prevent further spread of the virus.

References:

World Health Organization (WHO). Marburg Virus (https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease )

U.S. Centers for Disease Control and Prevention (CDC). Marburg Virus Travel Notice (https://wwwnc.cdc.gov/travel/notices/level2/marburg-rwanda )

European Centre for Disease Prevention and Control (ECDC). Marburg Virus Disease (https://www.ecdc.europa.eu/en/marburg-virus-disease )

UK Foreign Office. Foreign Travel Advice (https://www.gov.uk/foreign-travel-advice/rwanda/health )

3rd October 2024. Rwanda’s ongoing battle with its first Marburg virus outbreak intensified as the Ministry of Health confirmed seven new cases and an additional death yesterday. In a briefing today, Health Minister Sabin Nsanzimana provided updates, including plans to begin a vaccine trial soon.

Meanwhile, two travelers returning to Germany from Rwanda tested negative for the virus after being isolated in Hamburg due to potential exposure in a Rwandan hospital where Marburg patients were being treated.

The latest figures bring Rwanda’s Marburg virus outbreak to 36 cases, 11 of them fatal, marking it as one of the largest recorded globally. In a media briefing organized by the Africa Centres for Disease Control and Prevention (Africa CDC), Nsanzimana revealed that healthcare workers make up 80% of the infected, with 29 cases reported among them. Currently, 25 individuals are receiving care in isolation, and health officials are monitoring 323 identified contacts.

The outbreak was first detected when healthcare workers began falling ill, and early patients did not respond to treatment for conditions like malaria, which shares initial symptoms with Marburg. The virus spreads through contact with infected body fluids, and many cases have been linked to an ICU cluster where the suspected index patient was treated.

Nsanzimana also announced that Rwanda is expecting 5,000 doses of remdesivir to enhance treatment efforts. The ministry plans to initiate a vaccine trial soon, with details on the vaccine and its rollout to be announced in the coming days. As of now, no specific treatments or vaccines for the Marburg virus are officially approved.

Genetic sequencing and further epidemiologic investigations are ongoing, and though Nsanzimana described the outbreak as "controlled," it is not yet fully contained.

Read more: Gilead Donates Remdesivir for Emergency Use in Response to Marburg Virus Disease in Rwanda here  and 

Marburg Virus updates on this link and the Situation in Rwanda, Epidemiology, Public health response, WHO risk assessment, WHO advice at this link.

Marburg virus disease was first recognized in 1967 during simultaneous outbreaks in Germany and Yugoslavia, linked to African green monkeys from Uganda. Since then, outbreaks have occurred mainly in Africa, with cases in Ghana, Guinea, and Uganda, among others. The disease is highly fatal, with recent outbreaks (before the current in Rwanda) in Tanzania and Equatorial Guinea in 2023. Key historical outbreaks include Angola (2004-2005) and the Democratic Republic of Congo (1998-2000), which had some of the highest fatality rates. Read more on this link

East African Community Headquarters, Arusha, Tanzania, 4th October, 2024:  The East African Community (EAC) Secretariat has called for a swift and coordinated regional response to contain the ongoing Marburg Virus Disease (MVD) outbreak declared in Rwanda. The outbreak poses a serious threat to regional health security and requires urgent action from all EAC Partner States to prevent its spread across borders.

On the 27th September 2024 Rwanda’s Ministry of Health declared the Marburg Virus Disease (MVD) outbreak and as of 30th September, 2024 there were 29 confirmed cases and 10 deaths with more than 297 contacts under close monitoring and healthcare workers have been disproportionately affected. The World Health Organization (WHO) has raised concerns about the potential regional spread of the disease due to confirmed cases in districts near the borders of the Democratic Republic of the Congo (DRC), Uganda, and Tanzania.

“There is an urgent need for a coordinated regional response to contain the spread of this highly infectious virus through swift identification, isolation, and treatment of cases and enhanced screening at borders and health facilities,” said Hon. Andrea Aguer Ariik Malueth, EAC Deputy Secretary General, in charge of Infrastructure, Productive, Social & Political sectors

He called for Partner States to strengthen their public awareness and infection control protocols including handwashing, avoiding physical contact with symptomatic individuals and surveillance at borders and health facilities.  Read more on this link

In the face of recurring health crises and outbreaks of infectious diseases such as Ebola, malaria, yellow fever, and COVID-19, GIZ programmes across Regional Economic Communities (RECs) in Africa, together with their partners, are constantly engaging and co-creating collaborative and coordinated Pandemic Preparedness and One Health approaches to disease management.

