Safe delivery of intensive care for Marburg virus disease in Rwanda

Outbreaks of filovirus diseases, such as Marburg virus disease, present a threat to global health security, with high case-fatality rates and substantial risks of nosocomial transmission to health-care workers. However, recent advances in the delivery of optimised supportive care and pathogen-specific treatments have improved outcomes. In the third largest outbreak of Marburg virus disease (Rwanda, 2024), highly skilled medical and nursing staff provided critical care that included invasive mechanical ventilation, blood product replacement, advanced imaging, and laboratory-guided electrolyte management that led to the recovery of two critically ill patients. The delivery of intensive care in endemic settings represents an evolving paradigm shift in filovirus disease outbreak response. This Grand Round highlights the feasibility, effectiveness, and safety of intensive care management, including invasive mechanical ventilation combined with strict infection prevention and control practices in outbreaks of Marburg virus disease.