HAN Alert – 00517: Stay Informed for Your Health | Health

Distributed through the CDC Health Alert Network
October 3, 2024, 12:15 PM ET
CDCHAN-00517

Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to tell clinicians and well being departments concerning the Republic of Rwanda’s first confirmed outbreak of Marburg virus illness (MVD) with 36 laboratory confirmed instances and 11 deaths reported as of October 2, 2024, together with at the least 19 instances in healthcare staff. This report summarizes CDC’s suggestions for public well being departments and clinicians within the United States on case identification and testing and scientific laboratory biosafety concerns. No confirmed instances of MVD associated to this outbreak have been reported within the United States or different nations outdoors of the Republic of Rwanda so far. Currently, the danger of MVD within the United States is low; nevertheless, clinicians ought to concentrate on the potential for imported instances.

Background
MVD is a uncommon however extremely deadly viral hemorrhagic fever (VHF) attributable to an infection with one in every of two zoonotic viruses, Marburg virus or Ravn virus. Both Marburg virus and Ravn virus are throughout the virus household Filoviridae, which additionally contains Ebola viruses. An individual contaminated with the Marburg virus will not be contagious earlier than signs seem. Symptoms might embody fever, headache, muscle and joint ache, fatigue, lack of urge for food, gastrointestinal signs, or unexplained bleeding. Marburg virus is spread by direct contact with damaged pores and skin or mucous membranes with the physique fluids of somebody who's sick with MVD, or who not too long ago died from their an infection. These physique fluids embody blood, urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, or semen. People may contract MVD if they've contact with contaminated animals, or with needles, or with different objects or surfaces contaminated with the virus. Marburg virus is not unfold by airborne transmission.

On September 27, 2024, the Ministry of Health of the Republic of Rwanda reported instances of MVD in well being amenities within the nation. These are the primary recognized instances of MVD in Rwanda. As of October 2, 2024, Rwanda has recorded 36 laboratory confirmed instances, together with 11 deaths (31% case fatality charge) from MVD. At least 19 instances are in healthcare staff, nearly all of whom work in intensive care models. There are additionally a number of instances unlinked to recognized transmission chains, suggesting extra instances might have been undetected or unreported. Cases have been reported from seven of the 30 districts in Rwanda, with three districts (Gasabo, Kicukiro, Nyarugenge) in Kigali Province reporting the very best variety of instances. Other districts reporting instances embody Nyagatare, Gatsibo, Kamonyi, and Rubavu. Approximately 300 contacts to instances are being monitored in Rwanda. Investigations are ongoing to find out timeline, transmission chains, and potential supply of the outbreak.

CDC has reached out to U.S.-based nongovernmental organizations and medical facilities with workers working within the affected areas to offer guidance on education and how to conduct health assessments of U.S.-based staff before, during, and after their deployment. On October 3, 2024, CDC issued interim recommendations for public health management of U.S.-based healthcare personnel who were present in a healthcare facility in Rwanda in the previous 21 days.

There is presently no Food and Drug Administration (FDA)-approved vaccine or remedy for MVD. In the absence of early prognosis and acceptable supportive care, MVD has a excessive mortality charge of 23%–90%, relying on the virus pressure and the extent of case administration. With early intensive supportive care and fluid alternative, mortality charges may be decrease.