Aligning with these efforts, in June 2024, the GIZ Regional Programme, Support for Pandemic Prevention in the Economic Community of West African States (ECOWAS), invited the joint East African Community (EAC) and GIZ Pandemic Preparedness programme to a stakeholder workshop hosted by the West African Health Organization in Banjul, Gambia. The meeting aimed to develop collaborative mechanisms for the effective engagement of Civil Society Organizations (CSOs) and community leaders in epidemic preparedness, with a particular focus on Risk Communication and Community Engagement (RCCE).
Read more

On 31 July 2024, the EAC, together with the International Organization for Migration (IOM) and GIZ, announced the successful conclusion of the Water Sanitation and Hygiene (WASH) Project in the region.
The US$2.5 million WASH project commenced in 2021 with the aim of strengthening the capacities of EAC Partner States to prevent and control the spread of COVID-19 and other infectious diseases using hygiene measures, risk communication, and community sensitization.

The three-year project has achieved remarkable milestones, including the installation and renovation of 43 fixed handwashing facilities at the Points of Entry and border hotspots of all seven Partner States, namely Burundi, the Democratic Republic of the Congo (DRC), Kenya, Rwanda, South Sudan, Uganda, and the United Republic of Tanzania. Read more

On August 16, 2024, the European Centre for Disease Prevention and Control (ECDC) published a Rapid Risk Assessment for the EU/EEA regarding the Mpox epidemic caused by monkeypox virus clade I, with no change in risk levels or recommendations. An epidemiological update on August 26, 2024, reported a total of 102,977 confirmed Mpox cases globally since monitoring began in 2022, with 219 deaths. The majority of cases are from Africa, particularly the Democratic Republic of Congo. The Africa CDC declared mpox a Public Health Emergency of Continental Security on August 13, 2024, and the WHO followed by declaring it a Public Health Emergency of International Concern on August 14, 2024. The ECDC has issued additional recommendations for Substances of Human Origin (SoHO) professionals, advising careful screening of donors from affected regions and deferral guidelines for those exposed to Mpox.
Read more here

Kenya has confirmed its fifth Mpox case, involving a 29-year-old woman from the VOK area in Mombasa, near Tumaini Academy. Health Cabinet Secretary Deborah Barasa announced that the case was identified on Wednesday, and the patient is now in isolation at Utange Hospital.

According to CS Barasa, the patient has no recent travel history and is the spouse of the fourth confirmed Mpox case, who is currently hospitalized in Nakuru. The spouse had traveled to Rwanda and returned on August 24, 2024.

"Despite the lack of recent travel history to Mpox-affected countries, active surveillance of suspected cases is underway to prevent further spread of the disease," CS Barasa stated.

So far, 124 samples have been tested for Mpox, with 110 returning negative results and 9 still under analysis. Additionally, 687,233 travelers have been screened at Kenya’s 26 ports of entry as part of comprehensive containment measures. Currently, 33 contacts are under close observation. See official statement here.

As Mpox cases surge in various African countries, the government has assured the public that all measures are being taken to control the virus if cases will occur in the country. On 19th August, 2024, the Ministry of Health updated the public on the threat of Mpox outbreak following the global upsurge of cases, including in some East African countries. Due to this threat the public was advised to take recommended precautions to protect themselves and prevent the disease from entering the country. "I would like to inform you that, until now, no patient has been proven to have Mpox infection in the country. The Ministry of Health continues to take the following measures to prevent Mpox from entering the country," said the statement signed by Tanzania's Minister for Health.

Full statement here

In August 2024, both the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) declared Mpox a public health emergency, responding to the rapid spread of the disease across Africa, particularly in the Democratic Republic of the Congo (DRC) and neighboring countries.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared the Mpox outbreak a Public Health Emergency of International Concern (PHEIC) due to the emergence of a new Mpox strain in the DRC and its spread to countries like Kenya, Rwanda, Uganda, and Burundi. More than 15,600 cases and 537 deaths have been reported in 2024 alone, with experts warning of a potentially higher number of unreported cases. WHO is now mobilizing US$ 15 million for surveillance, vaccine access, and outbreak containment.

Similarly, Africa CDC Director General Dr. Jean Kaseya declared Mpox a Public Health Emergency of Continental Security (PHECS), marking the agency’s first-ever emergency declaration. The move aims to coordinate and support African nations in curbing the virus by boosting surveillance, laboratory testing, and equitable vaccine distribution. Africa CDC's partnership with the European Commission and Bavarian Nordic will bring over 215,000 doses of the MVA-BN® vaccine to affected countries.

Both organizations stress the importance of a unified global response, with Africa CDC calling for international solidarity to prevent further escalation of the crisis. Read more WHO and Africa CDC.