Here’s how Rwanda faced its first Marburg fever outbreak: strict controls and vaccine trials in hospitals and almost normal life outside | Planet of the future

Since the Rwandan government confirmed its first case of Marburg fever on September 27, little has changed on the country’s streets. Although this is one of the largest recorded outbreaks of the Ebola-like disease, with fifteen deaths, the population continues to live their lives, albeit with cleaner hands. However, fear and stricter prevention measures are evident in hospitals, as 70% of those infected are health workers from two centers in the capital Kigali.

“I’m afraid for my life,” explains Cecile, a nurse at a public hospital in Kigali who asks to be identified only by her first name for fear of retribution for speaking to the press. “This virus is very deadly and affects those of us who deal with infected people,” he says. The incubation period ranges from 2 to 21 days, so health care workers may interact with carriers without knowing it. “There are also no specific drugs,” he adds, so patients receive treatment only to relieve symptoms.

Marburg virus causes hemorrhagic fever and its mortality rate can reach 88%. It is usually initially transmitted by contact with the Egyptian bat (Rousettus) in mines or caves. Once in the human body, it spreads through direct contact with the body fluids of infected people or with contaminated surfaces. An outbreak declared last year in Equatorial Guinea has killed 35 people. The main symptoms are high fever, severe headaches, vomiting or bloody diarrhea, muscle pain and fatigue.

Since the first case was confirmed in Rwanda, the virus has killed 15 people, most of them health workers. Of the more than 4,200 suspected cases, 62 are confirmed cases and 38 people have recovered, according to data released Thursday by the Rwanda Biomedical Center. The Ministry of Health claims that more than 70% of those infected are medical workers at two hospitals in the capital – King Faysal and the University Hospital of Kigali (CHUK – an abbreviation in French), which received the first cases of Marburg. . In addition, both facilities employ multiple medical professionals, which has contributed to the spread of the outbreak, Rwandan officials told a briefing.

This high incidence rate explains why prevention is focused on frontline health workers. So those who work in treatment centers and hospitals where the virus has been detected are the first to receive an experimental vaccine being developed by the Sabin Vaccine Institute, which is an on-site clinical trial because it hasn’t been available there yet. is an approved immunization. According to data released on Monday by the Rwanda Biomedical Centre, more than 850 people have received the vaccine since the vaccination began on the 6th. In total, the American non-profit organization sent 1,700 doses.

Experimental vaccine

“I didn’t get vaccinated against Covid-19 three years ago, but I’ll get vaccinated against Marburg, no matter the cost,” says Cecile. Knowing it may be some time before his turn, he hides behind a mask, gloves and a thin white plastic coat.

The virus led to the closure of intensive care units (ICUs) at several hospitals after it was detected among staff. It also forced restrictions on visits from those allowed throughout the country. “Each patient is allowed to have a family caregiver to reduce the number of people in the rooms and minimize physical contact,” Christian Ngarambe, acting CEO of a university hospital in the southern province of Rwanda, explains in an interview.

With access severely limited, hospitals and health centers are seeing fewer visitors than usual. Nurses wearing masks and gloves check everyone who enters. They use infrared thermometers to check for fever, the main symptom of the disease. Everyone is also required to wash and disinfect their hands.

Busy markets

Behind the hospital doors, life continues as usual, as advised by Rwandan Health Minister Sabine Nsanzimana, who said that Marburg’s preventive measures do not prohibit any activity and that “there should be no panic among the population” as authorities have “identified all sources of the disease and are taking appropriate measures.” . Schools are open as usual, markets are busy as usual, and buses and public transport are full of passengers.

Kigali’s busy Kimironko Market remains unaffected by traffic two weeks after the first case was identified. The difference is that young volunteers wearing gloves and masks man the handwashing stations, calmly and efficiently guiding visitors to ensure they adhere to hygiene protocols reminiscent of Covid-era measures.

Officials in Paul Kagame’s government say measures including contact tracing, testing and vaccine rollout are keeping the outbreak under control. The director of the Africa Centers for Disease Control and Prevention (Africa CDC), Jean Kaseyya, last week praised the handling of the outbreak and said the risk of the Marburg virus spreading outside Rwanda was virtually zero.

According to the Minister of Health, the country is already close to declaring victory over the disease. At his latest briefing on Sunday, he said tests carried out over the previous three days had returned negative results and stressed that there had been a significant increase in the number of recoveries over the past week, surpassing the number of deaths. “This means we have the virus under control,” he said.

On September 30, the World Health Organization (WHO) assessed the risk of this outbreak as very high nationally and high regionally due to the potential for it to spread to neighboring countries such as the Democratic Republic of Congo. , Tanzania and Uganda, and around the world. However, on the 11th he said that “it is possible that this estimate will be revised.” The disease “is not easily transmitted and public health measures are being applied, such as active surveillance in facilities and communities, testing of suspected cases, contact tracing, isolation and treatment of cases,” he explained, WHO, which also recommends against restrictions. about travel and trade with Rwanda.

Dan Rwakagabo, a driver at the Musanze bus depot in Rwanda’s northern province, believes the extra hygiene procedures recently implemented are sufficient. “All drivers have been instructed to carry hand sanitizers to use when boarding passengers at bus stations” to keep all surfaces clean, he says.

But others argue that we should be more careful. Epifania Musanabera, an elderly resident of Musanze town in the northern province, expresses concern about people who do not adhere to safety measures. “Some young people are not following hygiene recommendations from local authorities. I saw some hugging, but we were told that we should shake hands and wash our hands as often as possible,” he explains.