Recommendations for Clinicians

• Systematically assess sufferers with publicity danger and appropriate signs for the opportunity of viral hemorrhagic fevers together with MVD by a triage and evaluation process together with a journey historical past. Early identification of MVD or different viral hemorrhagic fevers is necessary for offering acceptable and immediate affected person care and stopping the unfold of an infection.
• Include MVD within the differential prognosis for an ailing one that has been to an space with an energetic MVD outbreak up to now 21 days, AND who has appropriate signs (e.g., fever, headache, muscle and joint ache, fatigue, lack of urge for food, gastrointestinal signs, or unexplained bleeding), AND has reported epidemiologically appropriate danger components like  any a number of of the beneath, throughout the 21 days earlier than symptom onset:
  • Had direct contact with a symptomatic individual with suspected or confirmed MVD, or with any objects contaminated by their physique fluids.
  • Experienced a breach in an infection prevention and management precautions that resulted within the potential for contact with physique fluids of a affected person with suspected or confirmed MVD.
  • Participated in any of the next actions whereas in an space with an energetic MVD outbreak:
    • Contact with somebody who was sick or died or with any objects contaminated by their physique fluids.
    • Attended or participated in funeral rituals, together with getting ready our bodies for funeral or burial.
    • Visited or labored in a healthcare facility or laboratory.
    • Contact with cave-dwelling bats or non-human primates.
    • Worked or hung out in a mine or cave.
• Consider extra widespread diagnoses resembling malaria, COVID-19, influenza, or widespread causes of gastrointestinal and febrile sicknesses in an ailing affected person with current worldwide journey, and consider and handle appropriately.
• Know that sufferers with a Marburg virus an infection might current with concurrent infections (e.g., co-an infection with malaria), and the opportunity of a concurrent an infection needs to be thought-about if a affected person has a scientific and epidemiologic historical past appropriate with MVD. Travel to or from Rwanda up to now 21 days shouldn't be a cause to defer routine laboratory testing or different measures obligatory for commonplace affected person care.
• Isolate and handle sufferers with publicity dangers and signs appropriate with MVD in a healthcare facility till receiving a damaging Marburg virus take a look at outcome on a pattern collected ≥ 72 hours after symptom onset. If a pattern collected is <72 hours after symptom onset and is damaging, the affected person ought to stay within the healthcare facility and one other take a look at needs to be carried out on a brand new pattern taken ≥ 72 hours after preliminary symptom onset. Routine laboratory testing to watch the affected person’s scientific standing and diagnostic testing for different potential causes of the affected person’s sickness needs to be pursued whereas Marburg virus testing is underway. Marburg virus diagnostic testing shouldn't be delayed whereas awaiting outcomes of different diagnostic testing.
  • Patients needs to be held in isolation at their presenting medical facility and cared for by personnel carrying acceptable PPE, pending take a look at outcomes.
  • If a affected person exams constructive, they'd be transferred to a Regional Emerging Special Pathogens Treatment Center or a state-designated particular pathogens remedy heart. relying on the jurisdiction.
• Contact your state, territorial, native or Tribal (STLT) well being division instantly (through 24-hour Epi-on-Call contact list) if MVD is suspected and observe jurisdictional protocols for affected person evaluation. If a prognosis of MVD is taken into account, well being departments will work with CDC and the scientific staff to coordinate care and testing for the affected person and guarantee acceptable precautions are taken to assist stop potential unfold.
• Counsel sufferers with deliberate journey to an MVD outbreak-affected space on methods to prevent exposure throughout their journey. Prevention strategies embody:
  • Avoiding contact with blood and physique fluids (or with supplies probably contaminated with blood and physique fluids) of people who find themselves sick.
  • Not taking part in funeral or burial practices that contain touching the physique of somebody who died from suspected or confirmed MVD.
  • voiding contact with cave-dwelling fruit bats and non-human primates.
  • Refraining from coming into areas recognized to be inhabited by cave-dwelling fruit bats, resembling mines or caves.
• For this outbreak, vacationers are moreover suggested to keep away from visiting healthcare amenities within the outbreak space for nonurgent medical care or for nonmedical causes, and to keep away from visiting conventional healers.
• Counsel healthcare staff touring to Rwanda for work in scientific settings of their potential elevated danger of publicity to Marburg virus, the significance of following beneficial an infection prevention and management precautions, and the symptom monitoring and work-restriction they might have to observe after their return to the United States.

Recommendations for Infection Prevention and Control Measures in Hospitals

• Employ a combination of infection prevention and control measures to forestall transmission of MVD in hospitals. These an infection prevention and management measures embody, however will not be restricted to:
  • Isolating sufferers in a personal room with a personal toilet or coated bedside bathroom if MVD is suspected. Dedicated medical tools (ideally disposable, when attainable) needs to be used for the supply of affected person care.
  • Following separate PPE steering for managing clinically stable and clinically unstable sufferers.
  • Ensuring that healthcare staff caring for sufferers with VHFs have obtained complete coaching and demonstrated competency in performing VHF-associated an infection management practices and procedures.
  • Following the infection prevention and control measures as recommended for VHFs together with utilizing beneficial PPE and limiting the variety of personnel who enter the room for scientific analysis and administration.
  • Having an onsite supervisor supervise personnel offering care to those sufferers always. A educated observer should additionally supervise every step of each PPE donning/doffing process to make sure established PPE protocols are accomplished appropriately.
  • Excluding people unable or unwilling to stick to an infection management and PPE use procedures from offering care for sufferers with VHFs.
• Know that healthcare personnel might be uncovered by contact with a affected person’s physique fluids, contaminated medical provides and tools, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nostril, or mouth) are significantly hazardous.
• Minimize procedures that may enhance environmental contamination with infectious materials, contain dealing with of probably contaminated needles or different sharps, or create aerosols.

