Landmark research led by William Fischer II, MD, director of emerging pathogens for the UNC Institute for Global Health and Infectious Diseases, describes the successful delivery of advanced care to patients with Marburg virus disease during Rwanda’s third largest outbreak on record, published in The Lancet Infectious Diseasesand The New England Journal of Medicine.
CHAPEL HILL, N.C. – Outbreaks of diseases like Marburg virus disease present a threat to global health security, with high case-fatality rates and substantial risks of transmission to healthcare workers. Last September, Rwanda experienced the third largest outbreak of the Marburg virus disease, with 66 confirmed cases, mostly healthcare workers, and 15 deaths; however, once Rwanda’s National Marburg Treatment Unit was fully operational, there were none.
William Fischer II, MD, associate professor of pulmonary and critical care medicine, and director of emerging pathogens at the UNC Institute for Global Health and Infectious Diseases, was part of the World Health Organization’s (WHO) Health Emergencies Clinical Team deployed to Rwanda, alongside Professor Tom Fletcher from Liverpool School of Tropical Medicine, Dr. Frederique Bausch from HUG Geneva, and Jacob Goldberg, RN.
The outbreak began with a cluster of cases of patients admitted to the intensive care unit, with rapidly progressive fever, headache, and gastrointestinal symptoms, followed by multiple-organ failure and death within 48 hours after admission. Within two days, similar symptoms developed in numerous health care workers. Testing for viral hemorrhagic fever was positive for the Marburg virus, leading to the activation of a coordinated national emergency response.
Rwanda’s resilient healthcare infrastructure enabled a comprehensive response including early detection and initiation of supportive and critical care coupling early fluid resuscitation, laboratory-guided electrolyte correction, blood product replacement, medical imaging, and invasive mechanical ventilation—all of which supported patients through the acute phase of illness until clearance of virus and survival. This led to the recovery of critically ill patients, significantly reducing mortality and hospital transmission.
“The ability to deliver early supportive and critical care represents an important paradigm shift in outbreak response and filovirus disease care,” said Fischer. “The successful provision of this level of care, without transmission to healthcare workers, shows that advanced intensive care can be delivered safely in outbreak settings and contribute to improved outcomes in patients.”
The success comes ten years after the West African Ebola epidemic, where Fischer and Dr. David Wohl first deployed to help contain the virus. Their work has contributed to WHO treatment guidelines for Ebola virus disease, advocating for a single standard of care and not one determined by the country in which you live. Being able to deliver intensive care in an endemic setting represents a new advancement in clinical management.
The Marburg virus, a member of the family Filoviridae, which also includes the Ebola virus, was first discovered during an outbreak in 1967 that affected laboratory personnel in two European countries. MVD is a zoonotic infection transmitted to people from fruit bats and spreads through human-to-human transmission, which can occur through direct contact with bodily fluids of infected persons. MVD has an incubation period that ranges from 2 to 21 days, although in most reported cases symptom onset occurs between 5 and 10 days after exposure.
As a critical care physician with hands-on experience providing care to patients with severe viral infections, including Ebola virus, Sudan virus, Lassa virus and SARS-CoV-2, Fischer has been deployed to outbreaks in Guinea, Democratic Republic of Congo, Uganda, Liberia, Azerbaijan and the Republic of Korea. Everything he has learned about managing highly contagious diseases has been applied to North Carolina’s emerging pathogen preparedness program at UNC Health. In fact, UNC Medical Center is one of 13 Regional Emerging Special Pathogen Treatment Centers in the U.S. — and the only one in North Carolina — dedicated to the care of patients with high-consequence infectious diseases.
Published in The Lancet Infectious Diseases, “Safe delivery of intensive care for Marburg virus disease in Rwanda,” reviews two successful cases, highlighting the feasibility, effectiveness, and safety of intensive care management and control practices in outbreaks of Marburg virus disease.
Published in The New England Journal of Medicine, “The Marburg Virus Disease in Rwanda, 2024 — Public Health and Clinical Responses” is a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response, including outcomes among patients who received supportive care and investigational therapeutic agents.