Health Advisory

Summary 

• On October 3, 2024, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory to inform clinicians and health departments about the Republic of Rwanda’s first confirmed outbreak of Marburg virus disease (MVD) with 58 laboratory confirmed cases and 13 deaths reported (as of October 10, 2024), including numerous cases in healthcare workers.
• To date, no confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of the Republic of Rwanda. CDC has indicated that the risk of MVD in the United States is low.
• To further reduce the risk of U.S. cases, all travelers returning from Rwanda will be screened by CDC personnel at U.S. airports for potential exposure and symptoms of illness, beginning on October 14. Dulles International Airport is one of the three screening airports in the U.S.

Suggested Actions

• Include MVD in the differential diagnosis for any ill person who has been to an area with an active MVD outbreak in the past 21 days, and who has compatible symptom (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), and has reported epidemiologically compatible risk factors within the 21 days before symptom onset. Collect a detailed travel history and use a triage and evaluation process to assess exposure risk.
  • 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.
• Report all suspected MVD cases immediately to the Fairfax County Health Department by calling 703-409-8449. Health Department staff can confirm travel history, provide infection control guidance, and facilitate testing which is not commercially available.
• 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. Infection prevention and control guidance can be found here: https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/infection-control/index.html
• CDC issued additional guidance for U.S. healthcare workers who have been in any healthcare facility in Rwanda within the last 21 days. Returning healthcare workers should be excluded from work duties in a U.S. healthcare facility (clinical or non-clinical role). In partnership with public health, they should be placed under symptom monitoring until 21 days after their last presence in a healthcare facility in Rwanda

Additional Information

• Marburg is a virus that naturally occurs in fruit bats and is in the same family as the Ebola virus. It can spread from human to human when someone comes into contact with bodily fluids from a person who’s infected. People can also get sick after handling a patient’s clothing or bedding. Marburg virus is not spread through airborne transmission.
• Symptoms of Marburg can appear similar to other diseases and can include fever, chills, headache, muscle aches, rash, sore throat, nausea, vomiting and diarrhea. People infected with Marburg usually get sick between 2 and 21 days after exposure to the virus.
• On Monday, October 7, the US Centers for Disease Control and Prevention (CDC) issued a Level 3 notice to reconsider non-essential travel to the Republic of Rwanda. Patients who travel are advised to exercise caution.