Africa health chief criticizes US travel advice

Official US advice against non-essential travel to Rwanda in light of the deadly Marburg virus outbreak is “not fair”, Africa's top health official, Jean Kaseya, has said.

The head of the Africa Centers for Disease Control and Prevention (Africa CDC) added that this was “not the treatment that Rwanda and Africa deserve.”

In just two weeks, Rwanda has recorded 13 deaths from the disease, most of them among healthcare workers, according to a statement from the country's health minister.

But the epidemic is under control, authorities say.

Still, those on the front lines of dealing with its consequences remain nervous.

“What scares you most is seeing people in the same profession die,” said Maria, using her real name, an intensive care nurse at a hospital in the Rwandan capital, Kigali.

Maria spoke to the BBC on condition of anonymity because she feared that if she spoke publicly she would lose her job.

“I can't help but think that I could be next, that maybe I'm positive but without symptoms yet,” said the 46-year-old nurse and mother.

She told the BBC that several of her colleagues were sick, being treated in isolation, and that more than one had already died from the virus. She described the overwhelming pressure that staff at the facility face every day.

On average, half of patients infected with Marburg virus will die, according to the World Health Organization (WHO). Fruit bats harbor the virus and it spreads from human to human through contact with infected bodily fluids such as sweat, urine and blood.

Although no Marburg vaccine has been approved, Rwanda has begun trials with supplies sent by the Sabin Institute, a U.S.-based nonprofit.

It has vaccinated 200 people, prioritizing health workers and contacts of confirmed cases, with plans to expand vaccination as more doses arrive.

Africa CDC has also provided 5,000 Marburg test kits to Rwanda and neighboring countries to strengthen cross-border surveillance.

Maria has not yet been offered a vaccine but remains determined to continue working.

“I’m a nurse, I’m on the front line, you have to fight against it, but the fear is constant,” she says.

Concern over the spread of the virus in Europe prompted German authorities to close part of Hamburg Central Station a few days ago, after a medical student and his companion fell ill following their visit to Rwanda . Both ultimately tested negative for Marburg virus.

The U.S. Centers for Disease Control and Prevention issued its second-highest level of travel advisory for Rwanda, recommending people avoid all non-essential travel to Rwanda due to the outbreak.

Rwanda's neighbors Tanzania, Uganda and the Democratic Republic of Congo, all of which have recorded cases of Marburg in the past, have all stepped up their border surveillance to prevent the spread.

Burundi went further by setting up an emergency treatment and isolation center in anticipation of an outbreak.

The Africa CDC said it was improving public health emergency training to help staff more effectively manage any Marburg outbreaks.

Rwandan authorities have taken steps to limit funerals for virus victims to 50 people to help curb the spread of the disease.

Additionally, they have implemented passenger questionnaires and hand sanitizing stations at departure points, as well as temperature checks at entry and exit points across the country.

Rwanda's health minister said the outbreak was focused on a cluster of cases in the capital.

“In different departments, there were very few staff on duty,” explains Claire, a second nurse, who also wished to remain anonymous. She works in another hospital in Kigali.

“I lost people I knew; I lost a colleague who was dear to me, in another hospital,” she says.

Rwandan authorities said early identification of the Marburg cases was particularly difficult because they initially present with symptoms similar to malaria, which is widespread in the region.

Health Minister Sabin Nsanzimana said the country was being extremely cautious and mass testing was underway for anyone with high fever, headache, vomiting and muscle pain. Hospital visits have been halted at all facilities where health workers have tested positive for the virus.

The Marburg virus is closely related to Ebola, which killed more than 11,000 people in West Africa between 2014 and 2016, according to the WHO.

Drawing on information from this outbreak, Rwanda, in partnership with WHO and the Africa CDC, said it was responding quickly by taking strict hygiene measures, raising public awareness, providing equipment protection for health workers and isolating confirmed cases.

Rwanda received 5,100 vials of remdesivir, an antiviral drug from Gilead Science used in the past to fight Ebola, to combat the virus.

While vaccination trials are underway, the second nurse the BBC spoke to has not yet received a vaccine.

“I hope things will improve soon… some vaccines have arrived, that’s what gives us some hope,” she said.