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Three infectious diseases experts with the University of Nebraska Medical Center's Global Center for Health Security have returned to Omaha after spending about two weeks in Rwanda assisting with the east African nation's response to an outbreak of Marburg virus disease, a type of hemorrhagic fever.
Dr. James Lawler, an associate director of the center, said he and two other team members weren't involved in caring for patients but instead helped develop training plans, programs and materials to assist the Rwandan health care system and communities mitigate the risk of disease transmission.
But the trip, he said, also provided an opportunity for the team to build on some long-standing relationships with universities and other organizations there, including the Rwanda Biomedical Center, an agency similar to the U.S. Centers for Disease Control and Prevention.
International partnerships, Lawler said, are important for the global center's overall health security mission and proved invaluable during the early response to the COVID-19 pandemic. The center was involved in the return of American citizens from Wuhan, China, after the pandemic began and in monitoring and caring for Americans evacuated from a COVID-stricken cruise ship off the coast of Japan soon after. That effort resulted in some early insights into how the virus spread, among others.
"Engaging and (becoming) involved in outbreaks internationally helps our team, because we continue to build our skills that we can apply here," Lawler said, "which makes us better, which makes us all safer."
The Rwanda Ministry of Health first reported cases of Marburg on Sept. 27, including illnesses among health care workers. As of Wednesday, 66 cases, including 15 deaths, had been reported, according to the CDC. No cases have occurred outside Rwanda.
The virus is from the same family as the one that causes Ebola. But with Marburg, human infections are known to result from prolonged exposure to mines or caves inhabited by a type of fruit bat. Once in humans, the virus can spread from person to person by direct contact with blood, secretions or bodily fluids of infected people or contaminated surfaces and materials.
The trip came as a result of some discussions the team had with one of the Rwandan agencies involved in outbreak preparedness and response, Lawler said. Also playing a role were long-standing discussions with partners there about creating a twinning partnership between the global center and its biocontainment unit team and Rwandan health care providers who are involved in establishing a dedicated biocontainment unit in that nation. Construction is expected to start soon.
Delegations from Rwanda have visited the global center, he said, and center staff have visited the country a few times.
The UNMC team traveled to Rwanda in mid-October. The other members are Drs. Jana Broadhurst, director of UNMC's emerging pathogens laboratory, and David Brett-Major, an infectious diseases physician and professor in UNMC's epidemiology department.
Michael Wiley, a research assistant professor in the UNMC College of Public Health's environmental, agricultural and occupational health department, had already returned from the country. He'd traveled there to help expand its pathogen genetic sequencing capacity.
Lawler said representatives from a number of other international partners also were in the country, including the CDC and the World Health Organization. Also among the responders was a team from the Ugandan Ministry of Health, which included members that Lawler and Brett-Major previously had helped train to conduct investigative drug studies during an outbreak response.
The outbreak is Rwanda's first encounter with Marburg. Lawler said it took a while to recognize the initial cluster of cases, which can happen in such situations. A lot of the initial transmission took place inside hospitals and health care settings, where the virus can amplify.
The first patient, NPR reported, also had a severe case of malaria. Clinicians did not determine that Marburg was also present until other people around that patient started falling ill. As a result, many health care workers were exposed before infection control measures were improved.
"But in terms of rapid response (and) standing up diagnostic testing and managing patients," Lawler said, "there were some remarkable accomplishments from the Rwanda team to get their arms around the issue early."
Being a relatively tech-savvy country, Lawler said, Rwanda also took some innovative steps in the health arena, including using autonomous drones to distribute blood products and laboratory samples and tapping a QR code-enabled smart phone questionnaire to screen travelers before they left the airport.
Lawler said he anticipates the country may still see some sporadic cases in the next week or two. But in the best case scenario, those will continue to taper and fade.
Rwandan officials have said the same. The Center for Infectious Disease Research and Policy at the University of Minnesota reported that Dr. Yvan Butera, Rwanda's minister of state, said during an Africa Centres for Disease Control and Prevention (Africa CDC) briefing Thursday: "It's not time to declare victory, but we are headed in that direction."
WHO officials also have praised Rwanda's response.
Lawler said the UNMC team hopes to continue to expand its relationships there.
"Hopefully this will accelerate the partnership we had already been engaged with," he said. "We hope to do more with them on biopreparedness activities going forward."