Rwanda’s National Reference Laboratory Operational Capacity during the 2024 Marburg Virus Disease Outbreak Response

BACKGROUND: Rwanda reported its first Marburg virus disease (MVD) outbreak in September 2024. This study presents an assessment of Rwanda's National Reference Laboratory Operational Capacity during the 2024 Marburg Virus Disease Outbreak Response. METHODS: The assessment was conducted using the World Health Organization laboratory assessment tool for viral haemorrhagic fever (VHF) diagnostic capacity. This was complemented by an evaluation of various laboratory quality indicators like the turnaround time (TAT). Data were collected through direct observation, documents' review, and interviews with laboratory staff. Descriptive analysis of key response activities and observations was conducted using Microsoft Office (Excel). Also, the map of testing sites was drawn using QGIS 3.40.0 software. RESULTS: The NRL's response to the MVD outbreak achieved an overall score of 98%. All components scored 100% except for the quality of the laboratory system, which scored 89% due to the lack of External Quality Assessment (EQA) for MVD. Key achievements during the outbreak response included (i) reduction in the turnaround time (TAT) from sample reception to releasing results from 24 to 7 h, (ii) the recruitment of more laboratory staff supporting sample collection, transportation, testing and results reporting, (ii) creation of five new MVD testing sites, (iii) training of laboratory staff, (iv) digitalization of the laboratory flow, and (v) establishing a 24/7 telephone line for easy communication with laboratories on MVD suspected samples being processed. CONCLUSION: The strong performance of the NRL highlights its robust laboratory system, which allowed effective testing of MVD suspected cases. We recommend implementing an EQA scheme for VHF diagnostics in Rwanda, including the MVD. Also, improving measures for biosafety, biosecurity, and infection prevention and control in all health facilities would reduce the risk of such infections in the future.