Marburg is a particularly scary virus. Shouldn't fearing the Huns have been the way Rwanda broke out?

Do not continue your daily activities” if you have a high fever, severe headache, diarrhea or vomiting, urged Sabine Nsanzimana at a press conference this weekend.

    

If you're healthy, live a normal life and "don't panic," he said. But those who feel ill should seek immediate medical attention.

Nsanzimana is Rwanda's health minister - and his country is in the grip of the first outbreak of the deadly Marburg virus.

The virus comes from fruit bats and is in the same family as the Ebola virus. There is no known treatment or vaccine, although supportive care such as IV fluids is helpful. The mortality rate can be as high as 88%.

With more than 27 cases so far - and nine deaths - the outbreak is the fourth largest Marburg outbreak ever. The World Health Organization has rated "the risk of this outbreak as very high at the national level, high at the regional level and low at the global level".

Jennifer McQuiston is deputy director of a division at the US Centers for Disease Control and Prevention that studies deadly viral diseases. She says that whenever she hears about patients presenting with symptoms such as high fever and vomiting or blood in the stool, it sets off alarm bells in her mind. A whole host of serious viruses cause so-called viral hemorrhagic fevers—think Ebola and yellow fever.

"When this was confirmed as Marburg, it reinforced those concerns," she says.

She and other experts say there are several factors that make this epidemic particularly concerning. But there is a silver lining and some reassuring news.

Many cases at once

McQuiston says one of the first things that caught her attention was how many Marburg patients there were — more than two dozen — when the outbreak was announced Friday by Rwandan health officials.

"We are concerned about the number of cases that are diagnosed too quickly," she says, noting that it can take up to 21 days between exposure and the onset of symptoms. "That suggests to us that it's probably been moving around for a couple of weeks."

This may be because Rwanda has never reported a case of Marburg before, which would mean that health care professionals did not initially think about screening patients. That's likely because many symptoms — such as fever — can easily be caused by other illnesses.

"Knowing what's going on is an important first step so you can take appropriate prevention measures," says McQuiston. "It's happening now." Medical professionals are advised to wear impermeable gowns, respirators and double gloves when working with a potential Marburg patient, and Rwandan officials have set up hand-washing facilities to help people prevent further spread of the virus.

Another concern with the large number of cases is that the virus "may have time to spread in ways that they haven't even begun to understand," McQuiston says. In past outbreaks, the virus came from bats, possibly through contact with their urine or other excretions—or by eating the same fruit that an infected bat nibbled on, for example.

But some past epidemics have not had a clear link to bats, so there has been speculation that there may have been an intermediate host – for example, bats passing the virus to monkeys or pigs who then pass it on to humans who eat it. That meat. And an infected person can spread the virus to another person. However, outbreaks in the past have been relatively small, because patients die very quickly and the virus is not airborne.

Health care workers have been hit hard

Another major cause for concern is that 70% of Marburg's patients in Rwanda, so far, are health care workers.

Because the virus is spread from person to person through contact with bodily fluids — blood, vomit, stool, saliva and semen, for example — McQuiston speculates that missing early diagnoses meant that health care workers were potentially infected in the past few weeks. Caring for one or more Marburg-affected individuals but not in protective gear.

Now Rwandan officials are taking action. They have identified about 300 contacts of Marburg patients and are monitoring them to see if they have contracted the virus. His response has drawn praise — and some questions.

Stanford University infectious disease postdoctoral researcher Dr. Abrar Karan says that when he heard Rwandan health officials telling people with symptoms to go to their nearest health center, he found it a "dangerous" approach. He worries that patients could take public transport, putting others at risk - and that showing up in hospital waiting rooms could put other patients and clinical staff at risk of exposure until the diagnosis is confirmed.

Instead, says Karan, "it will be important for community health workers... to reach people's homes..." so they can wear protective gear while collecting samples for testing, and transport specially designated for Marburg patients. Helps to manage. Unit, he says.

It is in the capital

The Marburg virus — named for the German city where scientists first contracted the disease in 1967 while handling monkeys in Africa — is commonly found in Egyptian fruit bats that live deep in caves. Cases usually occur in remote areas - a person may go into a cave as a miner or collect bat guano to use as fertilizer and be exposed to the virus.

But this outbreak is not confined to remote areas. Instead, patients have been identified in seven of Rwanda's 30 districts — and that's in the capital, Kigali.

Karan says the concern is that through human transmission, the virus could quickly spread upstream to other locations. "It's already a hub, a transportation hub hit," he says. "You have a lot more movement between countries and between continents." It is easy for someone who has been exposed but does not yet have symptoms to jump on a bus or plane without realizing they are carrying the virus.