Rwanda restricts funeral crowds and bans hospital visits to fight spread of Ebola-like virus

Marburg has already killed eight people in an outbreak among healthcare workers treating an infectious patient

Rwanda has banned hospital visits and has curtailed funerals as it tries to halt a deadly Ebola-like haemorrhagic fever that has already killed eight in a flare-up among healthcare workers.
The outbreak of Marburg virus is suspected to have spread to medics treating a patient with the infection.
The small central African nation announced the outbreak late last week and on Saturday said the dead and other 26 known cases recorded so far were mainly health workers.
Previous outbreaks have typically seen around half of those infected die, though in the worst incidents where health care has been poor, that has risen to nearly 90 per cent.
Authorities are now racing to trace more than 300 people who may have been in contact with cases so that they can potentially be isolated to halt the spread of the virus.
Experts said Rwanda’s acknowledgement that the country had already found cases in seven different districts raised the prospect that the virus may have been previously spreading unrecognised.
But they also said that Rwanda’s relatively strong health system meant there was a good chance the infection could be halted.
The Marburg virus is in the same filovirus family as Ebola and causes similar symptoms.
Bats are a natural animal reservoir, and the virus has repeatedly spilled over into humans who have come into prolonged exposure to the infected mammals.
Once people are infected, it spreads person-to-person via droplets of blood, saliva, mucus and other bodily fluids. The virus is often transmitted to healthcare workers and relatives tending to the sick, or to funeral mourners or those preparing the dead.
Infections start with fever, fatigue, aches and pains, diarrhoea and vomiting. They can then go on to haemorrhage and bleed from bodily orifices. In some outbreaks as many as 88 per cent of those infected have died.
Rwanda’s health minister, Sabin Nsanzimana urged the public to maintain high levels of hygiene to contain the virus and announced a series of new preventative measures.
He said visits to hospitalised patients would be stopped for the next fortnight, and only one caregiver would be allowed per patient.
“Funeral services where the cause of death was determined to be Marburg will be attended by no more than 50 people,” the ministry added.
Homes, churches and mosques are prohibited from holding open-casket viewings of the dead, but limited numbers of people will be allowed controlled viewing of loved ones at health facilities.
Rwanda’s outbreak is already thought to be the fourth largest on record, since the virus was first recognised after outbreaks laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia).
The infections were traced back to a shared shipment of infected African green monkeys.
Thirty-one people became ill then, initially laboratory workers followed by several medical personnel and family members who had cared for them.
Peter Hornby, professor of emerging infections and global health at Oxford, said hospital outbreaks were common, especially when medical staff were slow to recognise symptoms of a virus which is still quite rare.
He said: “It’s generally spread by close contact of body fluids of people who are generally quite unwell.
“Hospital outbreaks are common, but there’s also transmission at the home of sick people, and at funerals.”
He said the geographic spread of the virus was a “concerning feature” and suggested there may have been unrecognised transmission before the outbreak was spotted.
Paul Hunter, professor in medicine at Norwich Medical School at the University of East Anglia, said people mourning an early victim could have spread the disease further afield.
He said: “In the past hospital outbreaks were often associated with the re-use of non-sterilised needles.
“But that cannot explain the recent appearance in multiple districts over a short period of time. That is puzzling me and so far, I can’t find any hard data to explain this.
“My guess (and it is a guess with no direct evidence) is that the index case died, and the infection was spread to other districts by mourners who attended his or her funeral.
“Attending a funeral is a well-known risk factor for these viruses. Funeral practices in some cultures entail close physical contact with the newly deceased person as that person is prepared for burial.”
Neighbouring Tanzania reported an outbreak in 2023, while three people died from the virus in Uganda in 2017. In West Africa, 12 people died in a 2023 outbreak in Equatorial Guinea.
Rwanda is thought to be better placed than many African countries to deal with the outbreak because of the strength of its health system. Its healthcare has often been praised as a role model for the continent.
Prof Hornby said: “It’s a relatively small country that has put in place strong governance and has a particularly well organised health system compared to some other countries in the region.”
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