Recommendations for Public Health Departments

• Follow your established jurisdictional protocols relating to affected person evaluation to find out if testing for Marburg virus is warranted for a affected person with regarding scientific and epidemiologic historical past for MVD is recognized in your jurisdiction.
  • Coordinate affected person administration, pattern referral, and Marburg virus testing with State, Territorial, Local and Tribal well being departments, CDC, and the scientific staff.
  • Contact CDC’s Viral Special Pathogens Branch (VSPB) 24/7 for consultations about Marburg virus illness or different viral hemorrhagic fevers. Call CDC Emergency Operations Center at 770-488-7100 and request VSPB’s on-name epidemiologist. For non-emergency inquiries, electronic mail [email protected].
  • For suspect instances, request testing for Marburg virus and different viral hemorrhagic fevers from CDC (Atlanta, Georgia) or the Laboratory Response Network (LRN).
    • To date, 37 geographically various LRN laboratories and 13 Regional Emerging Special Pathogen Treatment Centers can take a look at utilizing the Biofire FilmArray NGDS Warrior Panel, with a number of extra LRN laboratories working towards constructing testing functionality.
    • The Warrior Panel can detect orthomarburgviruses (Marburg and Ravn viruses) and orthoebolaviruses (Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses) along with different excessive-consequence pathogens.
    • Per producers’ suggestions, outcomes from the Biofire FilmArray NGDS Warrior Panel are presumptive, and outcomes require confirmatory testing which might be carried out in CDC laboratories.
• Follow CDC travel guidance for Rwanda and contemplate partaking journey well being clinics or different scientific and public well being companions to extend consciousness on MVD.
• Review CDC’s new interim recommendations for public health management of U.S.-based healthcare personnel who were present in a healthcare facility in Rwanda during the previous 21 days.
  • These interim suggestions embody submit-arrival monitoring by well being departments and exclusion from work duties in a U.S. healthcare facility till 21 days after their final presence in a healthcare facility in Rwanda.

Recommendations for Clinical Laboratory Biosafety

Recommendations for Healthcare Workers Returning from Work in Rwanda

• On October 3, 2024, CDC issued interim suggestions for monitoring and managing U.S. healthcare staff who've been current in any healthcare facility, together with outpatient settings or conventional healers, in Rwanda throughout the final 21 days and are returning to the United States.
• Returning staff and sponsoring organizations ought to review CDC’s new interim suggestions.
• These interim suggestions embody submit-arrival symptom monitoring by well being departments and exclusion from work duties in a U.S. healthcare facility till 21 days after their final presence in a healthcare facility in Rwanda.

Recommendations for the Public

• Protect your self and forestall the unfold of MVD when dwelling in or touring to a area the place Marburg virus is doubtlessly current or that's presently experiencing an outbreak.
  • Take the next actions to guard your self:
    • Avoid contact with blood and different physique fluids.
    • Avoid supplies probably contaminated with blood or different physique fluids of people who find themselves sick.
    • Avoid visiting healthcare amenities within the outbreak space for nonurgent medical care or for nonmedical causes.
    • Avoid visiting conventional healers.
    • Do not take part in funeral or burial practices that contain touching the physique of somebody who died from suspected or confirmed MVD.
    • Keep away from fruit bats and non-human primates and don't enter areas the place fruit bats reside, resembling mines or caves.
  • Monitor your well being for 21 days after you come back from an space experiencing an MVD outbreak.
  • Isolate (separate) your self instantly from others and search medical care instantly in the event you develop symptoms of MVD. Before you enter a healthcare facility, alert the healthcare suppliers of your current journey to an MVD-affected space.

For More Information

General Marburg Information

Clinician Resources

U.S. Healthcare Settings

Non-U.S. Healthcare Settings

U.S. Public Health Departments