Lessons from Rwanda’s Marburg Virus Outbreak and Building Resilient Systems in Global EM.
Hosts:
Tsion Firew, MD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Marburg_Virus.mp3



Download


Leave a Comment





Tags: Global Health, Infectious Diseases





Show Notes

Context and the Rwanda Marburg Experience

*
The Threat: Marburg Virus Disease is from the same family as Ebola and has historically had a reported fatality rate as high as 90%.

*
The Outbreak (Sept. 2024): Rwanda declared an MVD outbreak. The initial cases involved a miner, his pregnant wife (who fell ill and died after having a baby), and the baby (who also died).

*
Healthcare Worker Impact: The wife was treated at an epicenter hospital. Eight HCWs were exposed to a nurse who was coding in the ICU; all eight developed symptoms, tested positive within a week, and four of them died.

*
The Turning Point: The outbreak happened in city referral hospitals where advanced medical interventions (dialysis, mechanical ventilation) were available.

*
Rapid Therapeutics Access: Within 10 days of identifying Marburg, novel therapies (experimental drugs and monoclonal antibodies) and an experimental vaccine were made available through diplomacy with the US government/CDC and agencies like WHO, Africa CDC, CEPI and more.



*
The Outcome: This coordinated effort—combining therapeutics, widespread testing, and years of investment in a resilient healthcare system—helped curb the fatality rate down to 23%.



Barriers and Enablers in Outbreak Preparedness

*
Fragmented Systems: Emergency and surveillance functions often operate in silos, leading to delayed or missed outbreak identification (e.g., inconsistent travel screening at JFK during early COVID-19 vs. African countries).

*
Solution: Empowering Emergency Departments and the community as the sentinel site can bridge this gap.



*
Limited Frontline Capacity and Protection: Clinicians are often undertrained and underprotected and are frequently not part of the decision-making for surveillance.

*
Weak Governance and Accountability: Unclear command structures and lack of feedback discourage early reporting.

*
Enabler: Strong governance and accountability in Rwanda helped contain the virus.



*
Dependence on External Programs: Many low-income countries rely on outside sources for vaccines and therapeutics, slowing response.

*
Solution: Invest in local production (e.g., Rwanda’s pre-outbreak investment in developing its own mRNA vaccines).



*
Lack of Resource-Smart Innovation: Gaps exist in things like integrating digital triage tool...