Marburg Virus Disease Surveillance in the Community Through Active Case Finding in Rwanda, 2024

Marburg Virus Disease (MVD) is a high-threat pathogen with a high case fatality rate and rapid human-to-human transmission, posing serious public health risks. Rwanda's first confirmed MVD outbreak in September 2024 revealed critical gaps in early detection and community-level response. In response, a community-based surveillance strategy was rapidly implemented to strengthen early case identification, real-time reporting, and prompt containment, enhancing national capacity to prevent wider spread and protect vulnerable populations.

A cross-sectional, community-based surveillance approach was conducted from October 5-7, 2024. Under the supervision of health facilities and the MVD National Command Post, community health workers (CHWs) carried out house-to-house active case searches across the four (4) provinces and Kigali City. Individuals were screened for MVD symptoms using the national case definition, and suspected cases were referred for laboratory testing. Data were captured via the electronic Infectious Diseases Surveillance and Response (e-IDSR) system and analyzed using R 4.5.1 version statistical packages.

A total of 9,483,570 individuals were screened, with 57 symptomatic individuals identified across five provinces. Kigali City had the highest proportion of suspects (17; 29.8%), followed by West Province (16; 28.1%), East Province (11; 19.3%), North Province (10; 17.5%), and South Province (3; 5.3%). Clustering of suspected cases occurred primarily in western and central regions. Screening intensity varied geographically, with lower rates in southern regions, highlighting surveillance coverage disparities.

Community-based active surveillance effectively reaches large populations for early MVD case detection. Regional disparities highlight the need for targeted interventions, enhanced public awareness, and strengthened CHW training. These findings have informed national policies to expand and institutionalize community surveillance, guiding resource allocation and capacity building. Continued investment in this systems is critical for Rwanda's preparedness against future outbreak threats and for strengthening national and regional health security.