Abstract RationaleMarburg Virus Disease (MVD), a highly virulent hemorrhagic fever, has historically occurred in remote settings with mortality rates reaching up to 90%. In 2024, the first an unprecedented MVD outbreak occurred in Kigali, Rwanda. This report describes how transparency, coordinated leadership, and rapid multidisciplinary collaboration contributed to the lowest recorded mortality rate of any Marburg outbreak.MethodSeptember 23, 2024, clinicians at a tertiary hospital in Kigali observed unexplained hemorrhage during intubation of patients presenting with febrile illness. Viral hemorrhagic fever (VHF) was suspected, and samples were tested for dengue, Rift Valley fever, and Ebola—all negative. On September 25, MVD testing was requested; confirmation on September 26 led to the official outbreak declaration on September 27. A mobile hospital was promptly established to manage confirmed cases while nationwide surveillance and contact tracing were activated. Community health workers screened suspects using standardized algorithms, and all deaths were tested before burial.Due to escalating mortality, cases were transferred on October 5 to a permanent high-level isolation facility with full ICU capacity, including mechanical ventilation, dialysis, imaging, and laboratory support. A retrospective investigation identified a 27-year-old miner as the likely index case; his workplace hosted Egyptian fruit bats—the known Marburg reservoir. Of 66 confirmed cases, 77% were health workers. The case fatality rate was 22.7% (15/66), of which 73% were healthcare workers. Results: Fever (95%), fatigue (88%), gastrointestinal symptoms (82%), hemorrhage (42%), and liver dysfunction (70%) were predominant presentations. Problem based and goal oriented intensive supportive management included blood products, inotropes, dialysis, chest tubes, and mechanical ventilation. Under emergency approvals by Rwanda National Ethical Committee and Rwanda FDA respectively, investigational agents—Remdesivir, MBP091 monoclonal antibodies, and ChAd3-MARV vaccine — were imported and used despite limited evidence for Marburg Virus. Psychosocial support was integrated for patients, healthcare staff, and affected families.ConclusionThe outbreak was contained within 45 days, with full transparency and continuous updates via a national Marburg dashboard reporting number of testing, cases, deaths, and vaccination data. Shared leadership, open communication, and visible solidarity among health authorities and community stakeholders fostered trust and adherence to containment measures. The Kigali MVD outbreak demonstrates that transparent communication, shared leadership, and a rapid multisectoral response can drastically reduce mortality. Compassionate care, preparedness, and leadership trust transformed a potential urban catastrophe into a model of resilient epidemic management, achieving an unprecedentedly low CFR of 22.7% compared to historical rates of 80-90%.AcknowledgementThe MVD treatment center front liners and The Ministry of Health Rwanda This abstract is funded by: none
S Jean Pierre (Fri,) studied this question.